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| Severity | Isolated | Pattern | Widespread |
|---|---|---|---|
| Immediate jeopardy | J1 | K· | L· |
| Actual harm | G1 | H· | I· |
| Potential harm | D63 | E24 | F23 |
| Minimal | A· | B· | C6 |
CMS publishes about the three most recent standard surveys plus complaint and infection-control inspections from the prior three years. Older findings leave the dataset; their absence is not evidence they never happened.
Federal certification and the state license are different records. A nursing home is licensed by the state and, separately, certified by CMS to bill Medicare and/or Medicaid. We link them by the CCN when the state publishes it; otherwise by exact address, house number and street, or exact name within the same ZIP, and label that link as inferred. Never by name alone.
| Date | Domain | Survey types | Citations | Most severe | Open | |
|---|---|---|---|---|---|---|
| Jun 23, 2026 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Apr 16, 2026 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Apr 15, 2026 | Fire safety | Fire Safety Complaint | 1 | Potential harm | — | Open → |
| Feb 13, 2026 | Health | Health Complaint | 4 | Potential harm | — | Open → |
| Nov 25, 2025 | Fire safety | Fire Safety Standard | 11 | Potential harm | — | Open → |
| Nov 25, 2025 | Health | Health Complaint, Health Standard | 18 | Potential harm | — | Open → |
| Nov 3, 2025 | Health | Health Complaint | 2 | Potential harm | — | Open → |
| May 28, 2024 | Fire safety | Fire Safety Complaint | 2 | Potential harm | — | Open → |
| Feb 6, 2024 | Fire safety | Fire Safety Standard | 16 | Potential harm | — | Open → |
| Feb 6, 2024 | Health | Health Complaint, Health Standard | 51 | Immediate jeopardy | 1 | Open → |
| Feb 26, 2019 | Fire safety | Fire Safety Standard | 5 | Potential harm | — | Open → |
| Feb 26, 2019 | Health | Health Standard | 6 | Potential harm | — | Open → |
| Date | Type | Amount | Payment denial | Record |
|---|---|---|---|---|
| Feb 6, 2024 | Denial of payment for new admissions | — | May 6, 2024 · 35 days | 215331|Payment Denial|2024-05-06 |
| Feb 6, 2024 | Civil money penalty (fine) | $72,514 | — | 215331|Fine|10078 |
| Severity | Isolated | Pattern | Widespread |
|---|---|---|---|
| Immediate jeopardy | J1 | K· | L· |
| Actual harm | G1 | H· | I· |
| Potential harm | D63 | E24 | F23 |
| Minimal | A· | B· | C6 |
| Date | Tag | Deficiency | Scope / severity | Correction | Flags |
|---|---|---|---|---|---|
| Jun 23, 2026 | F-0609 | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Freedom from Abuse, Neglect, and Exploitation Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Jul 15, 2026 | Complaint |
| Apr 16, 2026 | F-0686 | Provide appropriate pressure ulcer care and prevent new ulcers from developing. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected May 1, 2026 | Complaint |
“Corrected” does not erase a citation: the historical finding stays listed with its disposition. Narrative statements of deficiencies are not part of the CMS dataset; see Care Compare for the official inspection report.
CMS ratings apply to CMS-certified nursing homes only and are relative within each state. They are not a guarantee of any individual resident’s experience.
CMS legal business name of the certified provider. Operates this facility only.
64 facilities in 5 states. CMS chain ID 768.
Chain average overall rating (CMS): 2.2
| Name | Type | Role (Carefield group) | CMS role text | Share | Since |
|---|---|---|---|---|---|
| Tortuga Health Holdco LLC | Organization | Direct owner | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 100% | Mar 1, 2020 |
| Ismd Holdings LLC | Organization | Indirect owner | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 47% | May 1, 2021 |
| Mlmd Holdings LLC | Organization | Indirect owner | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 47% | May 1, 2021 |
| Miro Investments LLC | Organization | Indirect owner | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 5% | Mar 1, 2020 |
| Name | Type | Role (Carefield group) | CMS role text | Share | Since |
|---|---|---|---|---|---|
| Tortuga Health Holdco LLC | Organization | Direct owner | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 100% | Mar 1, 2020 |
| Ismd Holdings LLC | Organization | Indirect owner | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 47% | May 1, 2021 |
| Mlmd Holdings LLC | Organization | Indirect owner | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 47% | May 1, 2021 |
| Miro Investments LLC | Organization | Indirect owner | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 5% | Mar 1, 2020 |
| Facility | Beds | CMS overall | Last inspection | Citations (window) | Fines |
|---|---|---|---|---|---|
| White Oak Rehabilitation and Nursing Center 6500 Riggs Road, Hyattsville, MD 20783 CCN 215024 | 160 | Jun 22, 2026 | 1202 IJ | $77k | |
| Potomac Valley Rehabilitation and Healthcare 1235 Potomac Valley Road, Rockville, MD 20850 CCN 215026 | 175 |
Coordinates as published by CMS.
| Facility | Distance | Beds | CMS overall | Last inspection | Citations (window) | Fines |
|---|---|---|---|---|---|---|
| Future Care Capital Region 1051 Brightseat Road, Landover, MD 20785 CCN 215364 | 4.1 km | 150 | Jan 30, 2026 | 60 | — | |
| Collington Episcopal Life Care 10450 Lottsford Road, Mitchellville, MD 20721 State license only | 4.5 km | 44 lic. | Not CMS rated | — | No inspections in window | — |
| Villa Rosa Nursing and Rehabilitation, LLC 3800 Lottsford Vista Road, Mitchellville, MD 20721 CCN 215350 | 6.6 km | 107 | May 1, 2026 | 98 | — | |
| Forestville Rehabilitation and Wellness Center 7420 Marlboro Pike, Forestville, MD 20747 CCN 215020Abuse icon | 6.9 km | 162 | Jun 4, 2026 | 951 harm | $16k | |
| Larkin Chase Center 15005 Health Center Drive, Bowie, MD 20716 CCN 215264 | 9.5 km | 120 | Jul 6, 2026 | 46 | $102k | |
| Deanwood Rehabilitation and Wellness Center 5000 Nannie Helen Burroughs Ave. NE, Washington, DC 20019 CCN 095019Abuse icon | 10.2 km | 296 | Feb 4, 2026 | 1142 IJ4 harm | $98k | |
| Doctors Community Rehabilitation and Patient Care 6710 Mallery Drive, Lanham, MD 20706 CCN 215108 | 11.7 km | 130 | Jul 10, 2026 | 631 harm | $16k | |
| Capitol City Rehab and Healthcare Center 2425 25th Street SE, Washington, DC 20020 CCN 095022Abuse icon | 13.8 km | 360 | Feb 13, 2026 | 1776 IJ4 harm1 open | $252k |
| Source | Record | Facts | Evidence | Source release | Retrieved |
|---|---|---|---|---|---|
| CMS Provider Information US-CMS | 215331 | name, address, phone, certification, certified_beds, ownership_type, legal_business_name, chain | Verified | Oct 1, 2026 | Nov 7, 2026 |
| CMS Provider Information US-CMS | 215331 | ratings, staffing, health_survey_score Five-Star ratings and PBJ staffing apply to the CMS-certified universe only. | Verified | Oct 1, 2026 | Nov 7, 2026 |
| CMS Provider Information US-CMS | 215331 | county_fips County assigned by locating CMS coordinates in Census county boundaries (the CMS county name did not match the Census code list). | Inferred | Oct 1, 2026 | Nov 7, 2026 |
| Maryland OHCQ Long Term Care MD | 2416024 | state_license, licensed_beds, licensee Linked to the CMS record by exact normalized street address and ZIP (the state roster does not publish the CCN). | Inferred | Jul 22, 2025 | Nov 7, 2026 |
First seen by Carefield Nov 7, 2026 · last changed Nov 7, 2026. This record as JSON · Report a correction
| Apr 15, 2026 | K-0741 | Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. Miscellaneous Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Apr 30, 2026 | Complaint |
| Feb 13, 2026 | F-0656 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Resident Assessment and Care Planning Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Mar 20, 2026 | Complaint |
| Feb 13, 2026 | F-0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Quality of Life and Care Deficiencies · Clinical care | E · Potential harm Pattern | Corrected Mar 20, 2026 | Complaint |
| Feb 13, 2026 | F-0760 | Ensure that residents are free from significant medication errors. Pharmacy Service Deficiencies · Medication management | D · Potential harm Isolated | Corrected Mar 20, 2026 | Complaint |
| Feb 13, 2026 | F-0880 | Provide and implement an infection prevention and control program. Infection Control Deficiencies · Infection prevention | D · Potential harm Isolated | Corrected Mar 20, 2026 | Complaint |
| Nov 25, 2025 | E-0039 | Conduct testing and exercise requirements. Emergency Preparedness Deficiencies · Emergency preparedness | F · Potential harm Widespread | Corrected Mar 30, 2026 |
| Nov 25, 2025 | K-0100 | Meet other general requirements. Construction Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Jan 9, 2026 |
| Nov 25, 2025 | K-0223 | Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector. Egress Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Jan 9, 2026 |
| Nov 25, 2025 | K-0345 | Have approved installation, maintenance and testing program for fire alarm systems. Smoke Deficiencies · Environment & life safety | F · Potential harm Widespread | Corrected Jan 9, 2026 |
| Nov 25, 2025 | K-0353 | Inspect, test, and maintain automatic sprinkler systems. Smoke Deficiencies · Environment & life safety | F · Potential harm Widespread | Corrected Jan 9, 2026 |
| Nov 25, 2025 | K-0355 | Properly select, install, inspect, or maintain portable fire extinguishes. Smoke Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Jan 9, 2026 |
| Nov 25, 2025 | K-0372 | Ensure smoke barriers are constructed to a 1 hour fire resistance rating. Smoke Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Jan 9, 2026 |
| Nov 25, 2025 | K-0712 | Have simulated fire drills held at unexpected times. Miscellaneous Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Jan 9, 2026 |
| Nov 25, 2025 | K-0761 | To conduct inspection, testing and maintenance of fire doors by qualified individuals. Miscellaneous Deficiencies · Environment & life safety | F · Potential harm Widespread | Corrected Jan 9, 2026 |
| Nov 25, 2025 | K-0914 | Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety | F · Potential harm Widespread | Corrected Jan 9, 2026 |
| Nov 25, 2025 | K-0918 | Have generator or other power source capable of supplying service within 10 seconds. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety | F · Potential harm Widespread | Corrected Jan 9, 2026 |
| Nov 25, 2025 | F-0553 | Allow resident to participate in the development and implementation of his or her person-centered plan of care. Resident Rights Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Dec 24, 2025 |
| Nov 25, 2025 | F-0561 | Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. Resident Rights Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Dec 24, 2025 |
| Nov 25, 2025 | F-0582 | Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. Resident Rights Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Dec 24, 2025 |
| Nov 25, 2025 | F-0584 | Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Resident Rights Deficiencies · Resident rights & abuse/neglect | E · Potential harm Pattern | Corrected Dec 24, 2025 |
| Nov 25, 2025 | F-0605 | Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function. Freedom from Abuse, Neglect, and Exploitation Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Dec 24, 2025 |
| Nov 25, 2025 | F-0610 | Respond appropriately to all alleged violations. Freedom from Abuse, Neglect, and Exploitation Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Dec 24, 2025 | Complaint |
| Nov 25, 2025 | F-0628 | Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies. Resident Rights Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Dec 24, 2025 |
| Nov 25, 2025 | F-0641 | Ensure each resident receives an accurate assessment. Resident Assessment and Care Planning Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Dec 24, 2025 |
| Nov 25, 2025 | F-0677 | Provide care and assistance to perform activities of daily living for any resident who is unable. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Dec 24, 2025 |
| Nov 25, 2025 | F-0679 | Provide activities to meet all resident's needs. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Dec 24, 2025 |
| Nov 25, 2025 | F-0684 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Dec 24, 2025 |
| Nov 25, 2025 | F-0686 | Provide appropriate pressure ulcer care and prevent new ulcers from developing. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Dec 24, 2025 |
| Nov 25, 2025 | F-0697 | Provide safe, appropriate pain management for a resident who requires such services. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Dec 24, 2025 |
| Nov 25, 2025 | F-0759 | Ensure medication error rates are not 5 percent or greater. Pharmacy Service Deficiencies · Medication management | D · Potential harm Isolated | Corrected Dec 24, 2025 |
| Nov 25, 2025 | F-0761 | 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. Pharmacy Service Deficiencies · Medication management | E · Potential harm Pattern | Corrected Dec 24, 2025 |
| Nov 25, 2025 | F-0812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Nutrition and Dietary Deficiencies · Food, nutrition & hydration | D · Potential harm Isolated | Corrected Dec 24, 2025 |
| Nov 25, 2025 | F-0842 | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Resident Assessment and Care Planning Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Dec 24, 2025 |
| Nov 25, 2025 | F-0880 | Provide and implement an infection prevention and control program. Infection Control Deficiencies · Infection prevention | D · Potential harm Isolated | Corrected Dec 24, 2025 |
| Nov 3, 2025 | F-0609 | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Freedom from Abuse, Neglect, and Exploitation Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Dec 17, 2025 | Complaint |
| Nov 3, 2025 | F-0628 | Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies. Resident Rights Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Dec 17, 2025 | Complaint |
| May 28, 2024 | E-0035 | Provide family notifications of emergency plan. Emergency Preparedness Deficiencies · Emergency preparedness | F · Potential harm Widespread | Corrected Jun 10, 2024 | Complaint |
| May 28, 2024 | K-0918 | Have generator or other power source capable of supplying service within 10 seconds. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety | F · Potential harm Widespread | Waiver granted Jul 26, 2024 | Complaint |
| Feb 6, 2024 | F-0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Quality of Life and Care Deficiencies · Clinical care | J · Immediate jeopardy Isolated | Corrected Mar 27, 2024 |
| Feb 6, 2024 | F-0600 | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Freedom from Abuse, Neglect, and Exploitation Deficiencies · Resident rights & abuse/neglect | G · Actual harm Isolated | Corrected Mar 27, 2024 | Complaint |
| Feb 6, 2024 | E-0004 | Develop and maintain an Emergency Preparedness Program (EP). Emergency Preparedness Deficiencies · Emergency preparedness | F · Potential harm Widespread | Corrected Apr 9, 2024 |
| Feb 6, 2024 | E-0039 | Conduct testing and exercise requirements. Emergency Preparedness Deficiencies · Emergency preparedness | F · Potential harm Widespread | Corrected Apr 9, 2024 |
| Feb 6, 2024 | K-0211 | Keep aisles, corridors, and exits free of obstruction in case of emergency. Egress Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Mar 18, 2024 |
| Feb 6, 2024 | K-0223 | Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector. Egress Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Mar 18, 2024 |
| Feb 6, 2024 | K-0225 | Have stairways and smokeproof enclosures used as exits that meet safety requirements. Egress Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Mar 18, 2024 |
| Feb 6, 2024 | K-0281 | Install proper backup exit lighting. Egress Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Mar 18, 2024 |
| Feb 6, 2024 | K-0321 | Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system. Smoke Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Mar 18, 2024 |
| Feb 6, 2024 | K-0345 | Have approved installation, maintenance and testing program for fire alarm systems. Smoke Deficiencies · Environment & life safety | F · Potential harm Widespread | Corrected Apr 9, 2024 |
| Feb 6, 2024 | K-0353 | Inspect, test, and maintain automatic sprinkler systems. Smoke Deficiencies · Environment & life safety | F · Potential harm Widespread | Corrected Apr 9, 2024 |
| Feb 6, 2024 | K-0355 | Properly select, install, inspect, or maintain portable fire extinguishes. Smoke Deficiencies · Environment & life safety | F · Potential harm Widespread | Corrected Mar 18, 2024 |
| Feb 6, 2024 | K-0363 | Install corridor and hallway doors that block smoke. Smoke Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Mar 18, 2024 |
| Feb 6, 2024 | K-0741 | Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed. Miscellaneous Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Mar 18, 2024 |
| Feb 6, 2024 | K-0761 | To conduct inspection, testing and maintenance of fire doors by qualified individuals. Miscellaneous Deficiencies · Environment & life safety | F · Potential harm Widespread | Corrected Apr 9, 2024 |
| Feb 6, 2024 | K-0918 | Have generator or other power source capable of supplying service within 10 seconds. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety | F · Potential harm Widespread | Corrected Apr 9, 2024 |
| Feb 6, 2024 | K-0921 | Ensure that testing and maintenance of electrical equipment is performed. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety | F · Potential harm Widespread | Corrected Mar 18, 2024 |
| Feb 6, 2024 | K-0923 | Have proper medical gas storage and administration areas. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Mar 18, 2024 |
| Feb 6, 2024 | F-0550 | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Resident Rights Deficiencies · Resident rights & abuse/neglect | E · Potential harm Pattern | Corrected Mar 27, 2024 | Complaint |
| Feb 6, 2024 | F-0565 | Honor the resident's right to organize and participate in resident/family groups in the facility. Resident Rights Deficiencies · Resident rights & abuse/neglect | F · Potential harm Widespread | Corrected Mar 27, 2024 |
| Feb 6, 2024 | F-0578 | Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. Resident Rights Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Mar 27, 2024 | Complaint |
| Feb 6, 2024 | F-0584 | Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Resident Rights Deficiencies · Resident rights & abuse/neglect | F · Potential harm Widespread | Corrected Mar 27, 2024 | Complaint |
| Feb 6, 2024 | F-0609 | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Freedom from Abuse, Neglect, and Exploitation Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Mar 27, 2024 | Complaint |
| Feb 6, 2024 | F-0610 | Respond appropriately to all alleged violations. Freedom from Abuse, Neglect, and Exploitation Deficiencies · Resident rights & abuse/neglect | E · Potential harm Pattern | Corrected Mar 27, 2024 | Complaint |
| Feb 6, 2024 | F-0622 | Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged. Resident Rights Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Mar 27, 2024 | Complaint |
| Feb 6, 2024 | F-0623 | Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. Resident Rights Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Mar 27, 2024 | Complaint |
| Feb 6, 2024 | F-0624 | Prepare residents for a safe transfer or discharge from the nursing home. Resident Rights Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Mar 27, 2024 | Complaint |
| Feb 6, 2024 | F-0625 | Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave. Resident Rights Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Mar 27, 2024 | Complaint |
| Feb 6, 2024 | F-0641 | Ensure each resident receives an accurate assessment. Resident Assessment and Care Planning Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Mar 27, 2024 |
| Feb 6, 2024 | F-0644 | Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. Resident Assessment and Care Planning Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Mar 27, 2024 | Complaint |
| Feb 6, 2024 | F-0655 | Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted Resident Assessment and Care Planning Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Mar 27, 2024 |
| Feb 6, 2024 | F-0656 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Resident Assessment and Care Planning Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Mar 27, 2024 |
| Feb 6, 2024 | F-0657 | Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. Resident Assessment and Care Planning Deficiencies · Clinical care | E · Potential harm Pattern | Corrected May 31, 2024 |
| Feb 6, 2024 | F-0658 | Ensure services provided by the nursing facility meet professional standards of quality. Resident Assessment and Care Planning Deficiencies · Clinical care | D · Potential harm Isolated | Corrected May 31, 2024 |
| Feb 6, 2024 | F-0679 | Provide activities to meet all resident's needs. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Mar 27, 2024 |
| Feb 6, 2024 | F-0684 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Mar 27, 2024 | Complaint |
| Feb 6, 2024 | F-0686 | Provide appropriate pressure ulcer care and prevent new ulcers from developing. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Mar 27, 2024 | Complaint |
| Feb 6, 2024 | F-0690 | Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Mar 27, 2024 |
| Feb 6, 2024 | F-0697 | Provide safe, appropriate pain management for a resident who requires such services. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Mar 27, 2024 |
| Feb 6, 2024 | F-0710 | Obtain a doctor's order to admit a resident and ensure the resident is under a doctor's care. Nursing and Physician Services Deficiencies · Staffing & supervision | D · Potential harm Isolated | Corrected Mar 27, 2024 | Complaint |
| Feb 6, 2024 | F-0711 | Ensure the resident's doctor reviews the resident's care, writes, signs and dates progress notes and orders, at each required visit. Nursing and Physician Services Deficiencies · Staffing & supervision | D · Potential harm Isolated | Corrected Mar 27, 2024 |
| Feb 6, 2024 | F-0725 | Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. Nursing and Physician Services Deficiencies · Staffing & supervision | E · Potential harm Pattern | Corrected Mar 27, 2024 |
| Feb 6, 2024 | F-0726 | Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. Nursing and Physician Services Deficiencies · Staffing & supervision | D · Potential harm Isolated | Corrected Mar 27, 2024 |
| Feb 6, 2024 | F-0730 | Observe each nurse aide's job performance and give regular training. Nursing and Physician Services Deficiencies · Staffing & supervision | D · Potential harm Isolated | Corrected Mar 27, 2024 |
| Feb 6, 2024 | F-0740 | Ensure each resident must receive and the facility must provide necessary behavioral health care and services. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Mar 27, 2024 | Complaint |
| Feb 6, 2024 | F-0741 | Ensure that the facility has sufficient staff members who possess the competencies and skills to meet the behavioral health needs of residents. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Mar 27, 2024 | Complaint |
| Feb 6, 2024 | F-0745 | Provide medically-related social services to help each resident achieve the highest possible quality of life. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected May 31, 2024 | Complaint |
| Feb 6, 2024 | F-0756 | Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. Pharmacy Service Deficiencies · Medication management | E · Potential harm Pattern | Corrected Mar 27, 2024 |
| Feb 6, 2024 | F-0757 | Ensure each resident’s drug regimen must be free from unnecessary drugs. Pharmacy Service Deficiencies · Medication management | E · Potential harm Pattern | Corrected May 31, 2024 |
| Feb 6, 2024 | F-0759 | Ensure medication error rates are not 5 percent or greater. Pharmacy Service Deficiencies · Medication management | D · Potential harm Isolated | Corrected Mar 27, 2024 |
| Feb 6, 2024 | F-0761 | 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. Pharmacy Service Deficiencies · Medication management | D · Potential harm Isolated | Corrected Mar 27, 2024 |
| Feb 6, 2024 | F-0790 | Provide routine and 24-hour emergency dental care for each resident. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Mar 27, 2024 | Complaint |
| Feb 6, 2024 | F-0800 | Provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs. Nutrition and Dietary Deficiencies · Food, nutrition & hydration | D · Potential harm Isolated | Corrected Mar 27, 2024 |
| Feb 6, 2024 | F-0801 | Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. Nutrition and Dietary Deficiencies · Food, nutrition & hydration | F · Potential harm Widespread | Corrected Mar 27, 2024 |
| Feb 6, 2024 | F-0803 | Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. Nutrition and Dietary Deficiencies · Food, nutrition & hydration | F · Potential harm Widespread | Corrected Mar 27, 2024 |
| Feb 6, 2024 | F-0835 | Administer the facility in a manner that enables it to use its resources effectively and efficiently. Administration Deficiencies · Administration & records | F · Potential harm Widespread | Corrected Mar 27, 2024 |
| Feb 6, 2024 | F-0842 | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Resident Assessment and Care Planning Deficiencies · Clinical care | E · Potential harm Pattern | Corrected Mar 27, 2024 | Complaint |
| Feb 6, 2024 | F-0865 | Have a plan that describes the process for conducting QAPI and QAA activities. Administration Deficiencies · Administration & records | F · Potential harm Widespread | Corrected Mar 27, 2024 |
| Feb 6, 2024 | F-0880 | Provide and implement an infection prevention and control program. Infection Control Deficiencies · Infection prevention | E · Potential harm Pattern | Corrected Mar 27, 2024 |
| Feb 6, 2024 | F-0881 | Implement a program that monitors antibiotic use. Infection Control Deficiencies · Infection prevention | E · Potential harm Pattern | Corrected Mar 27, 2024 |
| Feb 6, 2024 | F-0908 | Keep all essential equipment working safely. Environmental Deficiencies · Environment & life safety | F · Potential harm Widespread | Corrected Mar 27, 2024 |
| Feb 6, 2024 | F-0923 | Have enough outside ventilation via a window or mechanical ventilation, or both. Environmental Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected May 31, 2024 |
| Feb 6, 2024 | F-0947 | Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention. Nursing and Physician Services Deficiencies · Staffing & supervision | D · Potential harm Isolated | Corrected Mar 27, 2024 |
| Feb 6, 2024 | F-0949 | Provide behavior health training consistent with the requirements and as determined by a facility assessment. Administration Deficiencies · Administration & records | E · Potential harm Pattern | Corrected Mar 27, 2024 |
| Feb 6, 2024 | F-0582 | Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. Resident Rights Deficiencies · Resident rights & abuse/neglect | C · Minimal Widespread | Corrected Mar 27, 2024 |
| Feb 6, 2024 | F-0732 | Post nurse staffing information every day. Nursing and Physician Services Deficiencies · Staffing & supervision | C · Minimal Widespread | No plan of correction |
| Feb 6, 2024 | F-0944 | Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program. Administration Deficiencies · Administration & records | C · Minimal Widespread | Corrected Mar 27, 2024 |
| Feb 26, 2019 | K-0541 | Install properly constructed and protected linen or trash chutes. Services Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Mar 30, 2019 |
| Feb 26, 2019 | K-0923 | Have proper medical gas storage and administration areas. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Mar 30, 2019 |
| Feb 26, 2019 | F-0657 | Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. Resident Assessment and Care Planning Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Apr 10, 2019 |
| Feb 26, 2019 | F-0677 | Provide care and assistance to perform activities of daily living for any resident who is unable. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Apr 10, 2019 |
| Feb 26, 2019 | F-0684 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Apr 10, 2019 |
| Feb 26, 2019 | F-0697 | Provide safe, appropriate pain management for a resident who requires such services. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Apr 10, 2019 |
| Feb 26, 2019 | F-0761 | 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. Pharmacy Service Deficiencies · Medication management | D · Potential harm Isolated | Corrected Apr 10, 2019 |
| Feb 26, 2019 | F-0842 | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Resident Assessment and Care Planning Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Apr 10, 2019 |
| Feb 26, 2019 | K-0321 | Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system. Smoke Deficiencies · Environment & life safety | C · Minimal Widespread | Corrected Mar 30, 2019 |
| Feb 26, 2019 | K-0363 | Install corridor and hallway doors that block smoke. Smoke Deficiencies · Environment & life safety | C · Minimal Widespread | Corrected Mar 30, 2019 |
| Feb 26, 2019 | K-0911 | Meet requirements for the installation and maintenance of electrical systems. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety | C · Minimal Widespread | Corrected Mar 30, 2019 |
Reported from Payroll-Based Journal (PBJ) data, as published by CMS. Case-mix adjusted total: 3.38 (case-mix index 1.48).
| Israel Birnbaum |
| Individual |
| Corporate officer / director |
| CORPORATE DIRECTOR |
| not provided |
| Mar 1, 2020 |
| Israel Birnbaum | Individual | Managing employee | W-2 MANAGING EMPLOYEE | not provided | Mar 1, 2020 |
| Aug 19, 2026 |
63 |
| — |
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