Average — CMS composite of the measures below.
A standard survey is most likely before around December 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 Dublinair Health & Rehab during CMS and state inspections, most recent first.
A resident with severe dementia, daily wandering, and significant ADL dependence was ambulating quickly in a hall with a CNA when an LPN activated an air horn behind the resident, reportedly to startle other staff. Staff interviews indicated the noise startled the resident, who then increased walking speed and fell over lifting equipment left in the hallway. The resident later exhibited a right hip bruise, inability to bear weight, and pain, and hospital evaluation confirmed an acute comminuted intertrochanteric femur fracture and a large head hematoma, requiring surgical fixation.
The facility did not update comprehensive person-centered care plans to reflect MD orders for two residents. One resident with cognitive impairment and total dependence for ADLs had an order for a low bed with fall mats, but the care plan did not include this intervention and repeated observations showed the resident in bed without fall mats. Another resident with severe cognitive impairment and multiple chronic conditions had an order to wear bilateral heel boots at all times, yet the care plan was not revised and the resident was repeatedly observed in a geri chair without the boots; a family member reported the boots were only used occasionally. The DON acknowledged that her expectation is for staff to follow MD orders and ensure care plans are updated with significant changes.
Improper Food Labeling, Expired Food, and Unsanitary Ice Machine: Surveyors observed open dry-storage food items that were unlabeled and undated, a refrigerated food item past its expiration date, and an ice machine with visible residue and debris. The DM and CC stated that cooks and dietary staff were responsible for labeling and dating food items, and the Maintenance Director confirmed the ice machine cleaning had not been completed for the month.
Unsafe and Unhomelike Room Conditions: The facility failed to maintain a safe, clean, comfortable, and homelike environment in rooms on A hall and D hall. Observations found scuffed and peeling paint, cracked and gouged sheetrock, missing or damaged baseboards, and patched wall areas in disrepair in multiple resident rooms. The ADM, MD, MR, and Supply Clerk confirmed the damaged conditions and noted that room rounds should have identified the issues earlier.
Failure to Provide Nail Care: A resident with moderate cognitive impairment and dependence on staff for personal hygiene had long fingernails with a dark substance underneath them. The resident said he had told a CNA about trimming them, and a CNA, LPN, and DON all confirmed the nails were long and should have been trimmed and cleaned during care. The facility’s ADL policy stated residents unable to perform ADLs independently would receive services needed to maintain grooming and personal hygiene.
A facility failed to submit a PASARR Level II for a resident with schizophrenia, as required by policy. Despite the resident's diagnosis and behaviors such as cursing and mood swings, the Social Services Director did not initiate the necessary review, believing the resident's condition was stable. Staff interviews confirmed the resident's behaviors, but the Director of Nursing was unaware of the PASARR Level II criteria, as the responsibility was solely with the Social Services Director.
Resident Fall and Hip Fracture After LPN Activates Air Horn in Hallway
Penalty
Summary
The deficiency involves the facility’s failure to maintain an environment free from accident hazards and to provide adequate supervision to prevent a fall for one resident. The resident had dementia associated with other diseases, Alzheimer’s disease with mood disturbance, depression, severe cognitive impairment (BIMS of 99), and daily wandering. The resident’s care plan, last dated in October 2025 with no revision date, included interventions such as PT referral as needed, monitoring for condition changes that may warrant increased supervision, referral to restorative programs as needed, evaluation of psychotropic medications, encouraging non-skid footwear, and use of low beds with fall mats. At the time of the incident, the resident was ambulating in the hallway with a CNA and was known to walk quickly. On the date of the incident, multiple staff reported that an LPN activated an air horn (also described as a foghorn) on the hall while the resident was ambulating. One CNA stated she witnessed the LPN blowing the air horn behind the resident as the resident walked down the hall, which startled the resident and caused her to walk faster despite the CNA’s repeated instructions to slow down, and the resident fell before the CNA could reach her. Another LPN reported hearing the air horn at the nurses’ station and then observing the resident moving past at a fast pace. The LPN who blew the air horn acknowledged activating it, stating it was intended to startle other staff, and reported that after the CNA released the resident’s hand, the resident continued down the hallway and fell over lifting equipment positioned in the hallway. Staff accounts indicated that the air horn was being blown throughout the day and that it was used to scare other staff members on more than one occasion. Following the fall, staff observed a bruise on the resident’s right hip during care and notified the LPN, who assessed the resident. The resident’s family was informed of the fall and initially declined ER transport, and the facility reported that the resident appeared to be acting like herself with stable vital signs and a head hematoma. Later, when the resident was unable to bear weight on the right lower extremity and complained of pain, she was transported to the ER. Hospital records documented that the resident had sustained an acute comminuted intertrochanteric fracture of the right femur, along with a large head hematoma and an acute UTI, and she underwent operative fixation with right hip cephalomedullary nail placement and reduction before being discharged back to the facility.
Failure to Update Care Plans for Fall Mats and Heel Boots
Penalty
Summary
The facility failed to develop and implement comprehensive person-centered care plans that reflected physician orders for two residents. For one resident with a diagnosis including mood disorder and a left clavicle fracture, the most recent Significant Change MDS showed cognitive impairment with a BIMS score of 07 and total dependence for all ADLs. A physician order dated 12/31/2025 directed that the resident’s bed be kept in a low position with fall mats. However, the resident’s care plan, dated 12/29/2025, was not updated to include this order, and no related goals or interventions were developed. Multiple observations over several days documented the resident in bed without fall mats, and the DON confirmed that fall mats were not placed at the bedside or in the room, despite her expectation that staff follow physician orders and that such orders be reflected in the care plan. For a second resident with diagnoses including anxiety disorder, chronic pain syndrome, and mild protein-calorie malnutrition, the most recent Significant Change MDS documented severe cognitive impairment with a BIMS score of 99. A physician order dated 1/16/2026 required the resident to wear bilateral heel boots at all times, every shift. The resident’s care plan, dated 10/23/2025, was not updated to reflect this order, and no associated goals or interventions were developed. On multiple observations, the resident was seen in a geri chair without the ordered heel boots. The resident’s oldest daughter reported that the boots were only worn on occasion, despite the family’s expressed concerns to staff. The DON stated that her expectation is for staff to follow MD orders as written and to update the care plan when significant changes occur.
Improper Food Labeling, Expired Food, and Unsanitary Ice Machine
Penalty
Summary
Food storage and sanitation practices were not maintained in the kitchen dry storage area, one reach-in refrigerator, and one ice machine. During a kitchen tour, surveyors observed open food items in dry storage that were unlabeled and undated, including a 5 lb bag of grits, 160 oz bags of elbow macaroni and spaghetti noodles, a 5 lb bag of egg noodles, a 5 lb bag of breadcrumbs, and a 2 oz gourmet coffee blend. The facility policy titled Food Storage Guidelines required non-perishable foods to have delivery and open dates, and prepared foods to have delivery, open, and discard dates. The Dietary Manager and CC later stated that cooks and dietary staff were responsible for labeling and dating food items, and CC acknowledged uncertainty regarding the discard date. Surveyors also found one 6 qt Bacon-[NAME] in the reach-in refrigerator with an expiration date of 9/11/2025. CC stated she had checked for expiration dates, past usage, and expired foods during delivery from the truck the previous day. In addition, the ice machine had a black/reddish-like substance at the ice base and underneath it, a white substance near the bolt hinge where a bolt was missing, and various particles on the interior surfaces. The facility policy titled Ice Maker Sanitation required the ice cooler/chest to be cleaned weekly or more often if that was facility protocol. The Maintenance Director confirmed he had not completed the monthly cleaning for that month, and the cleaning log showed the last deep cleaning occurred on 8/15/2025.
Unsafe and Unhomelike Room Conditions
Penalty
Summary
The facility failed to provide a safe, clean, comfortable, and homelike environment on A hall and D hall, with deficiencies observed in rooms A3, A12, D1, and D2. Review of the facility policy titled Safe and Homelike Environment stated that the facility would provide a safe, clean, comfortable, and homelike environment and ensure residents could receive care and services safely. Observations in room D1 revealed scuffing and peeling paint on the dry walls, two large circular patched areas of gouged and uneven sheet rock at the head of bed B, and a missing baseboard found caught under the wheels of resident B's bed. In room D2, a wall contained a hole or gouge measuring approximately 36 inches in the sheetrock at the head of resident A's bed near the baseboard. Additional observations identified a crack approximately 13 inches long on the wall in room A3 near the bathroom door panel and a baseboard hanging off the wall in room A12 on the side of the resident in A bed. Interviews with the Administrator, Maintenance Director, Medical Records Director, and Supply Clerk confirmed the damaged walls, sheetrock in disrepair, and missing or damaged baseboards. The Administrator stated that each department head was responsible for completing Angel Rounds/Compliance Rounds, including observation of walls and other room surfaces, and confirmed that the findings should have been identified previously. The Administrator also stated that there were no risks, but the observations affected the residents' homelike environment.
Failure to Provide Nail Care
Penalty
Summary
The facility failed to ensure nail care was provided for one of four sampled residents, R96, who was unable to complete activities of daily living independently. The facility’s policy stated that residents who are unable to carry out ADLs independently will receive services necessary to maintain grooming and personal hygiene. R96’s record showed diagnoses including age-related physical debility, an admission MDS with a BIMS score of 12 indicating moderate cognitive impairment, and Section GG showing dependence on staff for personal hygiene. The care plan dated 8/28/2025 identified that R96 required assistance with ADLs and included interventions to provide assistance as needed. During an observation on 9/12/2025, R96’s fingernails were noted to be long with a dark substance underneath them. R96 stated his fingernails needed to be trimmed and that he had informed a CNA about cutting them. On 9/13/2025, a CNA confirmed the fingernails were long, needed trimming, and had a dark substance underneath them, and stated she would have taken care of them if R96 had been assigned to her. An LPN also confirmed the fingernails should be trimmed and cleaned during care and stated there was a check-off list at the nurse’s station to ensure nail care was completed. The DON observed the same condition and stated CNAs were supposed to check and perform nail care during baths.
Failure to Submit PASARR Level II for Resident with Schizophrenia
Penalty
Summary
The facility failed to submit a PASARR Level II for a resident diagnosed with mental illness, specifically schizophrenia, which is a requirement for ensuring appropriate care and services. The facility's policy mandates coordination with the PASARR program to provide care in the most integrated setting for individuals with mental disorders. However, the Social Services Director did not initiate a PASARR Level II despite the resident's diagnosis of schizophrenia, as documented in the Minimum Data Set (MDS) and electronic medical records. The Social Services Director acknowledged the diagnosis but believed the resident's hallucinations and delusions were stable and did not require further psychological services. Interviews with staff, including a CNA, LPN, and the Director of Nursing, revealed that the resident exhibited behaviors such as cursing, mood swings, and attention-seeking actions, which were communicated to the Social Services Director. Despite these observations, the Social Services Director did not pursue a PASARR Level II, and the Director of Nursing was unaware of the criteria for such a referral, as the responsibility was solely assigned to the Social Services Director. This oversight had the potential to impact the level of care and services provided to the resident.
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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.
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Nursing homes near Dublin
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Dublin Trails Of Journey Llc | 2.6 mi | ★★★★★ | 0 | 0 |
| Southland Healthcare And Rehab Center | 2.9 mi | ★★★★★ | 7 | 0 |
| Wrightsville Manor Health And Rehab | 18.6 mi | ★★★★★ | 10 | 0 |
| Pruitthealth - Toomsboro | 20.7 mi | ★★★★★ | 0 | 0 |
| Scott Health & Rehabilitation | 21.6 mi | ★★★★★ | 5 | 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.