Maryville

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.

65.3% of the Medicare patients who left this home got back to the community and stayed there for at least 31 days — CMS rates that better than the national rate. This is CMS’s risk-adjusted rate over 189 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.

Met the expected recovery: 49.6% 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 127 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 0.36 therapist hours per resident per day in 2026Q1 — more than 61% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 22% of this home’s weekday level — it runs some therapy at the weekend, at a lower level than on weekdays. The median home that reports therapy runs 13% — weekday-focused therapy is the industry norm, not a shortfall. But recovery does not pause on a Saturday: ask what the weekend actually looks like here.

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

Staffing

How full it usually is: this home is certified for 165 beds and averages 130.1 residents a day — about 79% occupied, or roughly 35 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 5.52 hrs/resident/day is at or above the 3.48-hour benchmark and RN staffing of 1.02 is at or above the 0.55-hour RN benchmark and nurse-aide staffing of 3.75 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 5.00 hrs/resident/day on weekends vs 5.73 on weekdays — 13% thinner on weekends. RN hours go from 1.18 to 0.62 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

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

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

Inspection trend

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

Inspection deficiencies

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

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

23 citations, most serious first. The 14 most serious are shown; the remaining 9 are one tap away and print in full.

• Immediate jeopardy · Jcited before2023-12-18 · 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 it was determined the facility failed to assess elopement risk and provide supervision to prevent a severely cognitively impaired resident from eloping for 1 of 3 sampled residents (#272) reviewed for elopement. This failure resulted in an immediate jeopardy situation when Resident 272 eloped from the facility, was exposed to cold and rainy weather conditions, was without supervision at night in a high-traffic area, and was at risk for wandering into additional unsafe areas and getting lost. This placed the resident at risk for hypothermia, accidents, and a lack of access to support services. Findings include: Resident 272 admitted on [DATE] with diagnoses including dementia with self-neglect. A 11/15/23 Hospitalist History and Physical (H&P) indicated Resident 272 was hospitalized after she/he was found wandering in the streets and trying to get into various homes. Resident 272 was diagnosed with dementia in 2022 and had slowly worsening cognition for some time.…

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

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Actual harm · Gcited before2024-03-20 · 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 interview and record review it was determined the facility failed to ensure the plan of care was followed to provide care-planned assistance to prevent a fall for 1 of 3 sampled residents (#3) reviewed for falls. This resulted in Resident 3's hospitalization with leg fracture and surgical repair. Findings include: Resident 3 admitted to the facility in 2023 with diagnoses including a history of falls. The 11/16/23 Care Plan indicated Resident 3 was at risk for falls related to impaired mobility. Interventions included providing a safe environment, including personal items within reach. The Care Plan also indicated Resident 3 required one-person assistance with bathing. The 11/23/23 admission MDS indicated Resident 3 was cognitively intact. A 12/30/23 fall investigation indicated Staff 3 (CNA) called Staff 4 (LPN) and Staff 5 (LPN) into Resident 3's room as the resident suffered a fall while in the shower. Upon entering the room, the resident was found lying on her/his right side. Resident 3 initially…

  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 · Past Non-Compliance
• Actual harm · Gcited before2023-12-18 · tag F0684 — failed to provide proper treatment and quality of care — isolated
  Provide appropriate treatment and care according to orders, resident’s preferences and goals.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on interview and record review it was determined the facility failed to prevent the development of moisture associated skin damage (MASD) and follow physician orders for 2 of 3 sampled residents (#s 322 and 372) reviewed for skin conditions and pain management. This failure resulted in Resident 372 developing MASD and placed residents at risk for increased pain. Findings include: 1. Resident 372 was admitted to the facility in 2018 with diagnoses including heart failure. On 3/1/23 a diagnosis of dementia with agitation was added. Resident 372's 4/21/23 physician order indicated to apply barrier cream and cover with a foam dressing to the coccyx area two times a day for skin care protection. The 8/2023 TAR indicated Resident 372 received dressing changes twice daily from 8/13/23 through 8/17/23. The 8/18/23 Skin Incident Report indicated on 8/17/23 during a preventative dressing treatment it was noted Resident 372 had a partial-thickness skin loss that measured 4.78 cm in length x 3.2 cm wide moisture associated dermatitis to the coccyx. Resident 372 did not know how she/he got…

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

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Actual harm · Gcited before2023-08-17 · 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 interview and record review it was determined the facility failed to follow resident care plans related to transfers for 3 of 7 sampled residents (#s 1, 2 and 24) reviewed for safety and transfers. Resident 1 fell and sustained a femur fracture. Findings include: Resident 1 was admitted to the facility in 2022 with diagnoses including hypertension, lymphedema, and reduced mobility. The admission MDS dated [DATE] indicated Resident 1 required two-person extensive physical assistance for transfers. Resident 1's Care Plan dated 8/30/22 identified Resident 1 to be at risk for falls due to decreased mobility and weakness. Interventions on the care plan included two person mechanical lift assistance for transfers. A Facility Investigation Report dated 6/15/22 at 3:10 PM indicated Resident 1 fell to the floor from the commode and sustained an oblique fracture of the right distal femur. According to the investigation, Staff 18 (CNA) assisted Resident 1 from the commode back to bed when Resident 1 slid from 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
• Potential for harm · D2026-04-23 · tag F0760 — failed to prevent significant medication errors — isolated
  Ensure that residents are free from significant medication errors.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on interview and record review it was determined the facility failed to ensure residents were free from significant medication errors for 1 of 3 sampled resident (#6) reviewed for medication administration. This placed residents at risk for adverse medication consequences. Findings include:Resident 6 was admitted to the facility in 2025 with diagnosis including orthostatic hypotension and implantation of a prosthetic heart value. Resident 6's 5/21/25 Care Plan indicated Resident 6 had impaired cardiovascular function and altered cardiovascular function due to the presence of a pacemaker. Resident 6's MDS identified the resident with a BIMS score of 12 out 15 indicating mild to moderate cognitive impairment. A 6/5/25 Facility Risk Management Report identified Staff 16 (LPN) wrongly administered a combination of the following medications to Resident 6: Levothyroxine 50mcg, Tylenol 500mg, Gabapentin 300mg, Bactrim 800-160, Amidarone 200mg, Baclofen 5mg, Calcium Citrate 315mg-5mcg, Vit D3 125 mcg, Clopidogrel 75mg, CoQ10 75 mg, Entresto 300mg, Finasteride 5mg, Multivitamin 1 tab,…

  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 · Fcited before2025-04-11 · tag F0880 — failed to prevent and control infections — widespread
  Provide and implement an infection prevention and control program.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY 1. Based on observation, interview and record review it was determined the facility failed to ensure proper hand hygiene was completed during meals for 1 of 6 halls reviewed for dining. This placed residents at risk for cross contamination. Findings include: The 8/2019 Handwashing/Hand Hygiene Policy indicated hand hygiene was the primary means to prevent the spread of infections. The policy indicated: 7. Use of an alcohol-based hand rub containing at least 62% alcohol; or alternatively, soap (antimicrobial or non-antimicrobial) and water for the following situations: a. before and after direct contact with residents; l. after contact with objects in the immediate vicinity of the resident; o. before and after eating or handling food; p. before and after assisting a resident with meals; On 4/7/25 during the lunch meal in the west hall and dining room the following observations were made: -12:05 PM Staff 10 (NA) removed three dirty breakfast trays from a two-tier serving cart and loaded the cart with three lunch…

  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 before2025-04-11 · tag F0677 — failed to help fully-dependent residents with daily care — isolated
  Provide care and assistance to perform activities of daily living for any resident who is unable.
  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 it was determined the facility failed to ensure dependent residents received required assistance with ADLs for 1 of 3 sampled residents (#36) reviewed for ADLs. This placed residents at risk for lack of personal hygiene. Findings include: Resident 36 was admitted to the facility in 8/2024 with diagnoses including cerebral atherosclerosis (hardening of arteries in the brain) and dementia. Resident 36's Significant Change MDS dated [DATE] indicated the resident was dependent on staff for personal hygiene and grooming. Resident 36 was observed on 4/8/25 at 10:24 AM, and on 4/9/25 at 8:24 AM with a significant amount of chin hair visible. On 4/8/25 at 10:24 AM, Resident 36 stated she/he did not want to have facial hair and would like for staff to take care of it for her/him. Resident 36 stated she/he relied on staff to shave unwanted facial hair. On 4/9/25 at 2:13 PM, Staff 6 (CNA) stated she obtained information to care for Resident 36 from the [NAME] (bedside care…

  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 · Dcited before2025-01-03 · 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

  Based on observation, interview and record review, it was determined the facility failed to follow care plan interventions related to aspiration risks for 1 of 3 sampled residents (#3) reviewed for accidents. Resident 3 admitted to the facility in 2024 with diagnoses including traumatic subdural hemorrhage (severe head injury) and dysphagia (difficulty with swallowing). Resident 3's 9/3/24 Care Plan indicated the resident required one on one eating assistance due to dysphagia. The care plan stated staff were not to deliver until staff was ready to assist the resident. The 9/2024 admission MDS identified Resident 3 was cognitively intact. A 9/4/24 choking/aspiration investigation revealed Staff 5 (CNA) delivered Resident 3's lunch tray to the resident and informed Resident 3 that she would return to assist Resident 3 after delivering the last lunch tray. Resident 3 was noted to have begun eating without assistance and began to choke due to placing too much food in her/his mouth. Staff 4 (OT) was in the room at the time assisting Resident 3's roommate. Staff 4 was alerted by 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
• Potential for harm · D2023-12-18 · tag F0550 — failed to protect resident dignity and rights — isolated
  Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on observation, interview and record review it was determined the facility failed to ensure a resident was treated in a dignified manner for 1 of 1 sampled resident (#324) reviewed for activities. This placed residents at risk for being treated in a dishonorable manner. Findings include: Resident 324 was admitted to the facility in 11/2023 with diagnoses including stroke and dysphagia (difficulty swallowing). A 11/28/23 care plan revealed Resident 324 required one staff person assistance with personal hygiene, dressing and needed one to one assistance with eating. On 12/13/23 at 8:30 AM Resident 324 was observed in bed asleep and two CNAs moved the resident up in bed and adjusted her/his pillows, the resident's eyes remained closed, and staff did not speak to the resident. Staff 32 (CNA) turned on the overhead light and said, it's time to wake up. Staff 32 used the bed control to raise the head of the bed to approximately 90 degrees (in an upright position) and Resident 324's head slumped towards her/his left shoulder. Staff 32 placed a clothing protector on the resident's…

  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 · D2023-12-18 · 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 interview and record review it was determined the facility failed to notify a resident's responsible party of a change in condition for 1 of 1 sampled resident (#372) reviewed for change of condition. This placed residents at risk for having uninformed responsible parties. Findings include: Resident 372 was admitted to the facility in 2018 with diagnoses including heart failure. On 3/1/23 a diagnosis of dementia with agitation was added. Resident 372's clinical record indicated Witness 2 (Family Member) was her/his responsible party, POA (Power of Attorney) for care, and Emergency Contact #1. On 12/11/23 at 9:55 AM Witness 2 stated Resident 372 passed away in 8/2023 and when she went to the facility the day after to collect the resident's belongings, Staff 5 (RNCM) told her the resident had pressure ulcers. Witness 2 stated it was the first time she was notified of Resident 372's skin issues. The 8/18/23 Skin Investigation by Staff 3 (LPN) indicated on 8/17/23 Resident 372 had a partial thickness skin loss which measured 4.78 cm x 3.2 cm to the coccyx. The investigation…

  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 · D2023-12-18 · tag F0582 — isolated
  Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review it was determined the facility failed to provide written notification to 2 of 3 sampled residents (#s 373 and 374) reviewed for Notice of Medicare of Non-Coverage (NOMNC). This placed residents at risk for unknown financial liabilities. Findings include: 1. Resident 373 was admitted to the facility on [DATE] and discharged from the facility on 6/27/23. The 6/27/23 Discharge MDS indicated Resident 373 had a planned discharge with a Medicare covered stay at the facility. A review of the resident's medical record revealed no indication a NOMNC was provided. On 12/14/23 at 10:17 AM Staff 16 (Assistant Administrator) acknowledged a NOMNC was not provided to Resident 373. 2. Resident 374 was admitted to the facility on [DATE] and discharged from the facility on 7/14/23. The 7/14/23 Discharge MDS indicated Resident 374 had a planned discharge with a Medicare covered stay at the facility. A review of the resident's medical record revealed no indication a NOMNC was provided. 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.

  Resident Rights Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2023-12-18 · tag F0690 — failed to manage incontinence, catheters, and urinary infections — isolated
  Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on interview and record review it was determined the facility failed to provide adequate bowel and bladder care for 2 of 3 sampled residents (#s 48 and 118) reviewed for bowel and bladder. This placed residents at risk for skin breakdown. Findings include: 1. Resident 48 was admitted to the facility in 11/2023 with diagnoses including left leg/hip fracture and right foot drop (difficulty lifting the front part of the foot). A 11/2/23 care plan revealed Resident 48 required one staff person assistance with toileting and personal hygiene needs. A review of a FRI dated 11/6/23 revealed Resident 48 was placed on a bedpan by Staff 41 (CNA). The resident was left on the bedpan for 30 minutes before Staff 43 (CNA) entered the room and removed the bedpan from under Resident 48. The resident was assessed by Staff 42 (RN) directly after the incident and was noted to have an indentation from the bedpan, she/he was not painful, not upset, or angry. Staff 2 (DNS) interviewed all parties involved and concluded Staff 41 did not abuse Resident 48 but could not rule out neglect. On 12/12/23 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.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2023-12-18 · tag F0695 — failed to provide proper breathing / tracheostomy care — isolated
  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

  Based on observation, interview and record review it was determined the facility failed to follow physician orders for oxygen therapy and to ensure respiratory equipment was maintained for 1 of 1 sampled resident (#89) reviewed for respiratory care. This placed residents at risk for adverse respiratory complications and outcomes. Findings include: Resident 89 was admitted to the facility in 6/2022 with diagnosis including COPD (chronic obstructive pulmonary disease). a. Resident 89's Physician Order Summary Report as of 12/13/23 revealed the resident was to wear oxygen at one to three liters to keep her/his oxygen saturation between 88 to 92 percent. Staff were directed to document the saturation levels three times a day. Resident 89's oxygen saturation levels from 11/12/23 through 12/12/23 indicated the resident wore oxygen at night and while oxygen was in use the resident's oxygen saturation levels ranged from 93 to 96 percent. The amount of oxygen the resident used at night was not documented. On 12/13/23 at 1:21 PM Staff 22 (RN) stated the resident wore oxygen at night for COPD…

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

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2023-12-18 · tag F0759 — failed to keep medication error rate low — isolated
  Ensure medication error rates are not 5 percent or greater.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on observation, interview and record review it was determined the facility failed to ensure a medication error rate of less than five percent for 2 of 7 sampled residents (#s 17 and 57) reviewed for medication administration. The facility's medication error rate was 10.71%. This placed residents at risk for adverse medication consequences. Findings include: 1. Resident 17 was admitted to the facility in 12/2017 with diagnoses including diabetes. Resident 17's 12/14/23 physician's orders included Humalog insulin 8 units to be administered to the resident subcutaneously (under the skin) two times a day. The Humalog manufacturer instructions indicated a priming dose of two units prior to each dose with the Humalog insulin pen was required to remove air and ensure an accurate dose. On 12/13/23 at 8:09 AM Staff 8 (LPN) was observed to dial 8 units on the Humalog insulin pen without first performing the two unit priming dose. On 12/13/23 at 8:09 AM the surveyor stopped Staff 8 and asked about the priming dose. Staff 8 stated she did not routinely use a priming dose. On 12/13/23 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

“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

$107,136 in federal fines across 1 penalty.

• $107,136 — penalty dated 2023-12-18

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 22 rows in the source record cover these 16 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.

This home reported $1.8M paid to related parties (affiliated landlords or management companies) in its most recent cost report. 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

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 OR