Oak Hills Living Center

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.

37.6% of the Medicare patients who left this home got back to the community and stayed there for at least 31 days — which CMS reads as no different from the national rate. This is CMS’s risk-adjusted rate over 34 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.

Met the expected recovery: 38.7% 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 62 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 0.05 therapist hours per resident per day in 2026Q1 — more than 2% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 0% of this home’s weekday level — it runs therapy on weekdays, with essentially none at the weekend. 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 160 beds and averages 116.8 residents a day — about 73% occupied, or roughly 43 beds typically open. It usually has some room. This is a CMS average, not live availability — no public source publishes real-time vacancies, and a home can be full the day you call. Confirm with the home, and if you need a Medicaid bed specifically, ask about that separately: a home with open beds may still not have an open Medicaid bed.

Against a benchmark — not a legal minimum. In May 2024 CMS finalized the first federal staffing floor for nursing homes: 3.48 total nurse hours per resident per day, including 0.55 RN hours and 2.45 nurse-aide hours. Its hour requirements never took effect and are no longer on the books. Homes had until 2026 (2027 if rural) to comply, and that deadline never arrived: a federal court vacated the hour requirements in April 2025 (CMS has appealed), Congress then barred enforcement until 2034, and CMS formally repealed them by rule effective February 2026. This home is not required to meet these numbers, and is not violating anything by missing them. We still show the comparison because the figures are CMS’s own published estimate of adequate staffing, which makes them a useful yardstick — but they are our benchmark, not federal law: this home’s total nurse staffing of 3.67 hrs/resident/day is at or above the 3.48-hour benchmark and RN staffing of 0.22 is below the 0.55-hour RN benchmark and nurse-aide staffing of 2.61 is at or above the 2.45-hour aide benchmark. What federal law does require today is unchanged: “sufficient” nursing staff for residents’ needs and an RN on duty at least 8 consecutive hours a day, 7 days a week (42 CFR 483.35). Those are judged by inspectors on site, not by these averages, so read this comparison alongside the inspection record rather than as a pass/fail.

Weekend coverage: total nurse staffing is 2.22 hrs/resident/day on weekends vs 4.26 on weekdays — 48% thinner on weekends — a notable drop. RN hours go from 0.28 to 0.09 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 83% 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 more than at the previous inspection — worsening. Fewer citations over time suggests a home is fixing problems; a rising count is a warning sign — though two surveys are a short record, and survey teams differ. These counts are from the standard annual health survey only; the full citation list below may also include findings from complaint investigations, so the two won’t always add up.

Inspection deficiencies

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

Each letter is a CMS scope-severity level; highlighted ones are where this home has citations. A–C = no harm found; D–F = potential for harm; G–I = actual harm; J–L = immediate jeopardy. Within each band the later letter is the more widespread finding (an isolated G is one resident; a widespread I is a pattern), so rightward and downward is worse.

37 citations, most serious first. The 15 most serious are shown; the remaining 22 are one tap away and print in full.

• Immediate jeopardy · Jcited before2025-12-03 · 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 A past noncompliance Immediate Jeopardy (IJ) situation was determined to exist effective 11/07/25 related to the facility's failure to provide supervision to prevent elopement.Based on observation, record review, and interview, the facility failed to ensure a resident requiring increased visual checks was not neglected for 1 (#1) of 3 sampled residents reviewed for neglect.LPN #1 identified 119 residents resided in the facility. The DON identified 21 residents at risk for elopement. Findings:On 11/18/25 at 5:46 a.m., window alarms were observed in all rooms on hall 500, the secured dementia unit.On 11/18/25 at 10:46 a.m., CNA #1 demonstrated a window alarm to be functioning by raising the window. The alarm sounded upon the window being raised.On 11/18/25 at 10:53 a.m., the fence outside the secured dementia unit was observed. There was a chain link fence. In some areas there was also a wooden fence. The chain link fence was less than 6 feet tall and the wooden fence was 6 feet.An undated admission record for…

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

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Past Non-Compliance
• Immediate jeopardy · J2025-12-03 · tag F0656 — failed to write and follow a full care plan — isolated
  Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY A past noncompliance Immediate Jeopardy (IJ) situation was determined to exist effective 11/07/25 related to the facility's failure to provide implement interventions for a resident with a known history of elopement.Based on record review and interview, the facility failed to implement care plan interventions for 1 (#1) of 3 sampled residents reviewed for care plan interventions with a known history of elopement risk.LPN #1 identified 119 residents resided in the facility. The DON identified 21 residents at risk for elopement.Findings:A Routine Resident Checks (Rounding Policy), dated 11/07/25, read in part, It is the policy of this facility to ensure the safety, well-being and supervision of all residents through consistent, documented routine resident checks (rounds) conducted at least every two (2) hours and more frequently as indicated by resident condition, care plan, or risk status. Increased Visual Checks - Enhanced frequency of rounding (e.g., every 15-60 minutes) for residents identified as high risk…

  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 · Past Non-Compliance
• Immediate jeopardy · Jcited before2025-01-21 · 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

  On 01/17/25, an Immediate Jeopardy (IJ) situation was determined to exist related to the facility's failure to ensure Resident #18 was free from abuse by not implementing company policy and procedures. This resulted in Resident #18 experiencing psychosocial harm. A nursing note, dated 12/25/24 at 9:39 a.m., read in part, [Resident #18] was observed walking down 400 hallway. [Resident #54] got mad and started ranting saying that,I will stub them because they didn't like that particular resident. The note also read, [Resident #54] pulled out a rail road track nail with the gestures of attacking [Resident #18]. The note also read, This Nurse yelled for help along side the Nurse aide who was close and witnessed they rushed to intercept and prevent any possible attack to the [Resident #18] who was asked to go back in their room. [Resident #54] did not succeed and the DON with another Nurse managed to retrieve the track nail from [Resident #54]. On 01/14/25 at 2:32 p.m., the DON was asked about reporting abuse according to company policy and procedures for the 12/25/24 note. They stated…

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

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
• Actual harm · Gcited before2025-09-18 · 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

  The Immediate Jeopardy (IJ) has been removed based on a determination resulting from an Informal Dispute Resolution (IDR).On 09/18/25 at 1:23 p.m., a past non-compliance Immediate Jeopardy (IJ) situation was determined to exist related to the facility's failure to protect residents from physical abuse. Resident #2 was involved in an altercation with Resident #1 resulting in a fist fight and Resident #1 falling to the ground. Resident #2 continued to sit on and hit Resident #1. Resident #1 lost their balance during the altercation and fell to the floor resulting in a fracture of their left femur.Based on record review and interview, the facility failed to ensure a resident was protected from physical abuse inflicted by another resident for 1 (#1) of 4 sampled residents reviewed for abuse.The administrator identified 117 residents resided in the facility.Findings:An undated facility policy titled Abuse and Neglect Policy, read in part, The Abuse/Neglect Policy of this facility will be implemented to ensure all residents entrusted in our care will be free from mental, verbal, or…

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

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Past Non-Compliance
• Actual harm · G2025-01-21 · 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 observation, record review, and interview, the facility failed to ensure: a. wound care was provided as ordered for two (#12 and #57); b. care was coordinated for a non pressure wound for one (#12); c. an order was obtained prior to providing wound care to a resident's wound for one (#12); d. the nurse was notified when the dressing of a wound became dislodged for one (#12); e. staff documented changes in the resident's skin before leaving for the day for one (#12); and f. treatment orders were obtained at the time a new wound was identified for one (#12) of four sampled residents reviewed for non pressure skin conditions. This resulted in actual harm when Resident #12's left gluteal fold wound increased in size after the facility failed to provide treatment as ordered. The administrator identified 114 residents resided in the facility. The DON identified 10 residents with non pressure wounds resided in the facility. Findings: A Wound Care policy, revised 10/2010, read in parts, Verify that there is a physician's order for this procedure .The following information should be…

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

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Ecited before2025-11-26 · tag F0600 — failed to protect residents from abuse and neglect — pattern
  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

  Based on record review and interview, the facility failed to ensure a resident was free from abuse for 1 (#2) of 3 sampled residents reviewed for abuse.The DON identified 115 residents resided in the facility.Findings:An undated facility policy titled Abuse and Neglect Policy, read in part, The Abuse/Neglect Policy of this facility will be implemented to ensure all residents entrusted in our care will be free from mental, verbal, or physical abuse. It is our goal to provide quality care to our residents.1.An undated admission Record showed Resident #2 had diagnoses which included major depressive disorder and anxiety disorder.Resident #2's annual assessment, dated 09/18/25, showed the resident's cognition was intact with a BIMS score of 15. No behaviors were documented on the assessment.An Incident Report Form, dated 09/29/25, read in part, Resident [#2] went to kitchen to ask that [their] cup be washed out. [Certified Dietary Manager] told resident [ Resident #2] 'hang on a minute.' Resident [#2] began cussing and using profanity and called [Certified Dietary Manager] a [explicit]…

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

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Dcited before2025-03-17 · tag F0602 — failed to protect residents from theft of their belongings — isolated
  Protect each resident from the wrongful use of the resident's belongings or money.
  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 a resident's personal funds were not misappropriated for 1 (#4) of 4 sampled residents reviewed for abuse. The assistant director of nursing identified 112 residents resided in the facility. Findings: An undated Abuse and Neglect policy, read in part, no resident shall be subject to abuse. Resident #4 had diagnoses which included bipolar and anxiety. An Incident Report Form, dated 03/12/25, read in part, Reported to this admin [administrator] by SSD [social service director]. Resident called [their] card and realized the balance was very low and stated [they] should have about $1000 .Resident then stated, 'I should have never given [CNA #5] my card [SSI debit card]' .Various charges noted today: [nail salon] $145, [gas station] $70, 2 ATM [automated teller machine] withdrawals $43 and $62, [cell phone carrier] $74. On 03/13/25 at 1:20 p.m., Resident #4 stated a couple of months ago, CNA #5 asked if they could borrow some money. They stated CNA #5 knew they received SSI. Resident #4 stated they gave CNA #5 the card…

  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 · Ecited before2025-01-21 · tag F0610 — failed to investigate and act on abuse reports — pattern
  Respond appropriately to all alleged violations.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on record and interview, the facility failed to thoroughly investigate an allegation of abuse for two (#18 and #54) of three sampled residents reviewed for abuse and neglect. The administrator reported the census was 114. Findings: An undated Abuse and Neglect policy, read in part, w. Following the initial verbal investigation, the Administrator will take written statements from all employees, residents, any witness if any, and will determine action to be taken. The Unusual Occurrence policy, revised 12/2007, read in part, 3. A written report detailing the incident and actions taken by the facility after the event shall be sent or delivered to the state agency (and other appropriate agencies as required by law) within (48) hours of reporting the event or as required by federal and state regulations. 1. Resident #18 had diagnoses which included unspecified schizophrenia. A nursing note, dated 11/29/24, read in part, another resident on hall 400 reported that [Resident #18] had offered [them] 7$ and a coke for a hand job. Another resident on 300 hall reported that [Resident #18]…

  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 · Ecited before2025-01-21 · tag F0641 — pattern
  Ensure each resident receives an accurate assessment.
  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 assessments were completed timely for two (#67 and #98) of 28 sampled residents reviewed for resident assessments. The administrator identified 114 residents resided in the facility. Findings: 1. An Annual Resident Assessment, dated 8/23/24, was the last assessment completed for Resident #67. A billing census documented billing had been stopped on 9/26/24. There was no discharge assessment. 2. An admission Resident Assessment, dated 8/12/24, was the last assessment completed for Resident #98. A billing census documented billing had been stopped on 8/26/24. There was no discharge assessment. On 01/21/25 at 11:51 a.m., MDS #1 stated Resident #67 was a death in facility on 9/06/24. They stated it had not been completed, but should have been completed within 14 days of the discharge. MDS #1 stated Resident #98 discharged on 8/26/24, but the discharge had not been completed. They stated there was no reason why it was not completed within the 14 day requirement. On 01/21/25 at 6:15 p.m., ADON #1 brought in LPN #5 to…

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

  Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Ecited before2025-01-21 · tag F0812 — failed to store, cook, and serve food safely — pattern
  Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation and interview, the facility failed to ensure the low temperature dishwasher had the appropriate amount of chemicals to sanitize dishes for three of four observations of dishwasher chemical sanitization level checks. ADON #1 identified 112 residents ate meals from the kitchen. Findings: An undated Dishwashing by Use of a Machine policy, read in part, check the machine during each procedure to determine if detergent, wetting agent, and chemical sanitizer is being dispensed properly. On 01/07/25 at 7:49 a.m., the DM measured the chemical sanitizer in the dishwasher and it did not register on the chemical strip. The DM realized the sanitizer was empty and added about two gallons to the five gallon bucket attached to the dishwasher. They then primed the dishwasher several times and was still unable to get a reading on the chemical strip. They stated the chemical strip should register between 50 parts per million of chloride (ppm) and 100 ppm. They stated they had not checked it this morning, but…

  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 · Ecited before2025-01-21 · tag F0880 — failed to prevent and control infections — pattern
  Provide and implement an infection prevention and control program.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on observation, record review, and interview, the facility failed to ensure: a. wound care was provided in a manner to prevent cross contamination for two (#12 and #57) of three sampled residents observed for wound care; b. a urinary catheter was stored in a manner to prevent cross contamination for one (#12) of one sampled resident observed with a urinary catheter; and c. infection control logs were completed for five (#22, 25, 54, 81, and #86) of five sampled residents reviewed for staph infections. The administrator identified 114 residents resided in the facility. The DON identified 10 residents with non pressure wounds, two residents with staph infections, and two residents with urinary catheters resided in the facility. Findings: A Handwashing/Hand Hygiene policy, revised 08/2019, read in parts, This facility considers hand hygiene the primary means to prevent the spread of infections .All personnel shall follow the handwashing/hand hygiene procedures to help prevent the spread of infections to other personnel, residents, and visitors .Hand hygiene products and supplies…

  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 · D2025-01-21 · tag F0580 — failed to tell family and doctor about changes — isolated
  Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on observation, record review, and interview, the facility failed to ensure the physician was notified when a resident experienced a change in their skin condition that required medical intervention for one (#12) of four sampled residents reviewed for non pressure skin conditions. The administrator identified 114 residents resided in the facility. The DON identified 10 residents with non pressure wounds resided in the facility. Findings: An undated Physician Notification for Resident Change in Condition policy, read in parts, Document in the medical record the date, time and name of each physician notified, actions taken and/or resident's response to treatment .Physician notification may be indicated in the following situations .new or worsening wounds. Resident #12 had diagnoses which included vasculitis, bipolar disorder, and schizoaffective disorder. A Wound Progress Note, dated 01/09/25, documented the resident had a wound to their right lower leg, left lower leg, left gluteal fold and right thigh. The note did not document the resident had any wounds to their feet. 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 Rights Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Dcited before2025-01-21 · tag F0584 — failed to keep a safe, clean, comfortable home — isolated
  Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on observation and interview, the facility failed to provide a safe, clean, and comfortable shower room in three of the four shower rooms observed. ADON #1 identified the facility had seven shower rooms. Findings: An undated facility Safe Environment policy, read in part, facility will maintain a safe, comfortable, and homelike environment. The policy also read, the facility will be designed, constructed, equipped and maintained to protect the health and safety of residents, personnel and the public. On 01/21/25 at 10:03 a.m., housekeeper #1 stated they cleaned hall 500 shower room every day, but the rust stains leaking from the rusted safety bars would not come off no matter how much it they were scrubbed. They stated the brown paint on the floor was peeling up all over the place and the shower room acted as a storage room as well. They stated this shower room was about to be remodeled, but they were not sure when. On 01/21/25 at 10:05 a.m., the floor had a sticky residue that caused shoes to stick to the floor while walking in the shower room. The entire right side 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.

  Resident Rights Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2025-01-21 · tag F0657 — failed to keep the care plan current — isolated
  Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on observation, record review, and interview, the facility failed to ensure a resident care plan was revised for one (#57) of one sampled resident observed self-administering a medication. The administrator identifed no residents with orders to self-administer medications resided in the facility. Findings: A Care Plans policy, revised 12/2016, read in parts, Assessments of residents are ongoing and care plans are revised as information about residents and the residents' conditions change .The interdisciplinary team must review and update the care plan. Resident #57 had diagnoses which included chronic obstructive pulmonary disease with acute exacerbation and acute and chronic respiratory failure with hypoxia. Resident #57's care plan documented focus: the resident had a physician's order for unsupervised self-administration of the following medications: Albuterol sulfate, date initiated 06/13/22, revision date 06/13/22. It documented goal: Resident #57 would take medications safely as prescribed through the review date, date initiated 06/13/22, revision on 12/13/24. 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 · Dcited before2025-01-21 · tag F0686 — failed to prevent and treat pressure sores (bedsores) — isolated
  Provide appropriate pressure ulcer care and prevent new ulcers from developing.
  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 wound care was provided as ordered for one (#17) of two sampled residents reviewed for pressure ulcers. ADON #2 identified three residents with pressure ulcers resided in the the facility. Findings: A Pressure Ulcers/Skin Breakdown policy, revised 04/2018, read in parts, The physician will order pertinent wound treatments, including pressure reduction surfaces, wound cleansing and debridement approaches, dressings .and application of topical agents. Resident #17 had diagnoses which included an unstageable pressure injury to the left heel and a deep tissue pressure injury to the right lateral heel. A Physician Order, dated 10/26/24, documented to cleanse left heel with ns, pat dry, apply santyl to wound bed, cover with calcium alginate, apply ABD pad, and wrap with rolled gauze and tape daily and PRN for soilage. A Physician Order, dated 12/20/24, documented to cleanse right lateral heel with ns, pat dry, apply calcium alginate to wound bed, cover with ABD pad, secure with tape daily and PRN. A Wound 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.

  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.

Fines & penalties

$137,412 in federal fines across 3 penalties. 2 Medicare payment denials on record.

• $11,360 — penalty dated 2025-12-03
• $9,252 — penalty dated 2025-09-18
• $116,800 — penalty dated 2025-01-21
• Medicare payment denial — starting 2025-02-15 for 20 days
• Medicare payment denial — starting 2024-02-06 for 62 days

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

Who owns this facility

CMS files one row per role, so the 5 rows in the source record cover these 3 parties — each is shown once here with every role it holds. Nothing is omitted.

1 organizational owner 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.

About 85% 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.

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 OK