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Lawton Post Acute & Rehab

1700 Northwest Fort Sill Blvd, Lawton, OK 73507 · For profit - Limited Liability company · 95 certified beds · (580) 355-1616 Medicare & Medicaid certified

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Special Focus candidate (CMS is watching this home)Abuse/neglect citation on record (F0600) — cited Apr 20265 immediate-jeopardy citations$124,185 in federal fines
Insights

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

Worth asking about
  • CMS lists it as a Special Focus candidate — not on the watch list itself, but among the homes CMS is watching because of its recent inspection history
  • it has an abuse, neglect, or exploitation citation (F0600), cited Apr 2026
  • inspectors cited 5 immediate-jeopardy problems — the most serious level
  • a high number of inspection citations overall (34) — worth reading through, though larger and more-often-surveyed homes tend to accrue more lower-severity tags
  • the CMS record shows $124,185 in federal fines (most recent 2026-04-28)
  • its independent health-inspection rating is low (1/5)
  • its payroll-based staffing rating is low (2/5)
  • its facility-reported quality-measure rating is low (1/5)

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.

1/5
CMS overall
1 of 5
Health inspectionSurveyor-assigned, ranked within your stateInspector-verified 1 of 5
StaffingFrom payroll records (PBJ) 2 of 5
Quality measuresSelf-reported by the facility 1 of 5

Location & what’s nearby

Hospital
Urgent care / clinic
1930 NW Ferris Ave · (405) 367-5638 · Call to confirm hours
Pharmacy
2107 NW Cache Rd · (580) 353-1588 · Call to confirm hours
Grocery
1608 NW Euclid Ave · (580) 357-9300 · Call to confirm hours
Park
NW 15th St · 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 1 of 5
Long-stay residentspeople who live here 2 of 5
Short-stay residentsrehab / post-hospital 1 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 fell from 2 to 1 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 rating1★
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 increased26.4%13.6%15.4%worse
Long-stay residents who lose too much weight5.0%3.3%5.4%typical
Long-stay residents with a catheter left in their bladder2.9%1.9%0.9%worse than state — see note marked double-dagger below the table
Long-stay residents with a urinary tract infection1.5%2.8%2.0%better
Long-stay residents with depressive symptoms6.8%3.4%6.5%typical
Long-stay residents who were physically restrained0.0%0.1%0.1%better
Long-stay residents with falls causing major injury2.9%4.7%3.3%better
Long-stay residents whose ability to walk worsened24.4%13.7%16.1%worse
Long-stay residents on antianxiety or hypnotic medication17.2%25.7%18.9%typical
Long-stay residents given the seasonal flu vaccine97.1%94.6%95.3%typical
Long-stay residents with pressure ulcers4.4%4.7%4.7%typical
Long-stay residents with worsening bladder/bowel control21.6%17.1%21.2%typical
Long-stay residents who got an antipsychotic medication — see the note below the table19.9%17.5%17.1%worse
Short-stay residents who newly got an antipsychotic medication2.1%1.8%1.4%worse
Short-stay residents given the seasonal flu vaccine77.1%74.1%79.4%typical
Short-stay residents rehospitalized after admission26.0%27.3%22.6%worse
Short-stay residents with an outpatient ER visit17.4%16.6%12.0%worse
Long-stay hospitalizations per 1,000 resident days1.342.311.67better
Long-stay outpatient ER visits per 1,000 resident days2.332.961.80worse

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.

37.7% of the Medicare patients who left this home got back to the community and stayed there for at least 31 days — CMS rates that worse than the national rate. This is CMS’s risk-adjusted rate over 60 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.

37.7%U.S. median 51.5%
Got home and stayed home
13.6%U.S. median 10.7%
Went back to hospital
46.9%U.S. median 56.6%
Met the expected recovery
0.50U.S. median 0.31
Therapy hours / resident / day
0.22hours / resident / day
Physical therapy
0.23hours / resident / day
Occupational therapy
0.05hours / resident / day
Speech therapy

Met the expected recovery: 46.9% 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 64 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 0.50 therapist hours per resident per day in 2026Q1 — more than 81% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 32% 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 SNF37.7%CMS range 28.4–48.551.5%Oct 2022–Sep 2024worse than U.S.
Went back to hospitalRate of potentially preventable hospital readmissions 30 days after discharge from a SNF13.6%CMS range 9.8–19.710.7%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 discharge46.9%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 discharge59.4%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 discharge48.4%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 identified96.1%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 setting98.8%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 dischargenot reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
Falls with major injuryPercentage of SNF residents who experience one or more falls with major injury during their SNF stay2.3%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 worsened4.7%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 hospitalization9.0%CMS range 5.6–14.97.1%Oct 2023–Sep 2024no different from U.S.
Medicare spending per stayMedicare Spending Per Beneficiary (MSPB) for residents in SNFs1.181.02Oct 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

0.28
RN hours/ resident / day
0.71
LPN hours/ resident / day
2.95
Aide hours/ resident / day
3.94
Total nurse hours/ resident / day
0.11
RN hoursweekends
52.7%
Total nursing turnover
RN turnover

How full it usually is: this home is certified for 95 beds and averages 82.2 residents a day — about 87% occupied, or roughly 13 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 3.94 hrs/resident/day is at or above the 3.48-hour benchmark and RN staffing of 0.28 is below the 0.55-hour RN benchmark and nurse-aide staffing of 2.95 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 3.29 hrs/resident/day on weekends vs 4.21 on weekdays — 22% thinner on weekends — a notable drop. RN hours go from 0.35 to 0.11 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 53% is about the same as the national median of 45%. 2 administrators have left in the past year — frequent leadership churn is a warning sign families often miss.

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

13
deficiencies at the latest standard inspection (2026-04-28)
13
at the previous standard inspection (2024-06-07)

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

Inspection deficiencies

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

ABCDEFGHIJKL

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

34 citations, most serious first. The 16 most serious are shown; the remaining 18 are one tap away and print in full.

  • Immediate jeopardy · Kcited before2026-04-28 · tag F0656 — failed to write and follow a full care plan — pattern
    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 Based on record review and interview, the facility failed to identify and implement interventions on care plans to prevent falls for 1 (#47) of 3 sampled residents reviewed for care plans. Resident #47 had 7 falls with 2 which resulted in fractures. The administrator identified 80 residents resided in the facility.On 04/27/26, an IJ situation was determined to exist related to the facility's failure to identify and implement interventions to prevent falls resulting in fractures for a resident who sustained seven falls in five months.On 04/27/26 at 10:44 a.m., the Oklahoma State Department of Health was notified and verified the existence of the IJ situation.On 04/27/26 at 12:48 p.m., the administrator and DON were notified of the IJ situation and provided the IJ template.On 04/27/26 at 4:52 p.m., an acceptable plan of removal was approved by the Oklahoma State Department of Health. The plan of removal, read in part, Plan of Removal - F656 (Comprehensive Care Plans) Immediate actions .Resident #47's comprehensive…

    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
  • Immediate jeopardy · Kcited before2026-04-28 · 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

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, and interview, the facility failed to:a. ensure adequate supervision was provided and exit doors and perimeter fences were secure to prevent an elopement for 1 (#92) of 3 sampled residents reviewed for elopement risk.The administrator identified 80 residents resided in the facility. The DON identified six residents in the facility at risk for elopement.An elopement evaluation for Resident #92, dated 02/28/26, showed the resident was at risk for elopement and wandering. The evaluation showed the resident wandered around the facility into rooms. The evaluation showed Resident #92 was a new admit.A baseline care plan for Resident #92, dated 02/28/26, showed no interventions for wandering or a risk for elopement.Resident #92 was last seen in the facility on 03/07/26 at 11:10 a.m. The resident was not observed in their room at 11:20 a.m. The resident was found approximately three blocks away, Southwest of the facility, half block away from a busy four-lane road, and was returned…

    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
  • Immediate jeopardy · J2026-04-28 · tag F0580 — failed to tell family and doctor about changes — isolated
    Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, the facility failed to ensure the physician and family were notified when a resident had a significant change of condition for 1 (#96) of 1 sampled resident reviewed for a change of condition which resulted in death. Resident #96 was on the toilet and bleeding. ACMA #2 stated they contacted LPN #1 about the residents' condition, and they had left the blood in the toilet for LPN #1 to observe. LPN #1 came to observe the resident; however, LPN #1 told them to continue to monitor the resident since they had refused to go to the ER. The physician or family was not notified of the serious change in condition of Resident #96.The administrator identified 80 residents resided in the facility.On [DATE], an IJ situation was determined to exist related to the facility's failure to notify the physician and family of a change in condition for Resident #96 who was reported to have active bleeding which resulted in death. On [DATE] at 5:24 p.m., the Oklahoma State Department of Health 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.

    Resident Rights Deficiencies · Deficient, Provider has date of correction
  • Immediate jeopardy · J2026-04-28 · tag F0684 — failed to provide proper treatment and quality of care — isolated
    Provide appropriate treatment and care according to orders, resident’s preferences and goals.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, the facility failed to promptly assess, identify, and intervene when a resident experienced an acute new onset of profuse bleeding from an unknown source for 1 (#96) of 1 sampled resident reviewed for a change in condition when facility staff failed to notify the medical provider of a critical hemoglobin lab value of 6.3 with a normal reference range was 13.7 to 17.5, and identify the new onset of profuse bleeding from an unknown source on a resident with a recent repair of an abdominal aortic aneurysm resulting in an attempted transfer to the acute care hospital and subsequent death in the ambulance while in the facility parking lot.Specifically, the facility failed to: a. Identify, monitor, intervene, and provide continuing assessments for Resident #96 who was admitted with a recent history of an abdominal aortic aneurysm repair. b. Notify the medical provider of, or intervene, for Resident #96's critically abnormal lab value of a hemoglobin of 6.3, and c. Notify 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.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Immediate jeopardy · J2026-04-28 · tag F0726 — failed to have competent, trained nursing staff — isolated
    Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, the facility failed to ensure sufficient/competent staff to assess, monitor, and intervene for a resident with profuse bleeding for 1 (#96) of 1 sampled resident reviewed for a change in condition when facility staff failed to assess, monitor, intervene for significant change in condition when a resident experienced an acute onset of profuse bleeding and failed to notify the medical provider of a critical hemoglobin lab value of 6.3 with a normal reference range of 13.7 to 17.5, and the onset of profuse bleeding on a resident with a known history of encounter for surgical aftercare following surgery on the circulatory system and the presences of an aortocoronary bypass graft resulting in the subsequent death of Resident #96.Specifically, the facility failed to:a. Identify, monitor, intervene, and provide continued assessments for Resident #96 who was admitted with known history of encounter for surgical aftercare following surgery on the circulatory system and the presences…

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

    Nursing and Physician Services Deficiencies · Deficient, Provider has date of correction
  • Actual harm · Gcited before2024-06-07 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — isolated
    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

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to develop and implement interventions to prevent falls with serious injury for one (#56) of one sampled residents reviewed for accidents. The lack of intervention development and implementation resulted in Res #56 suffering a broken hip. The administrator reported 69 residents resided in the facility. Findings: Res #56 admitted to the facility 06/01/23 with diagnoses which included dementia. A baseline care plan was not developed within 48 hours of admission. An incident report, dated 06/06/23 at 8:25 p.m., documented Res #56 had an unwitnessed fall. The incident report did not document an intervention. A progress note, dated 06/06/23 at 10:53 p.m., documented Res #56 had an unwitnessed fall in the bathroom. The progress note documented the resident was reminded to use their walker. The care plan was not developed after the fall. An admission MDS, dated [DATE], documented Res #56 was moderately cognitively impaired. A care plan, dated…

    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 · F2026-04-28 · tag F0835 — failed to run the facility competently — widespread
    Administer the facility in a manner that enables it to use its resources effectively and efficiently.
    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 was not administered in a manner that enabled it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, in that;The facility failed to:a. Ensure wandering residents did not elope and ensure residents at risk for wandering and elopement had not eloped for 1 (#92) of 6 residents at risk for wandering and elopement. Resident #92 was at risk for wandering and elopement. A baseline care plan, dated [DATE], showed no risk for elopement. Resident #92's care plan did not have interventions for wandering or elopement until [DATE]. ADON #1 stated they were not aware Resident #92 was found to be an elopement risk due to not communicating with the nurse that completed the assessment. ADON #1 stated there were no interventions implemented. An incident report, dated [DATE], showed Resident #92 was reported missing from their room and was found a couple of blocks away 10…

    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 · F2026-04-28 · tag F0838 — failed to assess facility resources and resident needs — widespread
    Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies.
    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 the facility assessment was completed annually to determine what resources were necessary to care for its residents competently, during both day-to-day operations (including nights and weekends), and emergencies.The administrator identified 80 residents resided in the facility. Findings: A document titled [NAME] Post Acute & Rehab Facility Assessment, showed the date of the assessment as 02/20/24. On 03/19/26 at 2:48 p.m., the interim administrator stated the facility assessment was completed annually. The interim administrator stated the assessment determined the resident needs based on resident needs at the time along with the quarterly QAPI. On 03/19/2026 at 3:30 p.m., DON #2 provided a facility assessment, dated 02/04/25, signed by the current interim administrator. DON #2 stated they completed the facility assessments for the year prior. DON #2 stated they did not have one for the current year. By the end of the survey, the facility…

    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 · D2026-04-28 · tag F0600 — failed to protect residents from abuse and neglect — isolated
    Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, the facility failed to ensure a resident was assessed and monitored by a licensed nurse for a significant change of condition and profuse bleeding for 1 (#96) of 1 sampled resident reviewed for neglect. LPN #1 was notified on [DATE] at 1:15 a.m. of Resident #96 with bleeding from an unknown source and failed to complete an assessment. EMS was notified at 3:12 a.m., left the building with Resident #96 at 3:35 a.m. and the resident ultimately expired in the ambulance at 3:40 a.m.The administrator identified 80 residents resided in the facility.Findings:A policy titled Acute Condition Changes - Clinical Protocol, dated 03/2018, read in part, The physician will help identify individuals with a significant risk for having acute changes of condition during their stay. In addition, the nurse shall assess and document/report the following baseline information:a. Vital signs,b. Neurological status,c. Current level of pain and any recent changes in pain level,d. Level of…

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

    Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Dcited before2026-04-28 · tag F0641 — isolated
    Ensure each resident receives an accurate assessment.
    What the surveyor found here — the official record, unedited, may be distressing

    Based on record review and interview, the facility failed to accurately code a resident assessment for hospice for 1 (#80) of 18 sampled residents reviewed for accurate assessments.The administrator identified 80 residents resided in the facility.Findings: A quarterly assessment for Resident #80, dated 02/11/26, showed the resident was receiving hospice care and their cognition was severely impaired with a BIMS score of 4.Resident #80's electronic health record did not show the resident had received any orders for hospice care. On 03/12/26 at 11:42 a.m., Resident #80's POA stated the resident did not receive hospice care. On 03/12/26 at 1:27 p.m., ADON #2 stated Resident #80 did not receive hospice care per Resident #80 POA's request.On 03/12/26 at 1:52 p.m., MDS coordinator #1 stated Resident #80 was not receiving hospice care and the assessment error was a mistake. MDS Coordinator #1 stated Resident #80's quarterly MDS assessment was not accurate.

    Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2026-04-28 · tag F0761 — failed to label and store drugs safely — isolated
    Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review and interview, it was determined the facility failed to ensure loose medications were not kept in the bottom of the medication cart drawers for 1 (North hall) of 1 medication cart observed. The administrator identified two medication carts in the facility.Findings: On [DATE] at 1:33 p.m., the medication cart for the North hall was observed with ACMA #1. There were six tablets and one capsule observed laying across the bottom of the drawer. An undated Medication Storage and Handling policy showed the medications would be monitored by the unit nurse, charge nurse, and the consultant pharmacist to assure they were not expired, contaminated, or unusable. On [DATE] at 1:40 p.m., ACMA #1 stated they checked for loose pills two times a week, but it had been a couple of days ago since they last checked. ACMA #1 stated when they found loose pills during their cleaning of the medication cart, they were to report to the charge nurse so the medications could be destroyed. On [DATE] at…

    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 · D2026-04-28 · tag F0812 — failed to store, cook, and serve food safely — isolated
    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 distribute food and ice in accordance with professional standards for food service safety for 2 of 2 kitchen observations. The administrator identified 80 residents resided in the facility. Findings: On 03/10/26 at 9:46 a.m., the initial tour of the kitchen with the dietary manager was conducted with the following observations made:a. one white paper bowl with orange ice cream wrapped in plastic wrap unlabeled and undated;b. one bag of opened hamburger buns unlabeled and undated; andc. ice machine with pink substance on the white plastic chute directly above the ice, that when wiped with a clean paper towel, resulted in pink and brown speckled substance. On 03/10/26 at 10:00 a.m., the dietary manager stated the food should be labeled. They stated they saw dirt on the towel used to wipe the ice machine chute. They stated the ice machine was wiped down last week and serviced recently. On 03/11/26 at 11:21 a.m., cook #1 was observed to have one hand gloved and one hand ungloved. [NAME] #1 used the gloved hand to place…

    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 · D2026-04-28 · 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

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, the facility failed to ensure accurate documentation for 1 (#96) of 2 sampled residents reviewed for death. The administrator identified 80 residents resided in the facility. Findings: An undated policy titled Nursing Documentation, read in part, Chart as soon as possible after giving care. Enter the date and time you are actually charting, and at the beginning of the entry - late entry for (date and time charting about).An admission assessment for Resident #96, dated [DATE], showed the resident's cognition was moderately impaired with a BIMS score of 12. The assessment showed Resident #96 required partial to moderate staff assistance with most activities of daily living.An EMS report for Resident #96, dated [DATE], showed the resident expired in the ambulance on [DATE] at 3:40 a.m.A task log for Resident #96, dated [DATE] and [DATE], showed the resident received assistance with activities of daily living on [DATE] at 10:08 a.m. The log showed the resident received…

    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 before2026-04-28 · 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

    Based on observation, record review, and interview, the facility failed to ensure enhanced barrier precautions were initiated and maintained during the provision of care to help prevent the development and transmission of communicable diseases and infections for 1 (#42) of 1 sampled resident reviewed for catheter care.The administrator identified 80 residents resided in the facility. The DON identified 21 residents were on EBP.Findings: On 03/10/26 at 11:44 a.m., Resident #42 was observed to have an indwelling urinary catheter. CNA #3 and CNA #5 entered the room with a mechanical lift to get resident up. They were observed to put on gloves. They did not put on a gown. There was no signage or PPE located inside of the room or near the room. An undated policy titled Enhanced Barrier Precautions, read in part, Enhanced Barrier Precautions (EBP) are required for residents with chronic wounds or indwelling medical devises during high-contact resident care activities regardless of their multi drug-resistant organism (MRDO) status. Indwelling medical device examples include . urinary…

    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 before2025-07-15 · 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

    Based on observation, record review, and interview, the facility failed to ensure proper PPE (personal protective equipment) was used for 1 (#3) of 2 sampled residents reviewed for enhanced barrier precautions. The director of nursing reported that 19 residents required enhanced barrier precautions. Findings: On 07/14/25 at 1:20 p.m., Res #3 was observed in bed with CNA #1 and CNA #2 present at the bedside providing care to the resident and changing the resident's linens. The two CNAs were observed wearing gloves but no gown. PPE supplies for enhanced barrier precautions were observed hanging on the resident's door. On 07/14/25 at 1:25 p.m., LPN #1 was observed to enter Res #3's room to perform feeding tube site care. The LPN performed hand hygiene and applied gloves. The LPN was observed to clean the feeding tube site and apply a clean gauze pad to the site. The LPN was observed not wearing a gown for enhanced barrier precautions. A policy titled Enhanced Barrier Precautions, revised date 05/01/25, showed enhanced barrier precautions refer to the use of a gown and gloves for use…

    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 · Ecited before2025-03-12 · tag F0641 — pattern
    Ensure each resident receives an accurate assessment.
    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 the minimum data set was coded accurately for Legionella for 1 (#1) of 1 sampled discharged resident from the hospital with Legionella. The administrator reported one resident tested positive for Legionella at the hospital and readmitted to the facility on [DATE]. Findings: Resident #1 diagnoses included COPD with acute exacerbation, pneumonia (unspecified organism), and chronic kidney disease stage 4. A hospital Discharge summary, dated [DATE], showed assessment: severe sepsis with acute organ dysfunction due to Legionella pneumonia/acute COPD exacerbation and urinary tract infection was improving. A Medicare-5 day assessment, dated 02/02/25, did not show a diagnosis for Legionella. On 03/12/25 at 12:19 p.m., the MDS/QS coordinator stated the resident discharged to the hospital on [DATE] and returned from the hospital on [DATE] and the Medicare-5 day care assessment was completed on 02/02/25 for skilled services. They stated the resident wanted…

    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 18 citations
  • Potential for harm · E2025-03-12 · tag F0657 — failed to keep the care plan current — pattern
    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

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, the facility failed to update a care plan for 1 (#1) of 1 sampled resident with a new diagnosis of Legionella. The administrator reported one resident tested positive for Legionella at the hospital and readmitted to the facility on [DATE]. Findings: An undated Care Plans, Comprehensive Person-Centered policy, read in part, The facility will develop a comprehensive person-centered care plan for each resident within 7 days after completion of the comprehensive assessment that includes: Measurable objectives and timeframes to meet the resident's medical, nursing, mental and psychosocial needs. Resident #1 diagnoses included COPD with acute exacerbation, pneumonia (unspecified organism), and chronic kidney disease stage 4. A care plan, dated 03/17/23 through 02/20/25, did not show Legionella. A hospital Discharge summary, dated [DATE], showed assessment: severe sepsis with acute organ dysfunction due to Legionella pneumonia/acute COPD exacerbation and urinary tract infection 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.

    Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Ecited before2025-01-13 · tag F0695 — failed to provide proper breathing / tracheostomy care — pattern
    Provide safe and appropriate respiratory care for a resident when needed.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, and interview, the facility failed to establish consistent protocol and follow facility policy for BiPAP therapy for two (#3 and #4) of two sampled residents reviewed for BiPAP therapy. The RN/DON identified two residents with BiPAP therapy. Findings: The CPAP/BiPAP Cleaning policy, dated May 2022, read in part, It is the policy of this facility to clean CPAP/BiPAP equipment in accordance with current CDC guidelines and manufacturer recommendations in order to prevent the occurrence or spread of infection. The policy also read, Respiratory therapy equipment can become colonized with infectious organisms and serve as a source of respiratory infections. The policy also read, Clean mask frame daily after use with CPAP cleaning wipe or soap and water. Dry well. Cover with plastic bag or completely enclosed in machine storage when not in use. Weekly cleaning activities (specify day of week): a. Wash headgear/straps in warm, soapy water and air dry. b. Wash tubing with warm, soapy…

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

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · E2024-06-07 · tag F0578 — failed to honor advance directives / code status — pattern
    Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, the facility failed to ensure residents were offered the choice to formulate advanced directives for three (#19, 42 and #55) of four sampled residents reviewed for advanced directives. The administrator reported 69 residents resided in the facility. Findings: The facility's Advance Directives policy, not dated, read in part The facility will provide to each resident or his surrogate his rights under State law to formulate advance directives . 1. Resident #42 was admitted to the facility on [DATE]. The resident had diagnoses which included chronic pain. Resident #42's advanced directive acknowledgement form was not completed. Resident #42's electronic medical record documented the resident's code status was full code 2. Resident #55 was admitted to the facility on [DATE] with diagnoses which included hypertension. Resident #55's advanced directive acknowledgement form was not completed. Resident #55's electronic medical record documented the resident's code status was full…

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

    Resident Rights Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Ecited before2024-06-07 · tag F0656 — failed to write and follow a full care plan — pattern
    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 — the official record, unedited, may be distressing

    Based on record review and interview, the facility failed to develop a comprehensive care plan related to anticoagulant therapy, chronic pain and opioid medication for one (#26) of five residents reviewed for unnecessary medications. 1. Resident #26 had diagnosis which included cerebrovascular accident and chronic pain medication. A care plan, dated 05/20/24, documented no care areas related to anticoagulant therapy, chronic pain, or opioid use. A quarterly assessment, dated 05/22/24, documented severly impaired cognition. The assessment documented anticoagulant and opioid medication use. Resident #26's order summary report, dated 06/05/24, documented Eliquis oral tablet 2.5 mg give by mouth two times a day .Norco oral tablet 7.5-325 mg give 1 tablet by mouth every 6 hours . On 06/06/24 at 1:30 p.m., the DON reported anticoagulant therapy, chronic pain and any prescribed medication should have been included on the resident care plans.

    Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · E2024-06-07 · tag F0698 — failed to provide proper dialysis care — pattern
    Provide safe, appropriate dialysis care/services for a resident who requires such services.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review and interview, the facility failed to ensure communication between the dialysis center and facility, and failed to obtain a physician order for dialysis for one (#14) of one sampled residents reviewed for dialysis. The administrator reported 69 residents resided in the facility. Findings: Res #14 admitted [DATE] with diagnoses which included end stage renal disease. A care plan, dated 04/14/24, documented Res #14 required hemodialysis due to renal failure. A physician order, dated 04/30/24, documented to remove dialysis bandage the morning after dialysis and check for bleeding on Tuesday, Thursday, and Saturday. On 06/04/24 at 9:40 a.m., Res #14 was observed in their bed resting. They stated they were sent with a notebook to dialysis and bring it back and forth to their appointments. Dialysis communication forms were missing or incomplete for 20 of 23 opportunities. On 06/06/24 at 8:31 a.m., ADON #2 stated the resident went to dialysis on Monday, Wednesday, and Friday. They…

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

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · E2024-06-07 · tag F0755 — failed to provide safe pharmacy services — pattern
    Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on record review and interview, the facility failed to administer medications according to physician's orders for two (#14 and #69) of eight sampled residents whose orders were reviewed. The administrator reported 69 residents resided in the facility. Findings: 1. Res #14 had diagnoses which included diabetes and hypertension. A physician order, dated 04/11/24, documented to administer Carvedilol 6.25 mg two times per day for hypertension. The order did not document a hold parameter. A physician order, dated 04/11/24, documented to administer Lisinopril 20 mg one time per day for hypertension. The order did not document a hold parameter. A physician order, dated 04/11/24, documented to administer Hydralazine 50 mg three times per day for hypertension. The order did not document a hold parameter. A physician order, dated 04/13/24, documented to administer Insulin Glargine 20 units two times per day for diabetes. The order did not document a hold parameter. A physician order, dated 04/13/24, documented to administer Insulin Lispro 13 units three times per day for diabetes. 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.

    Pharmacy Service Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Ecited before2024-06-07 · 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 follow infection control practices during wound care for Res #19, and failed to conduct infection surveillance and tracking. The administrator reported 69 residents resided in the facility. Findings: A Infection Prevention and Control Program policy, not dated, read in part : .The facility has established and maintains an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections as per accepted national standards and guideline . The designated Infection Preventionist is responsible for oversight of the program and serves as a consultant to our staff on infectious diseases, resident room placement, implementing isolation precautions, staff and resident exposures, surveillance, and epidemiological investigations of exposures of infectious diseases . A system of surveillance is utilized for prevention, identifying, reporting, investigating, and controlling infections 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.

    Infection Control Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · E2024-06-07 · tag F0881 — failed to use antibiotics responsibly — pattern
    Implement a program that monitors antibiotic use.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on record review and interview, the facility failed to maintain an antibiotic stewardship program to monitor antibiotic use for residents. The Administrator reported 69 residents resided in the facility. Findings: An Infection Prevention and Control Program policy, not dated, read in part .Antibiotic Stewardship: An antibiotic stewardship program will be implemented as part of the overall infection prevention and control program .Antibiotic use protocols and a system to monitor antibiotic use will be implemented as part of the antibiotic stewardship program .The Infection Preventionist, with oversight from the DON, serves as the leader of antibiotic stewardship program . On 06/05/24 at 1:30 p.m., IP reported they used the SBAR screening for antibiotic use. The IP reported antibiotic use and infection tracking and trending had not been done since January 2024. The IP reported tracking and trending of infections and antibiotics had not been monitored in accordance with facility policy. The IP reported not being aware of how the new owner wanted infection control to be conducted.…

    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 · E2024-06-07 · tag F0883 — failed to offer flu and pneumonia vaccines — pattern
    Develop and implement policies and procedures for flu and pneumonia vaccinations.
    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 residents were assessed for, offered, and received pneumococcal immunizations upon admission or when needed for seven (#6, 12, 18, 23, 26, 28, and #44) of eight residents reviewed for immunizations. The Administrator reported 69 residents resided in the facility. Findings: An Infection Prevention and Control Program policy, not dated, read in part .Influenza and Pneumococcal Immunization: Resident will be offered the pneumococcal vaccines recommended by the CDC upon admission .Education will be provided to the residents and/or representative regarding the benefits and potential side effects of the immunizations prior to offering the vaccines .Resident will have the opportunity to refuse the immunizations .Documentation will reflect the education provided and details regarding whether or not the resident received the immunizations . 1. Resident #6 was admitted on [DATE]. On 06/05/24, resident #6's medical record documented pneumovax dose one 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.

    Infection Control Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2024-06-07 · tag F0582 — isolated
    Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
    What the surveyor found here — the official record, unedited, may be distressing

    Based on record review and interview, the facility failed to complete a SNF ABN for two (#226 and #227) of three sampled residents reviewed for beneficiary notices. The administrator reported 69 residents resided in the facility. Findings: The BOM identified 23 residents who had been discharged from a Medicare Part A covered stay with benefit days remaining in the past 6 months 1. Res #226 admitted to Part A skilled services on 03/06/24 and discharged from skilled services 03/26/24. There was no documentation a SNF ABN was provided to Res #226 or their representative. 2. Res #227 admitted to Part A skilled services on 01/04/24 and discharged from skilled services 01/22/24. There was no documentation a SNF ABN was provided to Res #227 or their representative. On 06/04/24 at 2:13 p.m., the social services director stated the SNF ABN's for Res #1 and #2 were not completed.

    Resident Rights Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2024-06-07 · tag F0645 — isolated
    PASARR screening for Mental disorders or Intellectual Disabilities
    What the surveyor found here — the official record, unedited, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, the facility failed to accurately complete a level 1 pre-screening assessment for one (#56) of two sampled residents reviewed for pre-screening assessments. The administrator reported 69 residents resided in the facility. Findings: Res #56 admitted to the facility on [DATE] with diagnoses that included schizoaffective disorder. A level 1 pre-screening assessment, dated 06/08/23, documented the resident did not have a serious mental illness. On 06/07/24 at 8:44 a.m., admissions RN #2 stated the documentation on Res #56's level 1 screening was an oversight. They stated the diagnosis should have been documented on the form.

    Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2024-06-07 · tag F0693 — failed to provide proper feeding-tube care — isolated
    Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.
    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 notify the physician of dislodgement of PEG tube per policy for one (#48) of one sampled residents reviewed for enteral nutrition. The administrator reported 69 residents resided in the facility. Findings: An undated facility Feeding Tubes policy, documented in part .The resident's physician must be notified i the tube becomes clogged or displaced . An undated facility Care and Treatment of Feeding Tubes policy, documented in part .Direction for staff regarding the conditions and circumstances under which a tube is to be changed will be provided: a. when to replace and/or change a feeding tube (generally as ordered/scheduled by the physician, when a long-term feeding tube comes out unexpectedly, or when the tube is worn or clogged) .Notification of the practitioner when the need for a tube change arises unexpectedly .The facility will notify and involve the physician or designated practitioner of any complications, and in evaluating and managing care to address the complications and risk factors . Res #48 had…

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

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2024-06-07 · tag F0732 — isolated
    Post nurse staffing information every day.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation and interview, the facility failed to ensure daily staffing was posted and contained the required information. The administrator reported 69 residents resided in the facility. Findings: On 06/04/24 at 9:31 a.m., the north hall nurses station was observed. A clipboard containing daily assignments was observed with staff names and hall assignments. The document did not document the facility name, the total number and the actual hours worked, or the census. The required information was not observed posted elsewhere on the unit. On 06/04/24 at 9:33 a.m., the south hall nurses station was observed. A clipboard containing daily assignments was observed with staff names and hall assignments. The document did not document the facility name, the total number and the actual hours worked, or the census. The required information was not observed posted elsewhere on the unit. On 06/04/24 at 11:30 a.m., the south hall nurses station was observed. A clipboard containing daily assignments was observed with staff names and hall assignments. The document did not document 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.

    Nursing and Physician Services Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2024-06-07 · tag F0756 — failed to review each resident's drug regimen — isolated
    Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
    What the surveyor found here — the official record, unedited, may be distressing

    Based on record review and interview, the facility failed to ensure a MRR was responded to in a timely manner for one (#56) of five sampled residents reviewed for unnecessary medications. The administrator reported 69 residents resided in the facility. Findings: Res #56 had diagnoses which included schizoaffective disorder. A MRR, dated 03/11/24, documented a request for a GDR. The physician documented their declination on 04/16/24. On 06/06/24 at 1:32 p.m., the DON stated the MRR's must be responded to according to what is on the form. They stated 30 days was designated on the form.

    Pharmacy Service Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Ecited before2023-04-27 · tag F0695 — failed to provide proper breathing / tracheostomy care — pattern
    Provide safe and appropriate respiratory care for a resident when needed.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, and interview the facility failed to ensure: a. physician orders were obtained for oxygen therapy for two residents (#1 and #18), and; b. oxygen tubing and humidifier bottles were labeled with a date for one (#45) of three residents reviewed for oxygen use. The Resident Census and Conditions of Residents report, dated 04/26/23, documented 13 residents with respiratory treatments. Findings: A policy Oxygen Administration, undated, documented and read in parts, .oxygen is administered under orders of a physician .change oxygen tubing and mask/cannula 2 x month . 1. Resident #1 was admitted on [DATE] with diagnoses which included heart failure and hypertension. An Annual Assessment, dated 02/12/23, documented the resident's cognition was moderately impaired, required extensive assistance with ADL's, and was on hospice services. Oxygen services was not indicated on the assessment. A Care Plan, dated 02/14/23, documented the resident was on 02 to help maintain comfort levels. 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.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · E2023-04-27 · tag F0887 — pattern
    Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status.
    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 the COVID-19 vaccine had been offered, education provided, and declination signed by residents or resident representatives for five (#50, 52, 53, 60 and #63) of five residents reviewed for compliance with COVID-19 immunizations. The Resident Census and Conditions of Residents report, dated 04/26/23, documented 63 residents resided in the facility. Findings: The facility's COVID-19 Vaccination policy, dated 01/01/23, read in parts, .Prior to offering the COVID-19 vaccine, staff, residents, or the resident's representative, will be educated regarding the risks, benefits and potential side effects associated with the vaccine in a form and manner that can be accessed and understood .A copy of the Emergency Use Authorization For Recipients and Caregivers for the specific vaccination brand will be given to staff, residents or resident representatives prior to administration and in conjunction with education as noted above .Residents or their…

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

    Infection Control Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · E2023-04-27 · tag F0925 — failed to control pests — pattern
    Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
    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 maintain an effective pest control program to prevent the presence of pests. The Facility Census and Conditions of Residents report, dated 04/26/23, documented a total of 63 residents resided in the facility. Findings: An undated Pest Control Program Policy, read in parts, .effective pest control program is defined as measures to eradicate and contain common household pests .Facility will utilize a variety of methods in controlling certain seasonal pests . The Resident Council Meeting Minutes, dated 02/20/23, documented the housekeeping staff were only spot cleaning resident rooms. On 04/21/23 at 11:00 a.m., a tour of the facility was conducted. The facility had evidence of pests, mouse droppings, in resident rooms, and on the east hallway. Five resident rooms and east hallway were observed to have sticky traps and evidence of mice activity in their rooms. Droppings were observed under beds, along baseboards, closet floors, and along the hallway to the time clock. On 04/21/23 at 11:10 a.m., Resident #25,…

    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 before2023-04-27 · 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

    Based on observation, record review, and interview, the facility failed to ensure hand hygiene was performed during wound care for one (#60) of two residents sampled for infection control during pressure ulcer treatments. The Resident Census and Conditions of Residents report, dated 04/26/23, documented two residents with pressure ulcers and a total resident census of 63. Findings: Resident #60 was admitted with diagnoses which included heart failure and pressure ulcers. A Quarterly Assessment, dated 04/02/23, documented resident #60 was dependent on staff assistance with ADL's and had three pressure ulcers. A Care Plan, dated 04/02/23, documented resident #60 was bedfast and required total assistance from staff with all ADL's and wound care. Physician orders for resident #60, dated 04/26/23, documented wound treatments to bilateral heels and sacral wound. On 04/25/23 at 2:16 p.m., LPN #1 and LPN #2 were observed to collect supplies to provide wound care. The staff donned gloves and cut the dressing of the right heel with scissors and then placed them on the edge of the clean work…

    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

“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

$124,185 in federal fines across 1 penalty.

  • $124,185 — penalty dated 2026-04-28

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

Owner / managerTypeRoleShareSince
LAWTON POST ACUTE & REHAB,LLCOrganization5% OR GREATER DIRECT OWNERSHIP INTEREST; OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF100%since 01/02/2024
FAMILY TK5 HOLDINGS LLCOrganization5% OR GREATER INDIRECT OWNERSHIP INTEREST; OPERATIONAL/MANAGERIAL CONTROLNO PERCENTAGE PROVIDEDsince 01/02/2024
PRATT, KYLENEIndividual5% OR GREATER INDIRECT OWNERSHIP INTEREST; ADP OF THE SNFNO PERCENTAGE PROVIDEDsince 01/02/2024
BOKF,NAOrganization5% OR GREATER MORTGAGE INTEREST; OPERATIONAL/MANAGERIAL CONTROLsince 01/02/2024
GALBASINI, KEVINIndividualMANAGING CONTROL - GOVERNING BODY; OPERATIONAL/MANAGERIAL CONTROLsince 01/02/2024
LAMB, MARKIndividualMANAGING CONTROL - GOVERNING BODY; OPERATIONAL/MANAGERIAL CONTROL; TRUSTEE OF THE SNFsince 01/02/2024
PRATT, TODDIndividualMANAGING CONTROL - GOVERNING BODY; OPERATIONAL/MANAGERIAL CONTROL; GENERAL PARTNERSHIP INTEREST; ADP OF THE SNFsince 01/02/2024
1700 NW FORT SILL BLVD LLCOrganizationOPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNFsince 01/02/2024
K & JG HOLDINGS 2 LLCOrganizationOPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNFsince 01/02/2024
K & JG HOLDINGS LLCOrganizationOPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNFsince 01/02/2024
KOPIAN PROPERTY 2 LLCOrganizationOPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNFsince 01/02/2024
KOPION HEALTHCARE HOLDINGS LLCOrganizationOPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNFsince 01/07/2025
LAMB LIVING TRUST MAY 25, 2018OrganizationOPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNFsince 01/02/2024

CMS files one row per role, so the 30 rows in the source record cover these 13 parties — each is shown once here with every role it holds. Nothing is omitted.

9 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.

$4.7M
Net patient revenuemost recent cost report
-11.7%
Operating marginrevenue minus expenses
Who pays — share of resident-days
Medicaid 72%Medicare 4%Other / private 24%

About 72% 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. A reported operating loss is common in this industry and is not by itself a sign of trouble — but paired with large related-party payments it can mean profit is being taken elsewhere in the ownership structure.

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

$231per resident / day
operating cost
$7,016per month
≈ monthly operating cost
$207per 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 OK

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 Oklahoma Medicaid page.

Typical monthly cost in Oklahoma
$7,026/mo
Nursing home (semi-private)
$7,756/mo
Nursing home (private)
$6,150/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 375510. CMS refreshes its data monthly, and the star rating rests on the last standard inspection — dated 2026-04-28, which can lag current conditions. Staffing hours are CMS PBJ CY2026Q1 (Jan–Mar 2026). Check this record against the government’s own page for it: this home on Medicare Care Compare ↗ — the authoritative source, and the place to confirm anything here before you act on it. How we present it →

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

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

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