Majestic Care Of Deming Park

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.

52.0% 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 56 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.

Met the expected recovery: 32.3% 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 31 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 0.16 therapist hours per resident per day in 2026Q1 — more than 15% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 27% 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 86 beds and averages 68.9 residents a day — about 80% occupied, or roughly 17 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 3.41 hrs/resident/day is below the 3.48-hour benchmark and RN staffing of 0.73 is at or above the 0.55-hour RN benchmark and nurse-aide staffing of 1.89 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 2.77 hrs/resident/day on weekends vs 3.68 on weekdays — 25% thinner on weekends — a notable drop. RN hours go from 0.82 to 0.52 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.

28 citations, most serious first. The 13 most serious are shown; the remaining 15 are one tap away and print in full.

• Immediate jeopardy · Jcited before2025-11-03 · tag F0600 — failed to protect residents from abuse and neglect — isolated
  Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to protect the resident's right to be free from neglect, when staff failed to visualize a confused resident during their shift resulting in the resident eloping from the facility for 1 of 3 residents reviewed for neglect (Resident B). The immediate jeopardy began on 10/11/25 when the facility failed to protect the resident's right to be free from neglect when a resident with a traumatic brain injury and at risk of elopement was able to exit the facility sometime after 9:30 p.m., on 10/11/25, or early morning, on 10/12/25, despite wearing a WanderGuard (a type of wander management system used in senior living communities and healthcare facilities to prevent residents at risk of wandering from leaving the premises unsupervised) bracelet. The facility alarm system failed to alert staff of the resident exiting with a WanderGuard. The night shift nurse and night shift Certified Nurse Aide (CNA), on 10/11/25, failed to visualize the resident during their eight…

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

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
• Immediate jeopardy · Jcited before2025-11-03 · 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 record reviews, interviews, and observation, the facility failed to supervise and prevent a confused resident at risk of elopement from eloping from the facility sometime after 9:30 pm on 10/11/25 into the early morning of 10/12/25 (Resident B). A resident with a traumatic brain injury and at risk of elopement was able to exit the facility sometime after 9:30 p.m. on 10/11/25 or early morning on 10/12/25 despite wearing a WanderGuard bracelet (a type of wander management system used in senior living communities and healthcare and healthcare facilities to prevent residents at risk of wandering from leaving the premises unsupervised). The facility alarm system failed to alert staff of the resident exiting with a WanderGuard. The night shift nurse and night shift CNA on 10/11/25 failed to visualize the resident during their 8-hour shift. On 10/12/25 around 7 a.m. the dayshift staff were unable to locate the resident and started the elopement process. The resident was located approximately 0.6 miles away…

  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
• Immediate jeopardy · Jcited before2024-03-08 · tag F0690 — failed to manage incontinence, catheters, and urinary infections — isolated
  Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to assess and treat a resident's urinary catheter and follow-up on continued hematuria resulting in immediate jeopardy when the resident with a history of UTI and septic shock did not have a follow-up with a Urologist for continued hematuria and blood clots, had a change in condition with his urinary catheter, and was sent to the hospital several hours later in septic shock and respiratory failure for 1 of 5 residents reviewed for change in condition (Resident B). The immediate jeopardy began on [DATE] when Resident B, with a history of urinary catheter, severe sepsis with septic shock, and urinary tract infection (UTI) on [DATE], had a distended abdomen and low urine output in the foley drain bag on [DATE] at 10:19 p.m. The catheter was changed, and bloody urine was returned. The physician was not notified, and no assessment or vital signs were obtained. On [DATE] at 4:30 a.m. Resident B had black emesis, blood clots from the catheter, and bloody urine.…

  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 before2026-01-15 · tag F0600 — failed to protect residents from abuse and neglect — isolated
  Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interviews, the facility failed to ensure a resident's right to be free of sexual abuse was protected for 1 of 3 residents reviewed for abuse (Resident G). The deficient practice was corrected 12/10/25, prior to the start of the survey, and was therefore past noncompliance. Findings include:On 1/15/26 at 11:00 a.m., a review of an Indiana Department of Health reportable incident document dated, 12/9/25 at 4:44 p.m., indicated a hospice staff member who was a Certified Nursing Assistant (CNA) 13, entered the room of Resident H and found resident G sitting on the bed of resident H, with her pants down to her knees. The CNA observed resident H's hands were in resident G's brief. The residents were immediately separated, and Resident H was placed on one to one supervision and an investigation was initiated. 1. On 1/15/26 at 10:30 a.m., the medical record of Resident G was reviewed. The resident was admitted to the facility on [DATE]. admission diagnosis included dementia (the loss 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.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Past Non-Compliance
• Potential for harm · D2025-11-12 · tag F0609 — failed to report abuse allegations — isolated
  Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on interview and record review, the facility failed to report an allegation of resident-to-resident abuse to the Indiana Department of Health in a timely manner for 2 of 4 residents reviewed for abuse (Resident B and C). This deficient practice was corrected by 11/3/25 prior to the start of the survey and was therefore Past Noncompliance. Findings include: A Facility Reported Incident form, submitted by the Interim Administrator on 10/30/25, indicated, on 10/8/25 at 8:45 a.m., Resident B was sitting in the back west hallway with a female resident sitting close by, when Resident C came down the hall and yelled at Resident B to leave her alone. Resident B then yelled at Resident C in response. The residents were immediately separated. During an interview on 11/12/25 at 2:04 p.m., the Social Services Director (SSD) indicated the morning of 10/8/25, she heard yelling down the hallway. As she turned the corner to where the noise was coming from, she observed multiple staff members separating Resident B and Resident C. She spoke with all residents involved and then went to 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.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Past Non-Compliance
• Potential for harm · Fcited before2025-06-25 · tag F0812 — failed to store, cook, and serve food safely — widespread
  Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
  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 sanitary area for handwashing, the dishwasher functionality was effectively checked, foods were covered when stored, and foods were discarded once past the best if used by date. This deficient practice had the potential to effect 61 of 61 residents who received food from the kitchen. Findings include: During a kitchen observation, on 6/19/25 at 10:05 a.m., with the Culinary Manager, the handwashing sink had a trash cans nearby, but the trash can had a lid affixed to the top with no hands free way to open the trash can. The Culinary Manager indicated the dishwasher sanitized dishes through chemical sanitation. When the functionality of the dishwasher was tested, the Culinary Manager placed a thermometer in the dishwasher to check the highest temperature reached during the run cycle. The thermometer registered 121.4 degrees Fahrenheit (F) as the highest temperature reached. The Culinary Manager indicated there were no chemical test strips available to check the parts per million (ppm) concentration 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.

  Nutrition and Dietary Deficiencies · Deficient, Provider has date of correction
• Potential for harm · F2025-06-25 · tag F0882 — widespread
  Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on record review and interview, the facility failed to ensure a dedicated Infection Preventionist (IP-a healthcare professional who specializes in preventing the spread of infections within healthcare facilities) was designated to oversee the facility's Infection Prevention program. Findings include: During the entrance conference, on 6/19/25 at 10:00 a.m., Registered Nurse (RN) 11's certification of completion of the IP curriculum was provided. The RN was indicated as the dedicated IP for the facility. Review of entrance conference document of QAPI (Quality Assurance and Performance Improvement, the data-driven approach used, especially in healthcare settings like nursing homes, to ensure safety and improve the quality of care and services) Committee Membership lacked documentation of the IP being part of the QAPI Committee. The Facility Assessment, dated 3/2025 through 3/2026, indicated the IP was to be an RN and be a full-time employee. The QAPI Committee Meeting sign-in sheets, dated 4/29/25 and 5/27/25, lacked documentation that a dedicated IP was in attendance at 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.

  Infection Control Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2025-06-25 · 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, record review, and interview, the facility failed to ensure a resident's call light was kept within their reach for 1 of 24 residents reviewed for call lights (Resident B). Findings include: On 6/19/25 at 11:24 a.m., Resident B was observed lying in bed. The resident's call light was hanging off the side of the bed, nearly touching the floor. At the same time, the resident indicated she was not sure where the call light was or how she would call for assistance if needed. On 6/23/25 at 9:04 a.m., Resident B was observed lying in bed with the call light within reach. At the same time, the resident indicated she used the call light to call for assistance when needed and grabbed the call light to demonstrate. On 6/25/25 at 9:21 a.m., Resident B was observed lying in bed. The resident's call light was hanging off the side of the bed, approximately halfway to the floor. At the same time, the resident indicated she was not sure where her call light was and felt around with her right hand but was unable to find it. Resident B's record was reviewed on 6/24/25 at 1:37…

  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 · Dcited before2025-06-25 · tag F0561 — failed to honor residents' choices — isolated
  Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY 2. During the initial pool interview, on 6/19/25 at 11:12 a.m., Resident E indicated he was supposed to get two showers a week and had not had any this current week and only one the week before. The aides were asking him to sign off the shower sheet even though he was not getting one. Resident E's record was reviewed on 6/23/25 at 10:11 a.m. The profile indicated the resident had been admitted to the facility on [DATE], for diagnoses which included, but were not limited to, hemiplegia and hemiparesis due to cerebral infarction (weakness or paralysis on one side of the body caused by damage to the brain from a stroke). An admission Minimum Data Set (MDS) assessment, dated 6/6/25, indicated the resident had no cognitive deficit and no documentation for refusal of care. A care plan, dated 6/11/25, indicated the resident required assistance with activities of daily living (ADLs-basic tasks that individuals perform to maintain their daily life and care for themselves). Interventions 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.

  Resident Rights Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2025-06-25 · 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

  Based on observation, record review, and interview, the facility failed to ensure nail care was provided for a resident who required assistance with activities of daily living (ADLs) for 1 of 24 residents reviewed for ADLs (Resident B). Findings include: On 6/19/25 at 11:23 a.m., Resident B was observed lying in bed. The resident's fingernails on both hands were untrimmed with dark debris underneath them. At the same time, the resident indicated the staff did not clean her nails very often. On 6/23/25 at 9:04 a.m., Resident B was observed lying in bed. The resident's fingernails on both hands were untrimmed with dark debris underneath them. On 6/25/25 at 9:21 a.m., Resident B was observed lying in bed. The resident's fingernails on both hands were untrimmed with dark debris underneath them. Resident B's record was reviewed on 6/24/25 at 1:37 p.m. Diagnosis on the resident's profile included, but were not limited to, multiple sclerosis (chronic, debilitating disease that affects the central nervous system). A care plan, initiated on 5/3/25, indicated the resident required assistance…

  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 · D2025-06-25 · 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 record review and interview, the facility failed to ensure a physician's order was accurately transcribed from a pharmacy recommendation for 1 of 5 residents reviewed for unnecessary medications (Resident 38). Findings include: Resident 38's record was reviewed on 6/23/25 at 9:50 a.m. Diagnoses on the resident's profile included, but were not limited to, panic disorder, anxiety disorder, and post traumatic stress disorder (PTSD) (a mental health condition that can develop after experiencing or witnessing a traumatic event). A quarterly Minimum Data Set (MDS) assessment, dated 3/28/25, indicated the resident was cognitively intact and received an antianxiety medication during the assessment look-back period. A care plan, last revised on 9/11/24, indicated the resident exhibited behavior symptoms of paranoia, anxiety, and depression. Interventions included, but were not limited to, administer medications as ordered. A pharmacy recommendation, dated 6/3/25, indicated the resident received lorazepam (antianxiety medication) 1 milligram (mg) twice daily for panic 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.

  Pharmacy Service Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Dcited before2025-06-25 · 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

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to ensure an insulin pen medication was labeled to indicate date opened during 1 of 2 medication cart observations (Resident 29). Findings include: On 6/25/25 at 9:05 a.m., observed the East back hall medication cart, with Licensed Practical Nurse (LPN) 4. Observed an insulin pen labeled Lantus Insulin prescribed for Resident 29. The insulin pen (an injection device that you can use to deliver preloaded insulin into your subcutaneous tissue, the innermost layer of skin in your body) was dispensed from the pharmacy on 5/31/25. The pen had been opened and used and was not dated. On 6/25/25 at 9:08 a.m., during an interview LPN 4 acknowledged the insulin pen must be dated when opened. On 6/25/25 at 9:54 a.m., the medical record of Resident 29 was reviewed. The resident was admitted to the facility on [DATE]. Admitting diagnosis included but was not limited to Type 2 diabetes mellitus (a disease that occurs when your blood glucose, also called…

  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 · D2025-06-25 · tag F0880 — failed to prevent and control infections — isolated
  Provide and implement an infection prevention and control program.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation and interview, the facility failed to ensure infection control procedures were followed to prevent possible contamination of work surfaces with potential to affect residents for 1 of 1 glucometer (a small, portable device that measures the amount of glucose (sugar) in your blood) test observation. (Resident 39 Findings include: On 6/24/25 at 11:30 a.m., observed Licensed Practical Nurse (LPN) 8 administer a blood sugar assessment with a glucometer machine to Resident (39). The nurse obtained the glucometer device and donned (put on) clean gloves. She placed the glucometer on the resident's overbed table. The nurse failed to place a barrier between the glucometer and the resident's overbed table. The nurse completed the blood sugar assessment and cleaned the resident's finger of residual blood. The nurse picked up the glucometer and placed it on the top of the medication cart without a barrier between the glucometer and the cart. She removed her soiled gloves and discarded them into 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.

  Infection Control 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

$73,612 in federal fines across 2 penalties.

• $23,695 — penalty dated 2025-11-03
• $49,917 — penalty dated 2024-03-08

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.

Who owns this facility

The source lists no ownership percentage for any party here — PECOS records a share only for equity interests, not for board or management roles.

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 $929K paid to related parties — landlords or management companies under common ownership — equal to about 14% 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