No sales calls · nothing personal collected unless you ask us to · no facility pays to be here
Text size
Contrast

Gallup Nursing & Rehabilitation LLC

306 East Nizhoni Blvd, Gallup, NM 87301 · For profit - Limited Liability company · 62 certified beds · (505) 863-9551 Medicare & Medicaid certified

Need help choosing, fast? Free, unbiased: Eldercare Locator 1-800-677-1116
Abuse-prevention, restraint, or reporting citation — no harm found (F0609) — cited Dec 2024Behavioral-health or dementia-care citation — no harm found (F0740)1 immediate-jeopardy citation
Insights

This home has serious findings on its record. Read them closely before you consider it.

In its favor
  • 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
Worth asking about
  • it has a citation for its abuse-prevention policies, restraint use, or reporting and investigating of allegations (F0609) — cited below the harm level, meaning inspectors found the process wanting but did not find a resident harmed
  • inspectors cited 1 immediate-jeopardy problem — the most serious level
  • a high number of inspection citations overall (20) — worth reading through, though larger and more-often-surveyed homes tend to accrue more lower-severity tags
  • about 26% of its spending goes to commonly-owned related companies

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.

5/5
CMS overall
5 of 5
Health inspectionSurveyor-assigned, ranked within your stateInspector-verified 5 of 5
StaffingFrom payroll records (PBJ) 3 of 5
Quality measuresSelf-reported by the facility 5 of 5

Location & what’s nearby

Hospital
★★ 2/5 CMS · Emergency dept. usually open 24/7 · ER 24/7
Urgent care / clinic
516 E Nizhoni Blvd · (505) 722-1220 · Call to confirm hours
Pharmacy
204 S 3rd St · (505) 862-9707 · Call to confirm hours
Grocery
610 W Mesa Ave · (505) 722-7000 · Call to confirm hours
Park
Unm Trail0.6 mi
705 Gurley Ave · Typically dawn to dusk
Place of worship

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 5 of 5
Long-stay residentspeople who live here 5 of 5
Short-stay residentsrehab / post-hospital 5 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 improved from 4 to 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.

Overall rating5★
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 increased3.4%11.3%15.4%better
Long-stay residents who lose too much weight0.7%4.0%5.4%better
Long-stay residents with a catheter left in their bladder0.5%0.9%0.9%better
Long-stay residents with a urinary tract infection0.6%0.9%2.0%better than state — see note marked double-dagger below the table
Long-stay residents with depressive symptoms0.0%2.0%6.5%check this — see note marked star below the table
Long-stay residents who were physically restrained0.0%0.0%0.1%better than state — see note marked double-dagger below the table
Long-stay residents with falls causing major injury3.4%3.5%3.3%typical
Long-stay residents whose ability to walk worsened4.1%11.7%16.1%better
Long-stay residents on antianxiety or hypnotic medication3.4%14.7%18.9%better
Long-stay residents given the seasonal flu vaccine100.0%98.7%95.3%typical
Long-stay residents with pressure ulcers5.9%5.2%4.7%worse
Long-stay residents with worsening bladder/bowel control17.3%20.0%21.2%better
Long-stay residents who got an antipsychotic medication — see the note below the table16.0%14.5%17.1%typical
Short-stay residents who newly got an antipsychotic medication0.3%1.1%1.4%better
Short-stay residents given the seasonal flu vaccine85.6%86.4%79.4%typical
Short-stay residents rehospitalized after admission20.1%22.0%22.6%better
Short-stay residents with an outpatient ER visit3.9%15.7%12.0%better
Long-stay hospitalizations per 1,000 resident days1.101.651.67better
Long-stay outpatient ER visits per 1,000 resident days1.502.811.80better

* 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.

On this measure the state average is at least twice (or half) the typical state — a gap that size is usually how the state codes and reports the measure, not how its homes actually perform. Against a benchmark this state does not sit on, a “vs typical state” verdict would mostly be measuring the state, so we compare this home with its own state instead and show both averages.

§ 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.

52.8% 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 95 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.

52.8%U.S. median 51.5%
Got home and stayed home
12.8%U.S. median 10.7%
Went back to hospital
66.3%U.S. median 56.6%
Met the expected recovery
0.32U.S. median 0.31
Therapy hours / resident / day
0.13hours / resident / day
Physical therapy
0.13hours / resident / day
Occupational therapy
0.06hours / resident / day
Speech therapy

Met the expected recovery: 66.3% 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 86 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 52% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 21% 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 SNF52.8%CMS range 40.3–62.551.5%Oct 2022–Sep 2024no different from U.S.
Went back to hospitalRate of potentially preventable hospital readmissions 30 days after discharge from a SNF12.8%CMS range 8.1–16.510.7%Oct 2022–Sep 2024no 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 discharge66.3%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 discharge72.1%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 discharge54.6%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 identified95.8%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 discharge98.5%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 stay0.0%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 worsened2.5%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 hospitalization6.1%CMS range 3.5–10.97.1%Oct 2023–Sep 2024no different from U.S.
Medicare spending per stayMedicare Spending Per Beneficiary (MSPB) for residents in SNFs0.841.02Oct 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

0.73
RN hours/ resident / day
0.37
LPN hours/ resident / day
2.16
Aide hours/ resident / day
3.26
Total nurse hours/ resident / day
0.55
RN hoursweekends
46.4%
Total nursing turnover
40.0%
RN turnover

How full it usually is: this home is certified for 62 beds and averages 58.7 residents a day — about 95% occupied, or roughly 3 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 3.26 hrs/resident/day is below the 3.48-hour benchmark and RN staffing of 0.73 is at or above the 0.55-hour RN benchmark and nurse-aide staffing of 2.16 is below the 2.45-hour aide benchmark. What federal law does require today is unchanged: “sufficient” nursing staff for residents’ needs and an RN on duty at least 8 consecutive hours a day, 7 days a week (42 CFR 483.35). Those are judged by inspectors on site, not by these averages, so read this comparison alongside the inspection record rather than as a pass/fail.

Weekend coverage: total nurse staffing is 2.84 hrs/resident/day on weekends vs 3.44 on weekdays — 17% thinner on weekends. RN hours go from 0.81 to 0.55 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 46% is about the same as the national median of 45%.

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

Inspection trend

6
deficiencies at the latest standard inspection (2026-01-23)
4
at the previous standard inspection (2024-10-10)

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

Inspection deficiencies

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

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.

20 citations, most serious first. The 11 most serious are shown; the remaining 9 are one tap away and print in full.

  • Immediate jeopardy · J2024-12-18 · tag F0684 — failed to provide proper treatment and quality of care — isolated
    Provide appropriate treatment and care according to orders, resident’s preferences and goals.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on record review and interview, the facility failed to ensure residents received treatment and care in accordance with professional standards of practice for 1 (R #1) of 3 (R #'s 1, 2 and 3) residents when they failed to properly assess a resident following an unwitnessed fall that resulted in injury. If the facility fails to properly assess residents who have an unwitnessed fall with an injury, then the residents may experience unidentified life-threatening conditions such as a brain bleed. This deficient practice likely contributed to the hospitalization and passing of R #1. The findings are: A. Record review of Face Sheet for R #1 revealed an admission date of 7/13/24 and a discharge date of 09/21/24 and included the following diagnoses: - Lack of Coordination - Muscle Wasting and Atrophy (wasting away) - Depression (mood disorder that causes a persistent feeling of sadness and loss of interest) - Generalized Muscle Weakness (muscle weakness that affects the whole body) - Dysphagia (difficulty swallowing) - Difficulty in Walking - Parkinson's Disease (a brain disorder 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 before2026-01-23 · 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

    Based on record reviews and interviews, the facility failed to follow physician orders for 2 (R #50 and R #51) of 2 (R #50 and R #51) residents reviewed when: Facility staff failed to administer or withhold blood pressure medications as directed by blood pressure parameters (boundary or limit defining scope of particular activity or process) per R #50 and R #51's physician's order. If the facility does not follow physician orders for the management of a resident's blood pressure, then it is likely to result in the resident not maintaining optimal health outcomes as established by the medical provider. The findings are: R #50: A. Record review of R #50's physician's order dated 07/16/25 revealed, R #50's lisinopril (medication used to treat high blood pressure) medication was ordered to be held for systolic blood pressure (the pressure in the arteries when the heart beats, represented as the first (top) number in a blood pressure reading) less than 110 millimeters of mercury (mmHg). B. Record review of R #50's Medication Administration Record (MAR) dated 01/01/26 to 01/21/26,…

    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 · E2026-01-23 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — pattern
    Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation and interview, the facility failed to maintain a safe environment and protect the residents from the potential for accidents and hazards by: Failing to ensure adhesive tape (is a strip of material with a sticky surface on one side that is used to hold, fasten, or secure items in place) applied to resident room floors remained secured and flat to the surface in Room (RM) #41, Failing to ensure a water hose connected to the ice machine remained secured within its protective case, allowing water to drip onto the floor in a hall that is accessible to all residents. This deficient practice is likely to affect all 57 residents listed on the facility census by creating a tripping and slipping hazards, which can put the residents at risk for falls and potential injury. The findings are: A. On 01/21/26 at 10:31 a.m., during an observation of RM #41, multiple strips of adhesive tape were applied directly on the bedroom floor near the bedside area. Several strips of tape appeared worn, partially detached, and curling upward at the edges. Dark adhesive residue remained on…

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

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · E2026-01-23 · tag F0921 — failed to keep a safe, functional, sanitary building — pattern
    Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation and interview, the facility failed to ensure residents had a safe and functional environment for 7 (Rooms: RM's #15, 31, 33, 34, 36, 37, 43, 44 ) of 13 (RM's #15, 16, 17, 21, 25, 31, 33, 34, 36, 37, 43, 44, 45 and 49) rooms observed when the facility failed to: Repair walls with intact, smooth, and cleanable surfaces (scuff marks, chipped paint, uneven paint, visible putty).Repair windowsills and surrounding tiles.Repair fixtures and building components (heating vent and electrical outlet). These deficient practices are likely to expose residents to an unsafe and uncomfortable environment. The findings are: A. On 01/21/26 at 3:12 pm during an observation of RM #15, the windowsill closest to Bed B was unpainted and separating from the wall with a gap approximately 0.5 inches. B. On 01/23/26 at 9:50 am, during an observation of RM # 31, the bathroom walls had scuff marks and chipped paint. C. On 01/23/26 at 9:51am, during an observation of RM #33, the windowsill closest to Bed B had a loose tile. D. On 01/23/26 at 9:53 am, during an observation of RM #34, 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.

    Environmental Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Dcited before2026-01-23 · tag F0655 — isolated
    Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, the facility failed to create a baseline care plan (minimum healthcare information necessary to properly care for a resident immediately upon their admission to the facility) within 48 hours of admission for 1 (R #67) of 1 (R #67) resident reviewed for baseline care plans. This deficient practice could likely result in the residents' preferences and care needs not being met. The findings are: A. Record review of the facility's Care Plans- Baseline policy dated December 2016 revealed, to ensure resident's immediate care needs are met and maintained, a baseline care plan will be developed within forty-eight (48) hours of the resident's admission. B. Record review of R #67's face sheet revealed R #67 was admitted into the facility on [DATE]. C. Record review of R #67's baseline care plan revealed R #67's care plan was initiated on 01/12/26 (initiated and completed after 48 hours of admission). D. On 01/23/26 at 9:31 am, during an interview with Director of Nursing (DON), she…

    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 · D2026-01-23 · tag F0842 — failed to keep accurate, complete medical records — isolated
    Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on a record review and interviews, the facility failed to ensure medical records were complete for 1 (R #51) of 1 (R #51) resident reviewed when staff failed to: Document accurately and completely when R #51 was not administered medication per physician's orders. This deficient practice is likely to result in staff not having the information they need to provide competent, comprehensive care and services to residents. The findings are: A. Record review of R #51's physician's orders dated 11/20/25 revealed, R #51's carvedilol (medication used to treat chronic heart failure, left ventricular dysfunction following heart attack, and high blood pressure) administration for hypertension (HTN; high blood pressure) to be held for systolic blood pressure (the pressure in the arteries when the heart beats, represented as the first (top) number in a blood pressure reading) of less than 110 mmHg or a heart rate less than 60 beats per minute. B. Record review of R #51's Medication Administration Record (MAR) dated 01/01/26 to 01/21/26 revealed the administration for carvedilol on 01/01/26…

    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 before2026-01-23 · tag F0880 — failed to prevent and control infections — isolated
    Provide 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 observation, record review, and interviews, the facility failed to maintain an infection prevention and control program designed to provide a safe and sanitary environment to prevent the development and transmission of communicable diseases and infections for 1 (R #34) of 1 (R #34) resident reviewed for infection control when: The facility did not ensure R #34's urinary catheter (a thin, sterile tube inserted into the bladder to drain urine) drainage bag had a privacy bag (bag that covers urination drainage bag) present. The facility did not ensure R #34's urinary catheter tubing (is the flexible tube that carries urine from the catheter (inside the bladder) to the drainage bag outside the body) remained off the floor to prevent contamination. These deficient practices are likely to result in repeated and ongoing exposure of residents to increased risk of infection, cross-contamination, and injury. The findings are: A. Record review of the facility's Catheter Care Procedure (steps to maintain 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.

    Infection Control Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Dcited before2024-12-18 · tag F0609 — failed to report abuse allegations — isolated
    Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on record review and interview, the facility failed to provide facility Initiated Reports (mandatory self-initiated facility report of an incident) to the State Survey Agency (SSA) for 1 (R #1) of 3 (R #'s 1, 2 and 3) residents reviewed for incidents when staff failed to report an unwitnessed fall with an injury for R #1. The findings are: A. Record review of R #1's nursing progress notes dated 09/13/24 revealed that R #1 was found on the floor in his room laying on his stomach at the foot of the bed about 1 foot from floor safety mat. Upon assessment, resident was noted to have a cut about 4 centimeters long over his right eye. The wound was cleansed with normal saline, antibacterial ointment (topical medication used to prevent infections) was applied, and the wound was covered with a bandage which was used to reinforce and keep the resident from touching it. B. Record review of R #1's nursing progress note, also dated 09/15/24, revealed that R #1 had a change in condition of altered mental status. This nursing note also revealed that R #1 was alert and oriented x1 (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.

    Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · E2024-10-10 · tag F0848 — pattern
    Provide a neutral and fair arbitration process and agree to arbitrator and venue.
    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 their binding arbitration agreement included a provision for convenient venue (a location in which to carry out arbitration proceedings which should be agreed upon and suitable for both parties) selection. Failure to include this provision in the agreement could likely result in residents who choose to seek arbitration experiencing frustration and difficulty deterring them from exercising their rights. This deficient practice has the potential to affect 56 of the 57 facility residents who signed the binding arbitration agreement. The findings are: A. Record review of the facility's Voluntary Arbitration Agreement, undated, revealed it did not contain a provision for the selection of a convenient venue should arbitration become necessary. B. On 10/10/24 at 1:00 pm during an interview with the facility Administrator, she confirmed the binding arbitration agreement did not include a provision for a convenient venue selection and added the provision was stated in the facility's admission Guide. C. Record review 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.

    Administration Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2024-10-10 · 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

    Based on observation, record review, and interview, the facility failed to promote care with dignity and respect for 1 (R #35) of 1 (R #35) residents reviewed for residents' rights when staff closed the resident's room door against his wishes and without communicating why to the resident. This deficient practice is likely to result in residents feeling disrespected and as if they were kept in their room against their will. The findings are: A. On 10/07/24 at 1:35pm during at interview, R #35 stated the Housekeeping Manager (HM) #1 angrily slammed his door shut last week while he was listening to his music, which made him feel like the staff did not respect or care about his feelings. B. On 10/07/24 at 2:00pm, during an observation, R #35 listened to music. The volume was loud enough to be heard in the immediate hallway. Other residents in the hallway did not appear to be affected by the music. C. On 10/10/24 at 12:47pm, during an interview with HM #1, she recalled the incident in which she shut the resident's door and stated R #35's music was playing loudly while the staff had a…

    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 · Dcited before2024-10-10 · tag F0655 — isolated
    Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on record review and interview, the facility failed to create a Baseline Care Plan (minimum healthcare information necessary to properly care for a resident immediately upon their admission to the facility) within 48 hours of admission for 1 (R #108) of 3 (R #15, #25 and #108) residents reviewed for Baseline Care Plans. This deficient practice could likely result in a decline in the residents' condition due to staff not being aware of the care residents' need and residents not being able to attain or maintain their highest practical level of well-being. The findings are: A. Record review of the Face Sheet for R #108 revealed an admission date of 9/26/24 and included the following diagnoses: - Acute respiratory failure with hypoxia (when there is not enough oxygen in your blood/body tissue). - Type 2 diabetic mellitus with neuropathy (high blood sugar with nerve damage). - Hyperlipidemia (high blood fat levels). - Obstructive sleep apnea (repeated breathing interruptions during sleep). - Hypertension (high blood pressure). - Atherosclerotic heart disease (build up of fats,…

    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
Show the remaining 9 citations
  • Potential for harm · Dcited before2024-10-10 · 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 record review and interview, the facility failed to meet professional standards of practice for 1 (R #208) of 1 (R #208) residents reviewed for medication administration, when staff did not administer R #208's lactulose [a medication used to prevent and treat complications of hepatic encephalopathy (liver disease) by decreasing the amount of ammonia in the blood] as ordered by the medical provider. This deficient practice could likely lead to the resident having adverse (unwanted, harmful, or abnormal result) side effects or not receiving the desired therapeutic effect of the medication due to it not being administered. The findings are: A. Record review of R #208's Physician orders revealed the following: Lactulose. Give 45 milliliters (ml) by mouth three times a day for enchphalopathy with a start date of 08/30/24. B. Record review of R #208's Medication Administration Record (MAR), dated September 2024, revealed staff did not administer the lactulose midday dose to the resident due to hold/see nursing notes on 9/3/24. C. Record review of R #208's nurse progress note,…

    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 · F2023-06-16 · tag F0761 — failed to label and store drugs safely — widespread
    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 observations and interviews, the facility failed to: 1. Ensure that opened and accessed (has been opened or accessed) for a flex pen weren't dated as to when they were initially opened/accessed, by nursing staff. 2. Ensure that undated medications (not dated when opened) were not stored with dated medications that are available for use 3. Ensure that expired supplies are not stored with unexpired supplies in the storage rooms 4. To properly store medications in medications carts. 5. Ensure treatment/medication carts were kept locked when not in use. These deficient practices have the likelihood to result in 57 (fifty-seven) residents that were identified on the census list provided by Center Executive Director (CED) on 06/12/23, to receive medications that had either lost their potency or effectiveness. The findings are: Regarding Opened and Un-labeled Medications: A. On 06/12/23 at 10:45 am, during observation of the Hall A Medications Cart, three (3) medications were found to be undated as to when they were opened: 1. Senna Plus (a stool softener/laxative) in a bottle 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.

    Pharmacy Service Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · F2023-06-16 · tag F0812 — failed to store, cook, and serve food safely — widespread
    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 store and serve food under sanitary conditions by not ensuring: 1. Freezer units' temperatures were taken daily, 2. Proper handling techniques were used when handling cups and glasses when drinks were distributed to residents served in the dining room 3. Hands were not sanitized prior to handling residents' meals after handling resident's adaptive equipment during a meal. These deficient practices are likely to affect all 57 residents listed on the resident census list provided by the Administrator on 06/16/23; and could likely lead to foodborne illnesses in residents if safe food handling practices are not adhered to. The findings are: A. On 06/12/23 at 10:42 am during an observation during the initial tour of the kitchen, the reach-in freezer's (located on the back wall of the kitchen) temperature log was observed to have missing temperatures for the for the evening dates of 6/9/23, 06/10/23, and 6/11/23. The temperature for the day shift of 6/10/23 was also missing. The chest freezer's (deep freezers shaped like a trunk…

    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 · Fcited before2023-06-16 · tag F0880 — failed to prevent and control infections — widespread
    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 record reviews, interviews and observations, the facility failed to provide proper infection control practices by: 1. Not performing hand hygiene between residents, and 2. Providing resident care, not removing used gloves before entering the hallway. These deficient practices could likely affect all 57 residents in the facility on the census provided by the Center Executive Director (CED) on 06/12/23. Failure to practice infection control standards could likely cause the spread of infection and illnesses to residents and staff within the facility. The findings are: A. On 06/12/23 at 4:04 pm, during observation, Registered Nurse (RN) #1 walked from R #47's room with her gloves on. RN #1 then went into the treatment cart with the dirty gloves on, going through wound treatment items. RN #1 then walked down the hallway to the nurse's station, still wearing her dirty gloves, discarded her gloves and performed hand hygiene using hand alcohol gel. B. On 06/12/23 at 4:05 pm, during an interview with R #47's regarding wound care. R #47 stated, Nurses had been changing her dressing…

    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 · D2023-06-16 · 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

    Based on record review and interview, the facility failed to ensure that the resident's responsible party, Power of Attorney (POA) and/or family was notified of a resident's change in condition for 1 (R #49) of 1 (R #49) resident reviewed for weight decline. This deficient practice could likely result in the resident's responsible party, POA, and/or family not participating in important decisions regarding the resident's health and well-being. The findings are: A. Record review of R #49's nutrition progress notes dated 05/16/23, indicated the following: Current weight 124.4 lbs (pounds) triggers for 90-day weight loss -7.5% (percent) change comparison weight 2/20/23 150.2 Lbs, -17.2%, -25.8 lbs. B. Record review of R #49's Change in Conditions reports (CIC) for the dates of 04/07/23 through 05/19/23 revealed that no CIC reports had been completed for R #49's significant weight loss. The change of condition was not reported to POA. C. On 06/13/23 at 10:15 am, during an interview with the POA/daughter of R #49, she stated that she was not called or informed of R #49's decrease 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.

    Resident Rights Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Dcited before2023-06-16 · tag F0609 — failed to report abuse allegations — isolated
    Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on record review and interview, the facility failed to report an Injury of Unknown Origin to the State Survey Agency, for 1 (R #11) of 3 (R #s 11, 28, and 35) residents reviewed for Injury of Unknown Origin. This deficient practice is likely to result in the State Survey Agency not being aware of facility incidents, and unable to assure residents a safe and hazard free environment. The findings are: A. Record review of Face Sheet dated 10/01/15 for R #11 revealed this as an initial admission date and included the following diagnoses: Age-Related Osteoporosis (weakened bones due to the aging process), Weakness, Dementia (a group of symptoms that affect memory and thinking and interfere with daily life), Cognitive Communication Deficit (difficulty with thinking, understanding, and speaking), Personal History of Healed Traumatic Fracture (break in a bone), Pain, and Presence of Left Artificial Hip Joint. B. Record review of the Minimum Data Set (assessment tool used to assess the health and needs of residents) dated 04/14/23 revealed in Section C - Cognitive (how a person thinks,…

    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 · D2023-06-16 · tag F0679 — failed to provide activities — isolated
    Provide activities to meet all resident's needs.
    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 implement an ongoing one-to-one, resident-centered activities program for 1 (R #52) of 3 (R #s 14, 20 and 52) residents looked at for activities. This deficient practice does not encourage stimulation for residents who have a physical condition; as it does not allow them to attend the regularly scheduled activities programs. This could potentially cause depression and an overall decline of the resident's well-being. The findings are: A. Record review of R #52's Face Sheet revealed that he was admitted to the facility on [DATE] with the following diagnoses: Severe Protein Calorie Malnutrition (refers to a nutritional status in which reduced availability of nutrients leads to changes in body composition and function) and is being fed with a feeding tube (medical device to provide nutrition to people who cannot obtain nutrition by mouth) for all nutrition, Cerebral Palsy (a group of disorders that affect movement, muscle tone, balance, 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.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2023-06-16 · 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

    Based on record review, interview, and observation, the facility failed to ensure that restorative services (person-centered and designed to improve or maintain the functional ability of residents, so they can achieve their highest level of well-being possible) were being provided for 1 (R #15) of 1 (R #15) resident reviewed for mobility capabilities (ability to move purposely as you go throughout your day). This deficient practice could likely result in resident joints feeling contracted (when muscles, tendons, joints, or other tissues tighten or shorten causing a deformity) or weakened. The findings are: A. Record review of R #15's physician order dated 05/15/22 revealed Resident was to wear a left functional hand splint (a supportive device that helps prevent moving the affected body part while it is healing) in the AM, off at PM as tolerated. Staff to remove splint for hygiene, PROM (passive range of motion) and skin check. Every Shift (6 am to 6 pm). Order stated that the hand splint should be on during the AM shift, and taken off during the PM shift. B. Record Review of R…

    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 · D2023-06-16 · tag F0740 — failed to provide behavioral / mental-health care — isolated
    Ensure each resident must receive and the facility must provide necessary behavioral health care and 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 and interview, the facility failed to ensure that 1 (R #110) of 1 (R #110) resident reviewed for behavioral health concerns, was receiving necessary behavioral health care to meet the resident's needs. This deficient practice could likely cause the resident to not receive the mental health care and assistance that they may need. The findings are: A. Record review of the Face Sheet for R #110 indicated that resident was admitted on [DATE] to the facility and was discharged on 04/07/23. She had a mental health diagnosis of Bi-Polar Disorder (mental health condition that causes extreme mood swings that include emotional highs and lows, and depression). B. Record review of the admission nursing note dated 02/10/23 at 12:00 pm indicated in the Mental Health/Behavior section: Pt. (patient) has expressed/verbalized sadness or symptoms of depression. C. Record review of the physician orders dated 02/24/23 indicated that a referral to (name of company that provides comprehensive behavioral care via…

    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

“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 OPCO SKILLED MANAGEMENT — 66 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 5 of 52.3+2.7 vs chain
Health inspection 5 of 52.2+2.8 vs chain
Staffing 3 of 51.7+1.3 vs chain
Quality measures 5 of 54.3+0.7 vs chain
The other 65 homes this chain runs (chain average 2.3★, per CMS)
1 of 5Bluebird Wellness And RehabilitationSaint Louis, MO 1 of 5Brentwood Place ThreeDallas, TX 1 of 5Broadway Nursing & RehabilitationSan Antonio, TX 1 of 5Cameron Nursing CenterCameron, MO 1 of 5Carmel Hills Wellness & RehabilitationIndependence, MO 1 of 5Casa Arena Healthcare LLCAlamogordo, NM 1 of 5Casa Maria HealthcareRoswell, NM 1 of 5Forest Park Nursing & RehabilitationDallas, TX 1 of 5Fort Worth Wellness & RehabilitationFort Worth, TX 1 of 5Glenview Wellness & RehabilitationNorth Richland Hills, TX 1 of 5Highland Pines Nursing HomeLongview, TX 1 of 5Ivy Creek Wellness & RehabilitationWaco, TX 1 of 5Las Cruces Village Nursing & Rehabilitation LLCLas Cruces, NM 1 of 5Magnolia Wellness CenterSaint Louis, MO 1 of 5Maple Grove Wellness & RehabilitationFenton, MO 1 of 5Mineola Gardens Wellness & RehabilitationMineola, TX 1 of 5Pine Grove ManorSaint Louis, MO 1 of 5Rehab Of Kansas City SouthKansas City, MO 1 of 5The Hillcrest Of North DallasDallas, TX 1 of 5West Side Campus Of CareWhite Settlement, TX 1 of 5Willow Ridge Wellness & RehabilitationFort Worth, TX 1 of 5Willowcreek Wellness & RehabilitationFlorissant, MO 2 of 5Arbor Lake Nursing & Rehabilitation, LLCFort Worth, TX 2 of 5Aztec HealthcareAztec, NM 2 of 5Betty Dare Wellness & Rehabilitation LLCAlamogordo, NM 2 of 5Blue Springs Wellness & RehabilitationBlue Springs, MO 2 of 5Cypress Springs Wellness & RehabilitationMount Vernon, TX 2 of 5Fiesta Park Wellness & RehabilitationAlbuquerque, NM 2 of 5Hilltop At Blue River, TheKansas City, MO 2 of 5La Vida Buena HealthcareLas Vegas, NM 2 of 5Los Alamos Wellness & RehabilitationLos Alamos, NM 2 of 5McGregor Wellness & RehabilitationMc Gregor, TX 2 of 5Monarch Springs Wellness & RehabilitationUniversity City, MO 2 of 5Northrise Wellness & RehabilitationLas Cruces, NM 2 of 5Prescott Valley Nursing & RehabilitationPrescott Valley, AZ 2 of 5Prescott Village Nursing & RehabilitationPrescott, AZ 2 of 5Rehabilitation Center Of Independence, TheIndependence, MO 2 of 5San Antonio Wellness & RehabilitationSan Antonio, TX 2 of 5Skyline Nursing CenterDallas, TX 2 of 5Sunny Springs Nursing & RehabSulphur Springs, TX

Showing 40 of 65; lowest-rated first.

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 / managerTypeRoleSince
WALNUT SUMMER LLCOrganizationDIRECT OWNERSHIP INTERESTsince 06/12/2023
CALISTO HOLDINGS LLCOrganizationINDIRECT OWNERSHIP INTERESTsince 06/12/2023
FIRST SWEETZER HOLDINGS LLCOrganizationINDIRECT OWNERSHIP INTERESTsince 06/12/2023
HATTERAS INVESTMENTS LLCOrganizationINDIRECT OWNERSHIP INTERESTsince 06/12/2023
GARETZ, DAVIDIndividualCORPORATE OFFICER; OPERATIONAL/MANAGERIAL CONTROLsince 06/12/2023
GURWITZ, SOLOMONIndividualINDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNFsince 07/18/2025
HAGINS, ELIZABETHIndividualINDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNFsince 07/18/2025
KAPLAN, ESTHERIndividualINDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNFsince 07/18/2025
KAPLAN, MOSHAIndividualINDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNFsince 07/18/2025
MINDLE, ADAMIndividualINDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNFsince 07/18/2025
STERNSHEIN, JENNIFERIndividualINDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNFsince 04/07/2025
UNGER, JEFFREYIndividualINDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNFsince 07/18/2025
ZIMMERMAN, CAROLINEIndividualINDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNFsince 04/07/2025
306 E NIZHONI BLVD NM, LLCOrganizationADP OF THE SNFsince 06/12/2023
ACER REALTY INVESTORS, LLCOrganizationADP OF THE SNFsince 06/12/2023
CONTINUUM REHAB GROUP LLCOrganizationADP OF THE SNFsince 06/12/2023
HALLMARK ADVISORS, LLCOrganizationADP OF THE SNFsince 06/12/2023
HANSEN HUNTER LLCOrganizationADP OF THE SNFsince 07/18/2025
OPCO CA SKILLED MGMT INC.OrganizationADP OF THE SNFsince 06/12/2023
OPCO NM SKILLED MGMT, LLCOrganizationADP OF THE SNFsince 06/12/2023
THE WRIGHT GROUP CONSULTING, LLCOrganizationADP OF THE SNFsince 04/01/2024
GREENBERG, DAVIDIndividualADP OF THE SNFsince 03/19/2025
ISAACSON, SHEENAIndividualADP OF THE SNFsince 04/22/2024

CMS files one row per role, so the 24 rows in the source record cover these 23 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.

12 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.

$8.1M
Net patient revenuemost recent cost report
-0.2%
Operating marginrevenue minus expenses
$2.1M
Related-party expense26% of expenses
Who pays — share of resident-days
Medicaid 84%Medicare 10%Other / private 6%

About 84% of this home’s resident-days are paid by Medicaid, which reimburses well below the cost of care in most states. Heavily Medicaid-dependent homes run on thinner budgets — a context worth holding next to the staffing and inspection record, not a fault in itself. This home reported $2.1M paid to related parties — landlords or management companies under common ownership — equal to about 26% of its total expenses. Money routed to affiliated companies can leave a home’s own books looking lean while owners still profit; it is the mechanism regulators watch most closely in private-equity and REIT deals.

Source: CMS Healthcare Provider Cost Reporting Information System (HCRIS), Medicare cost report Form CMS-2540 · fiscal year 2024. 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

$390per resident / day
operating cost
$11,863per month
≈ monthly operating cost
$389per day
avg. revenue, all payers

Straight from this home’s Medicare cost report (CMS, FY2024). 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 NM

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 New Mexico Medicaid page.

Typical monthly cost in New Mexico
$9,125/mo
Nursing home (semi-private)
$10,633/mo
Nursing home (private)
$5,950/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 325118. CMS refreshes its data monthly, and the star rating rests on the last standard inspection — dated 2026-01-23, 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.

What to do next