The Foley Center at Chestnut Ridge

Location & what’s nearby

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Nearest of each type, straight-line distance. Hospitals come from the CMS Hospital General Information registry; everything else from Overture Maps (public data). Hospital and park hours are typical — call ahead to confirm.

Quality measures — how residents actually fare

Quality-measure stars summarize outcomes CMS tracks from the assessments each home submits — avoidable hospitalizations and ER visits, falls with injury, pressure ulcers, unplanned weight loss, and long-term antipsychotic use. Because the underlying data is self-reported, weigh a high score against the independent inspection record. Long-stay = permanent residents; short-stay = rehab and post-hospital stays.

Short-stay rehab — if you are coming here from a hospital

Arriving from a hospital right now? Read the discharge guide → — your appeal rights, how to slow a rushed discharge, and what to ask about the numbers below.

52.4% 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 199 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.

Met the expected recovery: 72.5% 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 109 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 0.32 therapist hours per resident per day in 2026Q1 — more than 53% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 13% of this home’s weekday level — it runs some therapy at the weekend, at a lower level than on weekdays. The median home that reports therapy runs 13% — weekday-focused therapy is the industry norm, not a shortfall. But recovery does not pause on a Saturday: ask what the weekend actually looks like here.

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

Staffing

How full it usually is: this home is certified for 92 beds and averages 80.6 residents a day — about 88% occupied, or roughly 11 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 3.45 hrs/resident/day is below the 3.48-hour benchmark and RN staffing of 0.66 is at or above the 0.55-hour RN benchmark and nurse-aide staffing of 2.18 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 3.26 hrs/resident/day on weekends vs 3.53 on weekdays — 7% thinner on weekends. RN hours go from 0.78 to 0.37 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 64% is well above 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.

20 citations, most serious first. The 14 most serious are shown; the remaining 6 are one tap away and print in full.

• Immediate jeopardy · J2024-07-03 · 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 record review, staff, Social Worker (SW), Nurse Practitioner (NP), and Medical Director (MD) interviews the facility failed to notify a medical provider when Resident #278 was noted by Medication Aide (MA) #1 to have difficulty breathing, had an oxygen saturation in the high 70's/low 80's (normal oxygen saturation is 92 to 100%), and was asking for help. On [DATE] at 7:00 am MA #1 was told by Nurse #2 that Resident #278 was having issues with breathing. MA #1 checked Resident #278 and noted an oxygen saturation in the high 70's/low 80's, and got the Director of Nursing (DON). The DON advised MA #1 to place Resident #278 on oxygen and continue to monitor her oxygen saturation levels. MA #1 reported Resident #278's oxygen saturation levels remained in the 80's and she appeared to be struggling to breathe and was asking for help. MA #1 continued to report breathing issues and concern about Resident #278 throughout the shift to the DON until Resident #278 was removed from the facility on [DATE] at 4:47 pm…

  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
• Immediate jeopardy · J2024-07-03 · tag F0600 — failed to protect residents from abuse and neglect — isolated
  Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record reviews, and Resident Representative (RR), staff, Nurse Practitioner (NP), and Medical Director (MD) interviews the facility failed to protect a Resident's right to be free from neglect when they failed to provide effective care and services to a resident experiencing a medical emergency. On [DATE] MA #1 was told by Nurse #2 that Resident #278 was not doing well. MA #1 checked Resident #278 and noted an oxygen saturation in the high 70's/low 80's (normal oxygen saturation is 92 to 100%), and got the Director of Nursing (DON). The DON advised MA #1 to place Resident #278 on oxygen and monitor oxygen saturation levels. MA #1 continued to report breathing issues and concern about Resident #278 to the DON throughout the day until Resident #278 was removed from the facility by the RR at 4:47 pm. The RR took Resident #278 to the Emergency Department where Resident #278 was diagnosed with Influenza A (the flu) Influenzal Bronchitis (inflammation of the airway), had an elevated white blood cell count…

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

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
• Immediate jeopardy · J2024-07-03 · 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, and staff, Resident Representative (RR), Social Worker (SW), Nurse Practitioner (NP), and Medical Director (MD) interviews Based on record review, and staff, Resident Representative (RR), Social Worker (SW), Nurse Practitioner (NP), and Medical Director (MD) interviews the facility failed to complete and document on-going thorough assessments for an acute change in condition and failed to respond effectively to a medical emergency. On [DATE] at 7:00 pm, Resident #278's Representative requested a chest x-ray, when Nurse #1 observed Resident #278 had a cough, congestion, and decreased appetite. Resident #278 was seen by the NP on [DATE] who ordered an oral medication for breaking up mucous/congestion every 12 hours and nebulizer breathing treatments four times a day were ordered for 7 days for a cough. On [DATE] at 7:00 am, Medication Aide (MA) #1 was told by the off going nurse, Nurse #2, that Resident #278 was not doing well. MA #1 checked Resident #278's oxygen saturation and noted it…

  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
• Actual harm · G2024-07-03 · tag F0697 — failed to manage pain — isolated
  Provide safe, appropriate pain management for a resident who requires such services.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, Resident Representative (RR), staff, Nurse Practitioner (NP) interviews, the facility failed to address a resident's pain after a resident requested pain medication and was observed screaming in pain, crying, and very upset by Nurse #10 on [DATE]. The deficient practice occurred for 1 of 3 residents (Resident #279) reviewed for pain. The findings included: Resident #279 was admitted to the facility on [DATE] with a diagnosis of left artificial knee joint replacement. A review of a physician's order dated [DATE] revealed an order for Resident #279 to be administered oxycodone (pain medication) 10 milligrams (mg) every four hours as needed for pain for 5 days. The order expired on [DATE]. A review of a physician's order dated [DATE] revealed an order for Resident #279 to be administered acetaminophen (pain medication) 1000 mg, every four hours as needed for general discomfort). A review of the January and February 2024 Medication Administration Record (MAR) revealed documentation that…

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

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Ecited before2025-07-31 · 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 observations and staff interviews, the facility failed to label and date leftover food and failed to discard food items by the expiration or used by date for 1 of 3 nourishment room refrigerators (300/400 hall) reviewed for food storage. This practice had the potential to cause foodborne illnesses.Findings included:An observation and interview were conducted on 07/28/25 at 10:50 AM with the Certified Dietary Manager (CDM) for review of the nourishment room refrigerator. The following were observed in the nourishment room refrigerator designated for the 300 and 400 hall used to store food brought into the facility for residents: a. A 12-ounce unopened container of egg salad with a use by date of 7/19/25. The CDM stated the date on the egg salad container indicated it should have been discarded on 7/19/25.b. A 10-ounce opened container of orange juice with a use by date of 6/25/25. The container did not have a resident name. The CDM revealed the orange juice should have been discarded on 6/25/25 as indicated on the container use by date and labeled with the resident's name.…

  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 · D2025-07-31 · 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

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, and interviews with the Medical Director and staff, the facility failed to prevent a medication error when Nurse #2 administered a medication to a resident without a physician's order. On 6/21/25, Resident #92 received a 300 milligram (mg) dose of gabapentin (nerve pain medication) that was left in a medication cup labeled with Resident #94's last name. The deficient practice occurred for 1 of 6 residents reviewed for unnecessary medications (Resident #92). Findings included: Resident #92 was admitted to the facility on [DATE] with diagnoses including volvulus (abnormal twisting of intestine) and aftercare following digestive system surgery, and chronic pain. The admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #92's cognition was moderately impaired. A review of Resident #92's active physician order summary as of 6/21/25 revealed no order was in place for the administration of gabapentin. Resident #94 was admitted to the facility on [DATE] with diagnoses…

  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 · D2025-07-31 · tag F0761 — failed to label and store drugs safely — isolated
  Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, and staff interviews, the facility failed to secure an opened tube of antifungal ointment and an opened tube of zinc oxide cream for 1 of 1 resident reviewed for medication storage (Resident #80). Resident #80 was admitted to the facility on [DATE]. The quarterly Minimum Data Set (MDS) assessment dated [DATE] coded Resident #80 with intact cognition. A review of Resident #80's medical records revealed he had never been assessed for self-administration of medication. During an observation conducted on 07/28/25 at 12:59 PM, one opened tube of Miconazole nitrate cream (an over-the-counter antifungal medication used to treat fungal infections of the skin, such as athlete's foot, jock itch, and ringworm) with the concentration of 2%, and an opened tube of Zinc oxide (a topical cream used to treat and prevent diaper rash) with the concentration of 20% were observed left unattended on top of the window sill in Resident #80's room and ready to be used. An interview was conducted with…

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

  Pharmacy Service Deficiencies · Deficient, Provider has date of correction
• Potential for harm · E2024-07-03 · tag F0607 — failed to have anti-abuse policies — pattern
  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

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and facility staff and Power of Attorney interviews, the facility failed to follow their abuse, neglect, and exploitation policies when they failed to immediately remove a nurse aide (Nurse Aide #10) from the facility following a reported allegation of potential abuse involving a resident (Resident #41). This resulted in the facility failing to protect the resident or other residents from potential further abuse. The facility also failed to thoroughly investigate an allegation of misappropriation of resident property involving Resident #26. This occurred for 2 of 4 residents reviewed for Abuse. The findings included: 1. Review of the facility's policy titled Abuse Identification last revised in January 2023 read, in part, under the section, Taking Steps to Prevent Further Potential Abuse: The administrator or director of nursing should ensure that steps are taken to prevent further abuse from occurring. These actions may include but are not limited to: Suspending the employee. Resident #41…

  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 · E2024-07-03 · tag F0644 — pattern
  Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and facility staff interviews, the facility failed to request a Pre-admission Screening and Resident Review (PASARR) review for a resident who was newly diagnosed with psychosis for 1 of 1 resident reviewed for level II PASARR. (Resident #50) The findings included: Resident #50 was admitted to the facility on [DATE] with diagnoses that included depression, and anxiety disorder. Review of Resident #50's quarterly Minimum Data Set assessment dated [DATE] revealed her to be moderately impaired with no delusions, behaviors, rejection of care, or instances of wandering. Resident #50 was coded as receiving antipsychotic and antidepressant medication. Resident #50 was coded as receiving antipsychotic medications on a routine basis and that a gradual dose reduction had been attempted and was not clinically contraindicated. Review of Resident #50's medical record revealed a pharmacy review dated 11/10/23 that requested a clarification diagnosis for the use of an antipsychotic. Additionally, 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 · E2024-07-03 · tag F0690 — failed to manage incontinence, catheters, and urinary infections — pattern
  Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, record review, Resident, staff, Nurse Practitioner (NP), and Medical Director (MD) the facility failed to have a documented diagnosis for the use of an indwelling urinary catheter (Resident #18) and facility failed to prevent urinary catheter bags from touching the floor to reduce the risk of infection (Resident #48) for 2 of 2 residents (Resident #18 and Resident #48) reviewed for urinary catheter. The findings included: 1) Resident #18 was admitted to the facility on [DATE] with no urinary diagnosis. A review of the physician's orders 2/13/2024 revealed an order for Resident #18 was to have an indwelling urinary catheter removed and replaced with a new catheter every 21 days and as needed for leaking or occlusion and was signed by the Medical Director (MD). A review of a history and physical note dated 2/19/2024 completed by the MD revealed Resident #18 was admitted from the hospital due to a necrotic (dead tissue) lesion on his right foot which required amputation. Resident #18 was…

  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 · E2024-07-03 · tag F0695 — failed to provide proper breathing / tracheostomy care — pattern
  Provide safe and appropriate respiratory care for a resident when needed.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, record review, and staff interviews, the facility failed to have cautionary oxygen signage posted (Resident #15) and failed to keep an oxygen concentrator free from dust and debris (Resident #37) for 2 of 3 residents reviewed for respiratory care. The findings included: 1. Resident #15 was admitted to the facility on [DATE] with diagnoses that included heart failure. The admission Minimum Data Set assessment dated [DATE] revealed Resident #15's cognition was severely impaired, and she required supplemental oxygen. A review of Resident #15's medical record revealed an order dated 05/28/24 for the hall nurse to wean oxygen via nasal cannula to maintain oxygen saturation above 92%. On 06/25/24 at 1:02 PM during an observation of Resident #15, the Resident wore supplemental oxygen via nasal cannula at 0.5 liters per minute. There was no oxygen cautionary sign posted on or near the Resident's door to indicate oxygen was in use. Subsequent observations of no cautionary sign posted on or near…

  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 · E2024-07-03 · tag F0759 — failed to keep medication error rate low — pattern
  Ensure medication error rates are not 5 percent or greater.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on observations, record review, staff, Nurse Practitioner (NP), and Medical Director (MD) interviews the facility failed to maintain a medication error rate of less than 5% by having 10 errors out of 25 opportunities which resulted in a 40% medication error rate. This affected 1 of 11 residents observed on medication pass (Resident # 286). The findings included: A review of Resident #286's 6/27/2024 active physician's orders revealed the following: - Prednisone (steroid medication) 10 milligrams (mg) tablets, 2 tablets by mouth one time a day for COPD. - Buspirone HCL (anxiety medication) 15 mg tablets, 2 tablets by mouth three times a day for anxiety. - Sertraline (depression and/or anxiety medication) HCL 100 mg tablets, 2 tablets by mouth one time a day for depression. - Levothyroxine Sodium (thyroid hormone medication) 150 micrograms (mcg) tablet once a day for hypothyroidism. - Hydralazine HCL (medication used to treat high blood pressure) 50 mg tablet by mouth two times a day for hypertension (high blood pressure). - Amlodipine Besylate (blood pressure medication) 10 mg…

  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 before2024-07-03 · 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 observations and staff interviews, the facility failed to label and date open food items and discard items that were beyond their expiration date in 1 of 1 walk in refrigerators and 2 of 3 reach in refrigerators in the kitchen. The findings included: On an initial tour of the facility's kitchen on 06/25/24 at 10:17 AM, an open gallon of whole milk with a sell by date of 06/23/24 located in a reach-in refrigerator. An observation of the facility's 2nd of 3 reach-in refrigerators revealed open and undated package of American cheese slices and ¼ block of open and undated butter with portions of the butter open to air. The cheese was wrapped in cellophane while the butter was in the original paper wrapping that was simply folded over the used end of the butter block. During a follow-up visit to the kitchen on 06/27/24 at 11:58 AM an observation of the walk-in refrigerator revealed an open and undated bag of shredded mozzarella cheese with a use by date of 06/09/24. An interview with the Dietary Manager on 06/27/24 at 12:01 PM she reported she goes through the refrigerators…

  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 · D2024-07-03 · tag F0550 — failed to protect resident dignity and rights — isolated
  Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and staff interviews, the facility failed to treat a resident with dignity and respect when a nurse aide was witnessed with her hand raised to a cognitively impaired resident's face during an interaction in the resident's room for 1 of 4 residents reviewed for dignity (Resident #41). A reasonable person would not like someone raising a hand in front of their face. The findings included: Resident #41 was admitted to the facility on [DATE]. Review of Resident #41's quarterly Minimum Data Set assessment dated [DATE] revealed Resident #41 was moderately cognitively impaired. Review of facility provided allegations of abuse, neglect, or misappropriation revealed Resident #41 was involved in an altercation with Nurse Aide #10 on 01/27/24 in which Nurse Aide #11 heard shouting coming from Resident #41's room and when she arrived, she witnessed Nurse Aide #10 and Resident #41 standing close together and face to face with Nurse Aide #10's hand raised in the air toward Resident #41's face. An…

  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.

Fines & penalties

$17,114 in federal fines across 1 penalty.

• $17,114 — penalty dated 2024-07-03

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

Part of a chain

This home belongs to LIBERTY SENIOR LIVING — 37 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 →

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

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.

This home reported $4.3M paid to related parties — landlords or management companies under common ownership — equal to about 34% of its total expenses. Money routed to affiliated companies can leave a home’s own books looking lean while owners still profit; it is the mechanism regulators watch most closely in private-equity and REIT deals. 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

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 NC