E.a. Hawse Healthcare Center
18086 State Route 55, Baker, WV 26801 · For profit - Individual · 60 certified beds · (304) 897-5903 Medicare & Medicaid certified
This home’s record is mixed — some reassuring signs, some worth asking about.
- a strong health-inspection score (4/5) — the hardest rating to game (though it’s ranked within its own state, not nationally)
- no federal fines or payment denials on record
- fewer deficiencies at its most recent standard inspection than at the one before — a sign of improvement
- a high number of inspection citations overall (23) — worth reading through, though larger and more-often-surveyed homes tend to accrue more lower-severity tags
- its payroll-based staffing rating is low (2/5)
- nursing-staff turnover (70%) runs well above the national median (45%)
- about 33% of its spending goes to commonly-owned related companies
One thing this read cannot see: what residents and families actually experience day to day. Public data misses the feel of a place — visit unannounced, ideally at a mealtime or on a weekend, talk to staff and families, and ask your tour questions.
A plain-English summary of the public record below — not a rating, ranking, or recommendation. We take no money from any facility.
| Health inspectionSurveyor-assigned, ranked within your stateInspector-verified | 4 of 5 |
| StaffingFrom payroll records (PBJ) | 2 of 5 |
| Quality measuresSelf-reported by the facility | 3 of 5 |
Location & what’s nearby
Open in Google Maps ↗ · Directions ↗ · Larger map ↗
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 | 3 of 5 |
| Long-stay residentspeople who live here | 5 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 5 to 4 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.
See all quality measures vs. state & national benchmarks
| Measure | This home | State avg | Typical state | vs typical state |
|---|---|---|---|---|
| Long-stay residents whose need for help with daily activities increased | 14.2% | 14.7% | 15.4% | typical |
| Long-stay residents who lose too much weight | 5.3% | 6.3% | 5.4% | typical |
| Long-stay residents with a catheter left in their bladder | 0.0% | 0.4% | 0.9% | better than state‡ — see note marked double-dagger below the table |
| Long-stay residents with a urinary tract infection | 1.7% | 1.6% | 2.0% | better |
| Long-stay residents with depressive symptoms | 0.0% | 7.6% | 6.5% | check this* — see note marked star below the table |
| Long-stay residents who were physically restrained | 0.0% | 0.2% | 0.1% | better |
| Long-stay residents with falls causing major injury | 5.5% | 4.4% | 3.3% | worse |
| Long-stay residents whose ability to walk worsened | 10.4% | 15.9% | 16.1% | better |
| Long-stay residents on antianxiety or hypnotic medication | 32.6% | 27.0% | 18.9% | worse |
| Long-stay residents given the seasonal flu vaccine | 85.4% | 97.6% | 95.3% | worse |
| Long-stay residents with pressure ulcers | 5.3% | 4.2% | 4.7% | worse |
| Long-stay residents with worsening bladder/bowel control | 18.8% | 22.1% | 21.2% | better |
| Long-stay residents who got an antipsychotic medication§ — see the note below the table | 8.8% | 13.4% | 17.1% | better |
| Short-stay residents who newly got an antipsychotic medication | 0.7% | 1.0% | 1.4% | better |
| Short-stay residents given the seasonal flu vaccine | 44.8% | 79.4% | 79.4% | worse |
| Short-stay residents rehospitalized after admission | 35.9% | 22.5% | 22.6% | worse |
| Short-stay residents with an outpatient ER visit | 15.9% | 11.3% | 12.0% | worse |
| Long-stay hospitalizations per 1,000 resident days | 1.24 | 1.80 | 1.67 | better |
| Long-stay outpatient ER visits per 1,000 resident days | 1.18 | 1.84 | 1.80 | better |
* This home reported 0% on a measure where lower is better. That can mean genuinely excellent care — but because the number is self-reported, a zero can also mean the problem was not recorded. Weigh it against the inspection record above.
‡ On this measure the state average is at least twice (or half) the typical state — a gap that size is usually how the state codes and reports the measure, not how its homes actually perform. Against a benchmark this state does not sit on, a “vs typical state” verdict would mostly be measuring the state, so we compare this home with its own state instead and show both averages.
§ Antipsychotics carry an FDA boxed warning — they raise the risk of death in older people with dementia-related psychosis, and are not approved for that use. So this measure is partly a read on whether a home sedates residents instead of staffing for them. But read a low rate carefully in both directions: CMS excludes residents coded with schizophrenia (and Tourette's or Huntington's) from this measure, and federal auditors have found implausible increases in schizophrenia coding since the measure was published — so a very low rate can reflect recoding rather than less prescribing. Ask the home what share of its residents carry a schizophrenia diagnosis, and how it handles behavioral symptoms without medication.
CMS quality measures, as Care Compare shows them. For most rows lower is better (fewer falls, ulcers, hospitalizations); vaccination rates are the exception. Not every row is risk-adjusted. CMS adjusts some measures for resident mix, but falls with major injury, antipsychotic use, physical restraints and the vaccination rates are unadjusted rates — so a home caring for heavier or more behaviorally complex residents can look worse on them without providing worse care. The “typical state” column is the median of the 50 state averages — not a national average of all homes. We use it because a plain average across homes is pulled badly off course by a few states’ reporting habits (long-stay depressive symptoms is the clearest case: Illinois codes it several times higher than most states, which alone lifted the all-homes figure to about twice what a typical state records). The median of state averages resists that — but it does weigh every state equally, so a large state counts no more than a small one, and it is a benchmark of our construction rather than a CMS-published figure. better/worse means the home differs from that benchmark by more than 10% of it; closer than that reads typical. CMS does not publish how many residents each measure covers, and the counts are often small — a single resident can move a rate by several points — so treat small gaps as noise. These come from data the facility reports, so weigh them against the independent inspection record above.
Short-stay rehab — if you are coming here from a hospital
Arriving from a hospital right now? Read the discharge guide → — your appeal rights, how to slow a rushed discharge, and what to ask about the numbers below.
42.2% 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 63 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.
Met the expected recovery: 57.6% 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 33 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 0.31 therapist hours per resident per day in 2026Q1 — more than 49% of the 13,892 homes that report any therapy hours at all.
Weekend therapy: weekend therapy hours are 15% 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
| Measure | This home | U.S. median | Period covered | CMS’s call |
|---|---|---|---|---|
| Got home and stayed homeRate of successful return to home or community from a SNF | 42.2%CMS range 31.2–55.3 | 51.5% | Oct 2022–Sep 2024 | no different from U.S. |
| Went back to hospitalRate of potentially preventable hospital readmissions 30 days after discharge from a SNF | 10.6%CMS range 7.3–15.8 | 10.7% | Oct 2022–Sep 2024 | no 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 discharge | 57.6% | 56.6% | Oct 2024–Sep 2025 | CMS 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 discharge | 33.3% | 52.8% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Moving around at dischargePercentage of residents who are at or above an expected ability to move around at discharge | 45.5% | 50.0% | Oct 2024–Sep 2025 | CMS 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 identified | 91.7% | 98.7% | Oct 2024–Sep 2025 | CMS 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 setting | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality 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 discharge | not 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 stay | 2.1% | 0.0% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| New or worsened pressure ulcersPercentage of residents with pressure ulcers/pressure injuries that are new or worsened | 6.2% | 1.9% | Oct 2024–Sep 2025 | CMS makes no comparison for this measure |
| Infections that led to hospitalPercentage of infections residents got during their SNF stay that resulted in hospitalization | 6.1%CMS range 3.5–11.7 | 7.1% | Oct 2023–Sep 2024 | no different from U.S. |
| Medicare spending per stayMedicare Spending Per Beneficiary (MSPB) for residents in SNFs | 0.93 | 1.02 | Oct 2022–Sep 2024 | CMS 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
How full it usually is: this home is certified for 60 beds and averages 55.7 residents a day — about 93% occupied, or roughly 4 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 3.46 hrs/resident/day is below the 3.48-hour benchmark and RN staffing of 0.85 is at or above the 0.55-hour RN benchmark and nurse-aide staffing of 1.99 is below the 2.45-hour aide benchmark. What federal law does require today is unchanged: “sufficient” nursing staff for residents’ needs and an RN on duty at least 8 consecutive hours a day, 7 days a week (42 CFR 483.35). Those are judged by inspectors on site, not by these averages, so read this comparison alongside the inspection record rather than as a pass/fail.
Weekend coverage: total nurse staffing is 2.97 hrs/resident/day on weekends vs 3.66 on weekdays — 19% thinner on weekends. RN hours go from 1.02 to 0.44 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)
This home’s total nursing-staff turnover of 70% is well above the national median of 45%.
Payroll-based (PBJ) staffing hours, as reported for Jan–Mar 2026 (CMS PBJ CY2026Q1) — the most recent quarter CMS has published, so they can lag a change of operator or staffing agency. Higher is generally better. Registered-nurse coverage and weekend staffing are the numbers families most often overlook — an RN on site matters most when something goes wrong, and coverage usually thins on weekends. High turnover means residents rarely see the same caregiver twice. One caveat: these are hours as reported, not adjusted for how sick or heavy-care this home’s residents are. CMS separately publishes a case-mix-adjusted view; we show the reported hours. A home caring for higher-acuity residents needs more hours to deliver the same care, so compare these figures against homes doing similar work, and read them next to the inspection record rather than alone.
Inspection trend
Deficiencies are 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 10 most serious are shown; the remaining 13 are one tap away and print in full.
- Potential for harm · Ecited before2026-06-10 · tag F0842 — failed to keep accurate, complete medical records — patternSafeguard 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, observation and staff interview, the facility failed to provide a complete and accurate medical record for a resident in the areas of [NAME] Virginia POST Form, care plan, and PASSR. This is true for Resident's #4, #6, #9 and #17. Facility Census 54. Findings included: a) Resident #4 A record review completed on [DATE] of Resident #4's WV POST revealed the following: Section A. Cardiopulmonary Resuscitation Orders. Follow these orders if the patient has no pulse and is not breathing. Resident checked Yes CPR: Attempt Resuscitation, including mechanical ventilation. defibrillation and cardioversion. (Requires choosing Full Treatments in section B) Section B read as follows: Initial treatment orders. Follow these orders if the patient has a pulse and is breathing. Option not checked by the resident was Full Treatments (required if CPR is chosen in section A). Goal: Attempt to sustain life by all medically effective means. Option checked was second option Selective treatments. Goal: Attempt…
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.
- Potential for harm · E2026-06-10 · tag F0925 — failed to control pests — patternMake 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 upon observation, resident interviews, staff interviews and record review. the facility failed to maintain an effect pest control program for flies. This failed practice had the potential to affect many residents in the facility. Facility census: 54. Findings included: a) On 06/08/26, during the initial walk through of the facility and resident rooms, the following rooms had flies present: #A01#A03#A11#A12#A15#B04#B06#B10 The residents in these rooms complained about the flies bothering them. Additionally during the course of the survey, flies were observed in the B Hallway and Administration Conference Room. This finding was discussed with the Nursing Home Administrator (NHA) on 06/08/26 at 2:40 PM. The NHA stated the whole area around the nursing home has problems with flies because of the large chicken and turkey processing plants in the area. NHA immediately called their pest control contract agency and asked them to come. A follow-up conversation on 06/10/2026 at 11:43 AM with the NHA asked about the outcome of the call with the pest control company. She stated 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.
- Potential for harm · D2026-06-10 · tag F0552 — isolatedEnsure that residents are fully informed and understand their health status, care and treatments.
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, the facility failed to inform the resident or their representative in advance of treatment risks and benefits, options, and alternatives for an anti-depressant medication prior to the administration of the medication. This failed practice did not allow the resident to be provided an informed choice. Resident identifier: #31. Facility census: 54.Findings included:a) Resident #31Resident #31 was admitted to the facility on [DATE].The resident had the following diagnoses pertaining to mental illness:-DEPRESSION, UNSPECIFIED, 08/16/2024, Admission-ANXIETY DISORDER, 08/16/2024, Admission-MAJOR DEPRESSIVE DISORDER, RECURRENT, MILD, 01/29/2026 During Stay-UNSPECIFIED DEMENTIA, UNSPECIFIED SEVERITY, WITHOUT BEHAVIORAL DISTURBANCE, PSYCHOTIC DISTURBANCE, MOOD DISTURBANCE, AND ANXIETY, 08/16/2024, AdmissionFor these diagnoses, the resident had the following orders:-Mirtazapine Oral Tablet 7.5 MG (Mirtazapine)Give 1 tablet by mouth one time a day for appetite stimulantPharmacy…
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.
- Potential for harm · Dcited before2026-06-10 · tag F0657 — failed to keep the care plan current — isolatedDevelop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation, record review and staff interview, the facility failed to ensure a resident's comprehensive care plan was revised upon change in physician's orders in regards to a perimeter mattress. This is true for Resident #5. Facility Census: 54. Findings included: a) Reviewed the following documents on 06/10/26: Care plan for Resident #5, page 1. Focus-Resident #5 is at risk for falls r/t pain, limited physical functioning, requires assist with transferring. He has a history of falling at home. Resident also is non-compliant with assistance for transfers. He is observed to independently transfer and ambulate. Date Initiated: 02/07/2026 Revision on: 05/27/2026 Interventions included- Perimeter mattress to aide in identifying the edge of the bed. Date Initiated: 11/25/2025 Revision on: 01/14/2026 Review of physician orders for Resident #5 revealed no orders for perimeter mattress on 06/10/26. b) An interview with Resident #5 on 06/10/26 10:00 AM was conducted. Resident pointed out bruises on his arm and stated he depends on others to help him use his walker to walk up 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.
- Potential for harm · D2026-06-10 · tag F0727 — failed to provide required RN coverage — isolatedHave a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.
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 have a Registered Nurse (RN) on duty for 8 hours per day for seven days a week on 01/01/26. This failed practice had the opportunity to lead to residents not receiving the care and treatment only an RN can provide, and could affect multiple residents. Facility census: 54.Findings included: a) Record Review On 06/10/2026, the surveyor requested posted nurse staffing sheets as well as time detail for hours worked from a report from the facility's time keeping system for twenty dates. These dates included: 02/22/25 thru 03/01/2506/22/25 thru 06/28/2512/31/2501/01/2602/14/2602/15/2605/31/2606/01/26 These records were reviewed for eight (8) hours of RN hours worked per day, plus calculations made to determine if the facility met the 2.25 hours per patient day minimum. It was determined the facility did not have eight (8) hours of RN staffing on 01/01/26. b) Staff interview During an interview with the Nursing Home Administrator (NHA) on 06/10/2026 at 3:19 PM, the NHA indicated an RN worked 1.25 hours and got sick. 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.
- Potential for harm · E2024-11-14 · tag F0677 — failed to help fully-dependent residents with daily care — patternProvide 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
Based on record review, and staff interview, the facility failed to provide activities of daily living (ADL's) to maintain good personal hygiene for dependent residents. This is true for 0ne (1) of three (3) residents reviewed for ADL care. Resident Identifiers: #20, #17, #33, #23, #16 and #34. Facility census: 54. Findings included: a) Resident #17 During an annual recertification with a simultaneous complaint investigation for Residents not being groomed adequately found Resident #17 on 11/11/24 not get his showers per schedule. Medical record review revealed, Resident #17's shower schedule and preference are two (2) times weekly. A continued review of Resident #17s ADL documentation found: No documentation for showers given. On 11/12/24 at 1:11 PM the Director of Nursing (DON) verified the facility could not provide documentation for Resident #17's showers. b) Resident #20 During an observation 11/11/24 at about 1:54 PM Resident #20 appeared to be unkept, with oily hair and facial hair. Medical record review revealed, Resident #20's shower schedule and preference are two (2)…
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.
- Potential for harm · Ecited before2024-11-14 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — patternEnsure 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 interviews, the facility failed to ensure Resident #18's environment remained as free of accident hazards as possible; and that each resident received adequate supervision and assistance devices to prevent accidents. Resident #18 had a care plan for nonskid footwear which were not in place at the time of a fall. The Central Supply closet which contained harmful chemicals was not secured by a locking door. Resident identfieir: #18. Facility census: 54. Findings included: Resident #18 a) Record review of nursing progress notes dated [DATE] revealed Resident #18 was found on the floor with a head injury and complaining of right leg pain. It was noted that Resident #18's feet were bare during assessment after the fall. On [DATE] at 3:15PM, During an interview with the Director of Nursing and the Assistant Director of Nursing They both confirmed resident #18 did not have nonskid footwear on at the time of her fall. Resident #18's Care Plan, dated back to [DATE], revealed the resident…
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.
- Potential for harm · Ecited before2024-11-14 · tag F0812 — failed to store, cook, and serve food safely — patternProcure 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
The facility failed to serve food in a safe sanitary manner in regards to hand washing after coughing and touching soiled items and storing medical ice packs in the freezer in the residents pantry. This has the potential to affect all resident that gets their nutrition form the kitchen. Facility census: 54. Findings Included: a) Resident Pantry During the tour on 11/11/24 at 12:20 PM to the Resident pantry found multiple medical Ice packs stored in resident freezer. An interview 11/11/24 at 12:20 PM with the Dietary Manager confirmed the medical ice packs should not be stored with resident food. b) Kitchen An observation on the second tour to the kitchen 11/13/24 at 12:35 PM found the [NAME] #46 testing holding temperatures, she coughed and stepped away to the office area, she then opened the trash with her hands, returned to tray line and started to continue temperature testing without washing her hands until surveyor intervention. [NAME] #46 verified she should have washed her hands prior to returning to steam table, she stated that she forgot. During an interview 11/13/24 at 1:18…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · Dcited before2024-11-14 · tag F0550 — failed to protect resident dignity and rights — isolatedHonor 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, and interview, the facility failed to ensure that residents were treated with dignity and respect, as demonstrated by leaving urinary catheter bags uncovered. This was a random opportunity for discovery during the Long-Term Care Survey Process. Resident identifiers #47 and #257. Facility census: 54. Findings included: a) Resident #47 On 11/12/24 at approximately 11:50 AM, Resident #47 was observed wheeling her chair down the corridor with her uncovered catheter bag and tubing resting in her lap. During an interview with Registered Nurse (RN) #1 at approximately 11:55 AM on 11/12/24, the RN confirmed that the catheter bag should not be placed in the resident's lap and should have been covered. The RN instructed a Nursing Assistant (NA) to find a cover for the resident's catheter bag or to place a blanket over the resident's lap immediately. The RN also confirmed that Resident #47 requires a two-person lift and cannot get into her chair without assistance. A review of Resident #47's care plan revealed the following: This resident is unable to do the following…
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.
- Potential for harm · D2024-11-14 · tag F0561 — failed to honor residents' choices — isolatedHonor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
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 resident interview, record review, and staff interview, the facility failed to promote self-determination and honor resident preferences regarding bathing/showers. This was true for two (2) out of five (5) residents reviewed under choices. Resident identifiers: #23 and #33. Facility census: 54. Findings included: a) Resident #23 During an interview, on 11/12/24 at 12:15 PM, Resident #23 reported she had not had a bath in a week. She also stated she had asked a half a dozen people not to have her shower day on Tuesday because she does not like to attend church services with her hair wet. The resident stated, I must not have asked the right people because they keep doing it. Resident #23 went on to state, I frequently do not accept a shower on Tuesdays because of my preference to not have wet hair when going to church but despite telling each CNA about my preference to have a different shower day, it has never been changed. A record review completed on 11/12/24 at 1:08 PM, confirmed resident's refusals…
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.
Show the remaining 13 citations
- Potential for harm · D2024-11-14 · tag F0655 — isolatedCreate and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, facility failed to develop a baseline care plan that addressed the risks associated with catheter-related urinary tract infections (CAUTI) and did not implement any protocols for the care of the in-dwelling catheter. Additionally, the facility failed to notify the physician, and obtain orders for the care of the indwelling catheter for a newly admitted resident This was a random opportunity for discovery. Resident Identifier: Resident #257. Facility Census: 54. Findings included: a) Resident #257 During an interview with Resident #257 on 11/11/24 at approximately 2:30 PM, resident was observed to have an in-dwelling catheter. The resident stated that the catheter had been inserted at the hospital. Record review on 11/12/24 at approximately 2:15 PM revealed that the resident had been admitted to the facility on [DATE]. Further record review revealed neither a physician's order for an in-dwelling catheter, nor any orders for catheter care. A review of the facility matrix…
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.
- Potential for harm · Dcited before2024-11-14 · tag F0657 — failed to keep the care plan current — isolatedDevelop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation, interview, and record review, the facility failed to revise and update the care plan based on the changing preferences and needs of the resident. Resident identifier: #16. Facility Census: 54. Findings: a) Resident #16 During a brief interview on 11/11/24 at approximately 12:09 PM, resident #16 stated that she was unable to move her left sided extremities. Resident's Medical Power of Attorney (MPOA), who was present in the room, explained that resident had recently been diagnosed with a malignant neoplasm of the right temporal lobe, and stated that resident had lost the use of her left side. Resident's bedside table was observed on the left side of the bed with the resident's eyeglasses, and a cup of water on it. Resident wanted some water, and upon being asked whether she could reach the water, the resident stated that she could not, because her left arm did not work. Resident's MPOA then retrieved the cup of water and offered it to the resident. Observation on 11/12/24 at 9:28 AM again revealed the bedside table with resident's water and eyeglasses on 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.
- Potential for harm · D2024-11-14 · tag F0661 — isolatedEnsure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge.
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, the facility failed to provide a resident with a discharge summary that was completed by all departments and failed to ensure it included follow-up dates and times for medical appointments. This was true for one (1) of two (2) residents reviewed under the discharged pathway. Resident identifier: #56. Facility census: 54. Findings included: a) Resident #56 A record review, completed on 11/12/24 at 8:56 PM, revealed the following details: -Resident #56 was admitted to the facility on [DATE]. -Resident went home with his significant other on 09/23/24. -Resident was cognitively intact -Resident was able to complete tasks independently. -An After Visit Summary from the hospital, dated 09/20/24, listed a follow-up neurosurgery appointment in two (2) weeks. -A facility discharge report, dated 09/23/24, reflected that the Nursing section was completed. However the Social Services section, Dietary Manager section, and the Activity Director section were left blank 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.
- Potential for harm · D2024-11-14 · tag F0690 — failed to manage incontinence, catheters, and urinary infections — isolatedProvide 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
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interviews, and record review, the facility failed to notify the physician, and obtain orders for the care of the indwelling catheter, for a newly admitted resident. Resident identifier: #257. Facility Census: 54. Findings: a) Resident #257 Record review on 11/12/24, at approximately 2:15 PM revealed that the resident had been admitted to the facility on [DATE]. Further record review revealed that there was neither a physician's order for an in-dwelling catheter, nor any orders for catheter care. A review of the facility matrix, provided to the surveyors, showed no evidence that Resident #257 had an indwelling catheter. On 11/12/24, at approximately 3:00 PM, further investigation revealed that the resident's baseline care plan did not indicate any awareness of the resident's in-dwelling catheter. Additionally, the plan failed to address the risks associated with catheter-related urinary tract infections (CAUTI) and did not implement any protocols for the care of the in-dwelling catheter.…
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.
- Potential for harm · D2024-11-14 · tag F0770 — failed to provide lab services — isolatedProvide 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 record review and staff interview, the facility failed to obtain laboratory services to meet the needs of its residents. This deficient practice had the potential to affect one (1) of five (5) residents reviewed for the care area of unnecessary medications. Resident identifier: #15. Facility census: 54. Findings included: a) Resident #15 Review of Resident #15's medical records showed a physician's order written on10/19/24 for laboratory testing consisting of Prothrombin Time/International Normalized Ratio (PT/INR) to be performed on 10/19/24. Resident #15 was receiving the medication Coumadin (warfarin) to prevent blood clots. PT/INR testing helps to determine effective Coumadin dosing. No PT/INR laboratory testing results for 10/19/24 were found in the resident's medical record. A physician's order was written on 10/23/24 for PT/INR every week for four (4) weeks, then monthly. The first INR was to be obtained on Wednesday 10/23/24 and then the laboratory testing was to be performed on Thursdays on night shift. A lab results report for a PT/INR specimen received 10/24/24…
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.
- Potential for harm · Dcited before2024-11-14 · tag F0842 — failed to keep accurate, complete medical records — isolatedSafeguard 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 staff interview, the facility failed to ensure an admission assessment was completed with an antipsychotic and residents reviewed during the long-term care survey process had a Physician Orders for Scope of Treatment (POST) form completed per directions specified by the [NAME] Virginia Center for End-of-Life Care in conjunction with the [NAME] Virginia Health Care Decisions Act (16-30-1). The POST forms were unsigned by the Resident or Medical Power of Attorney (MPOA). Resident identifiers: Resident #31and #15. Facility census: 54. Findings Included: a) Resident #31 Record review on 11/11/24 at 2:55 PM found, a POST Form patient information and section F health care provider on Resident #31's chart was completed with the Physicians Full name, Licenses number and phone number. The POST was dated 06/14/24. 11/13/24 09:18 AM 104 Corp nurse verified no physician full name During an interview on 11/13/24 at 9:18 AM with the Corporate Nurse #104, she confirmed Resident #31's POST form 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.
- Potential for harm · Ecited before2023-01-25 · tag F0550 — failed to protect resident dignity and rights — patternHonor 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 and staff interview, the facility failed to respect resident dignity. Four (4) residents requiring assistance with dressing were noted to have on non-skid socks that had the residents names either on the top or on the side of the sock. This practice was not inconspicuous and could readily be seen by any visitor. This was a random opportunity for discovery. Resident identifiers: #8, #13, #44, and #41. Facility Census: 47. Findings included: a) Resident #8 Observation, on 01/23/23 at 9:30 AM, found Resident #8 sitting in the hallway by the nurses station wearing non-skid socks with her name visible on the top of the left sock. A brief record review, completed on 01/23/23 at 9:45 AM, found Resident #8 required staff assistance with dressing. A second observation on 01/23/23 at 10:25 AM, Activity Assistant #14 was asked if she would agree Resident #8's name was visible on her left sock. Activity Assistant #14 glanced at Resident #8 and merely stated, Yeah. b) Resident #13 Observation, on 01/24/23 at 1:20 PM, found Resident #13 walking down the hallway wearing…
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.
- Potential for harm · E2023-01-25 · tag F0761 — failed to label and store drugs safely — patternEnsure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation, review of facility documentation, and staff interview, the facility failed to ensure drugs and biologicals, used in the facility, were stored, and administered in accordance with current accepted professional practices. This was true for medications stored in one (1) of two (2) medication carts and one (1) of one (1) medication storage rooms inspected. The facility failed to ensure medications were dated when opened and put in to use, failed to ensure medications being stored for use after the manufacturer's use by date, were discarded and not administered to residents and failed to ensure medications were stored at the proper manufacturer's temperature requirement. This deficient practice was identified during a random opportunity for discovery and had the potential to affect more than a limited number of residents. Facility census: 47 Findings included: a. Policy Review A review of the Policy : Lifetree Pharmacy Policy: Storage of Medications, revision date 09/01/20, showed medications and biologicals were to be stored safely and properly following…
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.
- Potential for harm · D2023-01-25 · tag F0583 — failed to protect personal privacy — isolatedKeep residents' personal and medical records private and confidential.
What the surveyor found here — the official record, unedited, may be distressing
Based on observation and staff interview, the facility failed to ensure the and privacy of Resident #27 during a treatment. This was a random opportunity for discovery. Resident identifier: #27. Facility census: 47. Findings included: a) Resident #27 Observation, on 01/24/23 at 11:40 AM, identified Resident #27's door was open. RN #20 had pulled the first privacy curtain between Resident #27 and his roommate but failed to pull the second privacy curtain by the foot of resident's bed to ensure resident privacy during treatment. During an interview on 01/25/23 at 8:25 AM, the Administrator reported all nursing staff have been trained to pull both privacy curtains to ensure resident privacy. .
- Potential for harm · D2023-01-25 · tag F0584 — failed to keep a safe, clean, comfortable home — isolatedHonor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation and staff interview, the facility failed to provide a safe, clean, comfortable, and homelike environment. The facility failed to ensure resident rooms were in good repair. These were random opportunities for discovery. Room identifiers: B09A and B05A. Facility census: 47. Findings included: a) Room B09A Observation, on 01/23/23 at 9:to AM, found the wall had multiple scrapes / gouges spanning the an area of approximately 18 inches. Additionally, the area behind the bed had scrapes / gouges spanning an area of approximately 28 inches. During a second observation, on 01/25/23 at 8:37 AM, Social Worker #39 reported the scrapes / gouges were not homelike and needed to be repaired. The social worker also stated, This definitely should have been addressed and repaired. I will see that it gets done. b) Room B05A Observation on 01/23/23 at 9:55 AM, found the wall had two white rectangular patched areas both approximately four (4) inches long and twelve (12) inches long. During an second observation, on 01/25/23 at 8:40 AM, Social Worker #39 reported it appeared 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.
- Potential for harm · D2023-01-25 · tag F0623 — isolatedProvide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
What the surveyor found here — the official record, unedited, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY . Based on medical record review and staff interview, the facility failed to provide evidence a the long-term care Ombudsman was provided a Notice of Transfer for a resident who had acute hospital transfers/discharges. This had the potential to affect all residents being transferred or discharged . Resident identifier: #45. Facility census: 47. Findings included: a) Resident #45 A medical record review was completed on 01/25/23 at 9:16 AM. There was no evidence the facility had provided the long-term care Ombudsman a copy of the written Notice of Transfer/Discharge for Resident #45's acute hospital transfer/discharge on [DATE] or for Resident #45's acute hospital transfer/discharge on [DATE]. In an interview on 01/25/23 at 9:41 AM, Social Worker #39 reported the facility was unable to produce evidence the Ombudsman had been notified via fax on both transfers/discharges to the hospital. .
- Potential for harm · Dcited before2023-01-25 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — isolatedEnsure 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 staff interview, the facility failed to provide an environment free from accident hazards over which it had control. The facility failed to ensure matches and a reusable razor with blade were kept in a secure place, not accessible to residents. A book of matches and a reusable razor with a double edge intact blade was observed on the bed of a resident with impaired cognition. This deficient practice was found to be true during a random opportunity for discovery and had the potential to affect a limited number of residents. Resident identifier: Resident #21. Facility census: 47. Findings included: a) Resident #21 During the initial tour, on 01/23/23 at 11:05 AM, while speaking to Resident #21, a match book with matches was observed to be laying on the resident's bed in plain view. An interview, with Nursing Assistant (NA) #26, on 01/23/23 at 11:06 AM, verified matches were laying on the resident's bed NA #26 confirmed at this time, the match book did contain matches. An…
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.
- Potential for harm · Dcited before2023-01-25 · tag F0812 — failed to store, cook, and serve food safely — isolatedProcure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
What the surveyor found here — the official record, unedited, may be distressing
Based on observation and staff interview, the facility failed to provide food services in accordance with professional standards. The facility failed to ensure food was labeled. This practice had the potential to affect a limited number of residents. Facility census: 47. Findings included: a) Unlabeled Food During a tour of the kitchen with the Dietary Manager, on 01/23/23 at 8:45 AM, the dry storage area had a clear Ziploc bag of noodles that had been half used and was not labeled. Additionally, in the freezer, there was a clear Ziploc bag of hotdogs that was not labeled. The Dietary Manager acknowledged the oversight and mentioned the guidelines are sometimes hard to implement when training new staff. .
“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.
- 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.
Fines & penalties
No federal fines in the current CMS record.
Part of a chain
This home belongs to COMMUNICARE HEALTH — 110 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 →
| Rating | This home | Chain avg | |
|---|---|---|---|
| Overall | 4 of 5 | 3.2 | +0.8 vs chain |
| Health inspection | 4 of 5 | 2.7 | +1.3 vs chain |
| Staffing | 2 of 5 | 2.6 | -0.6 vs chain |
| Quality measures | 3 of 5 | 4.5 | -1.5 vs chain |
The other 109 homes this chain runs (chain average 3.2★, per CMS)
Showing 40 of 109; lowest-rated first.
A home rated well below its chain’s average can signal local problems; a chain with a low average across the board is a bigger pattern worth researching. CMS chain data under-reports private-equity and REIT ownership, so treat this as a floor, not the full picture.
Who owns this facility
| Owner / manager | Type | Role | Share | Since |
|---|---|---|---|---|
| ZENITH HOLDINGS OP CO., LLC | Organization | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 100% | since 04/14/2023 |
| C.R. STOLTZ FAMILY INVESTMENT COMPANY INC | Organization | INDIRECT OWNERSHIP INTEREST; ADP OF THE SNF | — | since 04/14/2023 |
| C.R. STOLTZ IRREVOCABLE TRUST | Organization | INDIRECT OWNERSHIP INTEREST; ADP OF THE SNF | — | since 04/14/2023 |
| HEALTH CARE HOLDINGS, LLC | Organization | INDIRECT OWNERSHIP INTEREST; ADP OF THE SNF | — | since 04/14/2023 |
| I. ROSEDALE FAMILY INVESTMENT COMPANY INC | Organization | INDIRECT OWNERSHIP INTEREST; ADP OF THE SNF | — | since 04/14/2023 |
| I. ROSEDALE IRREVOCABLE TRUST | Organization | INDIRECT OWNERSHIP INTEREST; ADP OF THE SNF | — | since 04/14/2023 |
| MARANTZ WV HOLDINGS, LLC | Organization | INDIRECT OWNERSHIP INTEREST; ADP OF THE SNF | — | since 04/14/2023 |
| R.S. WILHEIM IRREVOCABLE TRUST | Organization | INDIRECT OWNERSHIP INTEREST; ADP OF THE SNF | — | since 04/14/2023 |
| RONALD S WILHEIM 2012 SPOUSAL TRUST | Organization | INDIRECT OWNERSHIP INTEREST; ADP OF THE SNF | — | since 04/14/2023 |
| ROSEDALE FAMILY INVESTMENT COMPANY, INC | Organization | INDIRECT OWNERSHIP INTEREST; ADP OF THE SNF | — | since 04/14/2023 |
| RRW, LLC | Organization | INDIRECT OWNERSHIP INTEREST; ADP OF THE SNF | — | since 04/14/2023 |
| S.L. ROSEDALE IRREVOCABLE TRUST | Organization | INDIRECT OWNERSHIP INTEREST; ADP OF THE SNF | — | since 04/14/2023 |
| WILHEIM FAMILY INVESTMENT COMPANY, INC. | Organization | INDIRECT OWNERSHIP INTEREST; ADP OF THE SNF | — | since 04/14/2023 |
| ZENITH HEALTHCARE HOLDINGS, LLC | Organization | INDIRECT OWNERSHIP INTEREST; ADP OF THE SNF | — | since 04/14/2023 |
| GROVES, DONNA | Individual | CORPORATE OFFICER; OPERATIONAL/MANAGERIAL CONTROL | — | since 04/14/2023 |
| ROMEO, DOMINIC | Individual | CORPORATE OFFICER; OPERATIONAL/MANAGERIAL CONTROL | — | since 04/14/2023 |
| STOLTZ, CHARLES | Individual | CORPORATE OFFICER | — | since 04/14/2023 |
| WILHEIM, RONALD | Individual | CORPORATE OFFICER | — | since 04/14/2023 |
| ROUTE 55 MGT CO., LLC | Organization | OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | — | since 04/14/2023 |
| RIGGLEMAN, MICHAEL | Individual | OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | — | since 04/14/2023 |
| VANCE, PAULINE | Individual | OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF | — | since 04/14/2023 |
| ODENTHAL, RICHARD | Individual | INDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNF | — | since 04/08/2025 |
CMS files one row per role, so the 40 rows in the source record cover these 22 parties — each is shown once here with every role it holds. Nothing is omitted.
15 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 76% 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 $1.7M paid to related parties — landlords or management companies under common ownership — equal to about 33% 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 WV
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 West Virginia Medicaid page.
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 515173. CMS refreshes its data monthly, and the star rating rests on the last standard inspection — dated 2026-06-10, 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 →
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