Inspection Report
Complaint Investigation
Deficiencies: 24
Nov 8, 2024
Visit Reason
State-compiled facility profile showing multiple inspections from 2021 to 2024 with complaint investigations, citations, enforcement actions, and deficiency history.
Findings
Across all inspections, the facility received multiple complaint-related citations primarily at Level 2 severity, with one Level 4 deficiency indicating immediate jeopardy. Deficiencies covered quality of care, life safety, and administrative issues, with most corrected promptly.
Complaint Details
Facility received 10 complaints from November 1, 2021 to October 31, 2025, with 14 complaint-related on-site inspections and 19 complaint-related citations during this period.
Severity Breakdown
Level 2: 23
Level 4: 1
Deficiencies (24)
| Description | Severity |
|---|---|
| Activities daily living (adls)/mntn abilities: Standard Health Inspection Citation pertaining to quality of care. | Level 2 |
| ADL care provided for dependent residents: Standard Health Inspection Citation pertaining to quality of care. | Level 2 |
| Care plan timing and revision: Standard Health Inspection Citation pertaining to quality of care. | Level 2 |
| Comprehensive assessment after signifcant chg: Standard Health Inspection Citation pertaining to quality of care. | Level 2 |
| Food procurement,store/prepare/serve-sanitary: Standard Health Inspection Citation pertaining to quality of care. | Level 2 |
| Free of medication error rts 5 prcnt or more: Standard Health Inspection Citation pertaining to quality of care. | Level 2 |
| Reporting of alleged violations: Standard Health Inspection Citation pertaining to quality of care. | Level 2 |
| Residents are free of significant med errors: Standard Health Inspection Citation pertaining to quality of care. | Level 2 |
| Respiratory/tracheostomy care and suctioning: Standard Health Inspection Citation pertaining to quality of care. | Level 2 |
| Ep program patient population: Standard Life Safety Code Citation pertaining to life safety requirements. | Level 2 |
| Protection - other: Standard Life Safety Code Citation pertaining to life safety requirements. | Level 2 |
| Electrical equipment - testing and maintenanc: Standard Life Safety Code Citation pertaining to life safety requirements. | Level 2 |
| Subdivision of building spaces - smoke barrie: Standard Life Safety Code Citation pertaining to life safety requirements. | Level 2 |
| Vertical openings - enclosure: Standard Life Safety Code Citation pertaining to life safety requirements. | Level 2 |
| Reporting of alleged violations: Standard Health Inspection Citation pertaining to quality of care. | Level 2 |
| Electrical systems - essential electric syste: Standard Life Safety Code Citation pertaining to life safety requirements. | Level 2 |
| ADL care provided for dependent residents: Standard Health Inspection Citation pertaining to quality of care. | Level 2 |
| Food procurement,store/prepare/serve-sanitary: Standard Health Inspection Citation pertaining to quality of care. | Level 2 |
| Free from unnec psychotropic meds/prn use: Standard Health Inspection Citation pertaining to quality of care. | Level 2 |
| Free of accident hazards/supervision/devices: Standard Health Inspection Citation pertaining to quality of care. | Level 4 |
| Personal privacy/confidentiality of records: Standard Health Inspection Citation pertaining to quality of care. | Level 2 |
| Egress doors: Standard Life Safety Code Citation pertaining to life safety requirements. | Level 2 |
| Ramps and other exits: Standard Life Safety Code Citation pertaining to life safety requirements. | Level 2 |
| Reporting - national health safety network: Standard Health Inspection Citation pertaining to quality of care. | Level 2 |
Report Facts
Inspections on page: 14
Inspections with citations: 7
Inspections with no citations: 7
Total citations: 23
Total complaints: 10
Total complaint-related citations: 19
Total fines: 26000
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