Silver Creek Rehab and Healthcare Center

Location & what’s nearby

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

Quality measures — how residents actually fare

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

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

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

52.4% of the Medicare patients who left this home got back to the community and stayed there for at least 31 days — which CMS reads as no different from the national rate. This is CMS’s risk-adjusted rate over 60 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.

Met the expected recovery: 61.9% 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 42 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 0.29 therapist hours per resident per day in 2026Q1 — more than 45% 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 128 beds and averages 114.0 residents a day — about 89% occupied, or roughly 14 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 3.39 hrs/resident/day is below the 3.48-hour benchmark and RN staffing of 0.69 is at or above the 0.55-hour RN benchmark and nurse-aide staffing of 2.42 is below the 2.45-hour aide benchmark. What federal law does require today is unchanged: “sufficient” nursing staff for residents’ needs and an RN on duty at least 8 consecutive hours a day, 7 days a week (42 CFR 483.35). Those are judged by inspectors on site, not by these averages, so read this comparison alongside the inspection record rather than as a pass/fail.

Weekend coverage: total nurse staffing is 3.08 hrs/resident/day on weekends vs 3.52 on weekdays — 13% thinner on weekends. RN hours go from 0.75 to 0.55 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 39% is about the same as the national median of 45%. 1 administrator has left in the past year.

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

Inspection trend

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

Inspection deficiencies

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

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

29 citations, most serious first. The 18 most serious are shown; the remaining 11 are one tap away and print in full.

• Immediate jeopardy · Lcited before2025-01-27 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — widespread
  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 surveyor observation, record review, and resident and staff interview it has been determined that the facility failed to ensure that the residents' environment remains as free from accident hazards as possible, as the facility experienced a fire incident. Findings are as follows: Review of a facility reported incident form submitted to the Rhode Island Department of Health on 1/24/2025 revealed that at approximately 7:25 AM on 1/24/2025, a Nursing Assistant was completing rounds and found a piece of paper on fire in a resident's room. A code red was initiated, and the fire was extinguished. The form further revealed that at the time of the fire, the room was unoccupied. Review of a manufacturer's booklet, for the electric baseboard heaters installed in the facility, titled, Marley Electric Baseboard Heaters states in part, .WARNING .This heater is hot when in use. To avoid burns, do not let bare skin touch hot surfaces. Keep combustible materials, such as furniture, pillows, bedding, papers, clothes,…

  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 · Jcited before2024-08-13 · 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

  Based on record review and staff interview, it has been determined that the facility failed to keep a resident free from physical abuse for 2 of 4 residents reviewed, Resident ID #s 2 and 3. Findings are as follows: Review of a facility policy titled, Abuse Prohibition last revised on 10/31/2022 states in part, It is the policy of this facility to ensure that all residents are treated with respect and dignity and that all residents are free from abuse, mistreatment, neglect .Abuse: willful infliction of injury, unreasonable confinement, intimidation, or punishment resulting in physical harm, pain or mental anguish . Review of a facility reported incident received by the Rhode Island Department of Health on 8/2/2024 states in part, On 8/1/24 at or around 9pm staff were made aware of an incident when they heard screaming .[Resident ID #1] was found on top of [Resident ID #2] with a sheet over [his/her] head . Record review revealed that Resident ID #1 (perpetrator) was admitted to the facility in September of 2023 with diagnoses including, but not limited to, dementia, anxiety 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.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
• Immediate jeopardy · J2024-08-13 · tag F0610 — failed to investigate and act on abuse reports — isolated
  Respond appropriately to all alleged violations.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on record review and staff interview it has been determined that the facility failed to provide evidence that an alleged violation of abuse was investigated, relative to an allegation of resident-to-resident abuse between Resident ID #s 1 and 3, which in turn resulted in Resident ID #2 sustaining abuse by the same alleged perpetrator, Resident ID #1. Findings are as follows: Review of a facility policy titled, Abuse Prohibition last revised on 10/31/2022 states in part, .Any instance of actual or suspected abuse, neglect, mistreatment, involuntary confinement, misappropriation of resident property, including injuries of unknown origins including bruises, skin tears, or lacerations must be reported immediately to the DNS [Director of Nursing Services]/designee, i.e., supervisor on duty and an incident report is filled out .immediate response to allegations and/or incidents may include as appropriate but not limited to, examination of the victim for physical injury, trauma assessment for psychosocial injury, increased supervision of the victim and others as needed, room changes…

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

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
• Immediate jeopardy · Jcited before2024-08-02 · 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 record review and staff interview it has been determined that the facility failed to ensure that residents who require supervision with meals, received supervision when eating, for 1 of 4 residents reviewed, Resident ID #1. Findings are as follows: Review of a facility reported incident received by the Rhode Island Department of Health on 7/25/2024 revealed that Resident ID #1 experienced a choking incident at 4:17 PM, the Heimlich maneuver (first aid method used when a person is choking) was initiated followed by Cardiopulmonary Resuscitation (CPR). The facility contacted Emergency Medical Services (EMS) and the resident was transported to the Hospital at 5:00 PM where s/he expired. Record review of the EMS report revealed that they were dispatched to the facility for a resident with airway obstruction, who was unconscious and not breathing. The facility communicated with EMS that the resident was eating pizza for dinner in his/her room when s/he choked causing complete airway obstruction and s/he…

  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 · H2024-10-31 · tag F0691 — failed to provide colostomy / ostomy care — pattern
  Provide appropriate colostomy, urostomy, or ileostomy 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 record review and staff interview, it has been determined that the facility failed to provide care consistent with professional standards of practice for 3 of 3 residents reviewed with an ostomy (colostomy/ileostomy; are surgical procedures that reroute the bowel to an opening in the abdomen, called a stoma. A wafer, which is fitted or cut to the individual size of the stoma, and a pouch are attached externally around the stoma, to collect the stool from the intestines), Resident ID #s 24, 60, and 99. Findings are as follows: Review of a facility policy titled, Colostomy and Ileostomy Care last revised on 6/1/2021, states in part, .Applying or changing the pouch .Empty, remove, and discard the old pouch, if applicable .Wipe the stoma and peristomal skin gently with a washcloth or gauze .Carefully wash the peristomal skin with soap and water and dry by patting gently .Allow the skin to dry thoroughly .Inspect the color and skin integrity of the stoma and peristomal skin .Notify physician .of abnormal…

  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 before2023-12-28 · 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 surveyor observation, record review, resident and staff interview, it has been determined that the facility failed to ensure that each resident receives the necessary care and services to maintain the highest practicable physical, mental, and psychosocial well-being for 1 of 1 resident reviewed with congestive heart failure (CHF), who experienced an acute change in condition which resulted in a hospital admission, Resident ID #1. Findings are as follows: Record review of a community reported complaint submitted to the Rhode Island Department of Health on 12/26/2023 alleges the following, .The resident's daughter stated that during [the resident's] stay [s/he] suffered pneumonia, swelling of extremities, and swelling of [his/her] abdomen . Record review of a facility policy titled, Resident Change in Condition dated 10/17/2023, states in part, .POLICY: The facility will ensure that resident changes in condition are identified timely, reported to the Physician .and documentation in the medical record…

  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 before2023-12-28 · tag F0686 — failed to prevent and treat pressure sores (bedsores) — isolated
  Provide appropriate pressure ulcer care and prevent new ulcers from developing.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on surveyor observation, record review and staff interview, it has been determined that the facility failed to provide necessary treatment and services, consistent with professional standards of practice, to promote healing and prevent new ulcers from developing for 1 of 2 residents reviewed for pressure ulcers (a localized injury to the skin or underlying tissue due to pressure), Resident ID #2. Findings are as follows: Review of the facility policy titled, Skin Care Protocol dated 2/2/2020, states in part, .The facility will follow appropriate standards of care as they relate to residents' skin care; identification of those at risk, appropriate interventions and documentation .Documentation: when a pressure ulcer exists, there must be daily monitoring to maintain awareness of area. Documentation of wound status shall include: an evaluation of the ulcer .the status of the area surrounding the ulcer .The presence of possible complications such as signs of increasing area of the ulceration . Record review revealed Resident ID #2 was admitted to the facility in November of 2023…

  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 · G2023-08-16 · tag F0692 — failed to prevent malnutrition and dehydration — isolated
  Provide enough food/fluids to maintain a resident's health.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on record review and staff interview, it has been determined that the facility failed to ensure that a resident is offered sufficient fluid intake to maintain proper hydration and health for 1 of 4 residents reviewed, Resident ID #1. Findings are as follows: Record review of a community reported complaint submitted to the Rhode Island Department of Health on 8/12/2023 from a hospital social worker alleges in part, .Doctor is concerned about neglect based on patient's medical condition . During a surveyor interview with the complainant on 8/16/2023 at 12:45 PM, she revealed that due to the degree of dehydration the resident was admitted with, the medical team suspected neglect. According to National Library of Medicine, Adult Dehydration, last updated 2022, indicates that dehydration may complicate other medical problems and may cause significant illness. A resident may appear with dark urine or decreased urine output and may be lethargic upon observation in severe cases of dehydration. Failure to treat dehydration in older adults may lead to significant mortality. The Centers…

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

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Potential for harm · E2026-01-23 · tag F0567 — failed to protect residents' money held by the home — pattern
  Honor the resident's right to manage his or her financial affairs.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on record review and staff interview, the facility failed to obtain written authorization of residents who choose to deposit personal funds with the facility relative to 4 of 7 residents reviewed, Resident ID #s 2, 6, 77, and 111.Findings are as follows: 1. Record review revealed Resident ID #2 was admitted to the facility in April of 2022. Further review revealed his/her personal funds are held by the facility with a balance of $425.17.Further record review failed to reveal evidence that a written authorization was obtained from the resident or his/her representative to hold his/her funds. 2. Record review revealed Resident ID #6 was admitted to the facility in December of 2022. Further review revealed his/her personal funds are held by the facility with a balance of $603.75.Further record review failed to reveal evidence of a completed authorization form including the date, resident's name, Medicaid number, and a witness signature. 3. Record review revealed Resident ID #77 was admitted to the facility in April of 2023. Further review revealed his/her personal funds were held…

  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 before2026-01-23 · tag F0658 — failed to meet professional standards of care — pattern
  Ensure services provided by the nursing facility meet professional standards of quality.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on surveyor observation, clinical record review, and staff interview, the facility failed to ensure that services provided meet professional standards of quality relative to following physician's orders for 1 of 1 resident who has an order for simvastatin (a medication prescribed to treat high cholesterol), Resident ID #45, for 1 of 2 residents recently admitted that were reviewed for weekly weights, Resident ID #14, and for 1 of 3 residents observed receiving a skin treatment, Resident ID #27.Findings are as follows:Mosby's 4th Edition, Fundamentals of Nursing, page 314 states, The physician is responsible for directing medical treatment. Nurses are obligated to follow physician's orders unless they believe the orders are in error or would harm the clients.1. Record review revealed Resident ID #45 was re-admitted to the facility in August of 2025 with a diagnosis including, but not limited to, hyperlipidemia (a condition characterized by an abnormally high level of fats, such as cholesterol and triglycerides, in the blood).Record review revealed a physician's order 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.

  Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Ecited before2026-01-23 · tag F0761 — failed to label and store drugs safely — pattern
  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 surveyor observations, clinical record review, and staff interview, the facility failed to store and label drugs and biologicals in accordance with currently accepted professional principles for 1 of 1 central (medication) supply closet and 2 of 3 medication carts reviewed. Findings are as follows:Record review of the facility policy titled, Medication Storage states in part, .Medications and biologicals are stored properly, following manufacturers or provider pharmacy recommendations.Outdated, contaminated, discontinued or deteriorated medications.are immediately removed from stock, disposed of according to procedures for medical disposal. 1. A surveyor observation on [DATE] at approximately 8:55 AM, of the first-floor central supply area in the presence of Licensed Practical Nurse (LPN), Staff H, revealed the following:-One unopened box of Prosource Tube Feeding (TF) Liquid neutral flavor with 100 pieces of 1.5 fluid ounce container labeled with the manufacturer's expiration date of [DATE].-One opened…

  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 · D2026-01-23 · tag F0557 — isolated
  Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on surveyor observation, clinical record review, and staff interview, the facility failed to ensure that residents have a right to be treated with respect and dignity, related to providing privacy during a skin treatment for 1 of 3 treatments observed, Resident ID #27. Findings are as follows:Record review revealed the resident was admitted to the facility in May of 2023 with a diagnosis including, but not limited to, erythema intertrigo (an inflammatory skin condition characterized by red, inflamed skin to the skin folds).During a surveyor observation on 1/23/2026 at 11:45 AM of Registered Nurse, Staff A, revealed the resident was lying on his/her back while in bed, with only a towel draped over his/her pelvic region and the rest of his/her body exposed. Staff A walked from the resident's bed to the doorway to access the treatment cart, located in the hallway, leaving the resident's door completely open and the privacy curtain only partially closed, leaving the resident visible to people from the hallway. Staff A returned to the resident to complete the treatment, exited the…

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

  Resident Rights Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2026-01-23 · tag F0641 — isolated
  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 surveyor observation, clinical record review, and resident and staff interview, the facility failed to ensure the assessments accurately reflect the resident's status for 2 of 4 residents reviewed with dental concerns, Resident ID #s 6 and 9, and for 1 of 1 resident reviewed who is prescribed clozapine (an antipsychotic medication), Resident ID #27.Findings are as follows: 1a. Record review revealed Resident ID #6 was readmitted to the facility in January of 2025 with diagnoses including, but not limited to, type 2 diabetes mellitus, dysphagia (difficulty swallowing), and the need for assistance with personal care.During a surveyor interview and simultaneous observation with the resident on 1/21/2026 at 11:26 AM, s/he indicated that s/he has dental concerns and revealed several teeth that are either broken or missing.Record review of a dental consult dated 10/9/2025 indicated the resident has eight missing teeth and three broken teeth.Record review of an annual Minimum Data Set (MDS) assessment 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.

  Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Dcited before2026-01-23 · 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 surveyor observation, clinical record review, and staff interview, the facility failed to provide necessary treatment and services, consistent with professional standards of practice, to promote and maintain skin integrity for 1 of 1 resident reviewed, relative to a fungal rash, Resident ID #27.Findings are as follows:Record review revealed Resident ID #27 was admitted to the facility in May of 2023 with a diagnosis including, but not limited to, erythema intertrigo (a common inflammatory skin condition characterized by red, inflamed skin to the skin folds. It is caused by friction, moisture, and heat, creating an environment conducive to bacterial and fungal growth).Record review of the Wound Care Nurse Practitioner's progress note dated 1/15/2026, revealed a recommendation to cleanse the area with wound cleanser followed by nystatin (an antifungal) cream, twice daily to the resident's right buttocks fungal rash.Record review of a progress note dated 1/15/2026 authored by the Registered Nurse, Staff L, revealed the resident was seen during wound rounds with an assessment…

  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 · D2026-01-23 · tag F0688 — failed to keep residents mobile / prevent decline — isolated
  Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on surveyor observation, clinical record review, and staff interview, the facility failed to ensure that a resident with limited range of motion receives the appropriate treatment to prevent further decrease in range of motion for 1 of 2 residents reviewed who utilizes a hand roll (an assistive device that helps maintain or prevent decline in mobility), Resident ID #54.Findings are as follows:Record review revealed the resident was admitted to the facility in October of 2020 with a diagnosis including, but not limited to, generalized muscle weakness.Record review of a Quarterly Minimum Data Set assessment dated [DATE] revealed the resident has an impairment to both upper extremities.Record review revealed a physician's order revised on 10/31/2025 to apply a left-hand roll daily.Surveyor observations failed to reveal evidence that the hand roll was applied, as ordered, on the following dates and times:- 1/20/2026 at 10:21 AM and 12:25 PM- 1/21/2026 at 9:05 AM- 1/22/2026 at 8:55 AM and at approximately 3:00…

  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 · D2026-01-23 · tag F0757 — failed to avoid unnecessary drugs — isolated
  Ensure each resident’s drug regimen must be free from unnecessary drugs.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on surveyor observation, clinical record review, and staff interview, the facility failed to ensure each resident's drug regimen is free from unnecessary drugs for 1 of 3 residents reviewed with a topical treatment, Resident ID #6.Findings are as follows:Record review revealed the resident was admitted to the facility in January of 2025 with a diagnosis including, but not limited to, generalized muscle weakness.Record review revealed a physician's order with a start date of 10/16/2025 for Santyl Ointment (a topical medication prescribed to remove dead tissue from chronic dermal ulcers) 250 units/gram, followed by calcium alginate (a treatment dressing), and a bordered gauze dressing to the left medial (the middle) knee every evening shift for a Stage III pressure ulcer (full thickness tissue loss, fat tissues may be visible but bone, tendon or muscle is not exposed. Slough [dead tissue] may be present but does not obscure the depth of tissue loss).Record review of the Wound Care Nurse Practitioner note dated 12/18/2025, revealed that the left medial knee wound was resolved,…

  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 · D2026-01-23 · tag F0770 — failed to provide lab services — isolated
  Provide timely, quality laboratory services/tests to meet the needs of residents.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on surveyor observation, clinical record review, and staff interview, the facility failed to ensure that residents receive laboratory services relative to diagnostic testing, for 1 of 1 resident reviewed with a physician's order for clozapine (an antipsychotic medication) level (a laboratory test that measures the amount of medication in the blood to ensure that the medication is at a therapeutic range), Resident ID #27.Findings are as follows:Record review revealed Resident ID #27 was admitted to the facility in May of 2023 with a diagnosis including, but not limited to, schizophrenia (a serious mental health condition that affects how people think, feel and behave).Record review revealed the following physician's orders:-4/30/2025 for clozapine 75 milligrams (mg) daily.-12/12/2025 obtain a clozapine level.Record review of the December 2025 Treatment Administration Record revealed that the clozapine level was signed of as completed 12/12/2025.Record review of a lab slip dated 12/12/2025 indicates additional testing: clozapine level.Record review of a Lab Results Report 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.

  Administration Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Dcited before2026-01-23 · tag F0880 — failed to prevent and control infections — isolated
  Provide and implement an infection prevention and control program.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on surveyor observations, clinical record review, and staff interview, the facility failed to ensure a sanitary environment to help prevent the transmission of infections for 2 of 3 residents observed during treatments, Resident ID #s 27 and 122.Findings are as follows:1. Record review revealed Resident ID #27 was admitted to the facility in May of 2023 with a diagnosis that including, but is not limited to, erythema intertrigo (a skin condition that manifests as a red, inflamed rash, often accompanied by a burning or itching sensation).During a surveyor observation on 1/23/2026 at approximately 10:45 AM, Registered Nurse (RN), Staff A, was observed applying Triad cream, a topical treatment for skin conditions, to the resident's left and middle buttocks, groin, and armpit without changing gloves or performing hand hygiene between applications. The nurse proceeded from the dirtiest area to the cleanest area of the resident's body.2. Record review for Resident ID #122 revealed the following physician's orders:-1/16/2026, cleanse right posterior (back) calf wound with normal…

  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.

Fines & penalties

$207,610 in federal fines across 4 penalties.

• $15,873 — penalty dated 2025-01-27
• $68,640 — penalty dated 2024-10-31
• $92,267 — penalty dated 2024-08-02
• $30,830 — penalty dated 2023-12-28

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.

Part of a chain

This home belongs to GREEN TREE HEALTHCARE MANAGEMENT — 4 facilities. Here is how its ratings compare with the chain’s average across all its homes: See the whole chain — ratings, flags, fines and finances →

A home rated well below its chain’s average can signal local problems; a chain with a low average across the board is a bigger pattern worth researching. CMS chain data under-reports private-equity and REIT ownership, so treat this as a floor, not the full picture.

Who owns this facility

CMS files one row per role, so the 15 rows in the source record cover these 9 parties — each is shown once here with every role it holds. Nothing is omitted.

5 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.

About 70% of this home’s resident-days are paid by Medicaid, which reimburses well below the cost of care in most states. Heavily Medicaid-dependent homes run on thinner budgets — a context worth holding next to the staffing and inspection record, not a fault in itself. This home reported $1.6M paid to related parties — landlords or management companies under common ownership — equal to about 12% of its total expenses. Money routed to affiliated companies can leave a home’s own books looking lean while owners still profit; it is the mechanism regulators watch most closely in private-equity and REIT deals.

Source: CMS Healthcare Provider Cost Reporting Information System (HCRIS), Medicare cost report Form CMS-2540 · fiscal year 2023. Facilities self-file these reports; figures are unaudited and a year or two behind. A home with no Medicare cost report on file shows no figures here.

Cost & finances

Straight from this home’s Medicare cost report (CMS, FY2023). These are its operating economics — what it costs to run per resident-day and what it collects on average across Medicare, Medicaid, and private pay — not a private-pay quote. Your out-of-pocket cost depends on payer and room type, so ask the facility directly; a higher operating cost can reflect richer staffing or a sicker population. The cost-of-care planner shows regional benchmarks by care type.

What families pay in RI