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Harbor House Nursing & Rehabilitation Center

11 Condito Road, Hingham, MA 02043 · For profit - Limited Liability company · 142 certified beds · (781) 749-4774 Medicare & Medicaid certified

Call the home — (781) 749-4774 Need help choosing, fast? Free, unbiased: Eldercare Locator 1-800-677-1116
Abuse-prevention, restraint, or reporting citation — no harm found (F0607) — cited Dec 2024
Insights

On the public record, this home looks stronger than most — but visit before you decide.

In its favor
  • a strong health-inspection score (4/5) — the hardest rating to game (though it’s ranked within its own state, not nationally)
  • no federal fines or payment denials on record
  • a high payroll-based staffing rating (4/5)
  • lower-than-typical staff turnover (32% vs 45% nationally) — better care continuity
Worth asking about
  • it has a citation for its abuse-prevention policies, restraint use, or reporting and investigating of allegations (F0607) — cited below the harm level, meaning inspectors found the process wanting but did not find a resident harmed
  • a high number of inspection citations overall (22) — worth reading through, though larger and more-often-surveyed homes tend to accrue more lower-severity tags

One thing this read cannot see: what residents and families actually experience day to day. Public data misses the feel of a place — visit unannounced, ideally at a mealtime or on a weekend, talk to staff and families, and ask your tour questions.

A plain-English summary of the public record below — not a rating, ranking, or recommendation. We take no money from any facility.

4/5
CMS overall
4 of 5
Health inspectionSurveyor-assigned, ranked within your stateInspector-verified 4 of 5
StaffingFrom payroll records (PBJ) 4 of 5
Quality measuresSelf-reported by the facility 4 of 5

Location & what’s nearby

Hospital
★★ 2/5 CMS · Emergency dept. usually open 24/7 · ER 24/7
Urgent care / clinic
6 Franklin Rodgers Rd · (781) 783-8427 · Call to confirm hours
Pharmacy
Walgreens0.3 mi
184 Lincoln St · (781) 749-0487 · Call to confirm hours
Grocery
185 Lincoln St · (781) 878-2810 · Call to confirm hours
Park
Typically dawn to dusk

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

Overall quality measures 4 of 5
Long-stay residentspeople who live here 4 of 5
Short-stay residentsrehab / post-hospital 4 of 5

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.

Trend — is this home getting better or worse?

Over 2025-02 to 2026-06, this home’s CMS overall rating held steady at 4 stars. From monthly CMS archive snapshots.

Horizontal axis runs 2025-02 to 2026-06. That is where CMS’s monthly archive ends, so the right-hand edge of each line is that month — not today.

Overall rating4★
Inspection scorelower = better
See all quality measures vs. state & national benchmarks
MeasureThis homeState avgTypical statevs typical state
Long-stay residents whose need for help with daily activities increased17.5%16.4%15.4%worse
Long-stay residents who lose too much weight1.5%5.1%5.4%better
Long-stay residents with a catheter left in their bladder0.2%0.8%0.9%better
Long-stay residents with a urinary tract infection1.5%1.8%2.0%better
Long-stay residents with depressive symptoms6.8%15.5%6.5%typical
Long-stay residents who were physically restrained0.0%0.1%0.1%better
Long-stay residents with falls causing major injury4.9%3.4%3.3%worse
Long-stay residents whose ability to walk worsened12.4%15.4%16.1%better
Long-stay residents on antianxiety or hypnotic medication13.7%19.5%18.9%better
Long-stay residents given the seasonal flu vaccine100.0%94.8%95.3%typical
Long-stay residents with pressure ulcers3.7%4.2%4.7%better
Long-stay residents with worsening bladder/bowel control12.1%21.2%21.2%better
Long-stay residents who got an antipsychotic medication — see the note below the table15.1%21.4%17.1%better
Short-stay residents who newly got an antipsychotic medication0.0%1.4%1.4%better
Short-stay residents given the seasonal flu vaccine98.7%77.7%79.4%better
Short-stay residents rehospitalized after admission21.5%25.7%22.6%typical
Short-stay residents with an outpatient ER visit8.1%11.9%12.0%better
Long-stay hospitalizations per 1,000 resident days1.321.881.67better
Long-stay outpatient ER visits per 1,000 resident days0.851.501.80better

§ Antipsychotics carry an FDA boxed warning — they raise the risk of death in older people with dementia-related psychosis, and are not approved for that use. So this measure is partly a read on whether a home sedates residents instead of staffing for them. But read a low rate carefully in both directions: CMS excludes residents coded with schizophrenia (and Tourette's or Huntington's) from this measure, and federal auditors have found implausible increases in schizophrenia coding since the measure was published — so a very low rate can reflect recoding rather than less prescribing. Ask the home what share of its residents carry a schizophrenia diagnosis, and how it handles behavioral symptoms without medication.

CMS quality measures, as Care Compare shows them. For most rows lower is better (fewer falls, ulcers, hospitalizations); vaccination rates are the exception. Not every row is risk-adjusted. CMS adjusts some measures for resident mix, but falls with major injury, antipsychotic use, physical restraints and the vaccination rates are unadjusted rates — so a home caring for heavier or more behaviorally complex residents can look worse on them without providing worse care. The “typical state” column is the median of the 50 state averages — not a national average of all homes. We use it because a plain average across homes is pulled badly off course by a few states’ reporting habits (long-stay depressive symptoms is the clearest case: Illinois codes it several times higher than most states, which alone lifted the all-homes figure to about twice what a typical state records). The median of state averages resists that — but it does weigh every state equally, so a large state counts no more than a small one, and it is a benchmark of our construction rather than a CMS-published figure. better/worse means the home differs from that benchmark by more than 10% of it; closer than that reads typical. CMS does not publish how many residents each measure covers, and the counts are often small — a single resident can move a rate by several points — so treat small gaps as noise. These come from data the facility reports, so weigh them against the independent inspection record above.

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.

61.6% of the Medicare patients who left this home got back to the community and stayed there for at least 31 days — CMS rates that better than the national rate. This is CMS’s risk-adjusted rate over 494 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.

61.6%U.S. median 51.5%
Got home and stayed home
13.2%U.S. median 10.7%
Went back to hospital
38.0%U.S. median 56.6%
Met the expected recovery
0.17U.S. median 0.31
Therapy hours / resident / day
0.08hours / resident / day
Physical therapy
0.06hours / resident / day
Occupational therapy
0.02hours / resident / day
Speech therapy

Met the expected recovery: 38.0% 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 179 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 0.17 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 40% 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.

See every short-stay measure CMS publishes for this home
MeasureThis homeU.S. medianPeriod coveredCMS’s call
Got home and stayed homeRate of successful return to home or community from a SNF61.6%CMS range 58.0–65.651.5%Oct 2022–Sep 2024better than U.S.
Went back to hospitalRate of potentially preventable hospital readmissions 30 days after discharge from a SNF13.2%CMS range 10.8–15.310.7%Oct 2022–Sep 2024worse than U.S.
Met the expected recoveryPercentage of residents who are at or above an expected ability to care for themselves and move around at discharge38.0%56.6%Oct 2024–Sep 2025CMS makes no comparison for this measure
Self-care at dischargePercentage of residents who are at or above an expected ability to care for themselves at discharge45.2%52.8%Oct 2024–Sep 2025CMS makes no comparison for this measure
Moving around at dischargePercentage of residents who are at or above an expected ability to move around at discharge35.2%50.0%Oct 2024–Sep 2025CMS makes no comparison for this measure
Medication problems followed upPercentage of residents whose medications were reviewed and who received follow-up care when medication issues were identified100.0%98.7%Oct 2024–Sep 2025CMS makes no comparison for this measure
Medication list to the next providerPercentage of residents where the SNF provided a current medication list to the next health care setting100.0%100.0%Oct 2024–Sep 2025CMS makes no comparison for this measure
Medication list to the familyPercentage of residents where the SNF provided a current medication list to the resident, family, and/or caregiver at final discharge100.0%98.7%Oct 2024–Sep 2025CMS makes no comparison for this measure
Falls with major injuryPercentage of SNF residents who experience one or more falls with major injury during their SNF stay0.8%0.0%Oct 2024–Sep 2025CMS makes no comparison for this measure
New or worsened pressure ulcersPercentage of residents with pressure ulcers/pressure injuries that are new or worsened2.8%1.9%Oct 2024–Sep 2025CMS makes no comparison for this measure
Infections that led to hospitalPercentage of infections residents got during their SNF stay that resulted in hospitalization7.8%CMS range 5.4–10.87.1%Oct 2023–Sep 2024no different from U.S.
Medicare spending per stayMedicare Spending Per Beneficiary (MSPB) for residents in SNFs0.791.02Oct 2022–Sep 2024CMS makes no comparison for this measure

From the CMS Skilled Nursing Facility Quality Reporting Program — Medicare short-stay outcomes, which is a different dataset from the long-stay quality measures above and describes a different set of residents. Where CMS risk-adjusts a measure we show its adjusted rate, and the CMS range beside it is the confidence interval CMS publishes: a home whose range is wide is a home with few stays, where one patient moves the number several points. Read the period column. These measures do not share a window — the claims-based ones (getting home, readmission, spending) lag by a year or more, because a stay has to finish and its claims settle before it can be counted. CMS’s call is CMS’s, not ours: it is the only place anyone tests whether this home differs from the national rate at all, and most homes on most measures do not. Two caveats on it. CMS tests only three of these measures — getting home, readmission, and infections that led to hospital; on the other nine it publishes a rate and no comparison, and rather than compute a verdict CMS declined to make, we say so in the column. And on readmission almost every home in the country lands on “no different”, so that row separates homes far less than getting-home does — which is why met the expected recovery, a measure CMS does not test but which spreads across the whole range, is called out above the table rather than left in this list. The U.S. median column is our own, taken across every home CMS publishes that measure for in this same file; it is not a CMS-published benchmark. Homes CMS gives no rate for are left out of it rather than counted as zero. Medicare spending per stay is a ratio, not a percentage — 1.00 means this home’s Medicare spending for a stay matched the national figure CMS compares it against, and it measures cost to Medicare, not quality of care.

Staffing

0.56
RN hours/ resident / day
1.03
LPN hours/ resident / day
1.94
Aide hours/ resident / day
3.54
Total nurse hours/ resident / day
0.35
RN hoursweekends
32.4%
Total nursing turnover
45.0%
RN turnover

How full it usually is: this home is certified for 142 beds and averages 132.5 residents a day — about 93% occupied, or roughly 10 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 3.54 hrs/resident/day is at or above the 3.48-hour benchmark and RN staffing of 0.56 is at or above the 0.55-hour RN benchmark and nurse-aide staffing of 1.94 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 3.27 hrs/resident/day on weekends vs 3.65 on weekdays — 10% thinner on weekends. RN hours go from 0.65 to 0.35 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 32% 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

3
deficiencies at the latest standard inspection (2025-11-14)
3
at the previous standard inspection (2024-08-06)

Deficiencies are unchanged from the previous inspection. 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.

ABCDEFGHIJKL

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.

22 citations, most serious first. The 10 most serious are shown; the remaining 12 are one tap away and print in full.

  • Potential for harm · E2025-11-14 · tag F0561 — failed to honor residents' choices — pattern
    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 Based on observation, interview, and record review, the facility failed to accommodate the Resident's preference for a Geri chair for comfort to enhance their out of bed tolerance and comfort for improved quality of life for one Resident (#4), out a total sample of 24 residents. Findings include: Resident #4 was admitted to the facility in December 2023 with current diagnoses which included: cerebrovascular accident (CVA) with left sided non-dominant hemiparesis, idiothetic gout (a form of inflammatory arthritis when buildup of uric acid in your body) right and left knee, pain right and left knee, chrondracallanosis (deposits of calcium pyrophosphate crystals in cartilage) left knee, abnormal posture, weakness, and chronic pain. Review of the Minimum Data Set (MDS) assessment, dated 7/7/25, indicated Resident #4 scored 15 out of 15 on the Brief Interview for Mental Status (BIMS), indicating he/she was cognitively intact.During an interview on 09/18/2025 at 3:16 P.M., Resident #4 said I have a high back…

    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 · Ecited before2025-11-14 · tag F0658 — failed to meet professional standards of care — pattern
    Ensure services provided by the nursing facility meet professional standards of quality.
    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 two Residents (#12 and #77), out of a total sample of 24 residents, received care and treatment in accordance with professional standards. Specifically, the facility failed:1. For Resident #12, to ensure a physician's order for Lidocaine 4% Patch (pain relief patch) was complete and accurately reflected the location the patch was to be applied, ensure the Lidocaine Patch was applied timely per the physician's order, and to ensure the medication was administer by licensed staff; and2. For Resident #77, to ensure the correct dose of Amlodipine (blood pressure medication) was administered per physician's order. Findings include: Review of the Lippincott Manual of Nursing Practice, 11th Ed. (2019) indicated: Scope of Practice, Licensure, and Certification: The professional nurse's scope of practice is defined and outlined by the State Board of Nursing that governs practice. The National Council of State Boards of Nursing and 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.

    Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2025-11-14 · tag F0688 — failed to keep residents mobile / prevent decline — isolated
    Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
    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 prevent loss of range of motion (ROM) in both knees for one Resident (#4), out of 24 residents. Specifically, Resident #4 had ROM within functional limits during last physical therapy session in April 2025 and is now presenting with severely limited right knee flexion (bending the knee) ROM to 12 degrees and left knee flexion to 7 degrees. Findings: Resident #4 was admitted to the facility in December 2023 with current diagnoses which included: Cerebrovascular accident (CVA, stroke) with left sided non-dominant hemiparesis, idiothetic gout (a form of inflammatory arthritis when buildup of uric acid in your body) right and left knee, pain right and left knee, chrondracallanosis (deposits of calcium pyrophosphate crystals in cartilage) left knee, abnormal posture, weakness, and chronic pain. Review of the Minimum Data Set (MDS) assessment, dated 7/7/25, indicated Resident #4 scored 15 out of 15 on the Brief Interview for Mental Status…

    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 before2024-12-02 · tag F0607 — failed to have anti-abuse policies — isolated
    Develop and implement policies and procedures to prevent abuse, neglect, and theft.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on interviews and records reviewed, for one of three sampled residents (Residents #1), who had moderate cognitive impairment, the Facility failed to ensure they developed and implemented an Abuse Prohibition Policy that included written procedures for staff to follow related to the need to immediately report, and to whom, allegations of abuse when, on 11/08/24 at around 1:00 A.M., Resident #1 came to the nurses station with a skin tear and told Nurse #1 that someone named David stabbed him/her with a box cutter and Nurse #1 did not immediately report the allegation to the Director of Nursing or Administrator, and as a result, they were not made aware of the allegation until about 8 hours later, when the Director of Nursing reviewed Nurse #1's written Incident Report regarding Resident #1's injury. Findings include: Review of the Facility Abuse Policies titled Identification and Reporting Allegations, Prevention of Resident Abuse and Neglect and Investigation Guidelines, last reviewed by the Facility during 9/2023, indicated that all staff members are mandated to report…

    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 · Dcited before2024-09-30 · tag F0607 — failed to have anti-abuse policies — isolated
    Develop and implement policies and procedures to prevent abuse, neglect, and theft.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on interviews and records reviewed, for one of three sampled residents (Resident #2), who was severely cognitively impaired and dependent upon staff for care, the Facility failed to ensure that staff implemented and followed the Facility Abuse Prohibition Policy when on 8/24/24 around 12:30 A.M., Nurse #1 was made aware of an allegation of abuse of Resident #2, that the door to his/her room was tied so that he/she could not exit if desired, and although Nurse #1 said he reported the allegation to Nurse #2, neither of them reported the allegation to facility Administration and, as a result, they were not aware of the allegation until more than 8 hours later, when Nurse #3 became aware and reported it, as required. Findings include: Review of the Facility Policy titled Prevention of Abuse and Neglect, effective 10/22, indicated that all employees of the Facility are mandated to report incidents of suspected resident abuse, neglect, mistreatment, exploitation or misappropriation to their immediate supervisor, nursing supervisor, Director of Nursing Services or the Executive…

    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 · Ecited before2024-08-06 · tag F0812 — failed to store, cook, and serve food safely — pattern
    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 and interview, the facility failed to follow professional standards of practice for food safety and sanitation to prevent the potential spread of foodborne illness to residents who are at high risk. Specifically, the facility failed to: 1. Ensure facial hair was restrained during food preparation; and 2. Maintain a safe and clean microwave in one out of three kitchenettes; and 3. Maintain a safe and clean ice scoop in one out of three kitchenettes. Findings include: 1. Review of the facility's policy titled Nutrition and Food Service: Employee Practices, dated as revised in September 2023, indicated employees shall use effective hair restraints when working in all food preparation areas to prevent contamination of food or food-contact surfaces. All hair must be restrained and tucked under hairnet. On 8/1/24 at 7:30 A.M., the surveyor observed Dietary Aide #1 at the meal preparation assembly line putting placemats and silverware on the trays. The surveyor observed the Dietary Aide not wearing a hair net on top of their head and not wearing a beard net on their…

    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 · D2024-08-06 · tag F0684 — failed to provide proper treatment and quality of care — isolated
    Provide appropriate treatment and care according to orders, resident’s preferences and goals.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, policy review, and interview, the facility failed to ensure for one Resident (#323), out of a total sample of 24 residents, that the Resident received care and treatment in accordance with the medical care plan. Specifically, the facility failed to perform physician-ordered treatments to the Resident's external fixator pins. Findings include: Review of the facility's policy titled Charting and Documentation, revised in July 2017, indicated but was not limited to the following: -Documentation in the medical record may be electronic, manual or a combination. -The following information is to be documented in the resident medical record: Treatments or services performed -Documentation in the medical record will be objective (not opinionated or speculative) complete, and accurate. Resident #323 was admitted in July 2024 with diagnoses which included bilateral patellar tendon rupture with surgical repair. Review of the Minimum Data Set (MDS) assessment, dated 8/1/24, indicated a Brief Interview…

    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 · D2024-08-06 · tag F0761 — failed to label and store drugs safely — isolated
    Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation, interview, and policy review, the facility failed to ensure staff stored all drugs and biologicals used in the facility in accordance with currently accepted professional principles for one Resident (#322), out of a total sample of 24 residents. Specifically, the facility failed for Resident #322, to ensure the medications were administered under direct supervision and not left at the bedside. Findings include: Review of the facility's policy titled Competency Assessment Administering Oral Medication, revised October 2020, indicated but was not limited to the following: -The purpose of this procedure is to provide guidelines for safe administration of oral medications. -Prepare the correct dose of medication. -Confirm the identity of the resident. -Allow the resident to swallow oral tablets or capsules at his or her comfortable pace. -Remain with the resident until all medications have been taken. -Notify the supervisor if resident refuses the procedure, -Report other information in accordance with facility policy and professional standards of practice.…

    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 · D2024-02-21 · tag F0580 — failed to tell family and doctor about changes — isolated
    Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the 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 records reviewed and interviews, for one of three sampled residents (Resident #1), who had experienced a fall at the Facility on 1/12/24 which resulted in him/her being diagnosed with a subdural hematoma (SDH, pool of blood between the brain and the outermost covering), the Facility failed to ensure nursing staff immediately notified his/her Physician, when on 01/31/24 at approximately 3:00 A.M., Resident #1 had a witnessed fall while being transferred by a Certified Nurse Aide (CNA), Resident #1 struck his/her head during the fall, had visible bruising and an injury to the right side of his/her face/head as a result of the fall, however the Physician was not notified until more than four hours later, at which time an order was obtained to transfer him/her to the Hospital Emergency Department (ED) for evaluation and treatment. Findings include: Review of the Facility Policy, titled Change in Resident Condition, dated 09/2022, indicated that the Facility shall promptly notify the resident, his/her…

    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 · Past Non-Compliance
  • Potential for harm · F2023-05-17 · tag F0809 — failed to serve meals on a reasonable schedule — widespread
    Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observations, interviews, and review of the meal truck delivery schedule, the facility failed to offer a nourishing evening snack when there was a greater than 14 hours between dinner and breakfast service. Findings include: During the Resident Group meeting held on 5/12/23 1:30 P.M., with 14 residents, the overall concern expressed by the group was evening snacks were not offered or available. Residents in the group specifically said the following: -They never have snacks available. -There are no snacks available at night. -If you want ginger ale or a snack you can have the nurses get them if there are some available. -The dietitian said there are no snacks at nighttime because you guys eat them all during the day. -They used to have a hostess that made sure snacks were always available, now that there is no hostess and we run out of snacks all the time. -They do not offer nighttime snacks and he/she said he/she has become hypoglycemic (low sugar) in the night. -They run out of ice cream at night. -They run out of juice at night. Review of the Food Truck Delivery Times,…

    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
Show the remaining 12 citations
  • Potential for harm · E2023-05-17 · tag F0760 — failed to prevent significant medication errors — pattern
    Ensure that residents are free from significant medication errors.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on record review and interview, the facility failed to hold the administration of insulin when the capillary blood glucose (CBG) was outside of the physician ordered parameters for one Resident (#86), out of a total sample of 25 residents. Specifically, the facility failed to hold the administration of insulin 26 times out of 228 administration opportunities from 2/25/23 through 5/15/23. Findings include: Resident #86 was admitted to the facility in February 2023 with diagnoses which included type 2 diabetes and dementia. Review of Resident #86's care plan indicated: -The Resident has diabetes mellitus -Administer diabetes medication as ordered by the doctor -Monitor blood sugars as ordered Review of the Medication Administration Record (MAR) for February 2023 indicated: -Humalog (short-acting insulin) Kwik Pen inject 25 units subcutaneously (under the skin) with meals for diabetes effective 2/25/23 through 2/28/23 -Hold for CBG less than 100 -One out of 12 administrations were administered out of parameters on the following dates: -2/26/23 at 5:00 P.M., CBG of 92 Review 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.

    Pharmacy Service Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Ecited before2023-05-17 · tag F0812 — failed to store, cook, and serve food safely — pattern
    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

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, policy review, and interview, the facility failed to ensure 4 of 5 nourishment kitchenettes were maintained in a sanitary manner to prevent potential illness or contamination of food. Specifically, the facility failed to: 1. Ensure foods brought in from the outside were labeled, dated, and discarded timely; and 2. Maintain kitchenette refrigerators, freezers, microwaves, counters, drawers, and cabinets in a clean sanitary manner. Findings include: 1. Review of the facility policy titled: Foods brought in by family/visitor/residents, dated as reviewed 1/2023, indicated but was not limited to the following: - the purpose of this policy is to ensure food safety for residents - food or beverages must be labeled and dated to monitor for food safety - foods must be stored in a clean, covered, container and/or securely wrapped, labeled with resident's name, room number and date food was cooked or stored - foods with manufacturer expiration dates must be labeled with the resident's name and will be…

    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 · E2023-05-17 · tag F0880 — failed to prevent and control infections — pattern
    Provide and implement an infection prevention and control program.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation, interview, and policy review, the facility failed to maintain a safe, sanitary and comfortable environment to help prevent the development and transmission of communicable diseases and infections. Specifically, the facility failed to: 1. For Resident #66, ensure intravenous tubing connections were disinfected prior to the administration of medication, per facility policy; 2. For Resident #108, a. Ensure staff changed their personal protective equipment in between tasks for the same Resident that could result in the introductions of hazardous germs into the system, b. Ensure staff stored an enteral irrigation syringe in a manner to prevent environmental debris and germs from contaminating it in between uses, and c. Ensure enteral food was labeled and dated per facility policy; and 3. Ensure hand hygiene was performed during medication pass administration. Findings include: 1. Review of the facility's policy titled Intermittent Medication Administration, dated January 2022, indicated but was not limited to the following: - purpose of this policy is to safely…

    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 · E2023-05-17 · tag F0881 — failed to use antibiotics responsibly — pattern
    Implement a program that monitors antibiotic use.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on interview, record review, and policy review, the facility failed to implement their Antibiotic Stewardship program and ensure antimicrobial medications were used for an acceptable and prescribed indication and duration of time for two Residents (#15 and #24), in a total sample of 25 residents. Findings include: Review of the facility's policy titled Antibiotic Stewardship Program, dated September 2022, indicated the mission of the program was to provide the best antibiotic therapy (right dose, drug, and duration) to residents that results in the best outcome with the least amount of toxicity and resistance. In addition, the policy indicated: -The Infection Control Nurse (ICN) will be responsible for infection surveillance and Multidrug Resistant Organism (MDRO) tracking. The ICN and will collect and review the following data: a. Type of antibiotic ordered, route of administration, and cost. b. Whether the order was made by phone, if the order was given by the attending physician or on-call physician/physician extender. c. Whether tests such as cultures were obtained prior…

    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 · D2023-05-17 · tag F0578 — failed to honor advance directives / code status — isolated
    Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
    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 Advance Directives were formulated and signed by the residents, for two Residents (#339 and #8), out of a total sample of 25 residents. Findings include: Review of the Massachusetts Medical Orders for Life-Sustaining Treatment (MOLST) form, dated August 10, 2013, indicated but was not limited to the following: Instructions: -This form should be signed based on goals of care discussions between the patient (or patient's representative signing below) and the signing clinician. -Sections A through C are valid orders only if sections D and E are complete. If any section is not completed, there is no limitation on the treatment indicated in that section. Section D: Patient or patient's representative signature is required. Section E: Clinician signature required. 1. Resident #339 was admitted to the facility in May 2023 with a diagnosis of a fracture of the proximal right femur (upper leg bone). Review of the Minimum Data Set (MDS) assessment, dated 5/8/23, indicated Resident #339 scored 12 out of 15 on the Brief…

    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 · D2023-05-17 · tag F0656 — failed to write and follow a full care plan — isolated
    Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on record review, interview, and policy review, the facility failed to consistently update and implement a fall care plan with interventions to prevent further falls for one Resident (#117), out of a total sample of 25 residents. Findings include: Review of the facility's policy titled Falls Program, dated as reviewed 9/2022, indicated but was not limited to the following: - the purpose of this policy is to prevent actual occurrences of falls and reduce the risk of any injury - develop individualized care plan - review and revise the care plan as needed - residents experiencing a fall will receive appropriate care with investigation of cause and care plan will reflect new interventions initiated Resident #117 was admitted to the facility in February 2023 with the following diagnoses: repeated falls, polyneuropathy (a dysfunction of the nerves that can cause decrease sensation, pain or involuntary movements), and orthostatic hypotension (a drop in blood pressure with a change in position of the body). Review of the Resident Fall Assessments indicated the Resident was a moderate…

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

    Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Dcited before2023-05-17 · tag F0658 — failed to meet professional standards of care — isolated
    Ensure services provided by the nursing facility meet professional standards of quality.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation, policy review, and interview, the facility failed for two Residents (#108 and #117) to maintain professional standards of practice, out of a total sample of 25 residents. Specifically, the facility failed to: 1. For Resident #108, a. Ensure medications that were administered through an enteral feeding tube met professional standards and the facility policy, and b. Provide enteral feedings as ordered by a physician; and 2. Follow the pharmacist recommendation to administer Tegretol (Carbamazepine - used to treat seizures, nerve pain, and bipolar disorder), with food for Resident #117. Findings include: 1. Resident #108 was admitted to the facility in May 2023 with diagnoses including unspecified intestinal obstruction and malignant neoplasm (abnormal growth of tissue) in the mouth. The Resident had a gastrointestinal feeding tube (tube goes into the stomach). a. Review of the facility's policy titled Medication Administration Through a Feeding Tube, dated as reviewed September 2022, indicated but was not limited to the following: - the purpose of this policy is…

    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 · D2023-05-17 · 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

    Based on observation, record review, and policy review, the facility failed to ensure that a licensed nurse had completed the necessary competencies prior to administering medication and enteral feeding through a gastrointestinal tube (tube goes into the stomach) for one Resident (#108). Findings include: Review of the facility's policy titled Orientation Program for Newly Hired Employees, Transfers, Volunteers, dated 2008, indicated but was not limited to the following: -An orientation program shall be conducted for all newly hired employees, transfers from other departments, and volunteers. -That's Our orientation program includes, but is not limited to: -In addition to our general orientation, each department will orientate the newly employee/transfer/volunteer to his or her department's policies and procedures, as well as other data will aid him/her in understanding the team concept, attitudes and approaches to resident care. -A written record will be maintained of each employee's/volunteer's individual orientation program. -Orientation records shall include the date reviewed,…

    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 · D2023-05-17 · tag F0756 — failed to review each resident's drug regimen — isolated
    Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on interview and record review, the facility failed to ensure a recommendation from the consultant pharmacist was acted upon timely for one Resident #119, out of a total sample of 25 residents. Findings include: Resident #119 was admitted to the facility in September 2022. Review of the medical record indicated Resident #119 had a medication allergy to Atorvastatin (Lipitor). Review of the Consultant Pharmacist's Progress Notes indicated recommendations were made for Resident #119 on 1/20/23. Review of the electronic and paper medical records failed to include the pharmacist's recommendation from 1/20/23. During an interview on 5/16/23 at 4:00 P.M., the Director of Nurses said she believed she kept copies of the recommendations and would follow up. The 1/20/23 Consultant Pharmacist Recommendations to Prescriber form was provided to the surveyor on 5/16/23 at 5:00 P.M. Review of the Consultant Pharmacist Recommendations to Prescriber form, dated 1/20/23, indicated Resident #119 had an allergy to Lipitor but was currently receiving Seroquel, to clarify and if no issues have…

    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 · D2023-05-17 · tag F0808 — failed to follow doctor-ordered diets — isolated
    Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law.
    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 provide a therapeutic diet as ordered by the physician for one Resident (#41), out of a total sample of 25 residents. Findings include: Resident #41 was admitted to the facility in December 2019 with diagnoses including dysphagia oropharyngeal phase (swallowing problems occurring in the mouth and/or the throat). Review of the 3/30/23 Minimum Data Set assessment indicated Resident #41's long and short term memory was intact, required supervision with eating, and had dysphagia. Review of the May 2023 Physician's Orders indicated: -House diet, puree texture, moderately thick liquids/honey thick liquids consistency (1/2/20) Review of the most recent Speech Therapy evaluation, dated 1/2/20, indicated Resident #41 had a moderate level of dysphagia with mild risk for aspiration. Review of the Speech Therapy Discharge summary, dated [DATE], indicated Resident #41 was discharged from therapy on International Dysphagia Diet Standardization…

    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
  • No harm found · C2023-05-17 · tag F0623 — widespread
    Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
    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 its staff issued transfer notices to one Resident (#138) or their Resident Representative of three closed records and two Residents (#108 and #122) or their Resident Representatives, out of a total sample of 25 residents. Findings include: 1. Resident #138 was admitted to the facility in October 2021 and had an activated Health Care Proxy. Review of the medical record indicated Resident #138 was transferred to the hospital on 1/2/23, 2/17/23, and 2/24/23. Further review of the medical record failed to indicate transfer notices for the above dates were issued to the Resident or Resident Representative as required. 2. Resident #108 was admitted to the facility in January 2023 with diagnoses of cancer, malnutrition, and intestinal (stomach) obstruction. Review of the medical record indicated Resident #108 was transferred to the hospital on 3/29/23, 4/5/23, and 4/24/23. Further review of the medical record failed to indicate transfer notices for the above dates were issued to the Resident or Resident Representative as…

    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
  • No harm found · C2023-05-17 · tag F0625 — widespread
    Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.
    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 that its staff issued bed hold notices to one Resident (#138) or their Resident Representative of three closed records and two Residents (#108 and #122) or their Resident Representatives, out of a total sample of 25 residents. Findings include: 1. Resident #138 was admitted to the facility in October 2021 and had an activated Health Care Proxy. Review of the medical record indicated Resident #138 was transferred to the hospital on 1/2/23, 2/17/23, and 2/24/23. Further review of the medical record failed to indicate bed hold notices for the above dates were issued to the Resident or Resident Representative as required. 2. Resident #108 was admitted to the facility in January 2023 with diagnoses of cancer, malnutrition, and intestinal (stomach) obstruction. Review of the medical record indicated Resident #108 was transferred to the hospital on 3/29/23, 4/5/23, and 4/24/23. Further review of the medical record failed to indicate bed hold notices for the above dates were issued to the Resident or Resident Representative…

    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

“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.

Worried about a resident here? There are three different people you can turn to, and they do different jobs:
  • Long-Term Care Ombudsman — a free, confidential advocate for the resident. They act only with the resident’s consent and work to resolve the problem. Find yours at theconsumervoice.org/get_help.
  • Adult Protective Services — the state agency that investigates suspected abuse, neglect, or exploitation of a vulnerable adult. Not sure of your state’s APS number? The federal Eldercare Locator will route you: 1-800-677-1116 or eldercare.acl.gov.
  • State survey agency — the regulator that licenses and inspects the home. Every state has an official nursing-home complaint line and most take complaints online; the Ombudsman or Eldercare Locator can connect you.
Not sure where to start, or need other help? Dial 2-1-1 for local resources — and if a call is hard or impossible for you, many local 211s also take a text (send your ZIP code to 898-211) or a web chat at 211.org; both vary by area, and 211.org will show what yours offers. Deaf or hard of hearing: dial 711 for the telecommunications relay service, then any number above. In an emergency, call 911.
It is illegal for a facility to retaliate against a resident or family for reporting a concern: federal law gives a resident the right to voice grievances — to the home or to any outside agency — without discrimination or reprisal (42 CFR §483.10(j)(1)). You may report anonymously.

Fines & penalties

No federal fines in the current CMS record.

Part of a chain

This home belongs to BANECARE MANAGEMENT — 7 facilities. Here is how its ratings compare with the chain’s average across all its homes: See the whole chain — ratings, flags, fines and finances →

RatingThis homeChain avg
Overall 4 of 54.0≈ chain avg
Health inspection 4 of 53.9+0.1 vs chain
Staffing 4 of 53.6+0.4 vs chain
Quality measures 4 of 53.9+0.1 vs chain
The other 6 homes this chain runs (chain average 4.0★, per CMS)

A home rated well below its chain’s average can signal local problems; a chain with a low average across the board is a bigger pattern worth researching. CMS chain data under-reports private-equity and REIT ownership, so treat this as a floor, not the full picture.

Who owns this facility

Owner / managerTypeRoleShareSince
MORRIS HEALTH MANAGEMENT LLCOrganization5% OR GREATER DIRECT OWNERSHIP INTEREST100%since 01/28/2022
FARIA, MARIEIndividualW-2 MANAGING EMPLOYEEsince 01/28/2022
MORRIS, KEVINIndividualCORPORATE OFFICERsince 01/28/2022
BANE CARE MANAGEMENT LLCOrganizationOPERATIONAL/MANAGERIAL CONTROLsince 07/01/2016

2 organizational owners listed — a facility can be part of a larger chain. CMS ownership data is known to under-report private-equity and REIT ties; treat as a starting point.

Follow the money — this home’s finances

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

$17.7M
Net patient revenuemost recent cost report
-5.0%
Operating marginrevenue minus expenses
$891K
Related-party expense5% of expenses
Who pays — share of resident-days
Medicaid 59%Medicare 16%Other / private 25%

This home reported $891K paid to related parties (affiliated landlords or management companies) in its most recent cost report. A reported operating loss is common in this industry and is not by itself a sign of trouble — but paired with large related-party payments it can mean profit is being taken elsewhere in the ownership structure.

Source: CMS Healthcare Provider Cost Reporting Information System (HCRIS), Medicare cost report Form CMS-2540 · fiscal year 2023. Facilities self-file these reports; figures are unaudited and a year or two behind. A home with no Medicare cost report on file shows no figures here.

Cost & finances

$407per resident / day
operating cost
$12,375per month
≈ monthly operating cost
$388per day
avg. revenue, all payers

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 MA

Paying with Medicaid

This is a Medicare- and Medicaid-certified nursing home, so it can accept Medicaid for long-term care — like nearly all U.S. nursing homes. The private-pay figures below are what families without Medicaid pay; once a resident qualifies for Medicaid, out-of-pocket cost for covered nursing-home care is typically close to $0 (almost all of their income goes to the home as their share of the cost; they keep a small personal needs allowance — for clothing, haircuts, a phone — and Medicaid pays the rest). The amount of that allowance is set by each state. Confirm Medicaid-bed availability with the home, and see the Massachusetts Medicaid page.

Typical monthly cost in Massachusetts
$14,448/mo
Nursing home (semi-private)
$15,817/mo
Nursing home (private)
$9,600/mo
Assisted living

Median private-pay cost, CareScout (Genworth) 2025 Cost of Care Survey — a regional midpoint, not any single community’s rate. Private rooms and higher care levels cost more; ask for a current quote. Project your own in the cost-of-care planner.

Every figure above is reproduced from the CMS Provider Data Catalog (a public record), from the CMS extract processed 2026-08-01 — CMS provider number 225662. CMS refreshes its data monthly, and the star rating rests on the last standard inspection — dated 2025-11-14, which can lag current conditions. Staffing hours are CMS PBJ CY2026Q1 (Jan–Mar 2026). Check this record against the government’s own page for it: this home on Medicare Care Compare ↗ — the authoritative source, and the place to confirm anything here before you act on it. How we present it →

Not a government site. Eldercare Lens is not affiliated with, endorsed by, or authorized by the Centers for Medicare & Medicaid Services (CMS), Medicare, or any government agency. The star ratings, citations, and inspection wording on this page are reproduced from the public CMS record; the plain-English summaries, tiers, and comparisons around them are ours. We do not speak for CMS, and CMS has not reviewed this page. For the official record, go to Medicare Care Compare. How we’re funded →

Are you this operator? If the record here is out of date, or misses what you have since fixed, tell us and we will look: hello@eldercarelens.com. We reproduce the public CMS record and cannot change what it says — corrections to the underlying data go through CMS and your state survey agency — but we will correct anything we have got wrong about it, and we will say so on the page.

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