Evervella Of Swansea

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.

45.9% of the Medicare patients who left this home got back to the community and stayed there for at least 31 days — which CMS reads as no different from the national rate. This is CMS’s risk-adjusted rate over 84 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.

Therapy staffing: this home’s payroll records show 0.36 therapist hours per resident per day in 2026Q1 — more than 61% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 16% of this home’s weekday level — it runs some therapy at the weekend, at a lower level than on weekdays. 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 120 beds and averages 90.5 residents a day — about 75% occupied, or roughly 30 beds typically open. It usually has some room. 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 3.03 hrs/resident/day is below the 3.48-hour benchmark and RN staffing of 0.25 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 2.79 hrs/resident/day on weekends vs 3.13 on weekdays — 11% thinner on weekends. RN hours go from 0.26 to 0.20 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 74% 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.

33 citations, most serious first. The 13 most serious are shown; the remaining 20 are one tap away and print in full.

• Actual harm · G2025-11-21 · 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 observation, interview, and record review, the facility failed to continue intravenous antibiotics to 1 resident (R1) of 1 resident reviewed for antibiotic use in the sample of 5. This failure resulted in R2 being re-diagnosed with osteomyelitis and having a peripherally inserted central catheter (PICC) reinserted. During the onsite survey, past noncompliance was cited after the facility implemented actions to correct the noncompliance which included in services and quality assurance checks. The deficient practice occurred on 10/10/2025 and was corrected on 11/11/2025 prior to the start of this survey and was therefore Past Noncompliance. The facility was able to demonstrate monitoring of the corrective action and sustained compliance. Findings include: R2's face sheet documents an admission date of 7/5/2018. Diagnoses include Osteomyelitis, Chronic Kidney Disease, Cerebral Infarction, Peripheral Vascular Disease, Dementia. R2's Minimum Data Set, MDS, dated [DATE] documents R2 is severely cognitively…

  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 · Past Non-Compliance
• Actual harm · Gcited before2024-07-26 · 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 interview and record review the Facility failed to seek medical interventions in a timely manner for 1 of 5 residents (R39) reviewed for medical interventions in the sample of 37. This failure resulted in R39 having a fall and not being sent out to the hospital for 2 hours and 34 minutes and sustaining a fracture of her left ankle. Findings include: R39's Physician Order Sheet (POS) July 2024, documents a diagnosis of Pneumonia, unspecified organism; Unspecified severe protein-calorie malnutrition; Hypertensive encephalopathy; Memory deficit following unspecified cerebrovascular disease; Unspecified osteoarthritis, unspecified site; Essential (primary) hypertension; Other specified nutritional anemias; dry eye syndrome of unspecified lacrimal gland; Polyarthritis, unspecified; Gastro-esophageal reflux disease without esophagitis; Anxiety disorder, unspecified; Hyperlipidemia, unspecified; Overactive bladder; Pain, unspecified; Allergy, unspecified, subsequent encounter; Major depressive disorder,…

  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 before2024-05-23 · 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 properly care for a hospice resident with Dementia residing at the facility for Respite Care, including Activities of Daily Living (ADLs) and Medication Administration for 1 of 1 resident (R2) reviewed for proper nursing care. This failure resulted in R2 having significant behaviors resulting in R2 obtaining a leg injury. Findings include: R2's Face Sheet, undated, documents R2 was admitted to the facility on [DATE] for a 5-day Respite stay and was discharged on 5/7/24. R2's diagnosis include Dementia and Parkinsonism. R2's Care Plan and Minimum Data Set (MDS) was not completed due to short stay at the facility. R2's admission Functional Ability Assessment, dated 5/2/24, documented that R2 was dependent on staff for all ADLs, and mobility. On 5/9/24 at 9:53 AM, V5 (R2's Daughter) stated (R2) went to the facility last Thursday (5/2/24) for Respite Care for five days as I had to go out of town. When he got there, the Hospice Nurse did a Tuck-In…

  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 before2026-06-16 · 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 answer call lights timely for 2 of 6 residents (R1, R3) reviewed for resident rights in the sample of 6. Findings include: 1-R1's Face Sheet documents R1 was admitted to the facility on [DATE] with diagnoses including chronic obstructive pulmonary disease (COPD) and age-related physical debility. R1's Minimum Data Set (MDS) dated [DATE] documented R1 was cognitively intact. On 6/11/26 at 1:50 PM, R1 stated it usually takes about 30 minutes for staff to respond after pressing the call light. 2-R3's Face Sheet documents R3 was admitted to the facility on [DATE] with diagnoses including diabetes mellitus and heart disease. R3's MDS dated [DATE] documented R3 was cognitively intact. On 6/11/26 at 12:55 PM, R3 stated sometimes call light waits take a long time, and it is usually worse on weekends due to short staffing. On 6/11/26 at 12:34 PM, V5, Ombudsman, stated residents have been complaining that call lights are not being answered in a timely manner.…

  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 · D2026-02-18 · tag F0558 — failed to accommodate residents' needs and preferences — isolated
  Reasonably accommodate the needs and preferences of each resident.
  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 answer call lights in a timely manner in 1 of 7 residents (R20) when reviewed for accommodation of needs in the sample of 16.Findings Include: On 2/17/26 at 1:54 PM, R20 was observed in her room in the wheelchair. R20 stated she filed a grievance because it takes too long to get her call light answered and needs met. R20 stated it also depends on who is working, the agency staff are the worst, and it is worse during the night and on the weekends. R20 stated she has had diarrhea and when she needs to go, she needs to go and worries that the staff will not get to her in time and she will have an accident in her pants. R20 stated since filing the grievance, things have not improved and are the same. On 2/18/26 from 11:33 AM until 1:10 PM, R22 was observed in her room with her call light on and stated she turned her call light on at 12:00 PM because she needs to use the bathroom. R22 stated the CNAs (Certified Nursing Assistants) were passing meal trays and the wait time for her call light to be answered depends…

  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 · D2026-01-15 · tag F0557 — isolated
  Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions.
  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 working call lights for 2 of 2 residents (R1, R3) reviewed for call lights in the sample of 6. Findings include:R1's admission Record documented an admission Date of 11/20/25 and listed Diagnoses including Hypertension, Prediabetes, and Postpolio Syndrome. R1's Minimum Data Set, dated [DATE] documented that R1 has no deficits in cognition and requires substantial/maximal assistance for toileting. R1's Care Plan dated 11/20/25 documented a problem area, Resident has an ADL (Activities of Daily Living) self-care performance deficit related to Musculoskeletal impairment /Postpolio Syndrome.On 1/14/26 at 12:15pm, R1 was alert and oriented to person, place, time, and purpose. R1 stated he was discharged home from the facility on12/30/25. R1 stated the care he received at the facility was 'terrible.' R1 stated twice during his stay, he was incontinent and left to sit in feces and was told by staff they were too busy serving supper, and he…

  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 · D2026-01-15 · tag F0919 — failed to provide a working call system — isolated
  Make sure that a working call system is available in each resident's bathroom and bathing area.
  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 maintain a working call light system for one resident (R3) of 5 residents reviewed for call lights in the sample of 6. Findings include:R3's admission Record documented an admission Date of 11/21/25 and listed Diagnoses including Diabetes Type 2 and Fractures of the Left Tibia and Fibula. R3's Minimum Data Set, dated [DATE] documented that R3 has no deficits in cognition and requires partial to moderate assistance for toileting. R Care Plan dated 12/12/25 documented that R3 has an activities of daily living self-care performance deficit related to right leg fractures.On 1/14/26 at 10:20am, R3 was alert and oriented to person, place, time, and purpose. R3 stated her call light has not been working for 3-4 days now. R3 pushed the button and the light did not come on outside the door. R3 stated it is her understanding that the facility does not currently have a Maintenance Supervisor. R3 stated staff are supposed to be checking on her more…

  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.

  Environmental Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Ecited before2025-12-15 · tag F0550 — failed to protect resident dignity and rights — pattern
  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 answer call lights in a timely manner for 6 (R1, R2, R3, R4, R5, and R6) of 6 residents reviewed for timely assistance in a sample of six. Findings include:1.R1's admission record documents an admission date of 111/21/25 with diagnoses including: nondisplaced comminuted fracture of shaft of right fibula, nondisplaced [NAME] fracture of right tibia, type two diabetes mellitus, hyperlipidemia, bell's palsy, and acute kidney failure. R1's Minimum Data Set, dated [DATE] documents a brief interview of mental status of 15 indicating cognitively intact. R1's toilet transfer ability was documented as not attempted due to medical condition or safety concerns and chair to bed transfer as: partial/moderate assistance, and walk 10 feet as not attempted due to medical condition or safety concernsOn 12/12/25 at 12:48 PM R1 stated, the facility to the cushion out of her wheelchair and she had been up sitting in her chair for a while and her bottom hurt so she wanted…

  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 · D2025-11-21 · tag F0677 — failed to help fully-dependent residents with daily care — isolated
  Provide care and assistance to perform activities of daily living for any resident who is unable.
  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 perform adequate incontinence care to 1(R1) of 4 residents reviewed for incontinence care in the sample of 5. Findings include:R1's face sheet documents an admission date of 10/8/2025. Diagnoses include Chronic Diastolic Congestive Heart Failure, Hepatic Failure, Nonalcoholic Steatohepatitis, Chronic Respiratory Failure, Pneumonia.R1's Minimum Data Set, MDS, dated [DATE] documents R1 has no cognitive deficits. R1 requires maximum assist with rolling side to side and transfers. R1's care plan dated 10/23/2025 documents R1 has a venous/stasis ulcer related to peripheral vascular disease, to left and right lower extremities. R1 picks and scratches at skin. Interventions include administer and monitor treatments as ordered. Give medications for pain and minimize skin exposure to moisture from incontinence, wound drainage or perspiration. On 11/20/2025 at 8:06AM R1 lying flat in bed. R1 stated, I need to get up. I should've gotten up 2 hours…

  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 · F2025-09-26 · 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 ensure there was an adequate number of CNAs (Certified Nursing Assistants) working to provide care to the residents. This failure has the potential to affect all 85 residents residing in the facility.Findings Include:On 9/23/25 at 9:24 AM, R35 stated that the facility is short staffed. On 9/23/25 at 9:40 AM, R28 stated that the facility is short staffed for CNAs. She stated that sometimes R28 has to wait 2 hours for her call light to be answered.On 9/23/25 at 9:55 AM, R75 stated since the new company took over, they have cut down on staff. R75 stated within the past 2 weeks, unsure of exact date, he had to wait 3 hours to get his call light answered because they don't have enough.The Facility Assessment, with a review date of 1/16/25, documents the following staffing plan for the number of licensed nurses and CNAs per shift per day: Licensed nurses - 4/4/3 and CNAs 8-10/8-10/5-7. The CNA/Nurse Schedules document the following: 9/6/25 - 3 nurses and 3 CNAs; 9/7/25 - 1 nurse and 4 CNAs; and 9/13/25 - 3 nurses and 3 CNAs.On…

  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 · F2025-09-26 · tag F0809 — failed to serve meals on a reasonable schedule — widespread
  Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times.
  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 offer snacks to the residents. This failure has the potential to affect all 85 residents residing in the facility.Findings Include:On 9/23/25 at 9:18 AM R68 stated since the new company took over the place isn't worth a s*, they used to give us soda, candy, cookies for snacks, now they don't even offer snacks. R68's MDS (Minimum Data Set), dated 8/19/25, documents he has moderate cognitive impairment. On 9/23/25 at 9:55 AM, R75 stated since the new company took over, they cut out their soda, fruit drinks at breakfast and evening snacks. R75 stated they don't offer any snacks. R75 stated about the only thing he likes is the hot dogs and he is getting tired of hot dogs. R75's MDS, dated [DATE], documents R75 is cognitively intact. On 9/23/25 at 9:40 AM, R16 stated the food tastes horrible, they took away our soda and snacks. R16 stated they don't offer any snacks throughout the day or in the evening time. R16 stated sometimes she gets so…

  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 · Dcited before2025-09-26 · 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 — the official record, unedited, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review the facility failed to maintain a resident's dignity in 1 of 1 residents (R104) reviewed for resident rights in the sample of 34.Findings Include:On 9/24/25 at 7:52 AM and 8:02 AM, R104 was observed in bed, uncovered with the blankets at the bottom of the bed, incontinent brief on, shirt pulled up under her breasts, privacy curtain pulled, resident not visible from door but once in the room, able to see around the curtain from bed one. R104's Minimum Data Set, dated [DATE], documents R104 has severe cognitive impairment and requires assistance with activities of daily living. R104's Care Plan, dated 9/19/25, documents R104 requires assistance with activities of daily living. On 9/25/25 at 1:33 PM V1 (Administrator) stated she would expect residents to be treated with dignity. The Resident Rights Policy, dated 6/1/25, documents the purpose of the policy is to promote the exercise of rights for each resident.

  Resident Rights Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2025-09-26 · tag F0580 — failed to tell family and doctor about changes — isolated
  Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
  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 the POA (power of attorney) was notified for change of condition for 1 of 3 residents (R19) reviewed for notification in the sample of 34. Findings include: R19's Physician Order Sheet for September 2025 documents a diagnosis of acute respiratory failure, unspecified whether with hypoxia or hypercapnia, sepsis, unspecified protein-calorie malnutrition, vitamin deficiency; hypo-osmolality and hyponatremia; unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance and anxiety; unspecified chronic conjunctivitis, right eye; non-st elevation myocardial infarction; pneumonia, pneumonitis due to inhalation of food and vomit; acute respiratory distress syndrome; repeated falls, urinary tract infection.R19's Minimum Data Set (MDS) quarterly assessment dated [DATE] document R2's cognition was not assessed. R19 MDS document R19 needs assistance with most ADL's (activities of daily living); 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.

  Resident Rights 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

$144,732 in federal fines across 21 penalties. 1 Medicare payment denial on record.

• $34,694 — penalty dated 2024-07-26
• $4,938 — penalty dated 2024-02-20
• $4,938 — penalty dated 2024-02-12
• $14,814 — penalty dated 2024-01-22
• $4,938 — penalty dated 2024-01-08
• $4,587 — penalty dated 2024-01-02
• $13,762 — penalty dated 2023-12-11
• $4,587 — penalty dated 2023-11-20
• $4,587 — penalty dated 2023-11-13
• $4,587 — penalty dated 2023-11-06
• $4,587 — penalty dated 2023-10-30
• $4,587 — penalty dated 2023-10-23
• $4,545 — penalty dated 2023-10-17
• $4,587 — penalty dated 2023-10-10
• $4,587 — penalty dated 2023-10-02
• $4,587 — penalty dated 2023-09-25
• $4,587 — penalty dated 2023-09-18
• $4,587 — penalty dated 2023-09-11
• $4,235 — penalty dated 2023-09-05
• $3,882 — penalty dated 2023-08-28
• $3,529 — penalty dated 2023-08-21
• Medicare payment denial — starting 2024-08-23 for 4 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 EVERCARE SKILLED NURSING — 8 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 18 rows in the source record cover these 9 parties — each is shown once here with every role it holds. Nothing is omitted.

2 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.

This home reported $558K paid to related parties (affiliated landlords or management companies) in its most recent cost report. 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 2024. 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, FY2024). 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