Average — CMS composite of the measures below.
Past the typical resurvey interval — a standard survey could occur at any time
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Gladeview Health Care Center during CMS and state inspections, most recent first.
A resident discharged after joint replacement surgery had oxycodone 5 mg tablets left in the medication cart, which were not promptly removed by staff. Multiple LPNs confirmed the medication remained in the cart after discharge, and the DON was not notified in real time. During a routine narcotic audit, it was discovered that two blister packs containing fifty-two oxycodone tablets and their disposition sheets were missing, with only eight tablets having been administered. The facility lacked a clear policy on the timely removal of narcotics after discharge, contributing to the loss.
Staff failed to follow transfer orders for a non-ambulatory resident with an above-the-knee amputation by attempting to use a sit-to-stand lift, resulting in an unsafe transfer and distress to the resident and family. The care plan required two-person assistance and did not support the use of this equipment for the resident's condition.
The facility failed to secure medication carts and narcotic boxes properly. Unlocked medication carts were left unattended on multiple floors, with residents nearby. LPNs acknowledged leaving carts unlocked while performing other duties. Additionally, narcotic boxes in the third-floor refrigerator were not properly secured, as required by facility policy.
The facility failed to adhere to proper food storage and handling practices, as observed in the Dietary Department. Opened and undated food items were found in the dry storage area, main freezer, and walk-in refrigerator, including granola, hamburger rolls, pancakes, imitation crabmeat, and moldy Feta cheese. The FSD admitted responsibility for dating items but could not explain the oversight, and the Administrator was unaware of a fly issue in the department.
The facility failed to maintain proper infection control practices, leading to deficiencies involving several residents. A resident's nebulizer equipment was improperly stored, and an LPN did not wear a gown during wound care. Another resident's medication administration involved inadequate hand hygiene, and two LPNs failed to don PPE or perform hand hygiene during wound care for a third resident. Additionally, personal care equipment was found unbagged and on the floor in multiple rooms.
The facility failed to ensure a dignified experience for three residents, leading to deficiencies in resident rights and dignity. A resident with multiple sclerosis reported undignified treatment by an LPN, including retaliatory actions. Another resident, dependent on tube feeding, was placed in view of others eating, raising concerns about dignity. A third resident reported feeling disrespected and threatened by the same LPN, with incidents not fully reported to facility staff.
The facility failed to notify the provider in a timely manner about changes in condition for two residents. One resident with respiratory issues was not evaluated promptly despite showing distress, leading to a hospital transfer with pneumonia. Another resident experienced significant weight loss, but the provider was not informed, delaying dietary interventions. The facility did not adhere to its policies on timely notification of medical providers.
A resident with cerebral palsy and anxiety reported an injury from a mechanical lift transfer, leading to daily pain management. The facility failed to document an evaluation by a provider and did not complete an incident form. The resident's history of confabulation was not included in the care plan, and the facility lacked a policy on Care Plans.
A resident with a history of respiratory issues experienced a change in condition, but the facility failed to ensure RNs completed and documented necessary assessments. Additionally, an LPN improperly conducted IV competency evaluations for RNs, which was beyond their scope of practice.
The facility failed to provide timely fingernail care for three residents dependent on staff for ADLs. One resident with vascular dementia had untrimmed, dirty fingernails despite being dependent on staff for personal care. Another resident with Parkinson's disease was observed with long fingernails and brown material underneath, contrary to facility policy. A third resident with multiple sclerosis also had lengthy, jagged fingernails, despite expressing a preference for short nails. Staff cited time constraints and task overload as reasons for the deficiency.
The facility failed to implement physician orders for two residents, leading to deficiencies in care. A resident with contractures was observed without prescribed rolled washcloths, and another resident with spastic hemiplegia was not consistently provided with a lap tray for their wheelchair. Staff interviews revealed inconsistencies in following care plans, and the absence of specific facility policies contributed to these deficiencies.
A resident with multiple health conditions experienced significant weight loss, which was not promptly addressed by the facility. Despite orders for weekly weight checks and nutritional supplements, the interventions were delayed, leading to a deficiency in nutritional care. The Dietitian confirmed the delay in increasing supplements, which should have been implemented when the weight loss was first identified.
A facility failed to adhere to a physician's order for oxygen administration for a resident with multiple health conditions. The resident was observed receiving higher oxygen levels than prescribed, and staff were unaware of the correct administration schedule. The facility's policy required oxygen therapy to be administered upon a physician's order, but no order for daytime oxygen therapy or titration based on saturation levels was found.
Two residents experienced delayed medication administration, resulting in a medication error rate of 17.6%. An LPN unfamiliar with the facility administered medications late to a resident with dementia, while another LPN was delayed due to attending to a vomiting resident. The facility's policy requires medications to be given within 60 minutes of the scheduled time.
The facility failed to conduct yearly performance evaluations for three nurse aides, leading to a deficiency in staffing sufficiency. The responsibility for evaluations shifted from supervisors to department heads, but evaluations had not been completed since 2015 due to other overwhelming issues. Instead, 30-day action plans were used, and the facility lacked a policy for performance evaluations.
The facility failed to maintain a safe and sanitary environment in common areas, with issues such as torn ceiling tiles, broken light fixtures, and unsecured drain covers observed during a tour with an LPN. The Maintenance Director, new to the position, noted delays in repairs, while the Administrator admitted to not reviewing environmental logs. The facility had prioritized mechanical repairs over cosmetic ones.
A resident with amputations and recent surgery was improperly transferred by a nursing assistant without using a Hoyer lift, as required by physician orders. The incident occurred when the Hoyer lift battery was dead, and the nursing assistant proceeded to lift the resident alone, despite another assistant's refusal to help due to the resident's condition. This action violated the facility's policy on mechanical lifts.
Failure to Remove Discharged Resident's Narcotics Led to Missing Oxycodone
Penalty
Summary
The facility failed to ensure that narcotic medications were promptly removed from the medication cart following the discharge of a resident, resulting in the misappropriation of oxycodone tablets. The resident in question had been admitted for aftercare following joint replacement surgery and had a physician's order for oxycodone 5 mg as needed for severe pain. Upon discharge, the resident's oxycodone was not removed from the medication cart, and subsequent audits revealed that two blister packs containing a total of fifty-two oxycodone tablets, along with the associated disposition sheets, were missing. Multiple staff interviews and record reviews confirmed that the oxycodone remained in the medication cart after the resident's discharge, with several LPNs recalling counting the medication during shift changes. Despite facility practice that the DON would collect discontinued or discharged residents' narcotics, there was no policy specifying the timeframe for removal, and staff did not consistently notify the DON in real time. The medication and disposition sheets were last accounted for during the morning shift count, but were discovered missing during the DON's bi-monthly narcotic audit later that morning. The investigation included review of surveillance footage, staff interviews, and examination of medication administration records, which showed that only eight of the sixty oxycodone tablets received for the resident had been administered, leaving fifty-two unaccounted for. The facility's lack of a clear policy and inconsistent communication regarding the removal of narcotics after discharge contributed to the failure to secure the medication, resulting in its disappearance.
Inappropriate Use of Mechanical Lift for Non-Ambulatory Resident
Penalty
Summary
The facility failed to provide appropriate transfer assistance for a resident with significant mobility limitations, including an above-the-knee amputation and a history of falls. The resident's care plan and physician's orders specified that transfers from bed to wheelchair and vice versa required the assistance of two staff members and that the resident was non-ambulatory. Despite these directives, staff attempted to transfer the resident using a sit-to-stand mechanical lift (Sara lift), which is not appropriate for individuals who cannot bear weight on both legs or have significant lower limb deficits. On the day of the incident, nursing assistants attempted to transfer the resident after a previous fall earlier in the shift. One nursing assistant requested additional help, but instead, another assistant brought in the Sara lift. During the transfer attempt, the resident's foot slipped, and the resident reported losing strength, resulting in the resident being left partially seated and slouching in the wheelchair while still attached to the lift. The situation caused distress to the resident's family, who witnessed the event and expressed concern about the safety of the transfer. Interviews with therapy staff confirmed that the resident's functional abilities fluctuated and that the Sara lift was not suitable given the resident's right leg amputation and inability to stand safely. The Director of Nursing Services stated that staff are expected to follow the plan of care and use mechanical lifts appropriately, but was uncertain if the Sara lift should have been used in this case. The facility was unable to provide a policy for the Sara lift when requested.
Medication Security Deficiency
Penalty
Summary
The facility failed to ensure that medication carts were locked when unattended and that narcotics were properly secured. On multiple occasions, medication carts on the second and third floors were observed to be unlocked and unattended, with residents in close proximity. Licensed Practical Nurses (LPNs) admitted to leaving the carts unlocked while attending to other duties, such as resident care or completing nursing notes. The narcotics within these carts were only secured with a single lock, as the main locks to the rolling carts were left unlocked. Additionally, the facility did not secure narcotic medication boxes within the third-floor medication refrigerator. The refrigerator was not locked, and the chains meant to secure the narcotic boxes were not affixed to the refrigerator. This was observed during a survey with the Assistant Director of Nurses (ADNS), who noted that maintenance was responsible for ensuring the boxes were properly secured. The facility's medication storage policy requires that controlled substances be stored in a double-locked compartment, and those in the refrigerator must be in a locked box permanently affixed to the refrigerator.
Deficiency in Food Storage and Handling Practices
Penalty
Summary
The facility failed to ensure proper food storage and handling practices in the Dietary Department, as observed during a tour with the Food Service Director (FSD). In the dry storage area, there were opened and undated bags of granola and hamburger rolls, along with a fly paper with a dead fly attached to the ceiling. In the main freezer, several opened and undated food items were found, including pancakes, imitation crabmeat, frozen shrimp, cookies, blueberries, leftover soup, and pizza dough. Additionally, the walk-in refrigerator contained a gallon container of Feta cheese with a greenish mold-like substance, dated from a previous date. Interviews with the FSD and the Administrator revealed lapses in communication and adherence to the facility's food storage policy. The FSD admitted responsibility for dating opened items but could not explain why the items were undated. He also acknowledged hanging fly paper due to a fly problem but did not contact the pest control vendor. The Administrator was unaware of the fly issue and stated he would have contacted pest control if informed. The facility's policy required dry storage foods to be dated and cold foods to be labeled and dated, which was not followed in these instances.
Infection Control Deficiencies in LTC Facility
Penalty
Summary
The facility failed to maintain proper infection prevention and control practices for several residents, leading to multiple deficiencies. For Resident #7, who was admitted with chronic obstructive pulmonary disease (COPD), pneumonia, and a chronic pressure ulcer, the facility did not ensure that nebulizer equipment was stored correctly. Observations revealed that the nebulizer machine was placed on the floor mat with the mask and tubing hanging off the wall without being bagged or labeled. Additionally, during wound care, a licensed practical nurse (LPN) did not wear a gown as required by the Enhanced Barrier Precautions for residents with multidrug-resistant organism (MDRO) infections. For Resident #85, who had diagnoses including diabetes and heart disease, the facility failed to ensure proper hand hygiene during medication administration. An LPN was observed picking up a medication package from the floor and continuing with medication preparation without sanitizing or washing her hands. Furthermore, the LPN changed gloves multiple times without performing hand hygiene, contrary to the facility's policy. Resident #101, who had congestive heart failure and chronic kidney disease, was also subject to inadequate infection control practices. LPNs entered the resident's room and performed wound care without donning the required personal protective equipment (PPE) such as gowns, and failed to perform hand hygiene between glove changes. Additionally, personal care equipment across multiple rooms was found unbagged and stored on the floor, contrary to facility policy, which requires such items to be labeled, bagged, and stored appropriately.
Deficiencies in Resident Dignity and Communication
Penalty
Summary
The facility failed to ensure a dignified experience for three residents, leading to deficiencies in resident rights and dignity. Resident #8, who has multiple sclerosis and is dependent on staff for daily activities, reported that LPN #11 treated them and other residents in an undignified manner. This included turning up the television volume intentionally to annoy Resident #8 and responding abruptly when asked to lower it. Resident #8 felt these actions were retaliatory and had previously reported similar incidents to the Director of Nursing Services (DNS). Resident #20, diagnosed with cerebral palsy and dependent on tube feeding, was observed sitting in the hallway with a clear view of other residents eating during meal times. Despite being unable to eat by mouth, Resident #20 was placed in this position for socialization, according to LPN #4 and the DNS. The facility did not provide a policy for a dignified dining experience, and the placement of Resident #20 in view of others eating was questioned in terms of dignity. Resident #105, with diagnoses including congestive heart failure and type 2 diabetes, reported feeling disrespected and threatened by LPN #11. Incidents included LPN #11 stating, "I don't like you" and responding harshly when Resident #105 requested assistance. These interactions were reported to the RN Supervisor and family members, but not all incidents were reported to facility staff. The facility's abuse policy requires an investigation when a complaint is made, but it is unclear if this was followed.
Failure to Notify Provider of Changes in Resident Condition
Penalty
Summary
The facility failed to notify the provider in a timely manner regarding changes in condition for two residents, leading to deficiencies in care. Resident #38, who had a history of respiratory issues and was dependent on a gastrostomy tube, exhibited symptoms of respiratory distress over several days. Despite being aware of these symptoms, the nursing supervisors did not notify the provider, resulting in a delay in medical evaluation and intervention. The resident was eventually found in respiratory distress and transferred to the hospital with pneumonia. Resident #95 experienced a significant weight loss over a short period, which was not promptly communicated to the provider. The resident, who was severely cognitively impaired and dependent on staff for eating, lost 12.6 pounds in less than a month. The facility's policy required notification of significant weight changes, but the APRN was not informed until much later, delaying appropriate dietary interventions. The facility's policies on observing and recording changes in residents' conditions were not followed, as evidenced by the lack of timely notification to medical providers. This oversight resulted in delayed medical assessments and interventions for both residents, highlighting a failure in communication and adherence to established protocols.
Inadequate Care Plan for Resident with Behavioral Issues
Penalty
Summary
The facility failed to ensure that the Resident Care Plan (RCP) for a resident with cerebral palsy, neuromuscular dysfunction of the bladder, and anxiety was comprehensive and included a known behavioral issue. The resident, who was cognitively intact and dependent on a motorized wheelchair, reported an injury from a mechanical lift transfer that occurred months prior, resulting in daily pain management with patches. Despite the resident's report of pain and an x-ray showing no fractures, there was no documentation of an evaluation by a provider on the date the pain was reported. Additionally, the Director of Nursing Service (DNS) was not informed of the incident, and no accident or incident form was completed. The Social Worker (SW) was aware of the resident's history of confabulation and manipulation but failed to include these behaviors in the RCP. The facility lacked a policy on Care Plans, and the SW acknowledged the omission and intended to incorporate the behaviors into the RCP moving forward. The absence of documentation and the failure to address the resident's behavioral issues in the care plan contributed to the deficiency identified during the survey.
Failure to Document Resident Assessment and Improper IV Competency Evaluation
Penalty
Summary
The facility failed to ensure that a Registered Nurse (RN) completed and documented an assessment for a resident who experienced a change in condition. The resident, who had a history of interstitial pulmonary disease, dysphagia with gastrostomy status, and traumatic brain injury, showed signs of respiratory distress on multiple occasions. Despite being notified of the resident's condition changes on specific dates, the RN supervisors did not perform or document the necessary assessments, including lung assessments and vital signs. This lack of documentation and assessment occurred even though the resident had a history of respiratory distress and aspiration. Additionally, the facility did not adhere to professional standards regarding the evaluation of nursing staff competencies in administering intravenous (IV) medications and fluids. An LPN, who was not authorized to assess RN competencies, conducted the annual IV competencies for the RNs. This was beyond the LPN's scope of practice, and the Director of Nursing Services (DNS) was unaware of this practice. The facility's policy on observing and recording changes in a resident's condition was not followed, as it required appropriate assessments and documentation when a change in condition occurred. The policy specified that vital signs should be included in all change of condition assessments, but this was not done for the resident in question. The failure to perform and document these assessments contributed to the resident's eventual transfer to the hospital with pneumonia.
Failure to Provide Timely Fingernail Care for Dependent Residents
Penalty
Summary
The facility failed to provide timely assistance with fingernail care for three residents who were dependent on staff for activities of daily living (ADLs). Resident #21, diagnosed with vascular dementia and other conditions, was observed with very lengthy, untrimmed, and jagged fingernails with a dark substance beneath them. Despite being dependent on staff for personal care, Resident #21's fingernails were not cleaned or trimmed during scheduled shower days. Staff interviews revealed that the nurse aides responsible for Resident #21's care were overwhelmed with tasks and did not have enough time to complete fingernail care. Resident #73, who had Parkinson's disease and was totally dependent on staff for personal hygiene, was observed with long fingernails and brown material underneath them. Although the facility policy required nail care on shower days, Resident #73's fingernails were not cleaned or trimmed as per the policy. The nurse aide responsible for Resident #73's care reported a lack of time to provide nail care and mentioned that other staff could have assisted but did not. Resident #77, diagnosed with multiple sclerosis and dementia, was also found with lengthy and jagged fingernails with a brown substance underneath. Despite being dependent on staff for ADLs and expressing a preference for short fingernails, Resident #77's nails were not cleaned or trimmed on scheduled shower days. The nursing supervisor confirmed that the resident's fingernails should have been attended to but could not explain why the task was not completed.
Failure to Implement Physician Orders for Resident Care
Penalty
Summary
The facility failed to ensure proper care for two residents, leading to deficiencies in their treatment plans. Resident #6, who has a history of contractures, peripheral vascular disease, diabetes, and dementia, was observed multiple times without the prescribed rolled washcloths in their hands. Despite a physician's order to place rolled washcloths in the resident's hands every shift to prevent skin breakdown, staff interviews revealed that the responsibility for this task was not consistently fulfilled. The absence of a facility policy for hand splints or rolled washcloth splinting further contributed to the oversight. Resident #81, diagnosed with spastic hemiplegia, osteoarthritis, and cataracts, was also not provided with the necessary care as per their physician's order. The resident was observed on several occasions without the lap tray in place on their wheelchair, which was intended to aid in positioning and prevent injury. Interviews with staff, including the Director of Nursing Services (DNS) and an Occupational Therapist, confirmed that the lap tray was not consistently applied, despite being a part of the resident's care plan and physician's order. The lack of adherence to the prescribed use of the lap tray increased the risk of the resident's arm slipping and potential skin breakdown. Both cases highlight a failure in the facility's adherence to physician orders and care plans, resulting in inadequate care for the residents. The absence of specific facility policies regarding the use of hand splints, rolled washcloths, and customized wheelchair positioning devices contributed to the deficiencies observed. Staff interviews indicated a lack of clarity and consistency in implementing these care interventions, leading to the residents not receiving the necessary support to maintain their range of motion and prevent further complications.
Delayed Response to Significant Weight Loss in Resident
Penalty
Summary
The facility failed to timely identify and address a significant weight loss in a resident, leading to a deficiency in nutritional care. Resident #95, who was admitted with conditions including vascular dementia, Down syndrome, depression, and hypothyroidism, experienced a notable weight loss over a short period. Despite physician orders for weekly weight monitoring and the resident's care plan indicating the need for nutritional supplements, the facility did not implement these interventions promptly. The resident's weight dropped from 190.1 pounds to 177.6 pounds within a month, a 6.5% loss, without timely action from the facility. The Dietitian acknowledged that the intervention to increase nutritional supplements was delayed, occurring 27 days after the initial weight loss was identified. The facility's policy required nursing and dietary staff to identify residents at risk for weight loss and provide calorically dense supplements, but this was not executed in a timely manner for Resident #95. The APRN's progress notes also failed to recognize the significant weight loss initially, and it was only later that the supplements were increased to three times a day. This delay in response contributed to the deficiency in maintaining the resident's nutritional health.
Failure to Follow Physician's Order for Oxygen Administration
Penalty
Summary
The facility failed to follow the physician's order for oxygen administration for a resident diagnosed with congestive heart failure, chronic kidney disease, and dementia. The resident was observed receiving higher levels of oxygen than prescribed, with 4 liters per minute (Lpm) via nasal cannula on multiple occasions, despite the physician's order specifying 2 Lpm at bedtime for shortness of breath. Interviews with nursing staff revealed a lack of awareness regarding the correct oxygen administration schedule and the absence of a continuous oxygen order. The Licensed Practical Nurse (LPN) and Registered Nurse (RN) involved were unable to provide a valid reason for the resident receiving oxygen therapy during the day, as the resident's oxygen saturation levels were consistently above 92%. The facility's policy required oxygen therapy to be administered upon a physician's written order and monitored by licensed nurses. However, the review of the resident's records and interviews with the Advanced Practice Registered Nurse (APRN) indicated that there was no order for daytime oxygen therapy or for titration based on oxygen saturation levels. The APRN acknowledged the need for a physician's order for daytime oxygen therapy and a PRN order to maintain oxygen saturation above 92%, but such orders were not present. The deficiency was identified when the APRN stated they would assess the resident for oxygen therapy needs following the surveyor's inquiry.
Medication Administration Delays Lead to High Error Rate
Penalty
Summary
The facility failed to maintain a medication error rate of less than 5%, as evidenced by two separate incidents involving late medication administration. Resident #84, who was admitted with dementia and anxiety, had physician orders for Trazodone, Namenda, and Depakote to be administered at 8:00 AM. However, these medications were administered at 10:30 AM by an agency nurse, LPN #8, who was unfamiliar with the facility and did not communicate the delay to the Director of Nursing Services (DNS) in time to receive assistance. This resulted in a medication pass that was an hour and a half late. Similarly, Resident #102, admitted with anemia and delusional disorder, had an 8:00 AM medication pass that was delayed until 9:45 AM by LPN #9. The delay was attributed to the LPN being busy with another resident who had vomited. The DNS was informed of the delay, and the Advanced Practice Registered Nurse (APRN) was notified but did not consider the delay significant. The facility's Medication Administration Policy requires medications to be administered within 60 minutes of the scheduled time, and the observed medication pass error rate was 17.6%, significantly exceeding the acceptable threshold.
Failure to Conduct Yearly Performance Evaluations for Nurse Aides
Penalty
Summary
The facility failed to conduct yearly performance evaluations for three nurse aides, leading to a deficiency in staffing sufficiency. NA #4, hired on 8/1/23, had not received a performance evaluation during their employment. NA #9, hired on 11/13/17, also had no performance evaluation completed. NA #10, hired on 5/7/02, last received a performance evaluation on 6/29/15, over nine years ago. An interview with the Administrator revealed that the responsibility for conducting performance evaluations had shifted from supervisors to department heads, but evaluations had not been completed since 2015 due to the facility being overwhelmed with other issues, such as Covid and Legionnaires Disease. Instead of performance evaluations, the facility had been using 30-day action plans for addressing problems. Additionally, the facility lacked a policy for performance evaluations.
Facility Fails to Maintain Safe and Sanitary Environment
Penalty
Summary
The facility failed to maintain a safe and sanitary environment in various common areas, as observed during an initial tour with an LPN. On the second floor, the shower room had torn ceiling tiles, a broken ceiling light fixture, and an unsecured drain cover. The third-floor dining room had discolored ceiling tiles and numerous burnt-out light bulbs. Additionally, the third-floor shower room had a black substance on the floor tiles. These issues were identified during the tour and were indicative of a lack of timely maintenance and repair. A follow-up tour with the Maintenance Director revealed that the ceiling tiles and light fixtures needed replacement, and repairs were not being completed in a timely manner. The Maintenance Director, who had only been in the position for seven days, was unsure why repairs were delayed. The Administrator later acknowledged that he had not reviewed the environmental round logs, which repeatedly listed the same repairs. He noted that the facility had focused on mechanical repairs over the past year and planned to address cosmetic repairs moving forward.
Improper Transfer of Resident Without Hoyer Lift
Penalty
Summary
The facility failed to ensure that a resident was transferred using a Hoyer lift as per physician orders. The resident, who had a history of post below the right knee and left toes amputations, anxiety disorder, and major depression, required extensive assistance with two staff members for bed mobility and transfers. A physician order dated 7/7/2022 specified the use of a Hoyer lift for all transfers with the assistance of two staff members. However, on 8/10/2022, a nursing assistant (NA #1) transferred the resident without the Hoyer lift or assistance, despite the resident's recent surgery and the facility's policy requiring mechanical lifts for transfers. The incident occurred when NA #1 attempted to transfer the resident to the shower, but the Hoyer lift battery was dead. NA #1 asked another nursing assistant (NA #2) for help, but NA #2 refused, citing the resident's need for a Hoyer lift due to recent surgery. Despite this, NA #1 proceeded to physically lift the resident alone, which was deemed improper and unsafe by the Director of Nursing (DON). The facility's policy on mechanical lifts, dated 8/2017, was violated as it mandates the use of mechanical lifts when ordered. The DON confirmed that the physician orders and care plan were not followed, leading to the termination of NA #1's employment.
What surveyors are citing around you — mapped
All 10 risk areas, ranked with evidence
Repeat citations, what's rising near you, and quality measures — ranked so department heads know exactly where to look first.
Illustrative
What surveyors actually found near you
We read the 273 citations issued within 25 miles in the last 12 months — including the 8 immediate-jeopardy cases — and tell you exactly what happened, in plain English, matched to your record.
Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
Illustrative
A prioritized, do-first checklist
Every risk area becomes concrete audit steps drawn from real citations at facilities like yours — run them this week, before your window opens.
Illustrative
Risk indicators are statistical estimates from public CMS data — not predictions, findings, or compliance advice.
Nursing homes near Old Saybrook
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Apple Rehab Saybrook | 1.2 mi | ★★★★★ | 5 | 0 |
| Essex Meadows Health Center | 2.8 mi | ★★★★★ | 2 | 0 |
| Bride Brook Rehabilitation & Nursing Center | 6.2 mi | ★★★★★ | 0 | 0 |
| Aaron Manor Nursing & Rehabilitation | 8.4 mi | ★★★★★ | 0 | 0 |
| Civita Care Bayview | 10.3 mi | ★★★★★ | 51 | 1 |
Every risk area ranked, a do-first checklist, and your local survey patterns
Built specifically for Gladeview Health Care Center.
100% money-back within 48 hours.
Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release July 2026) and official state health department websites.