The most recent inspection on September 30, 2025, found no deficiencies during complaint investigations. Earlier inspections showed a pattern of deficiencies primarily related to resident care, including abuse reporting and protection, care planning, infection control, medication management, and safety issues such as accident hazards and premises safety. Complaint investigations mostly resulted in no deficiencies, though some substantiated cases involved failure to report abuse allegations timely. There were no fines, immediate jeopardy findings, or license actions listed in the available reports. The trend suggests improvement, with the most recent inspections showing fewer or no deficiencies compared to prior surveys.
Deficiencies (last 3 years)
Deficiencies (over 3 years)14.3 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
Recertification survey for Medicare under Life Safety Code 2012 with 12 deficiencies cited related to emergency preparedness, fire safety, and electrical systems.
Findings
Recertification survey for Medicare under Life Safety Code 2012 with 12 deficiencies cited related to emergency preparedness, fire safety, and electrical systems.
Deficiencies (12)
Description
Emergency preparedness policies and procedures
Emergency preparedness communication plan
Means of Egress - General
Emergency Lighting
Fire Alarm System - Installation
Fire Alarm System - Testing and Maintenance
Sprinkler System - Installation
Portable Fire Extinguishers
Corridor - Doors
Subdivision of Building Spaces - Smoke Barrier Construction
Electrical Systems - Essential Electric System Maintenance and Testing
Electrical Equipment - Testing and Maintenance Requirements
State compliance survey with investigation of multiple complaint intakes and 14 deficiencies cited related to care planning, infection control, medication, and food safety.
Findings
State compliance survey with investigation of multiple complaint intakes and 14 deficiencies cited related to care planning, infection control, medication, and food safety.
Deficiencies (14)
Description
§483.21 Comprehensive Person-Centered Care Planning
§483.24(a)(2) Services to maintain nutrition and grooming
State compliance survey conducted August 28 through September 8, 2023 with 10 deficiencies cited related to infection control, care planning, pain management, and medication administration.
Findings
State compliance survey conducted August 28 through September 8, 2023 with 10 deficiencies cited related to infection control, care planning, pain management, and medication administration.
Deficiencies (10)
Description
R9-10-403.C Policies and procedures for health services
§483.21(b) Comprehensive Care Plans
§483.21(b)(3) Comprehensive Care Plans
§483.24(a)(2) Services to maintain nutrition and grooming
§483.25(b) Skin Integrity
§483.25(k) Pain Management
§483.80 Infection Control
R9-10-414.B Care plan review and revision
R9-10-414.B Care plan nursing care provision
R9-10-421.B Medication administration policies
Report
File
complaint-inspection_2023-04-12.pdf
Report
File
complaint-inspection_2024-02-22.pdf
Report
File
complaint-inspection_2024-11-21.pdf
Report
File
complaint-inspection_2025-03-14.pdf
Report
File
complaint-inspection_2025-04-17.pdf
Report
File
complaint-inspection_2025-07-31.pdf
Report
File
health-inspection_2022-07-14.pdf
Report
File
health-inspection_2023-09-08.pdf
Report
File
health-inspection_2025-03-14.pdf
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