Overview of Autumn Lake Healthcare at Alice Manor At 2095 Rockrose Ave in Baltimore’s Woodberry neighborhood, Autumn Lake Healthcare at Alice Manor operates as a 105-bed skilled nursing community under independent ownership by Alice Operator LLC. The facility has served residents for 33 years. Administrator John Rajakumar leads operations.
Care includes 24/7 skilled nursing, physical and occupational therapy, speech pathology, restorative care, bereavement counseling, diabetes management, and tracheostomy services, with psychiatry, wound care, and physiatry consultation.
Current residents are predominantly Medicaid-funded (81.1%), with admission patterns weighted toward Medicaid (40%), private pay (35%), and Medicare (24%). Average stay runs 137 days. Occupancy at 81.7% aligns with state average.
The facility recorded 55 citations since 2018; 6.9 annually, a rate 1280% above Maryland’s typical 0.5 per year.
Two complaint investigations in 2024–2025 documented critical deficiencies. The May 2025 survey found an unsecured biohazard storage room, understaffing substantiated by multiple resident and staff interviews, and nursing personnel unaware of AED locations. The November 2024 complaint investigation uncovered an unclean environment, verbal abuse by one staff member affecting three residents, four instances of delayed abuse reporting, 15 incidents inadequately investigated, and one medication error of grave severity: an agency-supplied nurse administered methadone to a patient not prescribed it, resulting in hospital admission.
Recurring deficiency patterns across 2018–2025 inspections implicate Resident Rights (22% of total citations), Quality of Life and Care (22%), and Pharmacy Services (13%).
The facility carries a 1-star CMS overall rating.
Daily nursing care totals 3 hours 28 minutes per resident, 19% below Maryland standard. Registered nurse presence is critically low at 15 minutes daily, 70% beneath state expectation.
The facility maintains 386 staff members, but contractor labor dominates the nursing workforce: 107 of 117 LPNs and 152 of 205 CNAs work under contract, representing 36% of total hours and raising continuity and quality concerns.
Depression affects 71.7% of long-stay residents, a 255% elevation above state prevalence. Functional decline scores run 13% worse than state. Conversely, urinary tract infection rates stand at zero, and 55.1% of residents successfully return to community settings post-discharge.
The facility maintains 4.0% operating margin but experienced occupancy erosion and income decline from 2022 to 2023.
No federal penalties appear in recent records, though complaint investigation severity may signal enforcement pending.
The facility is positioned for long-term Medicaid residents in an established urban location; recent substantive compliance findings, high depressive symptom prevalence, critical staffing shortfalls, and documented serious medication errors constitute material operational risks.
