Wellbrooke Of Avon

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.

68.7% of the Medicare patients who left this home got back to the community and stayed there for at least 31 days — CMS rates that better than the national rate. This is CMS’s risk-adjusted rate over 302 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.

Met the expected recovery: 79.1% 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 134 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 0.50 therapist hours per resident per day in 2026Q1 — more than 81% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 58% of this home’s weekday level — it runs therapy at close to weekday levels right through 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 70 beds and averages 49.8 residents a day — about 71% occupied, or roughly 20 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 3.99 hrs/resident/day is at or above the 3.48-hour benchmark and RN staffing of 1.24 is at or above the 0.55-hour RN benchmark and nurse-aide staffing of 2.17 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 3.39 hrs/resident/day on weekends vs 4.23 on weekdays — 20% thinner on weekends — a notable drop. RN hours go from 1.39 to 0.87 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 30% is below 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 fewer than at the previous inspection — improving. 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.

17 citations, most serious first. The 10 most serious are shown; the remaining 7 are one tap away and print in full.

• Potential for harm · Dcited before2026-03-13 · 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 record review and interview, the facility failed to hold ordered blood pressure medication when a resident's blood pressure was outside prescribed parameters for 1 of 6 residents reviewed (Resident 9) and failed to properly assess a Resident (Resident 96) for their ability to properly manage their own eye drops before they were kept at the bedside for 1 of 24 residents reviewed for medications at bedside.Findings include:.1. On 3/10/26 at 10:53 a.m., a record review was completed for Resident 9. She had the following diagnoses which included, but were not limited to, heart failure, and hypertension (high blood pressure). A physician order, dated 8/12/25, for carvedilol (medication for high blood pressure) 12.5 milligram (mg) administer 1 tablet two times daily for hypertensive heart disease with heart failure, hold if heart rate less than 60 or systolic blood pressure (SBP) less than 100. A physician order, current as of 3/10/26, for clonidine 0.1mg administer 1 tablet three times daily for essential…

  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 before2026-03-13 · 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 and interview, the facility failed to refrigerate a medication until opened and failed to date nasal sprays and eye ointment when opened for 1 or 2 medication carts reviewed.Findings include: On 3/11/26 at 11:55 a.m., medication carts were observed with LPN 4. Resident 6 had fluticasone nasal spray (used for seasonal allergies) in the cart without a date to indicate when opened. Resident 40 had deep sea premium saline (used for nasal congestion) in the cart without a date to indicate when it was opened. Resident 61 had retaine PM ointment (used for dry eyes) without a date to indicate when opened. Resident 8 had latanoprost eye drops (used for glaucoma) in the cart. They were unopened with a label indicating to refrigerate until opened. On 3/11/26 at 12:00 p.m., LPN 4 indicated there were no dates indicating medications had been opened. She removed latanoprost from the medication cart. The facility did not provide a policy by the end of exit. 410 Indiana Administrative Code (IAC) 16.2-3.1-25(j)410 Indiana Administrative Code (IAC) 16.2-3.1-25(m)410 Indiana…

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

  Pharmacy Service Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2026-03-13 · 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

  Based on observations, interviews, and record reviews, the facility failed to ensure proper infection control practices were in place for 2 of 24 residents reviewed for infection control when a resident with a central line (a long, flexible tube inserted into a major vein in the neck, chest, or groin, extending to just above the heart) and a resident with a suprapubic urinary catheter were not in Enhanced Barrier Precautions (EBP) (an infection control strategy designed to reduce the spread of multidrug-resistant organisms (MDROs) in nursing homes) (Residents 2 and 85) and the dressing for the central line was not changed per policy for 1 of 1 resident reviewed for central lines (Resident 2). Findings include:1. On 3/10/26 at 11:00 a.m. Resident 2 was observed as he lay in bed resting. Resident 2 had a central line inserted in his right chest, just under his clavicle. The dressing was a 4 by 4 gauze pad that covered the entire insertion site and the surrounding skin, with a clear adhesive dressing covering the gauze and adhering the dressing to his skin. The dressing was dated 3/9.…

  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 · D2026-03-13 · tag F0908 — failed to keep essential equipment working — isolated
  Keep all essential equipment working safely.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on observations, interviews and record reviews, the facility failed to ensure essential kitchen equipment and associated systems were maintained in proper working order to prevent the potential contamination for 2 of 2 observations. Findings include:On 3/10/26 at 9:45 a.m., during an initial kitchen tour with the Assistant Director of Food Service, the freezer was observed. Inside the freezer unit, an apparent leak from the freezer compressor system was observed. Frozen droplets and ice cycles were observed on the piping coming in and out of the unit. There were drops and mounds of ice that had developed on top of carboard boxes that contained frozen bread in opened plastic wrap. The presence of frozen condensation above exposed food items indicated the freezer system may have been leaking or producing excess condensation. During an interview with the Assistant Director at that time, he indicated, he had not noticed the ice, and kitchen staff had not notified him of any ice build up either. During a follow up observation on 3/12/26 at 10:35 a.m., the pipes had been cleared of…

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

  Environmental Deficiencies · Deficient, Provider has date of correction
• Potential for harm · E2025-03-07 · tag F0711 — pattern
  Ensure the resident's doctor reviews the resident's care, writes, signs and dates progress notes and orders, at each required visit.
  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 Medical Providers entered their visit assessments, summaries, and/or progress notes into the resident's medical records timely for facility staff access. Theis deficient practice had the potential to effect of 6 of 13 residents records reviewed, (Residents 1, 9, 12, 14, 16, and 99). Findings include: On 3/6/25 at 9:17 a.m., Residents 1, 9, 12, 14, 16, and 99's records were reviewed related to Medical Provider documentation into the electronic health record (EHR) for timely submission and access to facility staff as a part of resident's continuity of care. The following pattern of more than 3 business days late were noted: 1. Resident 1 was a long-term care resident who had resided in the facility for more than a year. The previous 6 months of physician documentation was reviewed. From 8/8/24 until 3/6/25, Resident 1 had 12 late entry physician's notes. Half were more than three business days late, the greatest discrepancy was a late note entered…

  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 · D2025-03-07 · tag F0656 — failed to write and follow a full care plan — isolated
  Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
  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 develop and implement a person-centered care plan related to recurrent Urinary Tract Infections (UTI) for a resident (Resident 4) who had seven UTI's in a 12-month period for 1 of 16 residents reviewed for care plans. Findings include: On 3/5/25 at 1:43 p.m. Resident 4's medical record was reviewed. She was a long-term care resident whose diagnoses included, but were not limited to, UTIs, chronic kidney disease, and sepsis (a life-threatening condition that occurs when the body's immune system overreacts to an infection, leading to widespread inflammation and organ damage). A physician note, dated 2/2/24, indicated on 1/29/24 the Resident was seen for dysuria (pain while urinating). A urine analysis (UA)(a test to determine if a UTI is present) and a C&S (culture and sensitivity)(a test to determine what antibiotic the infection is sensitive to) was ordered. It was found that the Residents UA was positive for E. Coli (a bacteria of the lower intestines commonly found in feces.). Macrobid (an antibiotic used…

  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 · D2025-03-07 · tag F0686 — failed to prevent and treat pressure sores (bedsores) — isolated
  Provide appropriate pressure ulcer care and prevent new ulcers from developing.
  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 appropriate/effective interventions were in place to prevent the development of new open pressure and failed to ensure accurate documentation was detailed in the medical records for 2 of 2 residents reviewed for pressure ulcers (Residents 16 and 24). Finding include: 1. On 3/4/25 at 12:36 p.m., Resident 16 was observed. She was seated in a wheelchair with a pressure reducing cushion in place. Resident 16 indicated her bottom had been sore a couple weeks ago, but she thought it had cleared up. It still got a little sore and tender if she stayed up for too long. On 3/5/25 at 11:44 a.m., Resident 16's medical record was reviewed. She had diagnoses which included, but were not limited to, urinary tract infection (UTI), type 2 diabetes mellitus, muscle weakness, and pelvic and perineal pain. An admission minimum data set (MDS) assessment, dated 11/21/24, indicated Resident 99 admitted with a stage II (partial-thickness skin loss 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.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2025-03-07 · 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 a resident (Resident 99) who had a history of falls, had an environment free from the potential for accidents when the rubber threshold of the shower was unattached and loose on the floor for 1 of 3 residents reviewed for accidents. Findings include: During an initial observation and interview on 3/4/25 at 11:00 a.m., Resident 99 indicated she was afraid of falling. She was observed as she sat in a wheelchair at the foot of her bed, with an over-bed table pulled in front of her. She had an immobilizer boot on her left foot and indicated she had broken her foot after a fall at home. Resident 99 indicated she often felt rushed, and staff told her not to hold onto the grab bars. She became tearful and indicated she was too afraid to fall because she could not see very well. Even when staff were there to help, she was afraid of falling especially in the bathroom because the rubber strip on the floor was loose. If she were on the…

  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 before2025-03-07 · 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 — the official record, unedited, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation and interview, the facility failed to date medications when opened for 1 of 3 medication carts reviewed. Findings include: On 3/6/25 at 10:53 a.m., the Renaissance ([NAME]) 1 B cart was observed. Resident 91 had an insulin pen, lantus 100 unit/milliliter (ml) in the medication cart and it lacked a date to indicate when it was opened. During an interview with the Assistant Director of Nursing Services (ADNS) on 3/6/25 at 11:00 a.m., he indicated that a nurse must have pulled the insulin pen from the refrigerator the night before and did not date it. A policy dated 11/18, titled, Medication Storage in the Facility was provided by the ADNS on 3/7/25 at 1:00 p.m. It indicated, .When the original seal of a manufacturer's container or vial is initially broken, the container or vial will be dated 3.1-25(j) 3.1-25(m) 3.1-25(n)

  Pharmacy Service Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2024-05-24 · 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 record review, and interview, the facility failed to ensure showers were provided for 1 of 1 residents reviewed for bathing preference (Resident B). Findings include: On 5/23/24 at 12:14 p.m., the medical record for Resident B was reviewed. The resident was admitted to the facility on [DATE]. Diagnosis included but were not limited to. Hemiplegia (a loss of strength in the arm, leg, and sometimes face on one side of the body) and hemiparesis (a relatively mild loss of strength) following cerebral infarction (stroke) affecting right dominant side. The point of care ADL (Activities of Daily Living) Report record, which was the documentation recorded by the Certified Resident Care Assistant (CRCA) indicated when the resident was provided a shower, a bed bath, or a partial bath: From 9/20/23 to 10/30/23 the resident was administered 2 showers. From 10/4/23 to 10/30/23 the resident was administered 5 showers. From 11/27/23 to 12/19/23 the resident was administered 6 showers. From 1/8/24 to 1/16/24 the…

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

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

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

Fines & penalties

No federal fines in the current CMS record.

Part of a chain

This home belongs to TRILOGY HEALTH SERVICES — 123 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 43 rows in the source record cover these 32 parties — each is shown once here with every role it holds. Nothing is omitted.

19 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 $1.4M paid to related parties — landlords or management companies under common ownership — equal to about 13% of its total expenses. Money routed to affiliated companies can leave a home’s own books looking lean while owners still profit; it is the mechanism regulators watch most closely in private-equity and REIT deals.

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