Spring Mill Meadows

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.

56.1% 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 172 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.

Met the expected recovery: 36.5% 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 52 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 0.27 therapist hours per resident per day in 2026Q1 — more than 41% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 12% 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 124 beds and averages 85.8 residents a day — about 69% occupied, or roughly 38 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 3.69 hrs/resident/day is at or above the 3.48-hour benchmark and RN staffing of 0.65 is at or above the 0.55-hour RN benchmark and nurse-aide staffing of 2.21 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 3.32 hrs/resident/day on weekends vs 3.84 on weekdays — 13% thinner on weekends. RN hours go from 0.75 to 0.41 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 55% is about the same as 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.

27 citations, most serious first. The 13 most serious are shown; the remaining 14 are one tap away and print in full.

• Actual harm · Gcited before2025-05-28 · 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

  Based on interview and record review, the facility failed to ensure a staff member followed the facility policy and procedure related to the use of a gait belt during a transfer which resulted in a resident fall for 1 of 3 residents reviewed for accidents. (Resident B) This deficient practice resulted in an abrasion on the resident's forehead and a fracture of the right femur. The deficient practice was corrected on 5/5/25, prior to the start of the survey, and therefore was past noncompliance. Findings include: During a telephone interview, on 5/27/25 at 8:47 a.m., Resident B's family indicated the resident was a fall risk. He was in the hall, heard a thump, and entered to find the resident on the floor. The resident had blood coming from her head. The CNA did not have a gait belt. He told the facility to call the paramedics. He indicated the resident sustained a right femur fracture (broken bone in the upper leg) and had emergency surgery the following day. The clinical record for Resident B was reviewed on 5/27/25 at 9:15 a.m. The diagnoses included, but were 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.

  Quality of Life and Care Deficiencies · Past Non-Compliance
• Actual harm · Gcited before2025-02-11 · 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

  Based on interview and record review, the facility failed to ensure a resident received a medication for cancer as ordered, follow-up appointments with an oncologist were scheduled, and the facility's medical director did not discontinue a medication without consulting with the resident's oncologist for 1 of 2 residents reviewed for quality of care. (Resident B) This deficient practice resulted in Resident B having no follow-up oncology care to prevent further spread of the metastasis to the bone related to his prostate cancer. Findings include: An email, dated 1/16/25, indicated there were concerns with Resident B's treatment plan for his metastatic prostate cancer. In February 2023, the resident was placed on docetaxel (chemotherapy) and Nubeqa (a hormone therapy medication used to treat prostate cancer) at the cancer center. In April 2023, his pain was much improved, and his prostate-specific antigen had dropped which indicated the treatment was working well. In September 2023, Resident B continued to receive treatment, and his cancer medications were being provided/covered by…

  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 · G2023-11-16 · 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

  Based on interview and record review, the facility failed to administer medications to ensure a resident was free from significant medication errors for 1 of 3 residents reviewed regarding medication errors. (Resident G) Resident G required a hospital admission of five days. Finding includes: A document, titled Intake Information, dated 11/2/23, indicated an anonymous complainant had concerns with Resident G having a critically low potassium level and not being treated with the potassium replacement ordered by the Nurse Practitioner (NP). During an interview, on 11/14/23 at 2:45 p.m., the Director of Nursing (DON) indicated Resident G did miss her dose of Potassium liquid, on 10/24/23, after the NP ordered it to be given that day. Agency Nurse 4 went to get the potassium liquid out of the Emergency Drug Kit, and it was not in there. Instead of calling the NP back, as she should have done to obtain further orders, she asked the other nurse on the unit what she should do. They decided to reschedule the medication for the following day after the pharmacy delivered it. The potassium…

  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 · E2025-08-05 · 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

  Based on interview and record review, the facility failed to ensure care plan meetings were held quarterly, the residents and the residents' representatives were invited to participate, and to develop a comprehensive care plan related to a PICC line (peripherally inserted central catheter) and enhanced barrier precautions for 4 of 20 residents reviewed for care plans. (Resident 40, 57, 5 and 2)Findings include: 1. During an interview, on 7/30/25 at 10:51 a.m., Resident 40 indicated he had not been to a care plan meeting to discuss his care at the facility. The clinical record for Resident 40 was reviewed on 8/5/25 at 1:40 p.m. The diagnoses included, but were not limited to, hypertension, major depressive disorder, and hemiparesis and hemiplegia following unspecified cerebrovascular disease. There was no documentation in the clinical record to indicate Resident 40 had a care plan meeting in 2025. During an interview, on 8/1/25 at 2:21 p.m., Social Service Worker 6 indicated it had been a while since the resident had a care plan meeting. Care plan meetings were supposed to be held…

  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 · E2025-08-05 · tag F0880 — failed to prevent and control infections — pattern
  Provide and implement an infection prevention and control program.
  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 Personal Protection Equipment (PPE) was used during care for residents on Enhanced Barrier Precautions (EBP), staff removed soiled gloves after cleaning a catheter line and prior to touching items in a resident's environment, to ensure EBP signage was posted, and to properly store a bed pan for 5 of 5 residents reviewed for infection control. (Resident 67, 81, 6, 2 and 5)Findings include:1. During an observation, on 7/31/25 at 8:10 a.m., a sign was posted outside Resident 67's door to indicate the resident was on EBP precautions. During the observation, LPN 1 was observed to perform hand hygiene and put on clean gloves. She was not observed to put on a gown. LPN 1 attached a piston syringe to the gastrostomy tube, flushed the line with water, administered liquid gabapentin (a medication for neuropathy and/or seizures), flushed the line again, and then reconnected the nutrition line. LPN 1 was not observed to use a gown throughout the procedure. During an interview, on 7/31/25 at 8:22 a.m., LPN 1…

  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 · D2025-08-05 · tag F0554 — isolated
  Allow residents to self-administer drugs if determined clinically appropriate.
  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 the interdisciplinary team (IDT) determined that a resident was safe to self-administer medications and to obtain a physician's order for self-administration for 1 of 1 resident reviewed for self-administration of medication. (Resident 57)Findings include:During an observation and interview, on 7/31/25 at 2:59 p.m., Resident 57 had 2 respiratory inhalers on her bed. Resident 57 indicated her inhalers had been at bedside with her for a long time and she kept the inhalers within arm's reach, either on her bed or in her bedside table drawer.During an observation and interview, on 8/1/25 at 8:55 a.m., Resident 57 had 3 respiratory inhalers with her at bedside. Resident 57 indicated she self-administered the medications, and the nurse would bring her replacements when the medications were empty.At bedside the 3 respiratory inhalers were:1. Spiriva 1.25 mcg (microgram), dated 5/20/25, with instructions to discard by 8/9/25.2. Albuterol rescue inhaler with 15 doses remaining.3. Breo Ellipta, dated 5/21/25,…

  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 · D2025-08-05 · tag F0582 — isolated
  Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
  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 a Notice of Medicare Non-Coverage (NOMNC) was signed by the resident or resident's representative for 1 of 3 residents reviewed for beneficiary notices. (Resident 68)Findings include:The beneficiary notices were reviewed on 8/4/25 at 3:00 p.m.A NOMNC document indicated the skilled services for Resident 68 would end on 6/16/25. The document indicated to sign to show you received, understood the notice, and was notified the service coverage would end on the date of the notice. The decision could be appealed by contacting the Quality Improvement Organization (QIO).The signature section was dated 6/13/25 and the signature of the patient or representative was blank and indicated Resident 68 was unable to sign due to their cognition.There was no documentation to indicate anyone had signed on behalf of Resident 68 to show they received and understood the notice of non-coverage.During an interview, on 8/4/25 at 3:35 p.m., the Executive Director (ED) indicated Resident 68 could not sign the NOMNC due to their cognition. She…

  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 · D2025-08-05 · tag F0644 — isolated
  Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
  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 a Preadmission Screening and Resident Review (PASARR) was updated when new diagnoses or psychotropic medications were added for 2 of 2 residents reviewed for PASARR. (Residents 3 and 79)Findings include:1. The clinical record for Resident 3 was reviewed on 7/31/25 at 2:51 p.m. The diagnoses included, but were not limited to, Alzheimer's disease with late onset, anxiety disorder, and major depressive disorder.A PASARR level I screen, dated 10/30/23, indicated Resident 3 did not have a diagnosis of dementia or neurocognitive disorder and was not taking donepezil or memantine. It indicated if changes occurred, a new screen must be submitted.A neurobehavior status exam note, dated 11/27/24, indicated Resident 3 displayed severe cognitive impairment on the brief cognitive assessment with impaired memory performance. Resident 3's history, symptoms, and current presentation appeared consistent with dementia with an etiology likely related 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 · D2025-08-05 · tag F0655 — isolated
  Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
  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 baseline care plans were developed within 48 hours of admission and included enhanced barrier precautions for 2 of 4 residents reviewed for baseline care plans. (Resident 5 and 79) Findings include: 1. During an observation, on 7/30/25 at 10:57 a.m., Resident 5 was lying in bed with a Foley catheter drainage bag attached to the bed frame and a PICC line (peripherally inserted central catheter used for medication administration and blood draws) was in his right arm. The clinical record for Resident 5 was reviewed on 8/4/25 at 2:39 p.m. The diagnoses included, but were not limited to, necrotizing fasciitis, obstructive and reflux uropathy, and urinary retention. A nursing progress note, dated 6/24/25, indicated Resident 5 was admitted to the facility by ambulance. An assessment was obtained by the staff, which included, but were not limited to, a PICC line in the right upper extremity and a Foley catheter in place. A physician's order, dated 6/24/25, indicated to monitor the PICC line site daily for warmth, redness or…

  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 · Dcited before2025-08-05 · 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 ensure physician's orders were followed related to obtaining and documenting weekly weights following an admission and to notify the physician when a bladder scan showed greater than 400 milliliters for 2 of 2 residents reviewed for quality of care. (Resident 5 and 11)Findings include:1. During an interview, on 7/30/25 at 11:05 a.m., Resident 5 indicated he did not eat every meal and believed he had lost weight but was not sure how much weight he had lost. The clinical record for Resident 5 was reviewed on 8/4/25 at 2:39 p.m. The diagnoses included, but were not limited to, type 2 diabetes mellitus, depression, and morbid obesity due to excess calories. A physician's order, with a start date of 6/24/25 and an end date of 7/22/25, indicated Resident 5 was to be weighed weekly for 4 weeks. A care plan, dated 6/30/25, indicated Resident 5 presented with nutritional concerns, which included, but were not limited to, weight fluctuations related to diuretic…

  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 · D2025-08-05 · tag F0695 — failed to provide proper breathing / tracheostomy care — isolated
  Provide safe and appropriate respiratory care for a resident when needed.
  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 a physician's order for the use of oxygen was prescribed for 1 of 3 residents reviewed for respiratory care. (Resident 16)Findings include:During an observation, on 7/30/25 at 12:35 p.m., Resident 16 was wearing oxygen which was set on 4.5 L (liters per minute).During an observation, on 7/31/25 at 10:34 a.m., Resident 16 was wearing oxygen which was set on 5 L.The clinical record for Resident 16 was reviewed on 7/31/25 at 2:25 p.m. The diagnoses included, but were not limited to, edema, moderate persistent asthma, and shortness of breath.A care plan, dated 6/19/25, indicated the resident had the potential for impaired gas exchange related to asthma. Interventions included, but were not limited to, administer oxygen as ordered.There was no physician's order for the use of oxygen, the type of oxygen delivery system, when to administer (such as continuous or intermittent and/or when to discontinue), the prescribed flow rates, or when to monitor SpO2 levels and vital signs located in the medical…

  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 · D2025-08-05 · tag F0756 — failed to review each resident's drug regimen — isolated
  Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
  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 the attending physician documented in the resident's medical record the rationale for not acting upon a pharmacist's recommendations for 1 of 5 residents reviewed for drug regimen review. (Resident 57) Findings include:The clinical record for Resident 57 was reviewed on 7/31/25 at 1:39 p.m. The diagnoses included, but were not limited to, dementia, major depressive disorder, and chronic pain syndrome.The monthly drug regimen reviews, for Resident 57, indicated the following:1. A recommendation, dated 8/27/24, indicated discontinue the lispro (insulin) sliding scale and relax A1C range. Closely monitor glucose levels with any change in diabetic therapy to guide further adjustments. The recommendation was declined by the physician without a rationale.2. a. A recommendation, dated 10/30/24, indicated to attempt a gradual dose reduction to hydroxyzine (an antihistamine sometimes used to treat anxiety) times 14 days and then discontinue. The facility did not provide the section of the document with the physician's…

  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 · Dcited before2025-08-05 · tag F0761 — failed to label and store drugs safely — isolated
  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

  Based on observation, interview and record review, the facility failed to ensure two tuberculin bottles, containing solution, had been labeled with an open date and a medication had a legible label for 1 of 3 medication storage refrigerators reviewed for medication storage. (PACU medication refrigerator)Findings include: During an observation with the Director of Nursing, on 8/1/25 at 11:20 a.m., the PACU medication storage refrigerator was found to contain a liquid medication with a dried crusty substance on the bottle and label. The label was not legible. Also found in the refrigerator were two open bottles of tuberculin which contained solution and did not have an open date.During an interview, on 8/1/25 at 11:22 a.m., the Director of Nursing indicated the bottles should have been labeled when open and then the solution was good for 30 days. A current facility policy, titled Medication Storage and Expiration Policy, dated 11/24 and received from the Director of Nursing on 8/4/25 at 2:35 p.m., indicated .Facility staff should record the date opened on the primary medication…

  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

“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

No federal fines in the current CMS record.

Part of a chain

This home belongs to AMERICAN SENIOR COMMUNITIES — 90 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 41 rows in the source record cover these 31 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.

This home reported $1.1M 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 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 IN