Rose Garden Of Pana

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.

Therapy staffing: this home’s payroll records show 0.14 therapist hours per resident per day in 2026Q1 — more than 10% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 4% 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 105 beds and averages 73.1 residents a day — about 70% occupied, or roughly 32 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 2.71 hrs/resident/day is below the 3.48-hour benchmark and RN staffing of 0.11 is below the 0.55-hour RN benchmark and nurse-aide staffing of 1.76 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 2.38 hrs/resident/day on weekends vs 2.84 on weekdays — 16% thinner on weekends. RN hours go from 0.12 to 0.08 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 45% is about the same as the national median of 45%.

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.

29 citations, most serious first. The 13 most serious are shown; the remaining 16 are one tap away and print in full.

• Actual harm · G2026-02-26 · tag F0697 — failed to manage pain — isolated
  Provide safe, appropriate pain management for a resident who requires such services.
  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 to manage pain for 1 of 3 (R3) residents reviewed for pain management in a sample of 41. This failure resulted in R3 experiencing unrelieved horrible pain. Findings include:R3's Care Plan, dated 10/16/2026, documents PAIN: The resident has occasional pain r/t (related to) T2DM (type 2 diabetic), heart disease, BPH (benign prostatic hyperplasia), HTN (hypertension), muscle weakness, HLD (Hyperlipidemia), and calcaneal spur to right foot. It also documents Administer analgesia as per orders. Give 1/2 hour before treatments or care. Anticipate the resident's need for pain relief and respond immediately to any complaint of pain. Evaluate pain relief 30-60 minutes after administering analgesics (depending on route).R3's Minimum Data Set, dated [DATE], documents that R3 has pain. R3's Physician order, dated 9/30/2025, documents Heel Protectors on while in bed.On 2/23/2026 at 10:12 AM observed R3 lying on back in bed on his back with heels on mattress.…

  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 before2025-10-28 · tag F0684 — failed to provide proper treatment and quality of care — isolated
  Provide appropriate treatment and care according to orders, resident’s preferences and goals.
  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 a resident with a change in condition for 1 of 3 residents (R2) reviewed for quality of care in the sample of 3. The facility also failed to notify the physician and resident representative of a change of condition. This failure resulted in a delay in hospitalization for R2 for the diagnoses of small bowel obstruction, dehydration, nausea, and vomiting. R2 required nasogastric decompression and endured three attempts at midline catheter placement to achieve intravenous access for fluid resuscitation. Findings include: R2's Face Sheet documents R2 was admitted to the facility on [DATE] with diagnoses including dementia, chronic kidney disease, and congestive heart failure.R2's Minimum Data Set (MDS) dated [DATE] documented R2 was moderately cognitively impaired and required substantial assistance with bed mobility and transfer.On 10/23/25 at 4:35 PM, V9 (R2's Family) stated she came to visit R2 over the weekend of 10/10/25-10/11/25. R2 was asleep…

  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 before2023-11-16 · 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 ensure there was sufficient supervision to prevent falls and ensure care plan interventions were appropriately in place for 2 out of 3 (R28, R36) reviewed for falls in a sample of 31. This failure resulted in R28 being sent to local emergency room with an acute to subacute right lateral 9th rib fracture, subacute to acute right anterolateral 3rd rib fracture and also had multiple healed rib fractures from other falls. Findings include: 1. R28's Face Sheet, print date of 11/16/23 documents R28 has the following diagnose Type II diabetes mellitus with hyperglycemia, multiple fractures of ribs, Alzheimer's disease, dementia, Hypertension. R28's Minimum Data Set (MDS), dated [DATE], documents R28 is severely cognitively impaired and requires substantial/maximal assistance with transferring, oral hygiene, toileting hygiene, shower/bath, dressing, and personal hygiene, he is frequently incontinent of bladder, and always continent of bowel.…

  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 before2026-02-26 · tag F0727 — failed to provide required RN coverage — widespread
  Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.
  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 schedule a Registered Nurse (RN) for at least 8 consecutive hours a day for 88 of the 88 days reviewed for December 2025, January 2026, and February 2026. This failure has the potential to affect all 71 residents that resides in the facility. Findings Include: During this investigation was V4 (Regional Nurse) was the only RN in the building. The facility's working schedules and daily staffing sheets were reviewed and documents the following: December 2025, there was no RN scheduled from 12/01/25 through 12/31/25.January 2026, there was no RN scheduled from 01/01/26 through 01/31/26.February 2026, there was no RN scheduled from 02/01/26 through 02/26/26. On 02/26/2026 at 9:21 AM, V23 (Certified Nursing Assistant/CNA), said V2 (Director of Nursing/DON) and V4 (Regional Nurse) are in the facility, but she did not know if they (V2 and V4) were working the floor as a nurse. On 02/26/26 at 9:25 AM, V22 (CNA) stated V2 and V4 are in the facility but didn't know if they worked on the floor. On 02/26/2026 at 9:45 AM,…

  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 before2026-02-26 · tag F0761 — failed to label and store drugs safely — widespread
  Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
  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 properly store medication and discard expired medication. This failure has the potential to affect all 71 residents residing in the facility.Findings include:On [DATE] at 9:51 AM the 200-hall medication cart was inspected. The medication cart contained the following:1 R23's opened and partially used multidose Novolin FlexPen Injection Solution Pen-injector 100 UNIT/ML. No open date.2. R38's opened and partially used multidose Lantus SoloStar Subcutaneous Solution Pen-injector 100 UNIT/ML. No open date.3. R68's opened and partially used multidose Toujeo SoloStar 300 UNIT/ML Solution pen-injector. No open date.4. R36's opened and partially used multidose Lantus Subcutaneous Solution 100 UNIT/ML (Insulin Glargine) Vial. No open date.On [DATE] at 9:55 AM V5 (Licensed Practical Nurse/LPN), stated that on the first date the insulin is accessed and used that date is placed on the multidose vials and pens. V5 stated that the insulins have a…

  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 · Fcited before2026-02-26 · tag F0804 — failed to serve food at safe, palatable temperature — widespread
  Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on observation, interview, and record review, the facility kitchen staff failed to calibrate a thermometer prior to taking the temperature of the food. This failure has the potential to affect all 71 residents who reside at the facility. Findings Include:On 02/23/26 at 10:55 AM, V7 (Cook) took the temperature (temp) of the food. V7 did not calibrate the thermometer prior to taking the temps. On 02/23/26 at 10:57 AM, V7 was asked how he calibrates the thermometer. He stated, I have no idea let me go ask. V7 talked with V6 (Dietary Manager) and came back and stated V6 said it can't be calibrated. On 02/24/2026 at 10:00 AM, R23, R35, R5, R46, R21 all stated that the food is cold. On 02/26/26 at 11:20 AM, V6 (Dietary Manager) stated that their thermometers are digital and they do not calibrate them and the only way to calibrate it is to put a new battery in it. The facility's Resident Council Concern Report, dated 02/26/26, documents Department: Dietary eggs this morning was cold. The facility's policy Food Preparation and Service, Revision date November 2022, documents Policy…

  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.

  Nutrition and Dietary Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Ecited before2026-02-26 · tag F0657 — failed to keep the care plan current — pattern
  Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
  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 add identified problem areas and to update care plans in a timely manner for 4 residents of 35 residents (R7, R34, R64, R86) whose care plans were reviewed in the sample of 35.Findings Include:1. R34's Face Sheet, print date of 02/25/26, documents he has diagnoses of but not limited to congestive heart failure (CHF), paroxysmal atrial fibrillation, muscle wasting and atrophy, multiple sites, and unsteadiness on feet. R34's Minimum Data Set (MDS), dated [DATE], documents R34 is cognitively intact with a Brief Interview for Mental Status (BIMS) of 13 out of 15 and he requires partial/moderate assistance with sit to stand, transfer chair/bed-to-chair transfer, and toilet transfers. R34's Care Plan, admission date of 12/05/24, documents R34's review shows moderate risk for falls. Risk factors include use of psychotropic medications, diuretics, incontinence, visual impairment, and cognitive impairment. Interventions include but not limited to…

  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 · Ecited before2026-02-26 · 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 implement progressive fall interventions, failed to implement fall reduction interventions in a timely manner, failed to complete post fall assessments per the facility policy, and failed to ensure fall interventions were in place per resident Care Plans for 4 of 10 residents (R7, R34, R64, R86) reviewed for falls in the sample of 35. Findings Include: 1.R7's Face Sheet, print date of 2/25/26, documents R7 has diagnoses including traumatic subdural hemorrhage, dementia, unspecified psychosis, generalized anxiety disorder, chronic myeloid leukemia, osteoporosis, and cerebral infarction. R7's MDS (Minimum Data Set), dated 1/21/26, documents R7 is severely cognitively impaired. R7's Fall Risk Evaluation dated 7/20/23 documents R7 is at risk for falls. R7's Fall Risk Evaluation dated 7/17/25 documents R7 is at risk for falls. On 2/26/26 at 10:53 AM V4 (Regional Nurse) stated R7's fall risk score indicates R7 is at risk for falls. R7's Care…

  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 · Dcited before2026-02-26 · 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 interview and record review, the facility failed to ensure dignity and respect for 4 of 5 (R23, R21, R35 and R46) residents reviewed for call lights in a sample of 35.Findings include: 1.On 02/24/2026 at 2:00 PM, R23 stated that if they don't answer her call light and she has to go to the bathroom and she has an accident it does not feel good and it embarrasses her.R23's Minimum Data Set (MDS), dated [DATE], documented that her cognition was moderately impaired and that she was frequently incontinent of urine and occasionally incontinent of stool. 2. On 02/24/2026 at 2:08 PM, R35 stated that she takes a water pill, and she is always incontinent but if she has to wait, she is just thinking about the other residents that need help and that are not getting it.R35's MDS, dated [DATE], documented that her cognition was intact and that she was frequently incontinent of urine. 3. On 02/24/2026 at 2:12 PM, R21 stated that it takes a long time for the night shift to answer her call light, but she will just get…

  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
• Potential for harm · D2026-02-26 · tag F0604 — failed to not use physical restraints improperly — isolated
  Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.
  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 ensure physical restraints were used to treat a medical symptom, failed to provide evidence of least restrictive methods attempted prior to initiating a physical restraint, failed to identify the amount of time the restraint will be used for, failed to identify risks versus benefits of restraints, failed to provide ongoing monitoring documentation of the restraint, and failed to remove the restraint at meals for 1 of 1 residents (R7) reviewed for physical restraints in a sample of 35. Findings Include: R7's Face Sheet, print date of 2/25/26, documents R7 has diagnoses including traumatic subdural hemorrhage, dementia, unspecified psychosis, generalized anxiety disorder, chronic myeloid leukemia, osteoporosis, and cerebral infarction.R7's MDS (Minimum Data Set), dated 1/21/26, documents R7 is severely cognitively impaired and has a physical restraint.R7's physician order, dated 7/16/25, documents lap restraint when in wheelchair due to frequent falls and decrease in mobility. Off during meals times. Release…

  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
• Potential for harm · Dcited before2026-02-26 · tag F0684 — failed to provide proper treatment and quality of care — isolated
  Provide appropriate treatment and care according to orders, resident’s preferences and goals.
  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 complete dressing changes and daily skin checks as ordered by the physician for wounds for 1 of 3 residents (R73) reviewed for wounds in a sample of 35. Findings Include: R73's Face Sheet, admission date of 02/24/23, documents R73 has diagnoses of but not limited to rheumatoid arthritis, sepsis, peripheral vascular disease, cellulitis of left lower limb, and atherosclerosis of native arteries of right leg with ulceration of other part of lower leg. R73's Minimum Data Set (MDS), dated [DATE], documents R73 is cognitively intact with a Brief Interview of Mental Status (BIMS) of 15 out of 15 and she is dependent on staff for most of her activities of daily living (ADLs). R73's Care Plan, admission date of 02/24/23, documents R73 has a venous/stasis ulcer of the right medial ankle (08/28/25), non-pressure related blister to left heel. Interventions include but are not limited to document location of wound, amount of drainage, peri-wound area,…

  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 · D2026-02-26 · tag F0880 — failed to prevent and control infections — isolated
  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 ensure infection control guidelines were in place and implemented for 2 of 3 (R3, R65) residents reviewed for infection control in a sample of 35. Findings include: 1 R3's Care plan, dated 2/9/2026, documents that R3 is on contact isolation; projected time frame start 11/21/2025 r/t (related to) Infection process ESBL to urine. 2/24/2026 Resident is on contact isolation; r/t Infection process in urine. It continues Isolation Precautions: Wear gowns and masks when changing contaminated linens. Place soiled linens in bags marked biohazard. Bag linens and close bag tightly before taking to laundry. Educate resident and family on the need of isolation precaution. Educate family and staff regarding the transmission, pathophysiology, etiology, and treatment of infection. Upon gown and glove removal, ensure hands and clothing does not contact potentially contaminated environmental surfaces.R3's Minimum Data Set (MDS), dated [DATE], documents that…

  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 · Fcited before2024-10-31 · tag F0727 — failed to provide required RN coverage — widespread
  Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on interview, observation, and record review the Facility failed to provide a Registered Nurse (RN) for at least 8 consecutive hours a day, 7 days a week. The facility also failed to employ a Director of Nursing (DON). This has the potential to affect all 53 residents in the facility. Findings include: On 10/28/2024 at 9:20 AM V1 (Administrator) stated, We do not currently have a DON and I can tell you we do not have enough RN coverage. We only have one (RN) who works 3 days a week. V1 stated the Facility census was 53. The Facility's Management Team document, undated, documents the DON position is vacant. During this survey 10/28/24-10/31/24, there were no observation of a DON at the Facility. There were also no observations of a RN on duty. On 8/30/2024 at 11:00 AM, V5 (Licensed Practical Nurse/LPN) stated, (Former DON)'s last day was 7/25/2024. We had a DON hired, but she only stayed 2 hours and never completed her (employment) paperwork. (V15 RN) is our only RN and works Fridays, Saturdays and Sundays. V15's Master Schedule documents V15 did not work 10/1/2024, 10/2/2024,…

  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

“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

$120,442 in federal fines across 2 penalties. 1 Medicare payment denial on record.

• $25,200 — penalty dated 2026-02-26
• $95,242 — penalty dated 2023-11-07
• Medicare payment denial — starting 2023-12-14 for 37 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 POINTE MANAGEMENT — 12 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 22 rows in the source record cover these 10 parties — each is shown once here with every role it holds. Nothing is omitted. The source lists no ownership percentage for any of them — PECOS records a share only for equity interests, not for board or management roles.

3 organizational owners listed — a facility can be part of a larger chain. CMS ownership data is known to under-report private-equity and REIT ties; treat as a starting point.

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 76% 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. A reported operating loss is common in this industry and is not by itself a sign of trouble — but paired with large related-party payments it can mean profit is being taken elsewhere in the ownership structure.

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