West Carroll Care Center, INC

Location & what’s nearby

Open in Google Maps ↗ · Directions ↗ · Larger map ↗

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.

50.0% 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 26 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.

Met the expected recovery: 65.2% 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 23 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 0.06 therapist hours per resident per day in 2026Q1 — more than 3% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 0% of this home’s weekday level — it runs therapy on weekdays, with essentially none at the weekend. The median home that reports therapy runs 13% — weekday-focused therapy is the industry norm, not a shortfall. But recovery does not pause on a Saturday: ask what the weekend actually looks like here.

This section is about rehab stays, not living here. Most of this page — the stars, the quality measures, the inspection record — describes the home the way a permanent resident experiences it. These figures describe the short Medicare stay after a hospital discharge: a hip, a stroke, a bad infection, six weeks and home. They are different residents, different staff, often a different wing. Therapy hours are per resident in the building, not per rehab patient — the count includes every long-stay resident, and they mostly get no therapy at all. So a home with a small rehab wing inside a large nursing population reads low here even if its rehab patients get plenty of therapy, and a mostly-rehab home reads high. Use it to compare homes doing similar work, ask what a rehab resident actually gets in a day, and remember that CMS does not publish therapy minutes per patient — nobody does.

Staffing

How full it usually is: this home is certified for 80 beds and averages 73.7 residents a day — about 92% occupied, or roughly 6 beds typically open. It runs fairly full. 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 3.51 hrs/resident/day is at or above the 3.48-hour benchmark and RN staffing of 0.19 is below the 0.55-hour RN benchmark and nurse-aide staffing of 2.32 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 3.02 hrs/resident/day on weekends vs 3.71 on weekdays — 19% thinner on weekends. RN hours go from 0.21 to 0.12 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 28% is below the national median of 45%.

Payroll-based (PBJ) staffing hours, as reported for Jan–Mar 2026 (CMS PBJ CY2026Q1) — the most recent quarter CMS has published, so they can lag a change of operator or staffing agency. Higher is generally better. Registered-nurse coverage and weekend staffing are the numbers families most often overlook — an RN on site matters most when something goes wrong, and coverage usually thins on weekends. High turnover means residents rarely see the same caregiver twice. One caveat: these are hours as reported, not adjusted for how sick or heavy-care this home’s residents are. CMS separately publishes a case-mix-adjusted view; we show the reported hours. A home caring for higher-acuity residents needs more hours to deliver the same care, so compare these figures against homes doing similar work, and read them next to the inspection record rather than alone.

Inspection trend

Deficiencies are more than at the previous inspection — worsening. Fewer citations over time suggests a home is fixing problems; a rising count is a warning sign — though two surveys are a short record, and survey teams differ. These counts are from the standard annual health survey only; the full citation list below may also include findings from complaint investigations, so the two won’t always add up.

Inspection deficiencies

State health-inspection citations, most serious first. Each carries an F-code (the federal rule it cites, e.g. F-684 = quality of care) and a letter A–L marking how serious and how widespread the problem was — we translate that grid into the plain tiers shown here. Wording is the official federal description.

Each letter is a CMS scope-severity level; highlighted ones are where this home has citations. A–C = no harm found; D–F = potential for harm; G–I = actual harm; J–L = immediate jeopardy. Within each band the later letter is the more widespread finding (an isolated G is one resident; a widespread I is a pattern), so rightward and downward is worse.

21 citations, most serious first. The 14 most serious are shown; the remaining 7 are one tap away and print in full.

• Immediate jeopardy · Jcited before2025-02-18 · 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 interviews and record reviews, the facility failed to ensure a resident received treatment and care in accordance with professional standards of practice when the nursing staff failed to recognize, assess, intervene, and document a resident's condition after a fall to avoid delayed treatment for 1 (#1) of 3 (#1, #2, and #3) residents reviewed for falls. This deficient practice resulted in an Immediate Jeopardy situation on 01/24/2025 at approximately 3:15 p.m., when resident #1 had a fall in his room. The resident's nurse failed to assess the resident after the fall, document the incident, and report the incident to the resident's physician and the director of nursing. On 01/28/2025, it was determined that the resident had obtained a left displaced femoral neck fracture, which required surgical repair on 01/29/2025. This deficient practice resulted in a delay of treatment for resident #1. The facility implemented corrective actions which were completed prior to the State Agency's investigation entry on…

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

  Quality of Life and Care Deficiencies · Past Non-Compliance
• Immediate jeopardy · Jcited before2024-05-07 · 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 record reviews and interviews, the facility failed to ensure each resident received adequate supervision and assistive devices to prevent accidents for 1 (#1) of 5 (#1, 2, 3, 4, 5) sampled residents by failing to ensure resident #1 was safely secured in a lift chair while bathing in the whirlpool room. This deficient practice resulted in an Immediate Jeopardy situation that began on 04/30/2024 at 9:15 a.m., when resident #1 was not properly secured with the seat belt in a lift chair while receiving a whirlpool bath. The resident fell from the chair to the floor and sustained a fractured skull, fractured left arm, laceration to the left side of the head and a brain bleed. The facility implemented corrective actions which were completed prior to the State Agency's investigation entry on 05/06/2024. It was determined to be a Past Noncompliance Citation. Findings: Review of the facility's current Bath, Shower/Tub policy, which was last revised February 2018 revealed When using the lift system, be sure…

  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
• Immediate jeopardy · Jcited before2024-04-25 · 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 observations, record reviews and interviews, the facility failed to ensure 1 (#1) of 5 (#1, #2, #3, #4 and #5) residents who was assessed at risk for elopement, was adequately supervised to prevent her from eloping from the facility. This deficient practice resulted in an Immediate Jeopardy situation on 04/19/2024 at approximately 6:20 p.m. when resident #1 (a severely cognitively impaired resident identified as an elopement risk) was found approximately 300 yards outside of the facility by a staff member. Resident #1 was located 10 minutes after she eloped on 04/19/2024 through a facility door and was returned to the facility at approximately 6:32 p.m. The facility implemented corrective actions which were completed prior to the State Agency's investigation entry on 04/24/2024. It was determined to be a Past Noncompliance Citation. Findings: Review of the facility's Emergency Procedure for Missing Resident Policy revised August 2018 revealed: Policy Interpretation and Implementation Residents at risk…

  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
• Immediate jeopardy · J2024-01-03 · 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 interviews and record reviews, the facility failed to protect the residents' right to be free from neglect by staff failing to provide the care needs every two hours as indicated in the care plan for 3 (#1, #2, and #3) of 3 (#1, #2, and #3) residents reviewed for neglect. This deficient practice resulted in an immediate jeopardy situation on [DATE] at 10:13 p.m. (two hours after resident #1 was last seen) when staff failed to make rounds every two hours on resident #1, who was on oxygen and was dependent on staff for transfers, toileting, and bed mobility. Video surveillance revealed the resident was administered medications on [DATE] at 8:13 p.m. by S3LPN (Licensed Practical Nurse) and no staff rounded on the resident or entered the resident's room until [DATE] at 5:57 a.m. (9 hours and 44 minutes). On [DATE] at 5:57 a.m., resident #1 was found in his room, lying on the floor, and deceased . S3LPN failed to perform rounds every two hours for resident #1 during his shift from 8:13 p.m. on [DATE] to 5:57…

  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 · E2025-08-13 · tag F0690 — failed to manage incontinence, catheters, and urinary infections — pattern
  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 record reviews, interviews, and observations, the facility failed to ensure a resident received appropriate treatment and services to prevent urinary tract infections for 1 (#22) of 1 resident sampled for urinary catheter. The facility failed to document intake and output records, document character and consistency of urine daily, and report unusual appearance of urine/signs and symptoms of a urinary tract infection to the Director of Nursing (DON) and physician immediately for Resident #22.Findings:Review of the facility's undated Catheter Care, Urinary policy and procedure revealed the following, in part:PurposeThe purpose of this procedure is to prevent urinary catheter-associated complications, including urinary tract infections.Complications1. Observe the resident for complications associated with urinary catheters. Report unusual findings to the physician or supervisor immediately:b. if urine has unusual appearance (example color, blood),e. if signs and symptoms of urinary tract infection 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.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Potential for harm · E2025-08-13 · tag F0692 — failed to prevent malnutrition and dehydration — pattern
  Provide enough food/fluids to maintain a resident's health.
  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 observations, the facility failed to ensure that a resident maintained acceptable parameters of nutritional status, such as usual body weight or desirable body weight range and electrolyte balance, unless the resident's clinical condition demonstrates that this is not possible for 1 (#47) of 4 (#3, #6, #35, and #47) residents sampled for nutrition. The facility failed to document meal intake for each meal and update care plan with a significant weight loss for Resident #47. Findings:Review of facility's Weighing and Measuring the Resident policy and procedure, revised March 2011, revealed the following, in part:Reporting1.) Report significant weight loss/weight gain to the nurse supervisor.2.) The threshold for significant unplanned and undesired weight loss/gain will be based on the following criteria (where percentage of body weight loss = (usual weight-actual weight) divided by the usual weight and multiply by 100):a. 1 month-5% weight loss is significant; greater than…

  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 · E2025-08-13 · tag F0698 — failed to provide proper dialysis care — pattern
  Provide safe, appropriate dialysis care/services for a resident who requires such services.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record reviews, interviews, and observations, the facility failed to ensure that residents who require dialysis receive such services, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences for 1 (#6) of 1 resident sampled for dialysis. The facility failed to document intake and output records as specified in plan of care for Resident #6.Findings:Review of the record for Resident #6 revealed an admission date of 06/16/2025 with diagnoses that included end stage renal disease, edema, hypertensive heart disease with heart failure, and type 2 diabetes mellitus with chronic kidney disease.Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed a Brief Interview of Mental Status score of 15 which indicated the resident is cognitively intact for daily decision making. The MDS also documented that the resident required dialysis.Review of the August 2025 Physician's Orders revealed an order to document…

  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 · E2025-08-13 · tag F0725 — failed to have enough nursing staff — pattern
  Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
  What the surveyor found here — the official record, unedited, may be distressing

  Based on interview and record review, the facility failed to ensure there was sufficient nursing staff with the appropriate competencies and skill sets to provide nursing and related services. The facility had excessively low weekend staff during Fiscal Year Quarter 2 2025 dated 01/01/2025 to 03/31/2025. Findings:Review of the facility's Payroll-Based Journal (PB&J) Staffing Report revealed the facility triggered excessively low weekend staff for Fiscal Year Quarter 2 2025 dated 01/01/2025 to 03/31/2025. Review of the facility's February 2025 weekend personnel staffing pattern revealed insufficient staff for the following date: 02/16/2025.Review of the facility's March 2025 weekend personnel staffing pattern revealed insufficient staff for the following dates: 03/08/2025 and 03/23/2025. An interview on 08/12/2025 at 11:25 a.m. with S1Administrator confirmed the facility had low staffing for the dates listed above and did not meet the required hours.

  Nursing and Physician Services Deficiencies · Deficient, Provider has date of correction
• Potential for harm · E2025-08-13 · tag F0756 — failed to review each resident's drug regimen — pattern
  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

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview the pharmacist failed to identify and report irregularities to the physician and DON (Director of Nursing) for 1(#39) of 5 (#1, #2, #38, #39, #47) residents reviewed for unnecessary medications. The pharmacist failed identify irregularities for Resident #39. Resident #39 was not being monitored for signs and symptoms of bleeding while receiving an anticoagulant medication.Findings: Record review revealed Resident # 39 was admitted to the facility on [DATE]. Resident #39's diagnoses included the following: hypertensive heart disease without heart failure, abnormal findings on diagnostic imaging of heart and coronary circulation, long term use of anticoagulants, type 2 diabetes mellitus unspecified dementia, unspecified severity, with other behavioral disturbance, chronic kidney disease stage 3, and hypothyroidism. Review of active August 2025 Physician Orders revealed Coumadin 4 milligrams (mg) tablet give1 tablet by mouth (po) at bedtime every Monday, Wednesday, and Friday.…

  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 · E2025-08-13 · tag F0757 — failed to avoid unnecessary drugs — pattern
  Ensure each resident’s drug regimen must be free from unnecessary 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 record review and interview, the facility failed to ensure that each resident was free from unnecessary medication use for 1 (#39) of 5 (#1, #2, #38, #39, #47) residents reviewed for unnecessary medications. The facility failed to monitor Resident #39 for signs and symptoms of bleeding while receiving an anticoagulant medication.Findings:Record review revealed Resident # 39 was admitted to the facility on [DATE]. Resident #39's diagnoses included the following: hypertensive heart disease without heart failure, abnormal findings on diagnostic imaging of heart and coronary circulation, long term use of anticoagulants, type 2 diabetes mellitus unspecified dementia, unspecified severity, with other behavioral disturbance, chronic kidney disease stage 3, and hypothyroidism. Review of active August 2025 Physician Orders revealed Coumadin 4 milligrams (mg) tablet give1 tablet by mouth (po) at bedtime every Monday, Wednesday, and Friday. Coumadin 5 mg tablet give 1 tablet po every Tuesday, Thursday, Saturday,…

  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 · D2025-08-13 · tag F0584 — failed to keep a safe, clean, comfortable home — isolated
  Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
  What the surveyor found here — the official record, unedited, may be distressing

  Based on observations and interviews, the facility failed to maintain a safe, clean, comfortable and homelike environment for 1 (# 45) of 1 sampled residents reviewed for environmental concerns. The facility failed to ensure that the resident's air conditioning vent remained clean and free of mold like substance.Findings:Review of Resident #45's record revealed an admit date of 09/30/2021 with diagnoses including cerebral infarction, unspecified; allergic rhinitis, unspecified; shortness of breath; and hemiplegia and hemiparesis following cerebral infarction affecting right dominant side.On 08/11/2025 at 9:45 a.m. and 08/12/2025 at 8:25 a.m., observations of Resident #45's air conditioner revealed a mold like substance on the surface of the vent.On 08/12/2025 at 8:50 a.m., an observation made with S1Administrator confirmed the presence of a mold like substance on Resident #45's air conditioner vent.

  Resident Rights Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2025-08-13 · tag F0640 — isolated
  Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment.
  What the surveyor found here — the official record, unedited, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview the facility failed to electronically transmit encoded, accurate and complete Minimum Data Set (MDS) data to Centers for Medicare and Medicaid (CMS) in a timely manner for 1 (#43) of 2 (#11, #43) residents reviewed for the completion of a seven day discharge assessment. Findings:Record review revealed Resident #43 was admitted to the facility on [DATE] and discharged on [DATE]. The last transmitted MDS assessment in the electronic health record was a Quarterly and State Optional-Other assessment completed on [DATE] in the batch accepted on [DATE].On [DATE] at 12:55 p.m. an interview with S3Licensed Practical Nurse (LPN)/MDS nurse revealed she failed to complete and transmit the discharge MDS assessment for Resident #43. S3LPN/MDS nurse reported Resident #43 expired at facility on [DATE] and should have submitted the MDS discharge assessment to the state by [DATE] within 7 days of discharge.

  Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2025-08-13 · 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

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, record review and interviews, the facility failed to ensure respiratory care was provided consistent with professional standards of practice for 1 (#71) of 1 (#71) resident reviewed for respiratory care. The facility failed to ensure Resident #71's nebulizer tubing and t-piece was properly stored in a plastic bag.Findings:Review of the facility's Administering Medications through a Small Volume (Handheld) Nebulizer policy dated August 2025 revealed in-part: 18. When the treatment is complete, turn off nebulizer and store in a plastic bag with the resident's name and date on it. On 08/11/2025 at 9:50 a.m. and 08/12/2025 at 8:20 a.m., observations of Resident #71's room revealed the nebulizer tubing and t-piece was dated 08/10/2025 and secured to a nebulizer machine sitting on dresser. The nebulizer tubing and t-piece was not stored in a plastic bag. Resident #71 reported she received breathing treatments several times daily. Record review revealed Resident #71 was admitted to the facility…

  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 · Ecited before2024-08-14 · tag F0656 — failed to write and follow a full care plan — pattern
  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

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview the facility failed to develop and implement a comprehensive person-centered care plan for each resident, that includes measurable objectives and timeframes to meet a resident's medical, nursing, mental, and psychosocial needs that are identified in the comprehensive assessment for 1 (#5) of 3 (#5, #6, and #61) residents reviewed for nutrition. The facility failed to document the supper meal intake percentages daily for resident #5. Findings: Review of the medical record for resident #5 revealed an admission date of 03/07/2024 with diagnoses including hypertension, diabetes mellitus, hypokalemia, insomnia, gout, polyneuropathy, reflux, dementia, anorexia, hyperlipidemia, and vitamin deficiency. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had severe cognitive impairment with daily decision making skills and required assistance with activities of daily living. Review of the current care plan revealed resident #5 had a potential…

  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

“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

$54,806 in federal fines across 4 penalties.

• $16,663 — penalty dated 2025-02-18
• $16,452 — penalty dated 2024-05-07
• $8,886 — penalty dated 2024-04-25
• $12,805 — penalty dated 2024-01-03

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

CMS files one row per role, so the 7 rows in the source record cover these 4 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.

Follow the money — this home’s finances

Where a nursing home’s revenue comes from and where it goes — including money paid to companies under the same ownership. Most consumer sites never show this; we reproduce it straight from the Medicare cost report.

About 84% of this home’s resident-days are paid by Medicaid, which reimburses well below the cost of care in most states. Heavily Medicaid-dependent homes run on thinner budgets — a context worth holding next to the staffing and inspection record, not a fault in itself. This home reported $1.0M paid to related parties — landlords or management companies under common ownership — equal to about 18% 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 LA