Above average — CMS composite of the measures below.
The next survey window likely opens 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 Wesley Park Centre during CMS and state inspections, most recent first.
Kitchen staff were not competent with dishwasher temperature checking procedures. During observation, the rinse-water gauge reached 171 degrees F in three cycles, but a dishwasher said he had never learned how to perform the temperature test and did not know where the test strips were located. Another dishwasher later found the strips and completed the check, which showed the rinse cycle reached 180 degrees F. A second dishwasher also stated he had never learned how to check the water temperature, and the Sous Chef said staff should have been trained on the process.
Food storage and meal service practices were not followed when staff left multiple refrigerated, frozen, and dry storage items unlabeled, undated, partially uncovered, or previously accessed, and a dented can of applesauce remained in storage. Food service staff were also observed without proper hair restraints, and a food server used a bare hand to place a dessert bowl directly on a resident's plate so it touched the meatloaf before the meal was served.
Improper Male Perineal Care and UTI Prevention Failure: A resident with moderately impaired cognition, multiple chronic conditions, and a recent UTI was treated with an antibiotic after urine testing showed bacteria. During observed toileting hygiene, CNAs performed male pericare out of order by cleaning the groin, testicles, and penis tip with the same wipe before cleaning the anus; one CNA admitted she rushed and did not follow the correct sequence, and the DHS confirmed the care should have been done properly.
A resident with multiple medical conditions fell and suffered a fatal injury after the facility failed to follow therapy recommendations for ambulation assistance. Despite therapy advising an assist of two, the facility continued with a baseline care plan requiring only one person assistance, leading to a fall during a bathroom transfer. The resident was hospitalized, underwent surgery, and later died due to complications from the fracture.
A resident with a history of stroke and other medical conditions developed a pressure wound on the right foot due to the continued use of an Ankle/Foot Orthotic (AFO) despite the absence of a physician's order and the identification of the wound. The facility failed to address the use of the AFO in the physical therapy evaluation, and the wound worsened, becoming infected with MRSA. The resident's wife reported that the splint caused the wound, and the nursing staff continued its use after the wound was identified.
The facility failed to maintain appetizing temperatures for hot foods during a lunch service, as observed by the State Agency. Despite initial acceptable temperatures, the food served to residents was significantly cooler by the time it reached them. Two residents reported receiving cold meals, requiring reheating, indicating a broader issue with food temperature maintenance.
The facility failed to maintain sanitary conditions in the kitchen, as observed during two inspections. Dust particles were found hanging from fire suppression spigots above boiling food, and a thick layer of dust was present behind the tilt skillet. The facility's checklists lacked instructions for cleaning these areas, and the Certified Dietary Manager acknowledged the need for improved sanitation.
The facility failed to maintain safe water temperatures, with several areas exceeding the policy limit of 110°F. Observations revealed high temperatures in four resident room sinks and one shower room, with some readings reaching 127.7°F. Staff acknowledged the issue, and the facility increased temperature checks following the findings.
A resident with a history of stroke and diabetes was left with unmet needs after activating the call light. Despite attempts to communicate discomfort due to a foot stuck in the bed's footboard, a CNA left without assisting, and the resident had to call family for help. Staff interviews revealed communication issues and lack of follow-up by the LPN, leading to the resident feeling ignored.
A resident with moderate cognitive impairment and multiple diagnoses was observed multiple times without a call light within reach. The resident believed her call necklace had been taken away, and the only call light available was on the wall above her bed, which was not accessible from her recliner. The DON confirmed the facility's policy requires call lights to be within reach, which was not followed.
Kitchen Staff Not Competent With Dishwasher Temperature Checks
Penalty
Summary
The facility failed to ensure kitchen staff were competent with dishwashing temperature checking procedures. During observation of three dishwashing cycles, the rinse-water temperature gauge reached 171 degrees Fahrenheit during all three observations. When Staff B, a dishwasher, was asked to perform a dishwasher temperature check using the color-changing temperature-sensitive strip, he stated he did not know how to do the test because he had never learned how to perform it. Staff B then told Staff E that a dishwasher temperature check had been requested, and Staff E asked where the test strips were located. Staff B did not know, and both staff searched for the strips until Staff E found them hanging in front of the dishwasher temperature check binder stored on the wall to the left of the dishwasher. Staff E then performed the temperature check and the strip indicated the rinse-cycle water temperature reached the required 180 degrees Fahrenheit. Later, Staff C stated he knew the dishwasher water temperature should reach at least 170 degrees Fahrenheit but said he had never learned how to check the water temperature, and when asked what would happen if the gauge registered 160 degrees, he said he would do nothing because the temperature would increase over time. Staff E stated the water temperature should be between 170 and 180 degrees Fahrenheit and that if it did not reach at least 170 degrees Fahrenheit, she would contact maintenance. The Sous Chef stated staff should have sought coworker assistance and that staff should have been trained on the process. The facility also indicated it did not have a policy directly related to dishwashing requirements.
Food Storage, Hair Restraint, and Meal Service Contamination
Penalty
Summary
The facility failed to properly store food in the kitchen and dry storage areas, failed to discard a dented can of applesauce, and failed to maintain required hair restraints for staff working in food service areas. During the initial kitchen tour, surveyors observed multiple refrigerated and frozen items that were unlabeled, undated, partially uncovered, or previously accessed, including bowls and pans of food, opened bags of produce and meat items, and several items in the dry goods storage room that were also unlabeled or undated. A dented can of applesauce was also observed in dry storage. Staff A, a cook, was first observed in the main kitchen without a hair net, and Staff B, a dishwasher, had a hair net pulled down below and behind the hairline of his beard while washing dishes. Staff C, a dishwasher, was later observed washing dishes without wearing a hairnet. During meal service, Staff D, a food server, placed a piece of meatloaf on a resident's plate, then used a dessert bowl with bare hands to scoop green beans and placed the bowl on the plate so it directly touched the meatloaf; the meal was then served to the resident. The report also noted a can of damaged applesauce that was not discarded and food items stored in the refrigerator, freezer, and dry storage without proper labeling, dating, or coverage. On follow-up kitchen observation, several items remained unlabeled or undated, including opened lettuce, meat-like items, grapes, shredded orange substance, cranberries, pasta-like items, tan flakes, and a clear plastic bin with multicolored items. Staff F, the Sous Chef, stated staff should have followed the facility policies.
Improper Male Perineal Care and UTI Prevention Failure
Penalty
Summary
The facility failed to provide appropriate treatment and services to prevent a urinary tract infection for one resident. The resident had a BIMS score of 11 out of 15, indicating moderately impaired cognition, and diagnoses that included coronary artery disease, high blood pressure, a stroke, and a UTI. The MDS also showed the resident was dependent with most ADLs and mobility, and had a UTI within the previous 30 days. A laboratory report confirmed bacteria in the resident’s urine specimen, and the physician reviewed the results and prescribed Levofloxacin for the UTI, which was administered for five days. During observation of toileting hygiene care, two CNAs provided perineal care to the resident. One CNA cleaned the resident’s groin, testicles, and then used the same wipe to clean the tip of the penis before cleaning the anus. The CNA later stated she had received infection prevention education and knew male pericare should begin at the tip of the penis, but she forgot to perform the care in the correct order because she was in a hurry. Another CNA stated male pericare should include cleaning the penis beginning at the tip and working down the shaft. The DHS stated staff should have followed proper pericare procedure or redone it correctly. The facility’s written perineal care procedure directed staff to clean a male resident’s penis from the tip to the base and then wash the scrotum and groin area.
Failure to Follow Therapy Recommendations Leads to Fatal Fall
Penalty
Summary
The facility failed to follow Physical Therapy recommendations regarding the ambulation status of a resident, leading to a fall and subsequent fatal injury. The resident, who was admitted for skilled rehabilitation with a history of multiple medical conditions including paraplegia and recent hospitalization for leg and groin abscesses, was initially assessed to require assistance of one person for transfers and ambulation. However, after an incident with Occupational Therapy where the resident attempted to fall and expressed a preference for using a wheelchair, therapy recommended an assist of two for ambulation with a front-wheel walker and wheelchair to follow. Despite this recommendation, the Interdisciplinary Team decided to continue using the baseline care plan, which required only one person assistance, as they believed that not ambulating would hinder the resident's progress. This decision was made without documented evidence of an IDT meeting or a formal update to the care plan. Consequently, the resident was assisted by a single CNA during a transfer to the bathroom, resulting in a fall that caused a right femur fracture. The resident was subsequently hospitalized, underwent surgery, and later died due to complications from the fracture. The facility's investigation revealed inconsistencies in the communication and implementation of therapy recommendations. Nursing staff continued to follow the baseline care plan, and there was a lack of documentation regarding the IDT's decision to disregard therapy's updated recommendations. The Medical Director confirmed that therapy recommendations should have been followed, indicating a breakdown in the facility's process for updating and communicating care plans effectively.
Failure to Prevent Pressure Ulcer Due to Improper Use of AFO
Penalty
Summary
The facility failed to accurately assess and prevent a pressure wound in a resident who was at risk for developing pressure ulcers. The resident, who had a history of stroke with aphasia and right-sided hemiplegia, diabetes mellitus, and end-stage renal disease, was admitted with a baseline care plan that noted redness of the coccyx but no other skin integrity issues. Despite the absence of a physician's order for an Ankle/Foot Orthotic (AFO), the resident was using one, which led to the development of a pressure wound on the right foot. The nursing staff continued to use the AFO for transfers even after identifying the pressure wound, which resulted in the wound requiring a higher level of treatment. The wound was first noted on the right lateral foot as a scab with surrounding redness, and it was later confirmed to be infected with Methicillin Resistant Staphylococcus Aureus (MRSA). The facility's documentation and interviews revealed that the AFO was not initially addressed in the physical therapy evaluation, and the brace was used until the wound worsened. The resident's wife reported that the splint caused the open wound, and the nursing staff continued its use after the wound was identified. The facility's Director of Nursing noted that additional nutritional support was attempted but refused by the resident's wife. The wound nurse assessed the wound and initiated a wound culture and antibiotics, but the facility's failure to discontinue the use of the AFO promptly contributed to the worsening of the wound.
Failure to Maintain Appetizing Food Temperatures
Penalty
Summary
The facility failed to ensure that hot foods were served at an appetizing temperature during a lunch service. Observations prior to the start of the lunch service revealed that the temperatures of various food items were within acceptable ranges, except for pureed vegetables, which were not heated up before service. However, by the time the last tray was served, the temperatures of the grilled ham and cheese sandwiches, noodles with meat sauce, and mashed potatoes had dropped significantly below the minimum required temperature of 135 degrees Fahrenheit, as per the facility's policy. This discrepancy was noted by the State Agency, which conducted a test tray temperature check immediately after the last tray was served. Additionally, two residents reported that their meals were often served cold. One resident, with an intact cognition as indicated by a Brief Interview for Mental Status (BIMS) score of 12, stated that food served in the dining room was cold and required reheating. Another resident, with a BIMS score of 15, also reported that meals delivered to his room were cold on multiple occasions and needed to be warmed up. These resident reports, combined with the observed temperature deficiencies, highlight a failure in maintaining food at appetizing temperatures, impacting the residents' dining experience.
Sanitation Deficiency in Kitchen Observations
Penalty
Summary
The facility failed to ensure that food was prepared under sanitary conditions during two kitchen observations. During an initial kitchen tour, dust particles were observed hanging from all eight fire suppression spigots, with two string-like dust particles approximately two inches in length hanging directly above a pot of boiling food. A follow-up visit revealed that the dust remained on the spigots, and a thick layer of dust was also found on the metal surface behind the tilt skillet. The facility's Night Closing List and Morning Checklist did not include instructions for cleaning the fire suppression system spigots. The facility's Food Safety policy, revised in July 2024, directed staff to monitor contamination risks during cooking, cooling, holding, and reheating. The Certified Dietary Manager acknowledged the need for kitchen sanitation and planned to address the dust buildup on the spigots.
Facility Fails to Maintain Safe Water Temperatures
Penalty
Summary
The facility failed to ensure that water temperatures at points of delivery did not exceed safe maximum temperatures in several areas, including four out of six resident room sinks and one out of three shower rooms. During a survey conducted by the State Agency, temperature readings were taken, revealing that water temperatures in these areas were above the facility's policy limit of 110 degrees Fahrenheit, with some readings as high as 127.7 degrees Fahrenheit. Staff B, a maintenance staff member, confirmed these high temperatures and acknowledged that they were not within the acceptable range. The facility's policy, revised in September 2019, directed staff to maintain hot water temperatures at 110 degrees Fahrenheit in all resident areas. However, the Executive Director stated that the acceptable range was between 100 and 120 degrees Fahrenheit. Following the discovery of the high temperatures, the facility increased the frequency of temperature checks. The deficiency was identified based on observations, staff interviews, and a review of the facility's policy, indicating a failure to maintain water temperatures within the safe range for resident safety.
Failure to Ensure Resident Dignity and Needs
Penalty
Summary
The facility failed to uphold the dignity of a resident by not ensuring their needs were met after activating the call light. The resident, who had a history of stroke with aphasia and right-sided hemiplegia, diabetes mellitus, and required assistance for repositioning, reported that a CNA left the room without addressing his need to adjust his foot, which was stuck in the footboard. Despite the resident's attempts to communicate his discomfort, the CNA did not assist him, and the resident had to call his family for help. The resident's wife confirmed receiving multiple calls from him, reporting that staff had forgotten his supper and left him without assistance. Interviews with staff revealed that the CNA on duty was unable to understand the resident's needs and did not inform the LPN of the situation. The LPN, who was aware of a call from the resident's wife, did not follow up on the resident's condition. The resident expressed feeling ignored and worthless due to the lack of attention from the night shift staff. Another CNA noted that some night shift staff lacked the patience to listen to residents, contributing to the deficiency in care.
Failure to Ensure Call Light Accessibility for Resident
Penalty
Summary
The facility failed to ensure that the call light was within reach for a resident with moderate cognitive impairment. The resident, who has diagnoses including heart disease, renal disease, dementia, anxiety, and a history of stroke, was observed multiple times without a call light within reach. The care plan noted that the resident often misplaced the call light pendant and had a wall pendant in place, but observations showed that the resident did not have access to a call light while sitting in her recliner or ambulating out of her room. Interviews with the resident revealed that she believed her call necklace had been taken away, and she acknowledged only having a call light on the wall above her bed, which was not accessible from her recliner. The Director of Nursing confirmed that the facility's policy requires call lights to be within reach and acknowledged the deficiency. The facility's policy on call lights, revised in April 2022, states that residents who can understand and use the call light system should have it within reach, which was not adhered to in this case.
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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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How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Newton Village Health Care Center | 0 mi | ★★★★★ | 3 | 0 |
| Valley Vista For Nursing And Rehabilitation | 0.7 mi | ★★★★★ | 18 | 0 |
| Accura Healthcare Of Newton East, Llc | 1.4 mi | ★★★★★ | 25 | 0 |
| Traditions Memory Care Of Newton | 2 mi | ★★★★★ | 2 | 0 |
| Mayflower Home | 17.2 mi | ★★★★★ | 1 | 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.