Below average — CMS composite of the measures below.
A standard survey is most likely before around October 2026
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 Winter Park Care And Rehabilitation during CMS and state inspections, most recent first.
The facility was cited for a repeat deficiency in the accuracy of MDS assessments due to insufficient auditing and oversight by the QAA/QAPI committee. Despite having a plan requiring ongoing monitoring and performance tracking, the facility did not sustain prior improvements, with lapses attributed to management and MDS staff transitions.
A resident with a history of mobility issues and cognitive intactness was provided only a transport wheelchair, despite her ability to independently use a standard wheelchair. The resident's repeated requests for a standard wheelchair were not addressed, and staff were unaware of her needs until months after admission. The care plan did not reflect her preference for independent mobility, and the correct wheelchair was not provided until the issue was raised during survey.
A resident with multiple medical conditions was inaccurately coded in the MDS assessment as receiving parenteral/IV feeding and a mechanically altered diet, despite medical records and staff interviews confirming the resident was only on a regular diet with fluid restriction and fortified food. Facility staff, including the Dietitian, CDM, and MDS Coordinator, confirmed the errors and were unable to justify the incorrect entries, resulting in inaccurate documentation of the resident's nutritional care.
A resident receiving IV antibiotic therapy did not have their IV catheter dressing changed within the required seven-day interval as ordered by the physician and facility policy. Nursing staff and the DON confirmed the dressing remained in place for over a week past the scheduled change, with documentation and direct observation supporting the missed dressing change.
A resident with multiple health conditions was admitted for respite care, and discrepancies in her medical record were noted regarding a bruise on her forehead. Initial assessments by an LPN showed no bruises, but later documentation by other staff indicated bruising after a fall. The RN Unit Manager claimed the bruise was present upon admission, conflicting with other records and family observations. The DON acknowledged the need for accurate documentation, but inconsistencies remained unexplained.
Repeat Deficiency in MDS Assessment Accuracy Due to Inadequate QAPI Oversight
Penalty
Summary
The facility failed to ensure that its Quality Assessment & Assurance (QAA) and Quality Assurance and Performance Improvement (QAPI) committee conducted effective performance improvement activities to sustain prior corrective measures. Despite having a QAPI plan that required ongoing actions, measurement of success, and tracking of performance, the facility did not implement adequate policies or monitoring to ensure improvements were maintained. A deficiency for inaccurate Minimum Data Set (MDS) assessments, previously cited during an earlier recertification survey, was cited again during the current survey, indicating that the facility did not provide sufficient auditing and oversight. The administrator attributed the repeat deficiency to lapses in maintaining documentation accuracy during transitions in management and MDS staff roles.
Failure to Provide Appropriate Wheelchair Limits Resident Independence
Penalty
Summary
A deficiency occurred when a resident, admitted with a history of wedge compression fracture, falls, muscle wasting, and requiring assistance with personal care, was not provided with an appropriate wheelchair to accommodate her needs and preferences. The resident was cognitively intact, able to make her needs known, and had no upper or lower range of motion limitations. Despite her ability to independently maneuver a standard wheelchair, she was given a transport wheelchair upon admission, which limited her independence and ability to move around her room or the hallway. The resident reported requesting a standard wheelchair multiple times but was told she could not have one, without explanation. Staff interviews revealed that the Therapy Director and DON were unaware that the resident had been using a transport wheelchair for daily use and that she desired a standard wheelchair. The facility's process for assigning wheelchairs relied on information from the State Agency transfer form and PT evaluation, but all staff had access to standard wheelchairs stored on site. The resident's care plan included interventions to encourage mobility but did not specify the use of a transport chair or reflect her preference for independent mobility. The DON acknowledged that a transport wheelchair was inappropriate for daily use by a resident capable of independent ambulation and that the resident did not receive the correct wheelchair until several months after admission.
Inaccurate MDS Assessment for Nutritional Approaches
Penalty
Summary
The facility failed to ensure the accuracy of the Minimum Data Set (MDS) assessment for a resident regarding nutritional approaches. The resident, who had a history of diffuse large B-cell lymphoma, muscle wasting, chronic kidney disease, and other conditions, was admitted for care and later readmitted with generalized weakness and edema. The admission MDS assessment inaccurately documented that the resident received parenteral or intravenous (IV) feeding and a mechanically altered diet, including specific entries for percent intake by artificial route and average fluid intake by IV or tube feeding. However, review of the resident's medical record and diet orders confirmed that at no time was the resident on parenteral, IV feeding, or a mechanically altered diet; the resident was consistently on a regular diet with regular texture and thin liquids, with a fluid restriction and fortified food as ordered. Interviews with facility staff, including the Dietitian, Certified Dietary Manager (CDM), and MDS Coordinator, confirmed the inaccuracies in the MDS assessment. The CDM acknowledged miscoding the resident as requiring a mechanically altered diet, and the MDS Coordinator was unable to explain the basis for the entries regarding parenteral or IV feeding. The facility's policy and job descriptions require accurate and comprehensive MDS assessments, but these were not followed in this instance, resulting in inaccurate documentation of the resident's nutritional status and care approaches.
Failure to Timely Change IV Dressing per Physician Order
Penalty
Summary
A deficiency occurred when the facility failed to ensure the intravenous (IV) catheter dressing for a resident was changed every seven days as ordered by the physician. The resident, who was admitted with a fracture of the neck, intraspinal abscess, and cervical spinal stenosis, was receiving IV antibiotic therapy. Physician orders and the care plan specified that the IV site should be observed every shift and the transparent dressing changed weekly, specifically on the night shift every Sunday. However, review of the Medication Administration Record and progress notes showed no documentation that the dressing had been changed between the time of admission and the survey dates. Direct observation by surveyors revealed that the IV dressing was dated eight days prior to the survey, exceeding the seven-day interval required by both physician orders and facility policy. Nursing staff, including an LPN and the DON, confirmed that the dressing change had been missed and that the order for the next change was incorrectly scheduled, resulting in the dressing remaining in place for almost two weeks. The facility's policy required transparent dressings to be changed every five to seven days, but this was not followed in this instance.
Inaccurate Medical Record Documentation for Resident
Penalty
Summary
The facility failed to maintain an accurate medical record for a resident, leading to a deficiency in safeguarding resident-identifiable information. The resident, an elderly female with multiple diagnoses including Alzheimer's Disease and vascular dementia, was admitted to the facility multiple times for respite care. Upon her most recent readmission, discrepancies were noted in the documentation of her skin condition. The medical record did not accurately reflect the presence of a bruise on her forehead, which was later documented after a fall. The inconsistency in documentation was highlighted by conflicting reports from different nursing staff. LPN B, who conducted the initial skin assessment upon readmission, noted no bruises, while the hospice RN and LPN C documented bruising after the resident's fall. The RN Unit Manager claimed the bruise was present upon admission, but this was not supported by the medical records or the observations of other staff and the resident's family. The Director of Nursing acknowledged the expectation for thorough documentation of any bruises or skin impairments upon admission and during regular evaluations. However, the RN Unit Manager's notes conflicted with other nurses' documentation, leading to an incomplete and inaccurate medical record for the resident. This discrepancy in documentation practices was not explained, as the Director of Nursing was on leave during the relevant period.
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 168 citations issued within 25 miles in the last 12 months — including the 9 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 Winter Park
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Regents Park Of Winter Park | 0.4 mi | ★★★★★ | 0 | 0 |
| Mayflower Healthcare Center | 1.1 mi | ★★★★★ | 0 | 0 |
| Parkview Rehabilitation Center At Winter Park | 1.2 mi | ★★★★★ | 0 | 0 |
| Alwyn C Cashe State Veterans Nursing Home | 1.5 mi | ★★★★★ | 6 | 2 |
| Avante At Orlando Inc | 1.5 mi | ★★★★★ | 3 | 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.