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| Severity | Isolated | Pattern | Widespread |
|---|---|---|---|
| Immediate jeopardy | J· | K· | L· |
| Actual harm | G2 | H· | I· |
| Potential harm | D48 | E14 | F11 |
| Minimal | A· | B3 | C3 |
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 → |
| Feb 11, 2026 | Health | Health Complaint | 3 | Actual harm | — | Open → |
| Dec 3, 2025 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Jan 15, 2025 | Health | Health Complaint | 1 | Potential harm | — | Open → |
| Oct 11, 2024 | Fire safety | Fire Safety Standard | 11 | Potential harm | — | Open → |
| Oct 11, 2024 | Health | Health Standard | 24 | Potential harm | — | Open → |
| Jul 9, 2024 | Health | Health Complaint | 2 | Potential harm | — | Open → |
| Jun 18, 2024 | Health | Health Complaint | 6 | Potential harm | — | Open → |
| Dec 1, 2023 | Fire safety | Fire Safety Standard | 6 | Potential harm | — | Open → |
| Dec 1, 2023 | Health | Health Standard | 12 | Potential harm | — | Open → |
| Jun 16, 2023 | Fire safety | Fire Safety Standard | 9 | Potential harm | — | Open → |
| Jun 16, 2023 | Health | Health Standard | 5 | Potential harm | — | Open → |
| Date | Type | Amount | Payment denial | Record |
|---|---|---|---|---|
| Feb 11, 2026 | Civil money penalty (fine) | $13,342 | — | 395164|Fine|137129 |
| Feb 11, 2026 | Civil money penalty (fine) | $13,342 | — | 395164|Fine|146480 |
| Severity | Isolated | Pattern | Widespread |
|---|---|---|---|
| Immediate jeopardy | J· | K· | L· |
| Actual harm | G2 | H· | I· |
| Potential harm | D48 | E14 | F11 |
| Minimal | A· | B3 | C3 |
| Date | Tag | Deficiency | Scope / severity | Correction | Flags |
|---|---|---|---|---|---|
| Jun 23, 2026 | 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 Jul 31, 2026 | Complaint |
| Feb 11, 2026 | 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 4, 2026 |
“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.
Not part of a CMS-reported chain.
| Name | Type | Role (Carefield group) | CMS role text | Share | Since |
|---|---|---|---|---|---|
| Samanth Rapuk | Individual | Operational / managerial control | OPERATIONAL/MANAGERIAL CONTROL | not provided | Jul 1, 2023 |
| Jeffrey Carraway | Individual | Corporate officer / director | CORPORATE DIRECTOR | not provided | May 27, 2021 |
| David Fenoglietto | Individual | Corporate officer / director | CORPORATE DIRECTOR | not provided | May 27, 2021 |
| Jeffrey Carraway | Individual | Corporate officer / director | CORPORATE OFFICER | not provided | May 27, 2021 |
| David Fenoglietto | Individual | Corporate officer / director | CORPORATE OFFICER | not provided | Jul 1, 2004 |
| Jeffrey Carraway | Individual | Trustee | TRUSTEE OF THE SNF | not provided | Jul 1, 2023 |
| David Fenoglietto | Individual | Trustee | TRUSTEE OF THE SNF | not provided | Jul 1, 2023 |
| Samanth Rapuk | Individual | Trustee | TRUSTEE OF THE SNF | not provided | Jul 1, 2023 |
| Lutheran Seniorlife | Organization | Additional disclosable party | ADP OF THE SNF | not provided | Jan 1, 1986 |
| Robert Pfoff | Individual | Additional disclosable party | ADP OF THE SNF | not provided | May 1, 2001 |
| Samanth Rapuk | Individual | Additional disclosable party | ADP OF THE SNF | not provided | Jul 1, 2017 |
Coordinates as published by CMS.
| Facility | Distance | Beds | CMS overall | Last inspection | Citations (window) | Fines |
|---|---|---|---|---|---|---|
| St Barnabas Nursing Home 5827 Meridian Road, Gibsonia, PA 15044 CCN 395605 | 6.6 km | 119 | Mar 11, 2026 | 41 | — | |
| Cranberry Place 5 Saint Francis Way, Cranberry Township, PA 16066 CCN 395845Abuse icon | 7.3 km | 150 | Apr 30, 2026 | 1156 harm2 open | $43k | |
| Harmony Hills Healthcare and Rehabilitation Center 194 Swinderman Road, Wexford, PA 15090 CCN 395903 | 7.3 km | 55 | Sep 11, 2026 | 439 open | — | |
| Sherwood Oaks 100 Norman Drive, Cranberry Township, PA 16066 CCN 395549 | 8.8 km | 43 | Feb 19, 2026 | 261 IJ | $8,281 | |
| Perry Health & Rehab Center 9850 Old Perry Highway, Wexford, PA 15090 CCN 395300 | 11.9 km | 182 | Aug 21, 2026 | 1261 IJ1 harm | $18k | |
| Concordia at Rebecca Residence 3746 Cedar Ridge Road, Allison Park, PA 15101 CCN 396067 | 14 km | 60 | Jun 25, 2026 | 30 | — | |
| Passavant Retirement and Healt 105 Burgess Drive, Zelienople, PA 16063 CCN 395001 | 14.9 km | 102 | Feb 27, 2026 | 463 harm | $77k | |
| Vincentian Home 111 Perrymont Road, Pittsburgh, PA 15237 CCN 395034Abuse icon | 15.5 km | 106 | May 29, 2026 | 45 | — |
| Source | Record | Facts | Evidence | Source release | Retrieved |
|---|---|---|---|---|---|
| CMS Provider Information US-CMS | 395164 | name, address, phone, certification, certified_beds, ownership_type, legal_business_name, chain | Verified | Oct 1, 2026 | Nov 7, 2026 |
| CMS Provider Information US-CMS | 395164 | 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 |
| Pennsylvania DOH Nursing Homes PA | 970802 | state_license, licensed_beds, licensee Linked to the CMS record by the same house number, street name and ZIP (the state roster does not publish the CCN). | Inferred | Sep 17, 2026 | Nov 7, 2026 |
First seen by Carefield Nov 7, 2026 · last changed Nov 7, 2026. This record as JSON · Report a correction
| Feb 11, 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 | G · Actual harm Isolated | Corrected Mar 4, 2026 | Complaint |
| Feb 11, 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 Mar 4, 2026 | Complaint |
| Dec 3, 2025 | 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 | D · Potential harm Isolated | Corrected Dec 9, 2025 | Complaint |
| Jan 15, 2025 | F-0580 | Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Resident Rights Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Feb 14, 2025 | Complaint |
| Oct 11, 2024 | K-0100 | Meet other general requirements. Construction Deficiencies · Environment & life safety | F · Potential harm Widespread | Corrected Nov 15, 2024 |
| Oct 11, 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 | D · Potential harm Isolated | Corrected Nov 15, 2024 |
| Oct 11, 2024 | K-0293 | Have properly located and lighted "Exit" signs. Egress Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Nov 15, 2024 |
| Oct 11, 2024 | K-0353 | Inspect, test, and maintain automatic sprinkler systems. Smoke Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Nov 15, 2024 |
| Oct 11, 2024 | K-0372 | Ensure smoke barriers are constructed to a 1 hour fire resistance rating. Smoke Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Nov 15, 2024 |
| Oct 11, 2024 | K-0712 | Have simulated fire drills held at unexpected times. Miscellaneous Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Nov 15, 2024 |
| Oct 11, 2024 | K-0912 | Have power receptacles that are properly grounded. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Nov 15, 2024 |
| Oct 11, 2024 | K-0920 | Ensure proper usage of power strips and extension cords. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Nov 15, 2024 |
| Oct 11, 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 | D · Potential harm Isolated | Corrected Nov 30, 2024 |
| Oct 11, 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 | D · Potential harm Isolated | Corrected Nov 30, 2024 |
| Oct 11, 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 | D · Potential harm Isolated | Corrected Nov 30, 2024 |
| Oct 11, 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 Nov 30, 2024 |
| Oct 11, 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 Nov 30, 2024 |
| Oct 11, 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 Nov 30, 2024 |
| Oct 11, 2024 | F-0641 | Ensure each resident receives an accurate assessment. Resident Assessment and Care Planning Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Nov 30, 2024 |
| Oct 11, 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 | D · Potential harm Isolated | Corrected Nov 30, 2024 |
| Oct 11, 2024 | F-0676 | Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Nov 30, 2024 |
| Oct 11, 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 Nov 30, 2024 |
| Oct 11, 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 | D · Potential harm Isolated | Corrected Nov 30, 2024 |
| Oct 11, 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 | E · Potential harm Pattern | Corrected Nov 30, 2024 |
| Oct 11, 2024 | F-0691 | Provide appropriate colostomy, urostomy, or ileostomy care/services for a resident who requires such services. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Nov 30, 2024 |
| Oct 11, 2024 | F-0742 | Provide the appropriate treatment and services to a resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Nov 30, 2024 |
| Oct 11, 2024 | F-0757 | Ensure each resident’s drug regimen must be free from unnecessary drugs. Pharmacy Service Deficiencies · Medication management | D · Potential harm Isolated | Corrected Nov 30, 2024 |
| Oct 11, 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 Nov 30, 2024 |
| Oct 11, 2024 | F-0810 | Provide special eating equipment and utensils for residents who need them and appropriate assistance. Nutrition and Dietary Deficiencies · Food, nutrition & hydration | D · Potential harm Isolated | Corrected Nov 30, 2024 |
| Oct 11, 2024 | 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 | F · Potential harm Widespread | Corrected Nov 30, 2024 |
| Oct 11, 2024 | F-0849 | Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. Administration Deficiencies · Administration & records | E · Potential harm Pattern | Corrected Nov 30, 2024 |
| Oct 11, 2024 | F-0880 | Provide and implement an infection prevention and control program. Infection Control Deficiencies · Infection prevention | E · Potential harm Pattern | Corrected Nov 30, 2024 |
| Oct 11, 2024 | F-0881 | Implement a program that monitors antibiotic use. Infection Control Deficiencies · Infection prevention | D · Potential harm Isolated | Corrected Nov 30, 2024 |
| Oct 11, 2024 | F-0942 | Ensure that staff members are educated on resident rights and facility responsibilities to properly care for its residents. Resident Rights Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Nov 30, 2024 |
| Oct 11, 2024 | F-0944 | Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program. Administration Deficiencies · Administration & records | D · Potential harm Isolated | Corrected Nov 30, 2024 |
| Oct 11, 2024 | K-0324 | Provide properly protected cooking facilities. Smoke Deficiencies · Environment & life safety | C · Minimal Widespread | Corrected Nov 15, 2024 |
| Oct 11, 2024 | 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 Nov 15, 2024 |
| Oct 11, 2024 | K-0923 | Have proper medical gas storage and administration areas. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety | C · Minimal Widespread | Corrected Nov 15, 2024 |
| Jul 9, 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 | D · Potential harm Isolated | Corrected Jul 29, 2024 | Complaint |
| Jul 9, 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 | D · Potential harm Isolated | Corrected Jul 29, 2024 | Complaint |
| Jun 18, 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 | D · Potential harm Isolated | Corrected Jun 28, 2024 | Complaint |
| Jun 18, 2024 | F-0604 | Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. Freedom from Abuse, Neglect, and Exploitation Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Jun 28, 2024 | Complaint |
| Jun 18, 2024 | F-0607 | Develop and implement policies and procedures to prevent abuse, neglect, and theft. Freedom from Abuse, Neglect, and Exploitation Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Jun 28, 2024 | Complaint |
| Jun 18, 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 | E · Potential harm Pattern | Corrected Jun 28, 2024 | Complaint |
| Jun 18, 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 Jun 28, 2024 | Complaint |
| Jun 18, 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 | D · Potential harm Isolated | Corrected Jun 28, 2024 | Complaint |
| Dec 1, 2023 | K-0311 | Have an enclosure around a vertical opening shaft. Smoke Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Feb 4, 2024 |
| Dec 1, 2023 | K-0353 | Inspect, test, and maintain automatic sprinkler systems. Smoke Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Feb 4, 2024 |
| Dec 1, 2023 | K-0753 | Have restrictions on the use of highly flammable decorations. Miscellaneous Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Feb 4, 2024 |
| Dec 1, 2023 | K-0761 | To conduct inspection, testing and maintenance of fire doors by qualified individuals. Miscellaneous Deficiencies · Environment & life safety | F · Potential harm Widespread | Corrected Feb 1, 2024 |
| Dec 1, 2023 | 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 Feb 4, 2024 |
| Dec 1, 2023 | K-0918 | Have generator or other power source capable of supplying service within 10 seconds. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Feb 4, 2024 |
| Dec 1, 2023 | F-0554 | Allow residents to self-administer drugs if determined clinically appropriate. Resident Rights Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Jan 19, 2024 |
| Dec 1, 2023 | F-0583 | Keep residents' personal and medical records private and confidential. Resident Rights Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Jan 19, 2024 |
| Dec 1, 2023 | 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 | D · Potential harm Isolated | Corrected Jan 19, 2024 |
| Dec 1, 2023 | F-0610 | Respond appropriately to all alleged violations. Freedom from Abuse, Neglect, and Exploitation Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Jan 19, 2024 |
| Dec 1, 2023 | 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 Jan 19, 2024 |
| Dec 1, 2023 | F-0695 | Provide safe and appropriate respiratory care for a resident when needed. Quality of Life and Care Deficiencies · Clinical care | D · Potential harm Isolated | Corrected Jan 19, 2024 |
| Dec 1, 2023 | F-0700 | Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. Quality of Life and Care Deficiencies · Clinical care | E · Potential harm Pattern | Corrected Jan 19, 2024 |
| Dec 1, 2023 | 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 Jan 19, 2024 |
| Dec 1, 2023 | 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 | F · Potential harm Widespread | Corrected Jan 19, 2024 |
| Dec 1, 2023 | F-0849 | Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. Administration Deficiencies · Administration & records | D · Potential harm Isolated | Corrected Jan 19, 2024 |
| Dec 1, 2023 | F-0880 | Provide and implement an infection prevention and control program. Infection Control Deficiencies · Infection prevention | F · Potential harm Widespread | Corrected Jan 19, 2024 |
| Dec 1, 2023 | F-0885 | Report COVID19 data to residents and families. Infection Control Deficiencies · Infection prevention | D · Potential harm Isolated | Corrected Jan 19, 2024 |
| Jun 16, 2023 | K-0293 | Have properly located and lighted "Exit" signs. Egress Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Aug 4, 2023 |
| Jun 16, 2023 | K-0324 | Provide properly protected cooking facilities. Smoke Deficiencies · Environment & life safety | E · Potential harm Pattern | Corrected Aug 4, 2023 |
| Jun 16, 2023 | K-0353 | Inspect, test, and maintain automatic sprinkler systems. Smoke Deficiencies · Environment & life safety | F · Potential harm Widespread | Corrected Aug 31, 2023 |
| Jun 16, 2023 | K-0355 | Properly select, install, inspect, or maintain portable fire extinguishes. Smoke Deficiencies · Environment & life safety | F · Potential harm Widespread | Corrected Aug 4, 2023 |
| Jun 16, 2023 | K-0374 | Install smoke barrier doors that can resist smoke for at least 20 minutes. Smoke Deficiencies · Environment & life safety | D · Potential harm Isolated | Corrected Aug 4, 2023 |
| Jun 16, 2023 | K-0521 | Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions. Services Deficiencies · Environment & life safety | F · Potential harm Widespread | Corrected Aug 4, 2023 |
| Jun 16, 2023 | 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 Aug 31, 2023 |
| Jun 16, 2023 | 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 | E · Potential harm Pattern | Corrected Jul 28, 2023 |
| Jun 16, 2023 | F-0695 | Provide safe and appropriate respiratory care for a resident when needed. Quality of Life and Care Deficiencies · Clinical care | E · Potential harm Pattern | Corrected Jul 28, 2023 |
| Jun 16, 2023 | 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 | F · Potential harm Widespread | Corrected Jul 28, 2023 |
| Jun 16, 2023 | F-0943 | Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation. Freedom from Abuse, Neglect, and Exploitation Deficiencies · Resident rights & abuse/neglect | D · Potential harm Isolated | Corrected Jul 28, 2023 |
| Jun 16, 2023 | K-0291 | Install emergency lighting that can last at least 1 1/2 hours. Egress Deficiencies · Environment & life safety | B · Minimal Pattern | Corrected Aug 4, 2023 |
| Jun 16, 2023 | K-0372 | Ensure smoke barriers are constructed to a 1 hour fire resistance rating. Smoke Deficiencies · Environment & life safety | B · Minimal Pattern | Corrected Aug 4, 2023 |
| Jun 16, 2023 | F-0949 | Provide behavior health training consistent with the requirements and as determined by a facility assessment. Administration Deficiencies · Administration & records | B · Minimal Pattern | Corrected Jul 28, 2023 |
Reported from Payroll-Based Journal (PBJ) data, as published by CMS. Case-mix adjusted total: 3.75 (case-mix index 1.53).