Onyx Care of Ruston

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.

38.3% 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 51 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.

Met the expected recovery: 44.4% 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 36 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 0.31 therapist hours per resident per day in 2026Q1 — more than 50% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 15% 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 157 beds and averages 129.7 residents a day — about 83% occupied, or roughly 27 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 3.63 hrs/resident/day is at or above the 3.48-hour benchmark and RN staffing of 0.25 is below the 0.55-hour RN benchmark and nurse-aide staffing of 2.42 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 2.98 hrs/resident/day on weekends vs 3.89 on weekdays — 23% thinner on weekends — a notable drop. RN hours go from 0.32 to 0.08 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 53% is about the same as 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.

25 citations, most serious first. The 14 most serious are shown; the remaining 11 are one tap away and print in full.

• Immediate jeopardy · Jcited before2025-06-03 · 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 review and interviews, the facility failed to maintain the door locking mechanism on an exterior door in the secured unit to prevent elopement from the secured unit for 1 (#1) of 3 (#1, #2, #3) residents reviewed. The deficient practice resulted in an immediate jeopardy for Resident #1 on 05/23/2025 at 11:07 a.m. when Resident #1 who was an elopement risk was able to exit the secured unit to the outside of the building through a door with a malfunctioning locking mechanism. Resident #1 was picked up on the two lane highway with a speed limit of 55 miles per hour approximately 0.2 miles from the facility by S8Housekeeper. The facility implemented corrective actions which were completed prior to the State Agency's investigation entry on 05/29/2025, thus it was determined to be a past noncompliance citation. Findings: Review of the record revealed Resident #1 was admitted to the facility on [DATE] from an inpatient psychiatric facility to the secured unit with diagnoses of unspecified dementia…

  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 · Kcited before2025-05-07 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — pattern
  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 review, observation, and interviews, the facility failed to ensure a resident received adequate supervision to prevent incidents and accidents. The facility failed ensure a resident received supervision during a bed bath for 1 (#1) of 3 (#1, #2, #3) residents reviewed for falls. The deficient practice resulted in an immediate jeopardy for Resident #1 on 04/15/2025 at 10:00 a.m. when Resident #1 fell out of the left side of the bed during a bed bath when S3CNA (Certified Nursing Assistant) failed to ensure the resident was secured and safe in the bed to prevent him from falling before she turned away to retrieve Resident #1's clothing from the closet. S3CNA had removed Resident #1's fall mat from the left side of the bed to provide ADL (Activities of Daily Living) care and Resident #1 landed on the floor on his right side. Resident #1 was transferred to a local emergency room (ER) related to a laceration to Resident #1's forehead. Resident #1's laceration was sutured closed and Resident #1…

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

  Quality of Life and Care Deficiencies · Past Non-Compliance
• Immediate jeopardy · Jcited before2023-11-02 · 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 provide an environment free of accident hazards for 1 (#2) of 5 (#2, #4, #5, #6 and #7) residents identified at high risk for elopement. The facility failed to ensure all exit doors were secured to prevent residents at high risk for elopement from exiting the facility unsupervised. This deficient practice resulted in an Immediate Jeopardy situation on 10/22/2023 at approximately 1:15 a.m. when resident #2 (a severely cognitively impaired resident identified as an elopement risk) was found across the street in a neighbor's yard by a staff member. Resident #2 was located 50 minutes after she eloped on 10/22/2023 through an unsecured door and was returned to the facility at approximately 2:00 a.m. S1Administrator was notified of the Immediate Jeopardy on 10/30/2023 at 5:30 p.m. The Immediate Jeopardy was removed on 10/31/2023 at 2:35 p.m., as confirmed by onsite verification through observations, interviews, and record reviews that 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
• Immediate jeopardy · J2023-11-02 · tag F0835 — failed to run the facility competently — isolated
  Administer the facility in a manner that enables it to use its resources effectively and efficiently.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on observations, record reviews and interviews the facility failed to administer its resources effectively to attain or maintain the highest practicable physical, mental, and psychosocial well-being for 1 (#2) of 5 (#2, #4, #5, #6 and #7) residents reviewed for elopement. The facility failed to: Have an effective system in place to ensure resident #2 (whom was at high risk for elopement, and wore a wander alert bracelet) was adequately supervised to prevent resident #2 from exiting the building through an unsecured door. The Administrator failed to ensure the facility's environment was free of accident hazards and resident #2 had increased monitoring after she eloped from the facility on 10/22/2023. This deficient practice resulted in an Immediate Jeopardy situation on 10/22/2023 at approximately 1:15 a.m. when resident #2, a severely cognitively impaired resident identified as an elopement risk was found across the street in a neighbor's yard by a staff member. Resident #2 was located 50 minutes after she eloped on 10/22/2023 and was returned to the facility at approximately…

  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.

  Administration Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Dcited before2026-01-07 · 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

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interviews, observations, and record reviews, the facility failed to implement a comprehensive person-centered care plan for each resident for 1 (#1) of 3 sampled residents reviewed for care plans. Findings: Review of the record revealed an admission date of 05/23/2025 with diagnoses including Alzheimer's disease, dementia in other diseases classified elsewhere mild with mood disturbance, repeated falls, hypothyroidism, and hyperlipidemia.Review of Resident #1's Quarterly MDS assessment dated [DATE] revealed a BIMS score of 7 indicating severe cognitive impairment. Further review of the MDS revealed resident required substantial/maximal assistance with shower/bathing and personal hygiene.Review of the Resident #1's current care plan revealed the resident had an actual fall with minor injury related to poor balance with an intervention updated on 11/05/2025 for meals to be eaten in dining room for lunch and supper.Review of Resident #1's current ADL care plan revealed resident required total care with…

  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 · Ecited before2025-04-16 · 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 each resident's medication regimen was free from unnecessary medications by failing to monitor for any active bleeding or bruising for a resident who received an anticoagulant for 1 (#104) of 5 (#20, #33, #60, #96, and #104) residents reviewed for unnecessary medications. Findings: Review of the medical record for resident #104 revealed an admit date of 12/29/2023 with diagnoses including chronic kidney disease, chronic diastolic congestive heart failure, and atrial fibrillation. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed resident #104's Brief Interview for Mental Status (BIMS) score was 14 which indicated intact cognition for daily decision making. Resident #104 was independent or required set up help only with activities of daily living. Review of the current care plan revealed resident #104 was at risk for abnormal bleeding and/or bruising related to the use of an anticoagulant. The interventions were 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.

  Pharmacy Service Deficiencies · Deficient, Provider has date of correction
• Potential for harm · E2025-04-16 · tag F0908 — failed to keep essential equipment working — pattern
  Keep all essential equipment working safely.
  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 maintain all mechanical, electrical, and patient care equipment in safe operating condition by having wheelchairs in need of repair for 5 (#6, #7, #22, #32, #33) of 9 (#6, #7, #19, #22, #29, #32, #33, #80, #133) residents reviewed for environment. Findings: Resident 32 Review of the medical record for resident #32 revealed an admission date of 12/8/2015. Resident #32 had diagnoses of Parkinson's disease, diabetes mellitus, heart disease, Alzheimer's disease, vascular dementia, anxiety and bipolar disorder. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident was cognitively intact for daily decision making. Resident #32 required extensive assistance with bed mobility, transfers and toilet use. On 04/14/2025 at 8:30 a.m. an observation of resident #32 revealed she was in a wheelchair and the armrest on the right side was missing. On 04/16/2025 at 9:15 a.m. an interview with S6Licensed Practical…

  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 · Dcited before2025-04-16 · 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

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, record reviews, and interviews, the facility failed to ensure residents received services for reasonable accommodation of needs by failing to provide set-up assistance with meals for 1 (#26) of 1 residents reviewed for positioning and mobility. Findings: Review of the record for resident #26 revealed an admission date of 04/13/2012. Resident #26 had diagnoses that included flaccid hemiplegia affecting right dominant side, right hand contracture, sequelae of cerebrovascular disease, and hypertension. Review of the annual Minimum Data Set (MDS) assessment dated [DATE] revealed a Brief Interview of Mental Status (BIMS) score of 12 which indicated that resident #26 had moderate cognitive impairment. Additionally, the MDS documented that resident #26 had a one sided functional limitation in range of motion and required set-up or clean-up assistance with meals. Review of resident #26's current plan of care revealed an intervention dated 12/20/2024, per occupational therapy, staff is to assist…

  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 · D2025-04-16 · 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 — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation and interviews, the facility failed to maintain a safe, clean, comfortable and homelike environment for 1 (#29) of 9 (#6, #7, #19, #22, #29, #32, #33, #80, #133) residents reviewed for environment. The failed practice was evidenced by resident #29 not having bed linen on the bed. Findings: Review of the record for resident #29 revealed an admission of 01/16/2024 with diagnoses of type 2 diabetes, cerebral vascular disease and chronic obstructive pulmonary disease. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed resident #29 was cognitively intact for daily decision making. Resident #29 required two person physical assistance with bed mobility, transfers, and toilet use. On 04/14/2025 at 3:19 p.m., observation of resident #29's bed revealed there was no linen on the bed and the resident was observed lying on a draw sheet. Interview with resident #29 at that time revealed this was a frequent problem with staff failing to put linen on the bed. Resident #29 stated…

  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 · D2025-04-16 · tag F0604 — failed to not use physical restraints improperly — isolated
  Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.
  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 a resident was free from physical restraints imposed for the purpose of discipline or convenience for 1 (#31) of 3 (#31, #53, and #96) residents reviewed for restraints. The facility failed to ensure that resident #31 was able to self-release his wheelchair seatbelt upon request which resulted in the failure to identify the seatbelt as a restraint. Findings: Review of the facility's Restraint Evaluation and Restraint Reduction Policy dated 08/2013 revealed: Restraints should be used only as a last alternative and only when other less restrictive measures have been tried and rejected. The policy states that individuals responsible for restraints include all members of the interdisciplinary team (as appropriate to individual resident needs) and the Director of Nursing (DON) monitors restraints. Seatbelts that are front-fastened and can be easily unfastened by the alert and somewhat oriented resident are not included if 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 · Deficient, Provider has date of correction
• Potential for harm · D2025-04-16 · tag F0657 — failed to keep the care plan current — isolated
  Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, record reviews, and interviews, the facility failed to ensure a care plan had been revised for 1 (#31) of 3 (#31, #53, and #96) residents reviewed for restraints. Findings: Review of the facility's Restraint Evaluation and Restraint Reduction Policy dated 08/2013 revealed: Restraints should be used only as a last alternative and only when other less restrictive measures have been tried and rejected. The policy states that individuals responsible for restraints include all members of the interdisciplinary team (as appropriate to individual resident needs) and the Director of Nursing (DON) monitors restraints. The policy procedure states that all residents using a restraint are to be evaluated and re-evaluated approximately every quarter. The policy procedure states that care plan updates are to occur approximately every quarter and/or as a goal or approach direction changes. Review of the medical record for resident #31 revealed an admission date of 08/14/2019 with diagnoses that included…

  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 · D2025-04-16 · 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 observations, record reviews, and interviews, the facility failed to ensure a resident who is unable to carry out activities of daily living (ADL) received the necessary services to maintain good personal hygiene for 1 (#20) of 2 (#20, #104) residents reviewed for ADL care. The facility failed to ensure that resident #20 had neatly groomed and shaved facial hair. Findings: Review of resident #20's record revealed an admission date of 07/26/2024 with diagnoses that included unspecified psychosis, end stage renal disease, right hand contracture, type 2 diabetes mellitus, and dependence on renal dialysis. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed a Brief Interview of Mental Status (BIMS) score of 4 which indicated that resident #20 had severe cognitive impairment. Resident #20 required substantial/maximal assistance with bathing and grooming. On 04/14/2025 at 4:10 p.m., resident #20 was observed seated in a wheelchair at the nurses station and it was noted that his…

  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 before2025-04-16 · tag F0726 — failed to have competent, trained nursing staff — isolated
  Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.
  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, record review, and interviews the facility failed to ensure that nursing staff had the appropriate competencies and skills necessary to care for resident needs. The facility failed to obtain orders and document treatment performed to a tracheostomy stoma for 1 (#34) of 2 (#34 and #60) residents reviewed for wound care. Findings: Review of the medical record revealed resident #34 was admitted to the facility on [DATE] with diagnoses that included in part, depression, schizoaffective disorder, depressive type, type 2 diabetes mellitus without complications, chronic cough, artificial opening status, and personal history of non-Hodgkin lymphoma. Review of Resident #34's significant change Minimum Data Set (MDS) assessment dated [DATE] revealed a Brief Interview of Mental Status (BIMS) score of 7 which indicated resident #34 had severe cognitive impairment for daily decision making. Review of Resident #34's care plan revealed the resident had a neck stoma related to an old tracheostomy and…

  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 · D2025-04-16 · tag F0804 — failed to serve food at safe, palatable temperature — isolated
  Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
  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, record review, and interview, the facility failed to ensure food was palatable, and served at an appetizing temperature. Findings: Review of the record for resident #29 revealed an admission date of 01/16/2024 with diagnoses of type 2 diabetes, cerebral vascular disease and chronic obstructive pulmonary disease. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed resident #29 was cognitively intact for daily decision making. Interview on 04/14/2025 at 10:00 a.m. with resident #29 revealed the food was terrible. Resident #29 stated that the taste, texture, and choices of food was poor and that no substitutions were offered. A lunch test tray was requested from S10 Dietary Manager (DM) on 04/14/2025. The test tray was placed on the hall meal cart and was observed to leave the kitchen at 12:02 p.m. Further observation revealed that the test tray was given to the surveyor by S9 Certified Nursing Assistant at 12:23 p.m. The test tray meal consisted of BBQ pork loin,…

  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

“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

$36,891 in federal fines across 3 penalties. 1 Medicare payment denial on record.

• $9,113 — penalty dated 2025-04-16
• $15,733 — penalty dated 2025-04-16
• $12,045 — penalty dated 2023-10-19
• Medicare payment denial — starting 2023-12-01 for 3 days

Dates are the dates CMS records the penalty, not the date of the conduct behind it. CMS publishes penalties on a rolling window, so this is what is currently on the public file — not the home’s lifetime history, and an older fine may attach to a problem that has since been corrected. The amounts are as imposed: the CMS file does not record whether a penalty was appealed, reduced, or paid, so we don’t say. Ask the home what each one was for and what changed since.

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.

About 76% 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 $1.3M paid to related parties — landlords or management companies under common ownership — equal to about 12% 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