Aspyre of Waukegan

WAUKEGAN, IL

CMS provider ID 146159CMS source updated July 29, 2026

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CMS overview

CMS rating overview

CMS overall

1 of 5 CMS stars

Health inspection

1 of 5 CMS stars

Staffing

2 of 5 CMS stars

Quality-measure

2 of 5 CMS stars

No proprietary TrustHub score. These ratings are published separately by CMS.

How CMS describes these ratings
CMS overall rating
The CMS overall rating summarizes health inspections, staffing, and quality measures within Medicare's Five-Star system.
Health inspection rating
The CMS health inspection rating reflects findings from standard and complaint inspections used in Medicare's Five-Star system.
Staffing rating
The CMS staffing rating reflects staffing levels and related measures used in Medicare's Five-Star system.
Quality-measure rating
The CMS quality-measure rating summarizes selected resident assessment and claims-based measures used in Medicare's Five-Star system.
CMS certified beds
115
Ownership descriptor
For profit - Corporation
Medicare participation
Yes
Medicaid participation
Yes

Facility information

Contact

CMS remains the primary federal record. Public website and additional contact details appear only when independently verified.

Phone
8472446700Verified public information · checked Aug 2026

Decision guide

What to review

Factual evidence to examine before you decide. These summaries are not a score or recommendation.

Staffing

CMS publishes a 2-star staffing rating for this facility.

RN staffing was 0.88 hours per resident day in 2026Q1, calculated from CMS PBJ records.

View staffing evidence

Ownership

CMS-published records list 9 ownership or control parties.

CMS records show an ownership change effective August 2019.

View ownership evidence

Chain context

CMS groups this facility with a chain covering 14 facilities across 1 states or territories.

View chain evidence
Enforcement record

CMS records show a $26,720 fine in the loaded enforcement dataset.

View enforcement evidence →

Ownership & operation

Ownership & Operation

Operator, licensee, owner, manager, and chain stay separate. A connected organization is not automatically the party that runs daily operations.

Ownership type
For profit - CorporationCMS
Chain
ALIYA HEALTHCARECMS identifies this facility as part of the ALIYA HEALTHCARE chain.
Ownership changes
1 recordedCMS enrollment records

Who is behind this facility?

SeniorTrustHub found evidence connecting this facility to:

  • 4 CMS-reported ownership organizations
  • CMS reports 4 individual ownership interests
  • a CMS chain / common-control group
  • recorded ownership-change events

Ownership

Who CMS records show is connected to this facility

These are CMS-published ownership disclosures. Medicare enrollment ownership and managerial-control information is reported by enrolled providers through CMS forms; it is not an independent determination of beneficial ownership.

Reported party records
9
Organizations shown
5
Individuals shown
4
Latest ownership source update
Jul 27, 2026

CMS-published ownership and control parties

  • LAUREATE CHICAGOLAND HOLDINGS LLC

    Organization · 5% OR GREATER DIRECT OWNERSHIP INTEREST

    Published ownership percentage: 99%

    Association date reported to CMS: Aug 30, 2019

    Other facilities connected through this exact CMS organization identity: 0 across IL.

    View ownership source details
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset
    Ownership
    CMS dataset identifier
    y2hd-n93e
    Source updated
    Jul 1, 2026
    Retrieved
    Aug 15, 2026
    View official CMS source
  • RPFG HOLDINGS INC

    Organization · 5% OR GREATER INDIRECT OWNERSHIP INTEREST

    Published ownership percentage: 100%

    Association date reported to CMS: Sep 1, 2019

    Other facilities connected through this exact CMS organization identity: 0 across IL.

    View ownership source details
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset
    Ownership
    CMS dataset identifier
    y2hd-n93e
    Source updated
    Jul 1, 2026
    Retrieved
    Aug 15, 2026
    View official CMS source
  • AHMAD, SHAUN

    Individual · CORPORATE OFFICER

    Association date reported to CMS: Aug 30, 2019

    View ownership source details
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset
    Ownership
    CMS dataset identifier
    y2hd-n93e
    Source updated
    Jul 1, 2026
    Retrieved
    Aug 15, 2026
    View official CMS source
  • DEMPSEY, KATHLEEN

    Individual · W-2 MANAGING EMPLOYEE

    Association date reported to CMS: Aug 30, 2019

    View ownership source details
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset
    Ownership
    CMS dataset identifier
    y2hd-n93e
    Source updated
    Jul 1, 2026
    Retrieved
    Aug 15, 2026
    View official CMS source
  • LAUREATE CHICAGOLAND HOLDINGS LLC

    Organization · 5% OR GREATER DIRECT OWNERSHIP INTEREST

    Published ownership percentage: 99%

    Association date reported to CMS: Aug 30, 2019

    Other facilities connected through this exact CMS organization identity: 1 across IL.

    View ownership source details
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset
    Skilled Nursing Facility All Owners
    CMS dataset identifier
    afe44b85-cc6d-40d7-b5df-00ae8910d1d2
    Source updated
    Jul 27, 2026
    Retrieved
    Aug 15, 2026
    View official CMS source
  • RPFG HOLDINGS INC

    Organization · 5% OR GREATER INDIRECT OWNERSHIP INTEREST

    Published ownership percentage: 100%

    Association date reported to CMS: Sep 1, 2019

    Other facilities connected through this exact CMS organization identity: 0 across IL.

    View ownership source details
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset
    Skilled Nursing Facility All Owners
    CMS dataset identifier
    afe44b85-cc6d-40d7-b5df-00ae8910d1d2
    Source updated
    Jul 27, 2026
    Retrieved
    Aug 15, 2026
    View official CMS source
  • AHMAD, SHAUN

    Individual · CORPORATE OFFICER

    Published ownership percentage: 100%

    Association date reported to CMS: Aug 30, 2019

    View ownership source details
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset
    Skilled Nursing Facility All Owners
    CMS dataset identifier
    afe44b85-cc6d-40d7-b5df-00ae8910d1d2
    Source updated
    Jul 27, 2026
    Retrieved
    Aug 15, 2026
    View official CMS source
  • DEMPSEY, KATHLEEN

    Individual · W-2 MANAGING EMPLOYEE

    Published ownership percentage: 100%

    Association date reported to CMS: Aug 30, 2019

    View ownership source details
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset
    Skilled Nursing Facility All Owners
    CMS dataset identifier
    afe44b85-cc6d-40d7-b5df-00ae8910d1d2
    Source updated
    Jul 27, 2026
    Retrieved
    Aug 15, 2026
    View official CMS source
  • LAUREATE TERRACE OPERATIONS LLC

    Organization · Medicare-enrolled legal organization

    Other facilities connected through this exact CMS organization identity: 0 across IL.

    View ownership source details
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset
    Skilled Nursing Facility Enrollments
    CMS dataset identifier
    5f2c306f-3b1c-42cd-b037-187b2ce22126
    Source updated
    Jul 27, 2026
    Retrieved
    Aug 15, 2026
    View official CMS source

Ownership changes reported in CMS enrollment records

  1. CHANGE OF OWNERSHIPTN CARE LLC to LAUREATE TERRACE OPERATIONS LLC
    View ownership source details
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset
    Skilled Nursing Facility Change of Ownership
    CMS dataset identifier
    f557a6ed-95b3-4a22-8433-4175db2dec1c
    Source updated
    Jul 27, 2026
    Retrieved
    Aug 15, 2026
    View official CMS source

What this means

Roles are shown as CMS publishes them. Different CMS sources can describe different enrollment, ownership, and control concepts, so TrustHub keeps each source-specific disclosure distinct.

Questions to ask

  • CMS records list several organizations with ownership or control roles. Which entity is responsible for day-to-day operations at this facility?
  • CMS enrollment records show a change of ownership effective Aug 30, 2019. What operational or leadership changes followed that event?
  • CMS records connect LAUREATE CHICAGOLAND HOLDINGS LLC to 2 facilities. Which policies and staffing decisions are managed centrally versus locally?

Chain context

CMS groups this facility with ALIYA HEALTHCARE

Chain-level values describe this CMS-defined group, not any one facility. CMS Chain ID 663 is a grouping identifier, not a legal organization.

Facilities
14
States and territories
1
Average overall rating
2.2
Average staffing rating
1.4
Average total nurse HPRD
3.1
Total fines
40
Review CMS chain evidence

CMS-published history

Monthly chain measures
MonthFacilitiesOverall ratingStaffing rating
Wed Jul142.21.4
Mon Jun122.61.4
Fri May122.51.4
Wed Apr92.61.3
Sun Mar92.91.3
Sun Feb92.81.3

Questions to ask

  • CMS groups facilities in 1 states or territories under this chain. Which operational policies are set at the chain level?
  • CMS reports 40 fines across the chain in this dataset. What compliance functions are managed centrally?
CMS chain source and methodology

Nursing Home Chain Performance Measures, fixed version da2db00a-0f3d-40a9-a535-588ff1220c55. Membership comes separately from CMS Skilled Nursing Facility Enrollments.

View official CMS source

Inspections & deficiencies

What CMS inspection records show

Scope and severity terms below are CMS classifications. They are not a TrustHub score.

Latest recorded inspection

Date
Apr 13, 2026
Survey type
Health Complaint
Linked findings
1
Highest linked CMS classification
J — Isolated; Immediate jeopardy to resident health or safety
View source details
Dataset
Inspection Dates
CMS dataset ID
svdt-c123
CMS source updated
Jul 1, 2026
CMS provider ID
146159
Source record locator
csv-row:38781:ccn:146159
View official CMS source
Apr 13, 2026Health Complaint 1 linked finding
  • F0689Quality of Life and Care Deficiencies

    Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

    CMS scope/severity J: Isolated; Immediate jeopardy to resident health or safety.

    Correction status: Deficient, Provider has date of correction (Apr 16, 2026)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:106102:ccn:146159
    View official CMS source
Feb 25, 2026Fire Safety Standard 0 linked findings

No health-deficiency rows were deterministically linked to this inspection.

Feb 25, 2026Health Standard 12 linked findings
  • F0644Resident Assessment and Care Planning Deficiencies

    Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Mar 30, 2026)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:106110:ccn:146159
    View official CMS source
  • F0645Resident Assessment and Care Planning Deficiencies

    PASARR screening for Mental disorders or Intellectual Disabilities

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Mar 30, 2026)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:106111:ccn:146159
    View official CMS source
  • F0684Quality of Life and Care Deficiencies

    Provide appropriate treatment and care according to orders, resident’s preferences and goals.

    CMS scope/severity J: Isolated; Immediate jeopardy to resident health or safety.

    Correction status: Deficient, Provider has date of correction (Mar 30, 2026)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:106103:ccn:146159
    View official CMS source
  • F0686Quality of Life and Care Deficiencies

    Provide appropriate pressure ulcer care and prevent new ulcers from developing.

    CMS scope/severity G: Isolated; Actual harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Mar 30, 2026)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:106104:ccn:146159
    View official CMS source
  • F0688Quality of Life and Care Deficiencies

    Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.

    CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Mar 30, 2026)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:106107:ccn:146159
    View official CMS source
  • F0689Quality of Life and Care Deficiencies

    Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Mar 30, 2026)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:106112:ccn:146159
    View official CMS source
  • F0692Quality of Life and Care Deficiencies

    Provide enough food/fluids to maintain a resident's health.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Mar 30, 2026)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:106113:ccn:146159
    View official CMS source
  • F0759Pharmacy Service Deficiencies

    Ensure medication error rates are not 5 percent or greater.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Mar 30, 2026)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:106114:ccn:146159
    View official CMS source
  • F0761Pharmacy Service Deficiencies

    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.

    CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Mar 30, 2026)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:106108:ccn:146159
    View official CMS source
  • F0805Nutrition and Dietary Deficiencies

    Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.

    CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Mar 30, 2026)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:106109:ccn:146159
    View official CMS source
  • F0812Nutrition and Dietary Deficiencies

    Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

    CMS scope/severity F: Widespread; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Mar 30, 2026)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:106105:ccn:146159
    View official CMS source
  • F0880Infection Control Deficiencies

    Provide and implement an infection prevention and control program.

    CMS scope/severity F: Widespread; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Mar 30, 2026)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:106106:ccn:146159
    View official CMS source
Dec 31, 2025Health Complaint 1 linked finding
  • F0755Pharmacy Service Deficiencies

    Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Jan 16, 2026)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:106115:ccn:146159
    View official CMS source
Jun 23, 2025Health Complaint 1 linked finding
  • F0812Nutrition and Dietary Deficiencies

    Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

    CMS scope/severity F: Widespread; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Jun 27, 2025)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:106116:ccn:146159
    View official CMS source
Jan 10, 2025Fire Safety Standard 0 linked findings

No health-deficiency rows were deterministically linked to this inspection.

Jan 10, 2025Health Complaint 0 linked findings

No health-deficiency rows were deterministically linked to this inspection.

Jan 10, 2025Health Standard 5 linked findings
  • F0584Resident Rights Deficiencies

    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.

    CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Feb 14, 2025)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:106118:ccn:146159
    View official CMS source
  • F0677Quality of Life and Care Deficiencies

    Provide care and assistance to perform activities of daily living for any resident who is unable.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Feb 7, 2025)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:106121:ccn:146159
    View official CMS source
  • F0755Pharmacy Service Deficiencies

    Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

    CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Feb 7, 2025)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:106119:ccn:146159
    View official CMS source
  • F0761Pharmacy Service Deficiencies

    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.

    CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Feb 7, 2025)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:106120:ccn:146159
    View official CMS source
  • F0808Nutrition and Dietary Deficiencies

    Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Feb 7, 2025)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:106123:ccn:146159
    View official CMS source
Dec 11, 2024Health Complaint 3 linked findings
  • F0684Quality of Life and Care Deficiencies

    Provide appropriate treatment and care according to orders, resident’s preferences and goals.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Dec 20, 2024)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:106125:ccn:146159
    View official CMS source
  • F0689Quality of Life and Care Deficiencies

    Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Dec 20, 2024)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:106126:ccn:146159
    View official CMS source
  • F0777Administration Deficiencies

    Provide or obtain x-rays/tests when ordered and promptly tell the ordering practitioner of the results.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Dec 20, 2024)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:106127:ccn:146159
    View official CMS source
Jul 30, 2024Health Complaint 1 linked finding
  • F0563Resident Rights Deficiencies

    Honor the resident's right to receive visitors of his or her choosing, at the time of his or her choosing.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Aug 14, 2024)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:106128:ccn:146159
    View official CMS source
Feb 28, 2024Fire Safety Standard 0 linked findings

No health-deficiency rows were deterministically linked to this inspection.

Feb 28, 2024Health Standard 6 linked findings
  • F0684Quality of Life and Care Deficiencies

    Provide appropriate treatment and care according to orders, resident’s preferences and goals.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Mar 22, 2024)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:106131:ccn:146159
    View official CMS source
  • F0686Quality of Life and Care Deficiencies

    Provide appropriate pressure ulcer care and prevent new ulcers from developing.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Mar 22, 2024)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:106132:ccn:146159
    View official CMS source
  • F0732Nursing and Physician Services Deficiencies

    Post nurse staffing information every day.

    CMS scope/severity C: Widespread; No actual harm with potential for minimal harm.

    Correction status: Deficient, Provider has date of correction (Mar 22, 2024)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:106134:ccn:146159
    View official CMS source
  • F0804Nutrition and Dietary Deficiencies

    Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.

    CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Mar 22, 2024)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:106130:ccn:146159
    View official CMS source
  • F0812Nutrition and Dietary Deficiencies

    Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

    CMS scope/severity F: Widespread; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Mar 22, 2024)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:106129:ccn:146159
    View official CMS source
  • F0883Infection Control Deficiencies

    Develop and implement policies and procedures for flu and pneumonia vaccinations.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Mar 22, 2024)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:106133:ccn:146159
    View official CMS source
Jan 31, 2024Health Complaint 1 linked finding
  • F0600Freedom from Abuse, Neglect, and Exploitation Deficiencies

    Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Feb 23, 2024)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:106135:ccn:146159
    View official CMS source
Nov 7, 2023Health Complaint 1 linked finding
  • F0600Freedom from Abuse, Neglect, and Exploitation Deficiencies

    Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Nov 28, 2023)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:106136:ccn:146159
    View official CMS source
Nov 1, 2023Health Complaint 1 linked finding
  • F0600Freedom from Abuse, Neglect, and Exploitation Deficiencies

    Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Nov 15, 2023)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:106137:ccn:146159
    View official CMS source
Sep 26, 2023Health Complaint 1 linked finding
  • F0600Freedom from Abuse, Neglect, and Exploitation Deficiencies

    Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

    CMS scope/severity J: Isolated; Immediate jeopardy to resident health or safety.

    Correction status: Deficient, Provider has date of correction (Oct 12, 2023)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:106138:ccn:146159
    View official CMS source

Tags appearing across inspections

  • F0600 appears in 4 linked inspections.
  • F0684 appears in 3 linked inspections.
  • F0689 appears in 3 linked inspections.
  • F0812 appears in 3 linked inspections.
  • F0686 appears in 2 linked inspections.
  • F0755 appears in 2 linked inspections.
  • F0761 appears in 2 linked inspections.

Penalties & enforcement

CMS penalty records in the loaded three-year dataset

  • FineApr 13, 2026

    Published fine amount: $26,720.00

    View source details
    Dataset
    Penalties
    CMS dataset ID
    g6vv-u9sr
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:4630:ccn:146159
    View official CMS source
  • Payment DenialFeb 25, 2026

    Payment denial length: 10 days

    View source details
    Dataset
    Penalties
    CMS dataset ID
    g6vv-u9sr
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:4632:ccn:146159
    View official CMS source
  • FineSep 26, 2023

    Published fine amount: $108,886.00

    View source details
    Dataset
    Penalties
    CMS dataset ID
    g6vv-u9sr
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    146159
    Source record locator
    csv-row:4631:ccn:146159
    View official CMS source

Questions to ask

Questions generated from the evidence above

  • CMS records show F0600 in 4 inspections in the available record. What changes has the facility made to address this issue?
  • CMS records show F0684 in 3 inspections in the available record. What changes has the facility made to address this issue?
  • CMS records show F0689 in 3 inspections in the available record. What changes has the facility made to address this issue?
  • CMS records show F0812 in 3 inspections in the available record. What changes has the facility made to address this issue?
  • CMS records show F0686 in 2 inspections in the available record. What changes has the facility made to address this issue?
  • CMS records show F0755 in 2 inspections in the available record. What changes has the facility made to address this issue?
  • CMS records show F0761 in 2 inspections in the available record. What changes has the facility made to address this issue?
  • CMS records include an Immediate Jeopardy-level finding. What corrective actions were taken after that inspection?
  • CMS records show a monetary penalty dated Apr 13, 2026. What changes were made after that enforcement action?

Facility history

Facility History

19 historical events available. Dates and values come from published CMS and official state regulator evidence, not a score.

What changed recently?

  • Complaint inspection recorded1 deficiencies were recorded. That includes 1 higher-severity deficiency.
  • Civil monetary penalty recordedCMS recorded a $26,720 civil monetary penalty.
  • RN staffing increasedRN staffing increased from 0.78 to 0.93 hours per resident day between 2025Q2 and 2025Q3. Staffing improved across those reported periods.

2026

  1. Complaint inspection recorded

    1 deficiencies were recorded. That includes 1 higher-severity deficiency.

    CMS · Recorded event date · View related evidence

  2. Civil monetary penalty recorded

    CMS recorded a $26,720 civil monetary penalty.

    CMS · Recorded event date · View related evidence

  3. Health inspection completed

    12 deficiencies were recorded. That includes 2 higher-severity deficiencies.

    CMS · Recorded event date · View related evidence

  4. Medicare payment denial recorded

    CMS recorded a Medicare payment denial lasting 10 days.

    CMS · Recorded event date · View related evidence

2025

  1. Complaint inspection recorded

    1 deficiency was recorded.

    CMS · Recorded event date · View related evidence

  2. RN staffing increased

    RN staffing increased from 0.78 to 0.93 hours per resident day between 2025Q2 and 2025Q3. Staffing improved across those reported periods.

    0.780.93

    CMS · Reported in a source release · View related evidence

  3. Total nurse staffing increased

    Total nurse staffing increased from 2.74 to 3.05 hours per resident day between 2025Q2 and 2025Q3. Staffing improved across those reported periods.

    2.743.05

    CMS · Reported in a source release · View related evidence

  4. Complaint inspection recorded

    1 deficiency was recorded.

    CMS · Recorded event date · View related evidence

  5. Complaint inspection recorded

    No linked health-deficiency findings were recorded for this survey.

    CMS · Recorded event date · View related evidence

  6. Health inspection completed

    5 deficiencies were recorded.

    CMS · Recorded event date · View related evidence

2024

  1. Complaint inspection recorded

    3 deficiencies were recorded.

    CMS · Recorded event date · View related evidence

  2. Complaint inspection recorded

    1 deficiency was recorded.

    CMS · Recorded event date · View related evidence

Staffing

Reported nursing staffing at a glance

CMS staffing rating: 2 of 5 stars. CMS calculates that rating separately using its published methodology. The values below are calculations from daily PBJ records for 2026Q1 (current source quarter).

Inspect a PBJ quarter
Total nursing
3.151
reported hours per resident day
RN categories
0.882
reported hours per resident day
LPN/LVN categories
0.424
reported hours per resident day
CNA
1.844
reported hours per resident day

Weekday and weekend calculations

2026Q1 reported hours per resident day
MeasureMonday–FridaySaturday–Sunday
Total nursing3.3282.714
RN categories0.9680.671

Contract staff accounted for 0% of reported nursing hours included in this quarter calculation.

Reported RN-category hours per resident day were 0.012 higher than the prior loaded quarter.

Staffing over time

Solid bar: Total nursing · Outlined bar: RN categories

Calculated reported hours per resident day by PBJ quarter
QuarterTotal nursingRN categoriesLPN/LVNCNAContract shareDays
2025Q22.7420.7810.4221.5390%91
2025Q33.0510.9270.3671.7570%92
2025Q42.9920.870.4051.7170%92
2026Q13.1510.8820.4241.8440%90

Questions to ask

  • PBJ records show lower calculated RN-category hours per resident day on weekends this quarter. How does the facility plan RN coverage on Saturdays and Sundays?
Staffing source and calculation details
Source
Centers for Medicare & Medicaid Services (CMS)
Dataset
Payroll Based Journal Daily Nurse Staffing
CMS dataset ID
7e0d53ba-8f02-4c66-98a5-14a1c997c50d
Quarter
2026Q1
Coverage
Jan 1, 2026Mar 31, 2026
Days represented
90 (90 with positive MDS census)
CMS source updated
Jul 29, 2026
Calculation version
pbj-quarter-ratio-of-sums-v1

Hours-per-resident-day values are calculated by this platform from CMS-published daily PBJ hours and MDS census. For each displayed period, included hours are summed and divided by the summed census for days with a positive census. They are not CMS case-mix-adjusted staffing measures or a staffing rating.

View official CMS PBJ source

What we can verify today

Current Provider Information facts

These measures come from the current successfully ingested CMS Nursing Home Provider Information release.

  • CMS reports a 1-star overall rating.
  • CMS reports a 1-star health inspection rating.
  • CMS reports a 2-star staffing rating.
  • CMS reports a 2-star quality-measure rating.

Planned evidence layers

Additional public-source research

These areas require separate authoritative CMS datasets. No findings are shown until those sources are ingested and reviewed.

    Trust participation

    See something that needs correction?

    Claims, corrections, and factual context are free. Submissions never replace CMS evidence or affect ranking.

    How corrections work

    Source register

    See where this record came from

    Provider Information
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset identifier
    4pq5-n9py
    Source updated
    Jul 29, 2026
    Retrieved
    Aug 14, 2026
    Supports
    Overview, facility facts, and CMS ratings
    View official CMS source
    Inspection Dates
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset identifier
    svdt-c123
    Source updated
    Jul 1, 2026
    Retrieved
    Aug 14, 2026
    Supports
    Inspections and facility history
    View official CMS source
    Health Deficiencies
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset identifier
    r5ix-sfxw
    Source updated
    Jul 1, 2026
    Retrieved
    Aug 14, 2026
    Supports
    Health deficiencies and facility history
    View official CMS source
    Penalties
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset identifier
    g6vv-u9sr
    Source updated
    Jul 1, 2026
    Retrieved
    Aug 14, 2026
    Supports
    Penalties, enforcement, and facility history
    View official CMS source
    Payroll Based Journal Daily Nurse Staffing
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset identifier
    7e0d53ba-8f02-4c66-98a5-14a1c997c50d
    Coverage
    Apr 1, 2025–Mar 31, 2026
    Source updated
    Jul 29, 2026
    Retrieved
    Aug 15, 2026
    Supports
    PBJ staffing cards, history, and transparent calculations
    View official CMS source
    Ownership
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset identifier
    y2hd-n93e
    Source updated
    Jul 1, 2026
    Retrieved
    Aug 15, 2026
    Supports
    Ownership parties, organization connections, and ownership history
    View official CMS source
    Skilled Nursing Facility All Owners
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset identifier
    afe44b85-cc6d-40d7-b5df-00ae8910d1d2
    Source updated
    Jul 27, 2026
    Retrieved
    Aug 15, 2026
    Supports
    Ownership parties, organization connections, and ownership history
    View official CMS source
    Skilled Nursing Facility Enrollments
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset identifier
    5f2c306f-3b1c-42cd-b037-187b2ce22126
    Source updated
    Jul 27, 2026
    Retrieved
    Aug 15, 2026
    Supports
    Ownership parties, organization connections, and ownership history
    View official CMS source
    Skilled Nursing Facility Change of Ownership
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset identifier
    f557a6ed-95b3-4a22-8433-4175db2dec1c
    Source updated
    Jul 27, 2026
    Retrieved
    Aug 15, 2026
    Supports
    Ownership parties, organization connections, and ownership history
    View official CMS source
    Nursing Home Chain Performance Measures
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset identifier
    97ecfad1-d3f1-4d42-b774-d74661d830bc
    Coverage
    Wed Jul
    Source updated
    Aug 12, 2026
    Retrieved
    Aug 16, 2026
    Supports
    CMS chain context, performance, and monthly history
    View official CMS source
    Verified public facility information
    Source organization
    Public facility listing
    Dataset identifier
    commercial-corroboration:public-listing
    Source updated
    Aug 18, 2026
    Retrieved
    Aug 18, 2026
    Supports
    Independently verified public website, phone, or publicly used name. Not a CMS rating or regulatory status.
    How sources work

    No paid placements. Facilities cannot pay to rank higher. We cite. You decide.