Above average — CMS composite of the measures below.
The next survey window likely opens around March 2027
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 Parklands Care Center And Rehab during CMS and state inspections, most recent first.
A resident with CVA sequelae, dementia, contractures, falls history, and no capacity for medical decisions was observed in a wheelchair with a buckled seatbelt/lap belt. The chart had no physician order, care plan, Kardex entry, or progress note documentation for the belt, and staff stated the facility did not use the seatbelt while rehab staff said the belt was part of the wheelchair design but had not been discussed with the family or care planned.
MDS assessments were inaccurate for multiple residents. One resident's MDS omitted psychiatric diagnoses despite psychiatry notes and a mood-stabilizing medication order; another resident's MDS did not reflect a mechanically soft, thickened-liquid diet ordered and observed; a third resident's MDS did not document a lap belt trunk restraint seen during observations; and a fourth resident's MDS did not code insulin use despite DM2 with autonomic neuropathy and active insulin orders.
PASRRs were not coordinated or updated for multiple residents with documented mental health diagnoses. Records showed residents with depression, major depressive disorder, bipolar disorder, adjustment disorder, dementia, and cognitive impairment whose PASRRs did not reflect those conditions, while staff stated diagnoses added by psych or found in records were not consistently communicated or entered on the PASRR. The DON also stated PASRRs and care plans should be reviewed and/or completed within 72 hours of admission.
The facility failed to complete comprehensive care plans for residents with documented depression, dementia, cognitive impairment, and wheelchair belt use. One resident had psych notes showing depression, adjustment disorder, helplessness, and hopelessness without a corresponding care plan focus; another had dementia and major depressive disorder with cognitive impairment but no cognition or mental health care plan; and a third was observed with a lap belt/seat belt in a wheelchair without documentation in the care plan, Kardex, progress notes, or MD orders.
Care plans were not reviewed and revised for 3 residents. One resident's smoking status was documented inconsistently, with staff describing the resident as a safe smoker while the care plan still reflected supervision due to poor safety awareness. Two residents had incorrect code status information in their care plans, with one care plan listing DNR despite a Full Code order and another listing Full Code despite a DNR form.
A resident with a skin tear on the hand had no documented wound orders or provider notification when the injury was identified, and two residents with DM had insulin-related issues without physician notification. One resident's insulin was held for low blood sugar without calling the MD, and another resident had repeated insulin refusals documented on the MAR with no progress note showing MD notification.
A facility failed to ensure medications were administered only within ordered parameters for three residents. One resident received Cozaar when HR was below the hold limit and there was no provider notification documented. Another resident had Amlodipine and Metoprolol documented as given when BP or HR were below ordered parameters, and staff said one entry was a documentation error. A third resident’s scheduled insulin was documented as given when blood sugar values were below the hold parameter, with staff describing the entries as missed documentation.
Unlabeled topical medication was left accessible near a resident, zinc oxide ointment was observed on another resident’s bedside table, and an enteral feeding bag for a third resident was not labeled with the formula name. In addition, an open bag on a medication cart contained a resident’s methylprednisolone acetate injection past its discard date. The DON stated feeding bags should be labeled, and the President of Clinical Operations stated labeling was standard of care.
Improperly labeled and dated food was found in 2 nourishment rooms. In one nourishment room, a frozen Salisbury steak meal was in the freezer without a label or date. In the other nourishment room, three packages of smoked vegan turkey packaged meats, a frozen falafel, and an open box of frozen cheese pizza were also found without labels or dates. The CDM stated the foods should be labeled and dated, and the facility policy required food items to be labeled with the item name and date received.
Incomplete and inaccurate records were found for two residents. One resident had a documented arm wound and dressing, but the physician order for wound care was missing even though the nurse said she obtained the order and may have forgotten to enter it. Another resident’s eye drop order was entered as self-administration on the MAR even though the care evaluation said the resident did not want to self-administer, and the DON said the order was incorrectly entered.
Laundry Room Infection Control Lapses: The facility failed to maintain separation of soiled and clean laundry in the laundry area. A soiled utility room door was propped open, soiled linen was left unsecured and uncovered, and clean-area items were observed uncovered, on the floor, and stored in an unorganized manner. The HSKP supervisor stated the doors should not be left open and the items should be covered, and the Administrator verified the concerns.
Surveyors found that multiple residents' rooms and both main hallways had significant debris, dust, and live insects present, with dirt and buildup on floors, walls, and baseboards. Several residents reported infrequent or insufficient cleaning, and staff confirmed the need for more thorough housekeeping. The facility's policy requiring a clean and comfortable environment was not followed, as evidenced by the observed conditions.
A facility failed to accurately document a resident's use of antiplatelet medication in the MDS assessment. The resident had a physician's order for Plavix, but this was not reflected in the MDS, leading to an inaccurate assessment. The MDS Coordinator confirmed the oversight during an interview.
A facility failed to complete an accurate Level I PASRR for a resident with a serious mental disorder. The resident's PASRR did not document any mental illness, despite the admission record indicating diagnoses of generalized anxiety disorder and unspecified psychosis. The DON confirmed the oversight and acknowledged that a revised PASRR had not been completed.
A facility failed to ensure proper PPE use during medication administration, potentially risking infection spread. An LPN prepared and administered a subcutaneous injection without performing hand hygiene or donning gloves. The LPN acknowledged the oversight, and the DON confirmed the correct procedure involves hand hygiene and glove use. The facility's policy mandates these steps.
The facility failed to document wound care for three residents, despite physician orders specifying detailed care regimens. Missing entries in the Treatment Administration Record (TAR) for July 2024 indicate a lack of documentation for wound care provided. Interviews with staff confirmed that care was given but not consistently recorded, violating the facility's documentation policy.
Unapproved wheelchair belt used without documentation or order
Penalty
Summary
The facility failed to ensure a resident was free from the use of a physical restraint when Resident #28 was observed sitting in a wheelchair with a buckled seatbelt and later observed in the hallway in her personal wheelchair with a lap belt in place. Resident #28’s record showed diagnoses including unspecified sequelae of cerebrovascular infarction, unspecified dementia, essential hypertension, unspecified protein-calorie malnutrition, multiple contractures, history of falls, and major depressive disorder. The resident was documented as lacking capacity to make medical decisions, and the MDS quarterly nursing comprehensive evaluation dated 04/06/2026 documented no enabler devices or restraints in place. Review of the resident’s chart found no documentation in the Kardex, progress notes, or physician orders for a seatbelt or lap belt restraint. Staff L stated the wheelchair was personal and the facility does not utilize the seatbelt. The President of Clinical Operations stated the resident should not have a belt, and the Director of Rehabilitation stated the wheelchair was specifically made for the resident and the belt was part of the manufacturer design, but also verified there was no place for a seatbelt, the family had not been contacted regarding use of the belt, and it was not care planned.
MDS Assessments Were Inaccurate for Multiple Residents
Penalty
Summary
Ensure each resident receives an accurate assessment was not met when the facility failed to accurately complete MDS assessments for 4 of 10 residents reviewed. For Resident #3, the Quarterly MDS dated 3/4/2026 did not document psychiatric or mood disorders in Section I Active Diagnosis, even though psychiatry notes dated 1/5/2026 and 2/19/2026 listed psychosis, mood disorder, depression, and dementia, and a physician order dated 2/12/2026 included Depakote for mood stabilization. During interview, the RN MDS Coordinator stated the resident's psychiatric diagnoses were not listed in the MDS and were not captured. For Resident #9, observations showed the resident eating independently in the room while receiving a mechanically soft diet with thickened liquids, and the physician order specified a consistent carbohydrate diet with mechanical soft texture and nectar consistency for fortified food; however, the Quarterly MDS dated 3/3/2026 did not document a mechanically altered therapeutic diet in Section K Swallowing/Nutritional Status. For Resident #28, observations showed the resident sitting in a wheelchair with a lap belt clasped over the trunk, but the Quarterly MDS dated 4/6/2026 did not document a trunk restraint in Section P Restraints and Alarms. For Resident #62, the medical record showed type 2 diabetes mellitus with autonomic polyneuropathy and orders for Lantus and NovoLOG insulin, but the Quarterly MDS dated 4/11/2026 did not code hypoglycemic use in Section N Medication, and MDS staff stated the section was coded incorrectly.
PASRRs Not Updated for Residents With Mental Health Diagnoses
Penalty
Summary
The facility failed to ensure that residents with newly evident or known diagnoses of serious mental disorders had coordinated PASRR reviews and that those diagnoses were reflected on the PASRR documentation for 5 of 10 residents reviewed. The record review and staff interviews showed that the facility did not consistently update PASRR information when mental health diagnoses were identified after admission or when existing diagnoses were documented in the medical record. For Resident #106, the medical record documented major depressive disorder recurrent mild, with a psychological evaluation confirming F33.0 Major Depressive Disorder Recurrent Mild. The resident also had a physician order for Remeron (mirtazapine) at bedtime for major depressive disorder and the April 2026 MAR reflected the medication for that diagnosis. However, the PASRR dated 11/6/2025 did not document major depressive disorder. During interview, the Social Services Director stated she was not aware that behavior changes had to be updated on the PASRR, and the DON stated PASRRs and care plans should be reviewed and/or completed within 72 hours of admission. For Resident #9, the PASRR dated 8/27/2025 did not document mental illness, yet later records included a psychiatry note describing depression and an adjustment disorder with depressed mood, a psychosocial evaluation diagnosing major depressive disorder, recurrent moderate, and a supportive care note documenting the same diagnosis with symptoms of depression, helplessness, and hopelessness. The Social Services Director stated she submitted a resident review but was not aware that a PASRR review needed to be submitted when psych added new diagnoses. The PMHNP stated the diagnosis was new after admission and that she might have missed communicating it, while the DON stated all diagnoses should have been updated on the PASRR. For Resident #14, the PASRR dated 8/7/2024 did not document mental illness, although the medical record included adjustment disorder with depressed mood, major depressive disorder, and bipolar disorder, with psychology notes diagnosing major depressive disorder recurrent mild and bipolar disorder current episode mixed moderate. For Resident #40, the PASRR dated 3/18/2026 documented no mental illness or suspected mental illness, but the psychosocial evaluation diagnosed major depressive disorder recurrent moderate and the psychiatry evaluation noted a history of depression and anxiety; the resident also had dementia and depression listed among her diagnoses and a BIMS score of 10 indicating some cognitive impairment. For Resident #12, the Level I PASRR dated 7/30/2025 did not identify mental illness or suspected mental illness and negatively documented dementia as a primary or secondary diagnosis, despite PCP and progress notes documenting cognitive impairment, dementia, depressive symptoms, and a history of manic depressive disorder. The Social Services Director confirmed she had not included mental health diagnoses for Resident #12, and the DON and VP of Clinical Operations stated PASRRs and care plans should be screened for accuracy and/or completed within 72 hours of admission.
Failure to Care Plan Mental Health, Cognition, and Wheelchair Belt Use
Penalty
Summary
The facility failed to develop and implement comprehensive care plans for residents with identified mental health, cognitive, and safety-related needs. For Resident #9, psychiatry documentation included depression, adjustment disorder with depressed mood, social isolation, helplessness, and hopelessness, but the care plan did not include a focus for adjustment mood disorder or depression. The Social Services Director stated psych was not communicating changes and new diagnoses, the PMHNP stated the resident should have been care planned for depression, and the DON stated all diagnoses should have been updated along with the care plan. For Resident #40, the record showed diagnoses including unspecified dementia, major depressive disorder, recurrent moderate, and other conditions. The MDS documented cognitive impairment, and the psychosocial evaluation described difficulty articulating what had happened, being alert but oriented only to self and the town, and delayed thought processes. Despite these findings, the care plan did not include a focus for dementia or major depressive disorder. The Social Services Director stated that mental health care plan areas depended on psych notes and behaviors and confirmed that Resident #40 did not have a cognition care plan, while the DON and VP of Clinical Operations stated PASRRs and care plans should be screened for accuracy and/or completed within 72 hours of admission. For Resident #28, staff observed the resident sitting in a wheelchair with a seatbelt/lap belt in place, and the resident had bilateral hand contractures. The clinical record included diagnoses such as cerebrovascular infarction sequelae, dementia, malnutrition, multiple contractures, history of falls, and major depressive disorder, but there was no care plan focus for the lap belt/seat belt restraint. The Kardex, progress notes, physician orders, and MDS did not document the restraint, and staff stated the wheelchair was personal, the facility did not utilize the seatbelt, the resident should not have had a belt, and the belt was part of the manufacturer design but was not care planned.
Care plans not updated to match current smoking status and code status
Penalty
Summary
The facility failed to review and revise the comprehensive care plan for 3 of 7 residents reviewed. For Resident #57, the quarterly nursing comprehensive evaluation dated 1/24/2026 documented that the resident may smoke independently or with set up, but the care plan initiated on 3/11/2026 stated the resident desired to smoke and had been assessed as able to smoke with supervision due to poor safety awareness. During interviews, a CNA stated the resident was considered a safe smoker and that she always lit cigarettes for residents, while an LPN and the DON both stated the care plan needed to be updated to reflect that the resident was considered a safe smoker. For Resident #62, the physician order dated 11/27/2018 read Full Code, but the care plan stated the resident had expressed wishes regarding code status and advanced directives and was a DNR. The Social Services Director stated the care plan was incorrect and needed changes to reflect the accurate code status. For Resident #93, the DNR form dated 9/3/2025 stated the resident was DNR, but the care plan stated the resident was Full Code, incapacitated, with HCP pending. The Social Services Director stated the care plan was incorrect and did not reflect the current code status.
Failure to Notify Physician and Document Treatment for Skin Tear and Insulin Issues
Penalty
Summary
The facility failed to ensure physician notification and documented treatment for a newly identified skin tear on a resident's right hand. On observation, the resident had gauze and tape over the right hand with dried dark matter and a bandage with dry blood, and the dressings were not dated. The resident stated the bandage had been placed several days earlier and had not been changed, and that the skin tear came from the door of the smoking patio. Review of the physician orders and progress notes did not show wound care orders or documentation about the skin tear, and staff stated there were no orders in place at the time the wound was observed. The wound care nurse later stated the skin tear was just seen, orders were entered, and the MD and family would be notified. The DON stated that once a skin impairment is observed, there should be a progress note documenting what happened and that the provider was notified. The facility also failed to notify the physician when a resident's insulin was held because of low blood sugar. The resident reported refusing long-acting insulin over the weekend because blood sugar had been 21 and had been low previously. The MAR showed Novolog insulin was held on multiple occasions, and an LPN stated she held the insulin because the resident was low and she did not want the resident to bottom out. The LPN acknowledged she should have called the doctor. The DON stated that when a nurse holds a medication based on lab values, the nurse should follow up with the physician and clarify whether to hold the medication. In addition, the facility failed to notify the physician regarding repeated insulin refusals for another resident. The MAR documented numerous refusals of ordered Humulin 70/30 insulin in the morning and at bedtime across March and April, and progress notes did not document provider notification for the refusals. The resident stated she often refused insulin because she was not taking insulin at home and did not like frequent finger sticks. The DON stated that if a resident refused medications multiple times, the nurse was expected to notify the physician, and the physician stated he did not recall receiving any calls about the resident's repeated refusals.
Medication Administration Outside Ordered Parameters
Penalty
Summary
The facility failed to ensure that residents were free from unnecessary medications by administering medications outside of ordered parameters for 3 of 6 residents reviewed. For Resident #8, the physician ordered Cozaar 100 mg daily with instructions to hold for systolic blood pressure less than 110 or heart rate less than 60. The MAR documented doses given on multiple dates when the resident’s heart rate was below the ordered limit, including readings of 58, 53, and 59, and there was no documentation in the progress notes of provider notification or confirmation of administration when the parameter was not met. For Resident #28, physician orders included Amlodipine 5 mg daily to be held if systolic blood pressure was less than 120 or diastolic blood pressure less than 60, and Metoprolol Tartrate 50 mg twice daily to be held if systolic blood pressure was less than 120 or heart rate was less than 70. The MAR showed both medications were administered on multiple occasions when recorded blood pressure or heart rate values were below the ordered hold parameters. An LPN stated that one of the out-of-parameter blood pressure entries was an accidental documentation error and that the medication had been given when the blood pressure was within range, while the DON stated staff were expected to administer medications according to the physician order. For Resident #74, physician orders included Insulin Aspart sliding scale coverage and a standing order for 9 units before meals with a hold parameter for blood sugar under 151. Review of the MAR and blood sugar schedule showed the 9-unit dose was documented as administered on several occasions when blood sugar values were below 151, including values of 132, 121, 137, 96, 110, 131, 103, and 125. Staff stated they normally would hold the insulin if the blood sugar was below the parameter, and one nurse described the entries as missed documentation, while the DON stated nurses were to follow orders as written.
Medication and Biological Storage and Labeling Deficiencies
Penalty
Summary
The facility failed to ensure drugs and biologicals were stored and labeled in accordance with accepted professional principles. During observations, an unlabeled clear plastic medication cup containing a white cream was left at the side of Resident #24 while the resident stated it was for his bottom and that he applied it himself. In another room, zinc oxide ointment was observed on Resident #15’s bedside table, and the resident stated she bought the cream and staff applied it for her. An enteral feeding formula was also observed running for Resident #13, but the feeding bag was not labeled with the name of the formula, although it was dated and timed. The East Long medication cart was also found with an open plastic bag containing Resident #14’s methylprednisolone acetate injection 80 mg/mL. The label showed it had a dispense date and stop date in 2025, and staff confirmed the medication was not administered by nursing staff, was intended for physician use, and was past the labeled expiration/discard date. The facility’s policy stated medications, drugs, and biologicals were to be stored in a safe, secured, and orderly manner, and that compartments containing them were to be locked when not in use and not left unlocked out of nurse’s view.
Improperly Labeled and Dated Food in Nourishment Rooms
Penalty
Summary
The facility failed to ensure food was properly and safely stored, labeled, and dated in 2 of 2 nourishment rooms. During an observation of the [NAME] Wing nourishment room, a Salisbury steak frozen meal was found in the freezer without a label or date. During an observation of the East Wing nourishment room, three packages of smoked vegan turkey packaged meats, a frozen falafel, and an open box of frozen cheese pizza were found in the freezer without labels or dates. In interview, the Certified Dietary Manager stated that the foods should be labeled and dated. The facility policy titled "Foods Brought in From the Outside" stated that food containers are to be labeled with the food item name and date received, and any item without a label and/or date is to be discarded.
Incomplete and Inaccurate Medication and Wound Care Documentation
Penalty
Summary
The facility failed to maintain complete and accurate medical records for two residents reviewed. For one resident, an observation showed a bordered gauze dressing on the left wrist, and the resident stated she was unsure what happened but that the nurse had put a dressing on it. The physician order record did not show an order for wound care to the left wrist, although a progress note documented that the resident had been scratching the left forearm, an open area was noted, the area was cleansed, xerofoam and a border gauze dressing were applied, and the MD and daughter were notified. An LPN stated she had seen the resident scratching her arm, called the doctor, obtained an order to clean it and apply a dressing, and believed she may have forgotten to enter the order in the computer. The DON stated the nurse who obtained the wound care order should have entered it into the system. For another resident, the physician order directed Systane Gel to be instilled in both eyes two times a day for dry eyes with unsupervised self-administration, and the MAR documented daily self-administration. However, the resident’s quarterly nursing comprehensive evaluation stated the resident did not wish to self-administer medication or treatments. The resident stated the eye drops were in the nurses’ cart, and the DON stated the order had been incorrectly entered into the computer as self-administration instead of clinician administration, and that nursing staff should have questioned and sought clarification of the order.
Laundry Room Infection Control Lapses
Penalty
Summary
The facility failed to ensure a safe, sanitary environment to prevent the possible spread of infection in the handling, storing, and processing of soiled linens and residents' clothing in the laundry room. During an observation of the laundry room, the door separating the soiled utility room and the washing machine area was propped open with two plastic bins, and the soiled room contained multiple bags of soiled linen. One bin was partially filled, and a large volume of soiled linen, including bedding and pillowcases, was piled unsecured on top of the containers rather than contained within closed, leak-proof bags or covered receptacles. The door in the washing machine area leading to the dryer room was open, and the dryer area contained a yellow rolling linen cart with articles of clothing draped over the exterior side and hanging down the side. A blue piece of clothing on a hanger was on the floor near the clean linen cart, and the clothing on the linen cart was not covered. A plastic shelving unit held multiple linens, towels, and clothing items in an unorganized manner. Several bags of laundry or linen were on the floor, a large quilted linen item was draped over and not fully contained, and a broom was leaning against the shelving unit with the broom head resting on the floor near the quilted linen. The Housekeeping Supervisor stated the doors from the soiled room should not be left open, the clothes and linen in the soiled room should be covered, and items in the clean area should not be left uncovered or on the floor. The Administrator later verified the areas of concern, and the facility policy required dirty and clean laundry to be maintained in separate areas and facility linens to be bagged and placed in soiled utility rooms for transport to the laundry room.
Failure to Maintain Clean and Homelike Environment
Penalty
Summary
Surveyors observed that the facility failed to maintain a safe, clean, comfortable, and homelike environment for multiple residents and throughout both main hallways. During the initial tour, significant debris buildup was noted on and around the walls, baseboards, and in the corners of the east and west wing hallways. Dust and debris were easily wiped off with a gloved finger from railings within resident rooms and hallways. In several resident rooms, there was visible accumulation of dirt, food particles, and debris on floors, walls, and baseboards. Live insects, including bugs in one resident's shoes and a winged insect on a bathroom floor, were also observed. Residents reported that cleaning was infrequent or insufficient, with some expressing a desire for more thorough cleaning of their rooms and bathrooms. Staff interviews confirmed the presence of dirt and buildup, with an Environmental Services Technician acknowledging the need for more thorough cleaning, particularly around the baseboards. The administrator also confirmed the observations of dirt, debris, and live bugs in the affected rooms and hallways. Review of the facility's policy indicated a requirement to provide a safe, clean, and comfortable environment, including necessary housekeeping and maintenance services, which was not met as evidenced by the surveyors' findings.
Inaccurate MDS Assessment for Antiplatelet Medication
Penalty
Summary
The facility failed to ensure the accuracy of the Minimum Data Set (MDS) assessment for a resident reviewed for mood and behavior. The Quarterly MDS for the resident indicated that they were not taking antiplatelet medication under Section N0415, which pertains to high-risk drug classes use and indication. However, a review of the resident's physician orders revealed that the resident had a current order for Plavix, an antiplatelet medication, at a dosage of 75 milligrams by mouth once daily, which had been ordered since May 22, 2022. During an interview, the MDS Coordinator confirmed that the resident had an order for Plavix and acknowledged that this should have been documented in Section N of the current MDS. This oversight resulted in an inaccurate assessment of the resident's medication regimen, specifically regarding the use of high-risk drug classes.
Failure to Complete Accurate PASRR for Resident with Mental Disorder
Penalty
Summary
The facility failed to ensure an accurate Level I Preadmission Screening and Resident Review (PASRR) was completed for a resident diagnosed with a serious mental disorder. The resident's Level I PASRR, dated 9/19/2023, did not document any mental illness in Section I: PASRR Screen Decision-Making. However, the resident's admission record indicated diagnoses of generalized anxiety disorder and unspecified psychosis not due to a substance or known physiological condition, with onset dates of 9/28/2023 and 9/19/2023, respectively. The clinical records lacked documentation that these diagnoses were included in an updated Level I PASRR. During an interview, the Director of Nursing confirmed that the resident's mental health diagnoses were not included in the PASRR completed on 9/19/2023 and acknowledged that a revised PASRR reflecting these diagnoses had not been completed.
Failure to Use PPE During Medication Administration
Penalty
Summary
The facility failed to ensure proper use of personal protective equipment (PPE) during the administration of medications through subcutaneous injection, which could potentially lead to the spread of infection and communicable diseases. During an observation, a Licensed Practical Nurse (LPN) prepared medications for a resident without performing hand hygiene. The LPN entered the resident's room with a Tresiba FlexTouch Solution Pen Injector, cleaned the injection site with an alcohol pad, and administered the medication without donning gloves. In an interview, the LPN acknowledged the failure to wear gloves. The Director of Nursing (DON) confirmed that the correct procedure should include performing hand hygiene, donning gloves, administering the injection, and then performing hand hygiene. The facility's policy on medication administration via injection, last reviewed in December 2023, requires hand hygiene and glove use prior to medication administration.
Incomplete Documentation of Wound Care
Penalty
Summary
The facility failed to ensure that resident records were complete and accurate for three residents, leading to a deficiency in safeguarding resident-identifiable information and maintaining medical records according to professional standards. For Resident #1, multiple instances of undocumented wound care were identified, despite physician orders specifying detailed wound care regimens for various wounds. The Treatment Administration Record (TAR) for July 2024 showed missing entries for wound care on several dates, indicating a lack of documentation for the care provided. Similarly, Resident #5's records revealed missing documentation for sacral wound care on specific dates in July 2024, despite physician orders outlining daily wound care requirements. The absence of entries in the TAR suggests that the care was either not provided or not documented, which is a breach of the facility's policy on charting and documentation. Resident #6 also experienced incomplete documentation for wound care, with several instances of missing entries in the TAR for different wounds. Interviews with staff, including a Licensed Practical Nurse (LPN) and the Director of Nursing, confirmed that while wound care was reportedly provided, it was not consistently documented. This lack of documentation contravenes the facility's policy, which mandates that all services and treatments be recorded in the resident's medical record to ensure effective communication among the care team.
What surveyors are citing around you — mapped
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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 105 citations issued within 25 miles in the last 12 months — including the 3 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
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Illustrative
Risk indicators are statistical estimates from public CMS data — not predictions, findings, or compliance advice.
Nursing homes near Gainesville
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Park Meadows Healthcare & Rehabilitation Center | 2.6 mi | ★★★★★ | 30 | 0 |
| Oak Hammock At The University Of Florida Inc | 2.6 mi | ★★★★★ | 0 | 0 |
| Gainesville Health And Rehabilitation | 2.9 mi | ★★★★★ | 4 | 0 |
| Plaza Health And Rehab | 4 mi | ★★★★★ | 19 | 0 |
| Palm Garden Of Gainesville | 4.2 mi | ★★★★★ | 0 | 0 |
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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.