Lakeview Extended Care and Rehabilitation
210 South First Street, Harbor Beach, MI 48441 · Non profit - Corporation · 30 certified beds · (989) 479-3201 Medicare & Medicaid certified
On the public record, this home looks stronger than most — but visit before you decide.
- a strong health-inspection score (5/5) — 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 (5/5)
- lower-than-typical staff turnover (18% vs 45% nationally) — better care continuity
- fewer deficiencies at its most recent standard inspection than at the one before — a sign of improvement
- a high number of inspection citations overall (15) — 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.
| Health inspectionSurveyor-assigned, ranked within your stateInspector-verified | 5 of 5 |
| StaffingFrom payroll records (PBJ) | 5 of 5 |
| Quality measuresSelf-reported by the facility | 4 of 5 |
Location & what’s nearby
Open in Google Maps ↗ · Directions ↗ · Larger map ↗
Nearest of each type, straight-line distance. Hospitals come from the CMS Hospital General Information registry; everything else from Overture Maps (public data). Hospital and park hours are typical — call ahead to confirm.
Quality measures — how residents actually fare
| Overall quality measures | 4 of 5 |
| Long-stay residentspeople who live here | 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 5 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.
See all quality measures vs. state & national benchmarks
| Measure | This home | State avg | Typical state | vs typical state |
|---|---|---|---|---|
| Long-stay residents whose need for help with daily activities increased | 16.3% | 10.8% | 15.4% | typical |
| Long-stay residents who lose too much weight | 3.9% | 5.4% | 5.4% | better |
| Long-stay residents with a catheter left in their bladder | 8.0% | 0.8% | 0.9% | worse |
| Long-stay residents with a urinary tract infection | 0.9% | 1.5% | 2.0% | better |
| Long-stay residents with depressive symptoms | 3.8% | 4.3% | 6.5% | better |
| Long-stay residents who were physically restrained | 0.0% | 0.1% | 0.1% | better |
| Long-stay residents with falls causing major injury | 0.0% | 3.0% | 3.3% | check this* — see note marked star below the table |
| Long-stay residents whose ability to walk worsened | 13.6% | 12.0% | 16.1% | better |
| Long-stay residents on antianxiety or hypnotic medication | 17.5% | 19.4% | 18.9% | typical |
| Long-stay residents given the seasonal flu vaccine | 100.0% | 95.0% | 95.3% | typical |
| Long-stay residents with pressure ulcers | 1.4% | 5.1% | 4.7% | better |
| Long-stay residents with worsening bladder/bowel control | 18.8% | 20.0% | 21.2% | better |
| Long-stay residents who got an antipsychotic medication§ — see the note below the table | 17.5% | 14.8% | 17.1% | typical |
| Short-stay residents who newly got an antipsychotic medication | 0.0% | 1.1% | 1.4% | better |
* This home reported 0% on a measure where lower is better. That can mean genuinely excellent care — but because the number is self-reported, a zero can also mean the problem was not recorded. Weigh it against the inspection record above.
§ 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.
57.0% of the Medicare patients who left this home got back to the community and stayed there for at least 31 days — which CMS reads as no different from the national rate. This is CMS’s risk-adjusted rate over 34 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.
Therapy staffing: this home’s payroll records show 0.07 therapist hours per resident per day in 2026Q1 — more than 3% of the 13,892 homes that report any therapy hours at all.
Weekend therapy: weekend therapy hours are 10% 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
| Measure | This home | U.S. median | Period covered | CMS’s call |
|---|---|---|---|---|
| Got home and stayed homeRate of successful return to home or community from a SNF | 57.0%CMS range 47.5–71.8 | 51.5% | Oct 2022–Sep 2024 | no different from U.S. |
| Went back to hospitalRate of potentially preventable hospital readmissions 30 days after discharge from a SNF | 10.8%CMS range 7.2–17.8 | 10.7% | Oct 2022–Sep 2024 | no different from U.S. |
| Met the expected recoveryPercentage of residents who are at or above an expected ability to care for themselves and move around at discharge | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Self-care at dischargePercentage of residents who are at or above an expected ability to care for themselves at discharge | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Moving around at dischargePercentage of residents who are at or above an expected ability to move around at discharge | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Medication problems followed upPercentage of residents whose medications were reviewed and who received follow-up care when medication issues were identified | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Medication list to the next providerPercentage of residents where the SNF provided a current medication list to the next health care setting | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality 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 discharge | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Falls with major injuryPercentage of SNF residents who experience one or more falls with major injury during their SNF stay | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| New or worsened pressure ulcersPercentage of residents with pressure ulcers/pressure injuries that are new or worsened | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Infections that led to hospitalPercentage of infections residents got during their SNF stay that resulted in hospitalization | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Medicare spending per stayMedicare Spending Per Beneficiary (MSPB) for residents in SNFs | 0.70 | 1.02 | Oct 2022–Sep 2024 | CMS 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
How full it usually is: this home is certified for 30 beds and averages 28.3 residents a day — about 94% occupied, or roughly 2 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 5.72 hrs/resident/day is at or above the 3.48-hour benchmark and RN staffing of 1.74 is at or above the 0.55-hour RN benchmark and nurse-aide staffing of 3.44 is at or above 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 4.60 hrs/resident/day on weekends vs 6.17 on weekdays — 25% thinner on weekends — a notable drop. RN hours go from 1.95 to 1.22 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)
This home’s total nursing-staff turnover of 18% is below the national median of 45%.
Payroll-based (PBJ) staffing hours, as reported for Jan–Mar 2026 (CMS PBJ CY2026Q1) — the most recent quarter CMS has published, so they can lag a change of operator or staffing agency. Higher is generally better. Registered-nurse coverage and weekend staffing are the numbers families most often overlook — an RN on site matters most when something goes wrong, and coverage usually thins on weekends. High turnover means residents rarely see the same caregiver twice. One caveat: these are hours as reported, not adjusted for how sick or heavy-care this home’s residents are. CMS separately publishes a case-mix-adjusted view; we show the reported hours. A home caring for higher-acuity residents needs more hours to deliver the same care, so compare these figures against homes doing similar work, and read them next to the inspection record rather than alone.
Inspection trend
Deficiencies are fewer than at the previous inspection — improving. Fewer citations over time suggests a home is fixing problems; a rising count is a warning sign — though two surveys are a short record, and survey teams differ. These counts are from the standard annual health survey only; the full citation list below may also include findings from complaint investigations, so the two won’t always add up.
Inspection deficiencies
State health-inspection citations, most serious first. Each carries an F-code (the federal rule it cites, e.g. F-684 = quality of care) and a letter A–L marking how serious and how widespread the problem was — we translate that grid into the plain tiers shown here. Wording is the official federal description.
Each letter is a CMS scope-severity level; highlighted ones are where this home has citations. A–C = no harm found; D–F = potential for harm; G–I = actual harm; J–L = immediate jeopardy. Within each band the later letter is the more widespread finding (an isolated G is one resident; a widespread I is a pattern), so rightward and downward is worse.
15 citations, most serious first. The 10 most serious are shown; the remaining 5 are one tap away and print in full.
- Potential for harm · D2026-05-12 · tag F0755 — failed to provide safe pharmacy services — isolatedProvide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY This citation pertains to Intake Number 3008221.Based on observation, interview and record review, the facility failed to ensure the accurate dispensing of medication, as ordered, for one resident (Resident #1) of three residents reviewed for medication administration.Findings include: Resident #1 (R1):On 5/11/26 at 6:25 PM, an interview was conducted with Confidential Person (CP) B regarding allegation details of Resident 1 (R1) receiving extra amount of metoprolol succinate capsules. The CP reported the Resident was ordered to receive the metoprolol (Kapspargo) sprinkles 100 mg (milligrams) one capsule but was administered 4 capsules (four 100mg capsules equals 400mg). The Resident had to be transferred to the emergency room, given charcoal, stay overnight in the hospital for observation and had loose bowel movements as a reaction to the charcoal causing exhaustion for the Resident.The CP reported that the medication was labelled as 25mg in the packaging from the facility pharmacy. The order was for 100mg, 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.
- Potential for harm · Dcited before2026-04-16 · tag F0761 — failed to label and store drugs safely — isolatedEnsure 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
This citation pertains to intake Number 2701247.Based on observation, interview and record review, the facility failed to ensure that the medication storage room was locked and secured.Findings include: On 4/16/26 at 8:49am, the medication storage room behind the nurse's station was observed to be open. There were no staff present at the nurse's desk and no staff in sight of the open door. On 4/16/26 at 9:44am, an interview was conducted with Certified Nursing Assistant (CNA) A. CNA A was asked if the medication storage room is left open throughout the day? CNA A stated, yes, it is open throughout the day every once in a while. On 4/16/26 at 9:47am, an interview was conducted with CNA B. CNA B was asked if the medication storage room is left open during the day? Yes, it is. However, usually, when it is open there are people sitting at the desk. CNA B was asked if they have seen the door open before with no one at the desk? Yes, I saw it that way before, with no one at the desk. It happens sometimes.On 4/16/26 at 9:50am, an interview was conducted with Environmental Services (ES) C:…
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.
- Potential for harm · D2026-01-29 · tag F0690 — failed to manage incontinence, catheters, and urinary infections — isolatedProvide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review the facility failed to provide appropriate treatment and services for an indwelling catheter for three residents (R3, R4, R19) of three residents reviewed for indwelling catheters, resulting in leaky catheter tubing, catheter tubing touching the floor and urine collection bags being uncovered. Findings include: Resident #19: R19 is [AGE] years old and admitted to the facility on [DATE]. R19 has a brief interview for mental status (BIMS) score of 14, indicating that he is cognitively intact. On 01/27/2026 at 10:21AM, during observation and interview with R19, the urine collection bag is observed not covered, urine was present and it was visible from the hallway. On 01/29/2026 at 8:36AM, during follow up observation and interview with R19, the urine collection bag is observed not covered, urine was present and visible upon entering the room. On 01/29/2026 at 8:41AM, an interview was conducted with the infection control (IC) nurse A. IC nurse A was asked 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.
- Potential for harm · E2024-11-20 · tag F0584 — failed to keep a safe, clean, comfortable home — patternHonor 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
Based on observation, interview, and record review, the facility failed to ensure a sanitary and homelike environment in the residents' bathroom and communal shower room, for four residents (#9, #13, #15, #16), and residents that use the shower room), of five residents reviewed for homelike environment, resulting in the potential for embarrassment, dissatisfaction of living conditions, and spread of infection. ]Findings include: Resident #9: An observation was made on 11/18/24 at 9:55 AM in Resident #9's bathroom of a denture cup under the hot water faucet handle at the sink. The lid of the denture cup was positioned just under the faucet handle. On 11/18/24 at 1:24 PM, an observation was made in Resident #9's room of the denture cup that was positioned under the hot water faucet handle of the sink. The room was shared with two residents. Resident #13: An observation was made on 11/18/24 at 9:56 AM of a denture cup positioned under the hot water faucet handle of the sink. Can not wash hands without the potential to drip or come in contact with the top of the denture cup. The room…
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.
- Potential for harm · D2024-11-20 · tag F0578 — failed to honor advance directives / code status — isolatedHonor 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
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review the facility failed to ensure that physicians' orders for code status was present in the EMR (electronic medical record) for three residents (R15, R19 and R21) of four residents reviewed for advance directives, resulting in the absence of code status orders in the EMR and the potential for the resident's preference for life sustaining treatment to not be followed by the facility. Findings include: Resident #19: R19 is [AGE] years old and re-admitted to the facility most recently on 03/19/2019 with diagnoses that include paraplegia, chronic pain, muscle wasting and contractures of the bilateral upper extremities. R19 has a BIMS (brief interview for mental status) score of 15 indicating they are cognitively intact. On 11/18/24 at 02:24 PM, record review revealed there was no physician order for code status in the EMR (electronic medical record). A signed DNR (do not resuscitate) form was in the paper chart at the nurse's station. On 11/20/24 at 11:13 AM, record review revealed…
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.
- Potential for harm · D2024-11-20 · tag F0656 — failed to write and follow a full care plan — isolatedDevelop 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 observation, interview and record review, the facility failed to develop and implement comprehensive person-centered care plans for two residents (Resident #6 and Resident #25), of 12 residents reviewed for care planning, resulting in the potential for unmet care needs and a decline in overall health and wellbeing. Findings include: Resident #6: A review of Resident #6's medical record revealed an admission into the facility on [DATE] with diagnoses that included right femur fracture, diabetes, poly arthritis, chronic pain and dementia. The Resident had an order, dated 5/31/24, Left hand resting hand splint at night-monitor skin integrity. On 11/18/24 at 11:10 AM, an observation was made of Resident #6 sitting in their room. A hand splint was observed among the Resident belongings. The Resident was observed to have right hand finger contracture. The Resident was interviewed, answered questions and engaged in limited conversation. When asked if the Resident could open her fingers up on her right hand,…
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.
- Potential for harm · D2024-11-20 · tag F0710 — isolatedObtain a doctor's order to admit a resident and ensure the resident is under a doctor's care.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review the facility failed to notify the physician of an unintended significant weight loss for one resident (Resident #17) of three residents reviewed for nutrition, resulting in a lack of physician oversight and potential interventions for weight loss. Findings include: Resident #17 (R17): R17 is [AGE] years old and re-admitted to the facility on [DATE] with diagnoses that include atrial fibrillation, nausea/vomiting, generalized weakness and GERD (gastroesophageal reflux disease). R17 has a BIMS (brief interview for mental status) score of 10 indicating moderate cognitive impairment. On 11/18/24 at 10:19 AM, R17 was asked if they felt like they had lost some weight since being in the facility. R17 stated they think they have lost some weight in the facility and believes it is because of their poor appetite. R17 stated, I really like the food but just don't always have the appetite to eat it. On 11/20/24 at 09:10 AM, record review revealed R17 has experienced an unintended…
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.
- Potential for harm · E2023-10-26 · tag F0726 — failed to have competent, trained nursing staff — patternEnsure 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 interview and record review, the facility failed to ensure that licensed nurses (RN-Registered Nurses, and LPN-Licensed Practical Nurses) and Certified Nursing Assistants (CNA) received yearly competencies and/or education/in-services for 4 of 12 staff reviewed for education and yearly competencies/education, resulting in the potential for nursing staff to lack the necessary qualifications and training to adequately care for the needs of all residents residing at the facility and according to the facility assessment. Findings include: On 10/19/23 at 2:05 PM, an interview was conducted with Director of Operations, Human Resources (HR) N during the Sufficient and Competent Nurse Staffing task of the survey. The training, Nurse licenses, CNA registrations, competencies, and backgrounds of five CNA's and five Nurses were reviewed with HR N. When asked about regular in-services, training and/or competencies for specific resident needs that were indicated in the Facility Assessment, such as hospice, the HR N indicated that the Relias training did not include Hospice training 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.
- Potential for harm · D2023-10-26 · tag F0645 — isolatedPASARR screening for Mental disorders or Intellectual Disabilities
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 that a timely Preadmission Screening/Annual Resident Review (PASARR) for a comprehensive level II OBRA evaluation was completed for one resident (Resident #14) of one resident reviewed for PASARR review, resulting in the potential for delayed mental health services and unmet care needs. Findings include: Resident #14: A review of Resident #14's medical record revealed an admission into the facility on 6/1/22 with diagnoses that included weakness, altered mental status, Alzheimer's dementia, PTSD (post-traumatic stress disorder), and depression with anxiety. Review of the Minimum Data Set assessment, dated 7/19/23 revealed the Resident had moderately impaired cognition and needed extensive assistance with bed mobility, dressing, and personal hygiene and was dependent on staff for transfers and toilet use. Further review of Resident #14's medical record revealed PASARR form DCH-3877, dated 2/15/23, had in Section II-Screening Criteria, was marked Yes 1. The person has a current diagnoses of Mental Illness and 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.
- Potential for harm · D2023-10-26 · tag F0657 — failed to keep the care plan current — isolatedDevelop 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 observation, interview and record review, the facility failed to ensure that care plans were evaluated, revised and/or updated for two residents (Resident #15 and Resident #17), of 14 residents reviewed for care planning, resulting in the lack of care plan revision and implementation of appropriate interventions and the potential for unmet care needs. Findings include: Resident #17: A review of Resident #17's medical records revealed an admission into the facility on 1/9/18 and re-admission on [DATE] with diagnoses that included dementia, Alzheimer's disease with behavioral disturbance, Parkinson's disease, generalized weakness, emphysema, and major neurocognitive disorder. Review of the Minimum Data Set (MDS) assessment, dated 9/14/23, revealed the Resident had severely impaired cognition and was total dependent on staff for activities of daily living such as bed mobility, transfer, locomotion on and off unit, dressing, eating, toilet use and personal hygiene. The MDS indicated the activity of walk in…
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.
Show the remaining 5 citations
- Potential for harm · D2023-10-26 · tag F0684 — failed to provide proper treatment and quality of care — isolatedProvide 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 observation, interview and record review, the facility failed to ensure proper communication/documentation of Hospice services were provided to one resident (Resident #25), of one resident reviewed for Hospice services and end-of-life care, resulting in a lack of coordination of comprehensive services and care provided to the resident and the potential for unmet care needs. Findings include: Resident #25: A review of Resident #25's medical record revealed an admission into the facility on [DATE] with diagnoses that included non-traumatic brain dysfunction, anxiety, atrial fibrillation, mood disorder, and Alzheimer's dementia. A review of the Resident's Minimum Data Set assessment, dated 9/14/23, revealed the Resident had severely impaired cognition and needed limited assistance with bed mobility, transfer, walk in room, dressing, toilet use and personal hygiene. Further review of the medical record revealed the Resident was receiving Hospice services. On 10/17/23 at 2:14 PM, the Resident was seen…
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.
- Potential for harm · D2023-10-26 · tag F0756 — failed to review each resident's drug regimen — isolatedEnsure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to ensure that drug regimen review recommendations were reviewed by the physician in a timely manner for one resident (Resident #21) of five residents reviewed for medications, resulting in the potential for the resident to receive unnecessary medications with potential adverse effects. Findings Include: Resident #21: Unnecessary Meds, Psychotropic Meds, and Med Regimen Review A record Review of the Face sheet and Minimum Data Set (MDS) assessment indicated Resident #21 was admitted to the facility on [DATE] with diagnoses: diabetes, diabetic wound right great toe non/healing, chronic kidney disease, hypertension, peripheral vascular disease, gout, arthritis, anemia, sepsis, osteomyelitis (bone infection). The MDS assessment dated [DATE] revealed the resident had full cognitive abilities with a Brief Interview for Mental Status (BIMS) score of 15/15 and the resident needed some assist with all care. A review of the monthly pharmacy reviews of 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.
- Potential for harm · Dcited before2023-10-26 · tag F0761 — failed to label and store drugs safely — isolatedEnsure 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 record review, the facility failed to properly secure a medication cart with medical supplies and prescription medications for the Long Hall medication cart, resulting in the medication cart left unlocked and not under direct supervision of the Nurse with the potential for drug diversion and ingestion of prescription medications. Findings include: On 10/18/23 at 12:05 PM, an observation was made of the Long Hall medication cart not locked and without a Nurse within the vicinity of the medication cart. An observation was made of staff in and out of the Nurses' Station and Resident's in the hallway. While waiting for the Nurse to return, an observation was made of Nurse K coming from the short hallway and returned to the cart. The Nurse had a cup with medication in her hand. When asked about the unsecured medication cart, the Nurse reported that she was responding to a call for help with an altercation between the housekeeping staff and a resident, and reported she was just around the corner and had taken the medication with her which was the cup in…
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.
- Potential for harm · D2023-10-26 · tag F0880 — failed to prevent and control infections — isolatedProvide and implement an infection prevention and control program.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to follow evidence-based practices for Infection Control, including : 1) That Infection Prevention and Control Program (IPCP) policies were reviewed annually, and 2) That surveillance for infectious illnesses was analyzed for identification of infections, communicable diseases, trends, patterns, and reported routinely, resulting in the potential for a lack of guidance to ensure compliance with infection control standards and exposure to infectious organisms, which could lead to an unidentified outbreak. Findings Include: FACILITY Infection Control On 10/25/23 at 11:07 AM, during a review of the Infection Prevention and Control Program (IPCP) with Infection Preventionist/IP Q, the facilities Infection Control policies were reviewed. The Infection Prevention and Control Program, was dated effective December 1, 2018 and last reviewed 10/2021; the program plan had not been reviewed yearly to ensure it contained current information. The Legionella Policy…
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.
- Potential for harm · D2023-10-26 · tag F0909 — failed to maintain a comfortable temperature — isolatedRegularly inspect all bed frames, mattresses, and bed rails (if any) for safety; and all bed rails and mattresses must attach safely to the bed frame.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation, interview and record review, the facility failed to conduct inspection of bed assist bars to monitor securement, bed safety and risk for entrapment for one resident (Resident #2) of two residents reviewed for bed assist bar safety, resulting the potential of injury and entrapment. Findings include: Resident #2: A review of Resident #2's medical record revealed an admission into the facility on 6/21/18 with diagnoses that included peripheral vascular disease, cellulitis of lower extremities, cerebrovascular disease, osteoporosis, non-traumatic brain dysfunction, depression, and dementia. A review of the Minimum Data Set assessment, dated 9/14/23, revealed the Resident had severe cognitive impairment, was independent in bed mobility, needed limited assistance with transfer, and extensive assistance with locomotion on unit, dressing, toilet use and personal hygiene. On 10/17/23 at 10:26 AM, an observation was made of Resident #2 dressed and sitting in her wheelchair in her room. An interview was conducted with the Resident who engaged in conversation. The Resident…
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.
“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.
- 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.
Fines & penalties
No federal fines in the current CMS record.
Who owns this facility
| Owner / manager | Type | Role | Since |
|---|---|---|---|
| HUNTER, DAVID | Individual | CORPORATE DIRECTOR | since 01/01/2008 |
| KABBAN, ELIAS | Individual | CORPORATE DIRECTOR | since 01/01/2008 |
| KADAR, WAYNE | Individual | CORPORATE DIRECTOR | since 01/01/2008 |
| KHAN, ALI | Individual | CORPORATE DIRECTOR; OPERATIONAL/MANAGERIAL CONTROL | since 06/01/2017 |
| MCCOLLOUGH, PATRICK | Individual | CORPORATE DIRECTOR | since 04/27/2011 |
| RAYL, SCOTT | Individual | CORPORATE DIRECTOR | since 04/28/2010 |
| SLOAN, JANET | Individual | CORPORATE DIRECTOR | since 04/23/2013 |
| WOODKE, GREGORY | Individual | CORPORATE DIRECTOR | since 06/01/2015 |
| WEHNER, JILL | Individual | CORPORATE OFFICER; OPERATIONAL/MANAGERIAL CONTROL | since 07/01/2023 |
CMS files one row per role, so the 11 rows in the source record cover these 9 parties — each is shown once here with every role it holds. Nothing is omitted. The source lists no ownership percentage for any of them — PECOS records a share only for equity interests, not for board or management roles.
What families pay in MI
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 Michigan Medicaid page.
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 235295. CMS refreshes its data monthly, and the star rating rests on the last standard inspection — dated 2026-01-29, 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.