Richland Nursing & Rehab

Location & what’s nearby

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Nearest of each type, straight-line distance. Hospitals come from the CMS Hospital General Information registry; everything else from Overture Maps (public data). Hospital and park hours are typical — call ahead to confirm.

Quality measures — how residents actually fare

Quality-measure stars summarize outcomes CMS tracks from the assessments each home submits — avoidable hospitalizations and ER visits, falls with injury, pressure ulcers, unplanned weight loss, and long-term antipsychotic use. Because the underlying data is self-reported, weigh a high score against the independent inspection record. Long-stay = permanent residents; short-stay = rehab and post-hospital stays.

Short-stay rehab — if you are coming here from a hospital

Arriving from a hospital right now? Read the discharge guide → — your appeal rights, how to slow a rushed discharge, and what to ask about the numbers below.

29.0% of the Medicare patients who left this home got back to the community and stayed there for at least 31 days — CMS rates that worse than the national rate. This is CMS’s risk-adjusted rate over 54 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.

Met the expected recovery: 7.4% of this home’s Medicare short-stay residents left it at or above the ability to care for themselves and move around that CMS predicted for them, across 27 stays in Oct 2024–Sep 2025. The median of the 11,061 homes CMS publishes this for is 56.6%. Read it beside the getting-home figure, not instead of it: unlike the two measures above, CMS makes no better-or-worse call on this one and publishes no confidence interval for it, so this is a comparison and not a verdict — but it is the short-stay measure that separates homes most, and the one to ask about.

Therapy staffing: this home’s payroll records show 0.17 therapist hours per resident per day in 2026Q1 — more than 16% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 1% of this home’s weekday level — it runs therapy on weekdays, with essentially none at the weekend. The median home that reports therapy runs 13% — weekday-focused therapy is the industry norm, not a shortfall. But recovery does not pause on a Saturday: ask what the weekend actually looks like here.

This section is about rehab stays, not living here. Most of this page — the stars, the quality measures, the inspection record — describes the home the way a permanent resident experiences it. These figures describe the short Medicare stay after a hospital discharge: a hip, a stroke, a bad infection, six weeks and home. They are different residents, different staff, often a different wing. Therapy hours are per resident in the building, not per rehab patient — the count includes every long-stay resident, and they mostly get no therapy at all. So a home with a small rehab wing inside a large nursing population reads low here even if its rehab patients get plenty of therapy, and a mostly-rehab home reads high. Use it to compare homes doing similar work, ask what a rehab resident actually gets in a day, and remember that CMS does not publish therapy minutes per patient — nobody does.

Staffing

How full it usually is: this home is certified for 157 beds and averages 75.3 residents a day — about 48% occupied, or roughly 82 beds typically open. It often has substantial empty capacity — worth asking why, since low census can reflect either a new or shrinking home or one families are avoiding. This is a CMS average, not live availability — no public source publishes real-time vacancies, and a home can be full the day you call. Confirm with the home, and if you need a Medicaid bed specifically, ask about that separately: a home with open beds may still not have an open Medicaid bed.

Against a benchmark — not a legal minimum. In May 2024 CMS finalized the first federal staffing floor for nursing homes: 3.48 total nurse hours per resident per day, including 0.55 RN hours and 2.45 nurse-aide hours. Its hour requirements never took effect and are no longer on the books. Homes had until 2026 (2027 if rural) to comply, and that deadline never arrived: a federal court vacated the hour requirements in April 2025 (CMS has appealed), Congress then barred enforcement until 2034, and CMS formally repealed them by rule effective February 2026. This home is not required to meet these numbers, and is not violating anything by missing them. We still show the comparison because the figures are CMS’s own published estimate of adequate staffing, which makes them a useful yardstick — but they are our benchmark, not federal law: this home’s total nurse staffing of 2.85 hrs/resident/day is below the 3.48-hour benchmark and RN staffing of 0.39 is below the 0.55-hour RN benchmark and nurse-aide staffing of 1.83 is below the 2.45-hour aide benchmark. What federal law does require today is unchanged: “sufficient” nursing staff for residents’ needs and an RN on duty at least 8 consecutive hours a day, 7 days a week (42 CFR 483.35). Those are judged by inspectors on site, not by these averages, so read this comparison alongside the inspection record rather than as a pass/fail.

Weekend coverage: total nurse staffing is 2.62 hrs/resident/day on weekends vs 2.94 on weekdays — 11% thinner on weekends. RN hours go from 0.40 to 0.35 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 64% is well above the national median of 45%. 1 administrator has left in the past year.

Payroll-based (PBJ) staffing hours, as reported for Jan–Mar 2026 (CMS PBJ CY2026Q1) — the most recent quarter CMS has published, so they can lag a change of operator or staffing agency. Higher is generally better. Registered-nurse coverage and weekend staffing are the numbers families most often overlook — an RN on site matters most when something goes wrong, and coverage usually thins on weekends. High turnover means residents rarely see the same caregiver twice. One caveat: these are hours as reported, not adjusted for how sick or heavy-care this home’s residents are. CMS separately publishes a case-mix-adjusted view; we show the reported hours. A home caring for higher-acuity residents needs more hours to deliver the same care, so compare these figures against homes doing similar work, and read them next to the inspection record rather than alone.

Inspection trend

Deficiencies are more than at the previous inspection — worsening. Fewer citations over time suggests a home is fixing problems; a rising count is a warning sign — though two surveys are a short record, and survey teams differ. These counts are from the standard annual health survey only; the full citation list below may also include findings from complaint investigations, so the two won’t always add up.

Inspection deficiencies

State health-inspection citations, most serious first. Each carries an F-code (the federal rule it cites, e.g. F-684 = quality of care) and a letter A–L marking how serious and how widespread the problem was — we translate that grid into the plain tiers shown here. Wording is the official federal description.

Each letter is a CMS scope-severity level; highlighted ones are where this home has citations. A–C = no harm found; D–F = potential for harm; G–I = actual harm; J–L = immediate jeopardy. Within each band the later letter is the more widespread finding (an isolated G is one resident; a widespread I is a pattern), so rightward and downward is worse.

57 citations, most serious first. The 23 most serious are shown; the remaining 34 are one tap away and print in full.

• Immediate jeopardy · J2025-11-04 · tag F0678 — failed to provide CPR when needed — isolated
  Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review the facility failed to initiate Cardiopulmonary Resuscitation (CPR) for 1 of 3 (R1) residents reviewed for death in the sample of 13. This failure resulted in facility staff not initiating CPR for R1 when R1 was found unresponsive on [DATE]. R1 was found unresponsive by V7 (Certified Nurse Assistant/CNA) and V8 (CNA). V8 notified V4 (Registered Nurse) that R1 was unresponsive. V8 asked V4 if R1 was a Full Code or DNR (Do Not Resuscitate), and V4 responded she did not know. V4 stated she did not initiate CPR because there was nothing in her chart saying R1 was a Full Code or DNR. R1's progress note dated [DATE] documents R1 was a full code. R1 was pronounced dead at the facility by V4 and V6 (Licensed Practical Nurse). This failure resulted in an Immediate Jeopardy, which was identified to have begun on [DATE] when facility staff failed to initiate CPR after finding R1 with no pulse and no respirations. The failure resulted in R1 who was without a pulse and respirations not…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Quality of Life and Care Deficiencies · Past Non-Compliance
• Immediate jeopardy · Jcited before2025-04-21 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — isolated
  Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview, observation, and record review, the facility failed to prevent a cognitively impaired ambulatory resident (R1) from exiting the facility unwitnessed and without staff supervision for 1 of 3 residents reviewed for elopement in the sample of 3. This failure resulted in R1, unknown to staff, exiting the facility and walking approximately one block away, falling and sustaining a skin tear over his left temporal region and scattered abrasions over both hands, wrists, and elbows, and then entering a private citizens unlocked vehicle. R1 was treated at the local ER (Emergency Room) for the skin tears and released later that evening. The Immediate Jeopardy began on [DATE] between 6pm and 6:18pm when R1 exited the facility's Dementia Care Unit unsupervised, walked about a block away, fell in the street, gained access to an unlocked vehicle, and was then found by police, bleeding from the head and confused about his whereabouts. V1, Administrator, was notified of the Immediate Jeopardy on [DATE] at…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Actual harm · Gcited before2026-04-21 · tag F0760 — failed to prevent significant medication errors — isolated
  Ensure that residents are free from significant medication errors.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to ensure that residents were free from medication errors for 2 (R6, R63) of 13 residents reviewed for medication errors in the sample of 51.This failure resulted in R63, after receiving monthly doses of injectable atypical antipsychotic on 1/31/26 and 2/5/26, experiencing extrapyramidal symptoms and sedation. These symptoms resulted in R63 being sent to the local ER (Emergency Room) and poison control being contacted. Findings include: 1. R63's Face Sheet documented an admission Date of 3/24/20 and listed Diagnoses including Metabolic Encephalopathy, Schizoaffective Disorder, Bipolar Type, Hypertension, and Diabetes Type 1. R63's Minimum Data Set, dated [DATE] documented that R63 is severely cognitively impaired. R63's Care Plan dated 3/29/26 documented a problem area, Resident is at risk for adverse consequences related to receiving antipsychotic medication monthly for the treatment of Schizoaffective Disorder, with a corresponding goal, Resident will…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Pharmacy Service Deficiencies · Deficient, Provider has date of correction
• Actual harm · Gcited before2026-02-24 · tag F0600 — failed to protect residents from abuse and neglect — isolated
  Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review the facility failed to ensure residents were free from resident to resident physical abuse for 3 (R2, R7 and R8) of 3 residents reviewed for abuse in the sample of 9. This failure resulted in R2 being woken up to R1 having R1's hands over R2's mouth and nose while pushing down and with R2 yelling out she was trying to kill me., R7 being kicked in the leg above the knee by R5 and R8 being hit in the back by R5 a few hours later. A reasonable person being held down and potentially suffocated, kicked and slapped would feel fearful, intimidated, and threatened while residing in their home.Findings Include: 1.R2's Face Sheet documented an admission date of 10/31/18 with diagnoses that included other schizoaffective disorders, dorsalgia, unspecified, anemia, unspecified, chronic obstructive pulmonary disease, unspecified, and personal history of traumatic brain injury. R2's Minimum Data Set (MDS) annual assessment dated [DATE], documented a Brief Interview for Mental Status Score…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
• Actual harm · Gcited before2025-10-23 · tag F0600 — failed to protect residents from abuse and neglect — isolated
  Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on interview and record review the facility failed to prevent resident to resident abuse for 3 of 6 (R1, R3 and R4) residents reviewed for abuse in a sample of 6. This failure resulted in R3 being bit on the wrist by R4, leaving a bruise, and R4 being grabbed by the shirt and slapped on the face by R3. A reasonable person being bit and slapped would feel fearful, intimidated, and threatened.Findings include:1. Facility form titled Long-Term Care Facility-Serious Injury Incident and Communicable Disease Report dated 10/10/2025 documented R3 resides at this facility and has diagnoses of unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety among others. This report documented R4 also resides at this facility and has diagnoses of cerebral infarction, aphasia following cerebral infarction, unspecified dementia, severe, with other behavioral disturbance; bipolar II disorder; Guillain-Barre syndrome; major depressive disorder among others.This same form titled Long-Term Care Facility-Serious Injury Incident…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
• Actual harm · Gcited before2025-09-12 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — isolated
  Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to provide proper resident supervision during ambulation for 1 (R1) of 3 residents reviewed for accidents in the sample of 6. This failure resulted in R1 falling and sustaining a fracture to the right arm and elbow. Findings included: R1's Face Sheet documented an admission date of 8/25/2025 and diagnoses including unsteadiness on feet, metabolic encephalopathy, nondisplaced intertrochanteric fracture of right femur, subsequent encounter for closed fracture with routine healing, wedge compression fracture of thoracic11-12 vertebra, subsequent encounter for fracture with routine healing, unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety.R1's Minimum Data Set (MDS) dated [DATE] documented in section C, that R1 had a BIMS (Brief Interview of Mental Status) of 7 indicating R1 had severe cognitive impairment. This same MDS documented under section GG- Mobility that R1 is dependent,…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Actual harm · Gcited before2025-05-08 · tag F0550 — failed to protect resident dignity and rights — isolated
  Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review the facility failed to ensure residents were assisted with activities of daily living (ADL's) and call lights were answered in a timely manner promoting dignity for 3 of 5 (R3, R4, R5, R10 and R13) residents reviewed for dignity in the sample of 26. This failure resulted in R13 asking for assistance to toilet for at least 35 minutes while in the dining room and common area and subsequently having an episode of incontinence. R13 was visibly upset and crying out for help during this 35-minute time frame. This would cause any reasonable person to feel embarrassed and humiliated. Findings include: 1. R13's Resident Face Sheet with a print date of 5/6/25 documents R13 was admitted to the facility on [DATE] with diagnoses that include unspecified dementia, moderate, with anxiety. R13's MDS (Minimum Data Set) dated 2/5/25 documents a BIMS (Brief Interview for Mental Status) score of 01, indicating R13 has a severe cognitive deficit. This same MDS documents R13 is…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Resident Rights Deficiencies · Deficient, Provider has date of correction
• Actual harm · Gcited before2025-03-12 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — isolated
  Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to safely transfer residents according to Transfer Assessments and Care Plans for three residents (R2, R3, R4) of four residents reviewed for falls in the sample of six. This failure resulted in R2, on 1/27/25, falling during a transfer and fracturing his 8th left rib and dislocating his left shoulder. Findings include: 1. R2's Face Sheet documented an admission Date of 2/18/20 and listed Diagnoses including Hemiplegia and Hemiparesis Following Cerebral Infarction Affecting Left Non-dominant side, Dissociative Disorder, Intermittent Explosive Disorder, and Unspecified Dementia, Mild, With Other Behavior Disturbance. R2 Minimum Data Set (MDS) dated [DATE] documented that R2 has severe deficits in cognition and requires substantial or maximal assistance for transfers. R2's Fall Risk assessment dated [DATE] indicated R2 is at high risk for falls. R2's Transfer assessment dated [DATE] indicated R2 requires the assistance of 2 staff and a gait belt for…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Actual harm · Gcited before2025-01-02 · tag F0550 — failed to protect resident dignity and rights — isolated
  Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to respond to residents' requests for assistance in a timely manner to ensure dignity and respect for quality of life for 3 (R3, R6 and R7) of 7 residents reviewed for dignity. This failure resulted in care not being provided timely, causing R3, R6 and R7 to experience discomfort/pain, and caused R3 to feel humiliation and anxiousness from sitting in urine and/or feces for extended periods of time, not knowing how long it will take for her to receive necessary assistance. Findings Include: 1. R3's Resident Face Sheet with a print date of 12/27/2024, documented R3 was admitted to the facility on [DATE], with diagnoses that included acute respiratory failure with hypoxia, chronic obstructive pulmonary disease, heart failure, secondary pulmonary arterial hypertension, major depressive disorder, type 2 diabetes mellitus, and anxiety disorder. R3's Physician Order Summary with date range from 11/27/2024 - 12/27/2024 documented an order to apply…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Resident Rights Deficiencies · Deficient, Provider has date of correction
• Actual harm · Gcited before2024-08-12 · tag F0600 — failed to protect residents from abuse and neglect — isolated
  Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review the facility failed to prevent physical abuse of a resident from another resident with a known history of aggression towards other residents in 1 of 3 residents (R1) reviewed for abuse in the sample of 33. This failure resulted in R1 being slapped, choked, and hit in the stomach by R2. These actions would cause a reasonable person to have feelings of fear and insecurity while living in their home. Findings included: R1's Resident Face Sheet documented R1 was admitted to this facility on 5/1/2023 with diagnoses of Dementia without behaviors, Psychotic Disturbance, Mood Disturbance and Anxiety. R1's MDS (Minimum Data Set), dated 5/13/2024, documented R1 with a BIMS (Brief Interview for Mental Status) score of 8 out of 15 total indicating R1 has severe cognitive impairment. R2's Resident Face Sheet documented R2 was admitted to this facility on 12/9/2023 with the diagnoses of Moderate Dementia with Agitation Intermittent Explosive Disorder, Delusional disorders and Cognitive…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
• Actual harm · Gcited before2024-02-27 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — isolated
  Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to initiate a safe transfer to a wheelchair for 1 of 3 resident (R2) reviewed for safety in a sample of 5. This failure resulted in R2, during a transfer, receiving a laceration to her leg requiring an emergency room visit and a total of 16 stitches to the wound. Findings include: R2's Face Sheet documented an admission date of 7/11/23, and listed diagnoses including Bipolar Disorder, Unspecified Dementia, Diabetes Type 2, and Chronic Peripheral Venous Insufficiency. R2's Minimum Data Set (MDS), dated [DATE], documented a Brief Interview for Mental Status Score of 8, indicating R2 had moderate deficits in cognitive functioning. The same MDS documented R2 utilized a wheelchair for mobility and was totally dependent on staff for transfers. R2's Care Plan, dated 2/19/24, documented a problem area,Dependent transfers, with a corresponding goal, Transfer from chair/bed without injury, safely, using (mechanical lift). The Care Plan further…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Actual harm · G2024-02-27 · tag F0692 — failed to prevent malnutrition and dehydration — isolated
  Provide enough food/fluids to maintain a resident's health.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to assess for risk of dehydration, to contact a medical provider to report lack of food and fluid intake, and to implement in a timely manner orders for labs to identify dehydration for 1 of 3 residents (R1) reviewed for hydration in the sample of 5. This failure resulted in R1 requiring hospitalization from 2/4/24 through 2/14/24 for a diagnosis of dehydration and requiring IV (Intravenous) fluid replacement. Findings include: R1's Face Sheet documented an admission date of 1/19/24, and listed diagnoses including Huntington's Disease, Unspecified Dementia, Unspecified Psychosis, and Moderate Protein-Calorie Malnutrition. R1's Minimum Data Set(MDS), dated [DATE], documented R1 requires substantial/maximum assistance from staff for eating, defined as, The ability to use suitable utensils to bring food and/or liquid to the mouth and swallow food and/or liquid once the meal is placed before the resident,and a BIMS (Brief Interview for Mental Status Score) of…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Actual harm · Gcited before2024-01-19 · tag F0760 — failed to prevent significant medication errors — isolated
  Ensure that residents are free from significant medication errors.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to provide anti-anxiety medications as prescribed for 1 (R47) of 3 residents reviewed for behavior in the sample of 40. This failure resulted in R47 engaging in severe behaviors, including self-injurious behavior, and R47 was transferred to the local hospital for evaluation and treatment, requiring 6 staples to a head laceration. Findings Include: R47's Face sheet documented an admission date to the facility of 11/6/19. Diagnoses on this same form include, but are not limited to Major Depressive Disorder; Undifferentiated Schizophrenia; Schizoid Personality Disorder; Dementia in other diseases classified elsewhere, unspecified severity, with mood disturbance; Anxiety Disorder; and Suicidal Ideations. V9 (Physician) is documented as being R47's physician. Review of R47's Minimum Data Set (MDS), dated [DATE], documented a Brief Interview for Mental Status score of 9, indicating she has moderate cognitive impairment. Review of R47's Physician Orders document…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Pharmacy Service Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2026-05-12 · tag F0688 — failed to keep residents mobile / prevent decline — isolated
  Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed implement PROM (Passive Range of Motion) exercises per COTA (Certified Occupational Therapy Assistant) recommendations for 1 of 3 (R1) residents reviewed for range of motion in the sample of 4.Findings include:R1's Face Sheet documented an admission Date of 3/17/26 and listed Diagnoses including Quadriplegia, Cervical Spine Fusion, and Neuromuscular dysfunction of the Bladder. R1's Minimum Data Set, dated [DATE] documented that R1 had no deficits in cognition. R1's Care Plan dated 3/30/26 did not document any problem areas related to R1 requiring restorative nursing or therapy services for quadriplegia.R1's Occupational Therapy Treatment Encounter Report dated 4/20/26 documented, Therapist educated staff on performing PROM (Passive Range of Motion) exercises daily to resident to prevent stiffness and contractures, as patient is unable to move his extremities on his own. Staff verbalized understanding. Therapist initiated self-care in-service…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2026-05-12 · tag F0690 — failed to manage incontinence, catheters, and urinary infections — isolated
  Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to provide urinary catheter care according to professional standards of practice to prevent a Urinary Tract Infection for 1 of 3 residents (R1) reviewed for catheter care in a sample of 4.Findings include:R1's Face Sheet documented an admission Date of 3/17/26 and listed Diagnoses including Quadriplegia, Cervical Spine Fusion, and Neuromuscular dysfunction of the Bladder. R1's Minimum Data Set, dated [DATE] documented that R1 had no deficits in cognition. R1's Care Plan dated 3/30/26 documented a problem area, Resident requires EBP (Enhanced Barrier Precautions) related to (indwelling) catheter, with a corresponding goal, Resident will receive care from staff using EBP while maintaining a homelike environment and will remain free from infection through next review, with a corresponding intervention, EBP will be utilized while providing direct care (for example, wound dressing change, showers/bathing, transfers, hygiene, linen change,…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Fcited before2026-04-21 · tag F0725 — failed to have enough nursing staff — widespread
  Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on interview and record review, the facility failed to provide adequate CNA (Certified Nursing Assistants) staff to meet residents needs. This has the ability to affect all 76 residents living at the facility.Facility Grievance/Concern documents documented the following:On 10/15/26: No one answered call light from 2am or maybe 3am until 6am.On 12/23/26: Call lights not being answered timely.On 1/19/26: Had to wait 45 minutes with light on to get put on the toilet. Then had to wait 45 minutes to get off the toilet. On 04/14/2026 at 12:16 PM, R25 was alert and oriented. R25 stated when there is only one CNA (Certified Nursing Assistant) working, there have been times she has been left on the toilet over an hour. R25's Face Sheet documented an admission Date of 2/15/24.On 04/14/2026 at 2:20 PM, R14 was alert and oriented. R14 stated there is only one CNA working on the Delta Unit on the night shift, and he has waited over an hour on his call light. R14's Face Sheet documented an admission Date of 9/24/19.On 4/15/26 at 10:01am during the Resident Council Meeting, R5, who was alert…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Nursing and Physician Services Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Fcited before2026-04-21 · tag F0880 — failed to prevent and control infections — widespread
  Provide and implement an infection prevention and control program.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review the facility failed to establish and maintain infection prevention and control practices. This has the potential to affect all 76 residents living in the facility. The Findings Include: 1. R35's face sheet documents an admission date to the facility of 02/27/2026. The diagnoses listed include spinal stenosis, type 2 diabetes mellitus, generalized anxiety disorder, bipolar disorder, atherosclerotic heart disease if coronary artery, seizures, chronic diastolic heart failure, acute kidney failure, chronic obstructive pulmonary disease, and gastro -esophageal reflux disease. R35's care plan with a start date of 03/10/2026 documents a focus area of resident is frequently incontinent of bowel and bladder. Interventions listed include provide incontinent care as needed and toilet as scheduled and as needed. On 04/14/2026 at 12:10 P.M. R35 was observed sitting in the dining room with a puddle of liquid underneath his wheelchair. R35 rolled himself out of the dining room…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Infection Control Deficiencies · Deficient, Provider has date of correction
• Potential for harm · F2026-04-21 · tag F0881 — failed to use antibiotics responsibly — widespread
  Implement a program that monitors antibiotic use.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on interview and record review the facility failed to establish an antibiotic stewardship program that includes protocols to ensure appropriate antibiotic use, and systems to monitor antibiotic outcomes. This failure has the potential to affect all 76 residents who reside at the facility.The Findings IncludeOn 04/16/2026 an infection control log was presented by V2 (Director of Nursing). The log contained a floor plan for the months of January 2026 - April 2026 that were color coated to differentiate between the different types of infections that residents were experiencing. The log contained a monthly summary of antibiotics that were utilized for the months of January 2026 - April 2026. That log had a print date of 04/16/2026 at 12:48 P.M. The log did not document resident symptoms, if any standardized criteria were used to justify and guide antibiotic use, when antibiotics were first initiated, if response to treatment was monitored, or any laboratory results when available to guide appropriate antibiotic use.On 04/17/2026 at 11:23 A.M. V7 (Regional Nurse) stated she has…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Infection Control Deficiencies · Deficient, Provider has date of correction
• Potential for harm · F2026-04-21 · tag F0882 — widespread
  Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on observation, interview, and record review the facility failed to employ an Infection Preventionist who remains on site. This failure has the potential to affect all 76 residents who reside at the facility. The Findings IncludeOn 04/17/2026 at 11:23 A.M. V7 (Regional Nurse) stated she is responsible for the role of infection preventionist until V2 completes the course. V7 stated she is not sure how often she is actually at the facility. V7 stated she logs in remotely and reviews infections for the facility. On 04/17/2026 at 12:10 P.M. V2 (Director of Nursing) stated she has not completed the course, but she will be taking it to be the infection preventionist for the facility. On 04/17/2026 at 12:23 P.M. V1 (Administrator) stated V26 (Former Employee) was the infection preventionist for the facility. V1 stated that V26 quit without notice. V1 stated V7 (Regional Nurse) is who the facility is currently utilizing for the infection preventionist role. V1 stated that V7 is not in the building every day and looks at the facility data remotely. A Long-Term Care Facility Application…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Infection Control Deficiencies · Deficient, Provider has date of correction
• Potential for harm · E2026-04-21 · tag F0638 — pattern
  Assure that each resident’s assessment is updated at least once every 3 months.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on interview and record review, the facility failed to ensure quarterly assessments were completed within the required time frames for 7 (R2, R20, R48, R57, R68, R72, and R81) of 7 residents reviewed for quarterly MDS (Minimum Data Set) assessments in the sample of 51. The Findings Include:1. R2's face sheet documents R2 has an admission date to the facility of 11/22/2023. Diagnoses listed include retention of urine, unspecified dementia, major depressive disorder, unilateral primary osteoarthritis, anemia, obstructive sleep apnea, anxiety disorder, and hypothyroidism. On 04/15/2026 at 12:33 P.M. V7 (Regional Nurse) stated R2's quarterly MDS with an ARD (Assessment Reference Date) of 03/12/2026 has not been completed yet.2. R20's face sheet documents R20 has an admission date to the facility of 11/06/2019. Diagnoses listed include unspecified dementia, major depressive disorder, undifferentiated schizophrenia, anxiety disorder, neuroleptic induced parkinsonism, and unspecified intellectual disabilities. On 04/15/2026 at 12:33 P.M. V7 stated R20's quarterly MDS with an ARD of…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
• Potential for harm · E2026-04-21 · tag F0640 — pattern
  Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on interview and record review the facility failed to complete timely quarterly MDS (Minimum Data Set) for 4 (R8, R13, R51, and R56) of 4 residents reviewed for quarterly MDS assessments completed timely in the sample 51. The Findings Include:1. R8's face sheet documents an admission date to the facility of 10/01/2025. The diagnoses listed include metabolic encephalopathy, acute kidney failure, dementia, type 2 diabetes mellitus, anxiety disorder, essential hypertension, hyperlipidemia, gastro esophageal reflux disease, and mood disorder. A final validation report dated 04/14/2026, provided by V1 (Administrator) documents that R8's quarterly MDS (Minimum Data Set) was submitted on 4/14/26 and had a target/ due date of 03/03/2026. The same document had a warning message of assessment completed late: more than 14 days after the assessment reference date.2. R13's face sheet documents an admission date to the facility of 01/28/2020. The diagnoses listed include unspecified dementia, Type 2 diabetes mellitus, Alzheimer's disease, chronic kidney disease, essential hypertension,…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
• Potential for harm · E2026-04-21 · tag F0679 — failed to provide activities — pattern
  Provide activities to meet all resident's needs.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on observation and interview the facility failed to ensure that residents were offered activities who chose to stay in their room for 4 of 4 residents (R22, R64, R66 and R80) reviewed for activities in a sample of 51.The Findings Include:1. R64's face sheet documents an admission date of 1/11/24 and includes the following diagnosis: chronic respiratory failure, major depression disorder, heart failure, anxiety, and morbid obesity.On 4/14/26 at 11:00 AM, R64 who is alert and oriented to person, place and time stated that she has not gotten any activities given to her since she can remember. R64 stated that due to her being bed bound she chooses to spend her time in her room rather than being transferred to a chair and out to the dining room for activities and meals. R64 stated that she used to receive puzzles and various items to color or read but honestly cannot remember the last time those were passed out to her. R64 stated that she would like to receive those again. 2. R66's face sheet documents an admission date of 2/6/19 and includes the following diagnosis: unspecified…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Ecited before2026-04-21 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — pattern
  Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review the facility failed to provide an environment free of hazards, implement appropriate interventions for falls, and provide a safe transfer with a mechanical lift for 4 (R2, R12, R22, and R81) of 4 residents reviewed for accidents in a sample of 51.Findings include: 1. R12's admission Record documented an admission date of 12/20/2023 and included diagnoses of unspecified dementia, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety, hyperlipidemia, unspecified, essential hypertension, unspecified hearing loss, and unspecified ear. R12's Minimum Data Set (MDS) dated [DATE] documented a Brief Interview for Mental Status (BIMS) score of 5, which indicates severe cognitive impairment. Under section B. B1200. Corrective Lenses documented R6 used corrective lenses for her vision. R12's Care Plan had a focus area of risk for falls related to visual acuity impairments and cognitive impairments with interventions that included:…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction

“Cited before” means this same F-tag appears on at least one other survey date in the record we hold — counting complaint investigations as well as standard surveys, with no time limit. It is our own read of the data, not CMS’s: CMS uses repeat deficiency as a formal term tied to consecutive standard surveys, and that is a narrower test than this one. A tag marked here may or may not meet it.

Fines & penalties

$394,198 in federal fines across 10 penalties. 3 Medicare payment denials on record.

• $86,220 — penalty dated 2026-04-21
• $39,780 — penalty dated 2026-02-24
• $19,115 — penalty dated 2025-10-23
• $26,685 — penalty dated 2025-10-23
• $14,505 — penalty dated 2025-09-12
• $10,209 — penalty dated 2025-04-21
• $16,828 — penalty dated 2025-04-21
• $98,982 — penalty dated 2025-01-02
• $25,662 — penalty dated 2024-08-12
• $56,212 — penalty dated 2024-01-19
• Medicare payment denial — starting 2026-05-15 for 5 days
• Medicare payment denial — starting 2025-01-28 for 48 days
• Medicare payment denial — starting 2024-02-16 for 18 days

Dates are the dates CMS records the penalty, not the date of the conduct behind it. CMS publishes penalties on a rolling window, so this is what is currently on the public file — not the home’s lifetime history, and an older fine may attach to a problem that has since been corrected. The amounts are as imposed: the CMS file does not record whether a penalty was appealed, reduced, or paid, so we don’t say. Ask the home what each one was for and what changed since.

Part of a chain

This home belongs to HELIA HEALTHCARE — 13 facilities. Here is how its ratings compare with the chain’s average across all its homes: See the whole chain — ratings, flags, fines and finances →

A home rated well below its chain’s average can signal local problems; a chain with a low average across the board is a bigger pattern worth researching. CMS chain data under-reports private-equity and REIT ownership, so treat this as a floor, not the full picture.

Who owns this facility

CMS files one row per role, so the 4 rows in the source record cover these 2 parties — each is shown once here with every role it holds. Nothing is omitted.

Follow the money — this home’s finances

Where a nursing home’s revenue comes from and where it goes — including money paid to companies under the same ownership. Most consumer sites never show this; we reproduce it straight from the Medicare cost report.

About 83% of this home’s resident-days are paid by Medicaid, which reimburses well below the cost of care in most states. Heavily Medicaid-dependent homes run on thinner budgets — a context worth holding next to the staffing and inspection record, not a fault in itself. This home reported $382K paid to related parties (affiliated landlords or management companies) in its most recent cost report.

Source: CMS Healthcare Provider Cost Reporting Information System (HCRIS), Medicare cost report Form CMS-2540 · fiscal year 2023. Facilities self-file these reports; figures are unaudited and a year or two behind. A home with no Medicare cost report on file shows no figures here.

Cost & finances

Straight from this home’s Medicare cost report (CMS, FY2023). These are its operating economics — what it costs to run per resident-day and what it collects on average across Medicare, Medicaid, and private pay — not a private-pay quote. Your out-of-pocket cost depends on payer and room type, so ask the facility directly; a higher operating cost can reflect richer staffing or a sicker population. The cost-of-care planner shows regional benchmarks by care type.

What families pay in IL