Average — CMS composite of the measures below.
The next survey window likely opens around November 2026
Estimate from public CMS data, current as of August 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Aspen Transitional Rehabilitation during CMS and state inspections, most recent first.
A resident with significant mobility limitations and a care plan requiring two-person assistance for transfers was transferred by a CNA alone, contrary to documented protocols. This resulted in the resident falling and sustaining a fracture that required hospitalization and surgery.
The facility did not ensure an RN was present for at least 8 consecutive hours each day, with several days lacking consecutive RN coverage or any RN coverage at all. The DON was unaware of the requirement for consecutive hours and confirmed the absence of an RN on one of the days in question.
A resident with multiple medical conditions, including CHF and diabetes, was care planned for two-person or mechanical lift transfers. Despite this, a CNA performed a solo transfer, resulting in the resident falling and sustaining a knee fracture that required surgery.
Nurses failed to administer pain medications according to provider orders for three residents with fractures and pain management needs. Pain medications were given outside the prescribed pain level ranges, and the DON confirmed that provider orders were not followed, despite resident preferences.
Surveyors found that an LPN left a medication cart unlocked and unattended, stored refused medications in the cart for later use, and left prepared medications unsupervised on the cart. In the medication storage room, the refrigerator for narcotics was unlocked and a box containing Lorazepam was not permanently affixed, contrary to facility expectations for secure storage.
An LPN was observed preparing and administering insulin to a resident without performing hand hygiene prior to donning gloves or before the injection, instead only performing hand hygiene after glove removal. The LPN acknowledged the lapse, and facility leadership confirmed that the expected practice is to perform hand hygiene and don fresh gloves before administering injections.
The facility failed to maintain a clean kitchen environment, with undated food items and improper storage near a flaking water heater pipe. The freezer had issues with ice build-up and improperly closed ice cream containers, acknowledged by the NSD as due to a faulty door.
A resident with multiple diagnoses, including a fracture and Parkinson's disease, reported an incident where aides told her to urinate in her pad instead of assisting her to the bathroom. Despite reporting this to an LPN, the grievance was not documented in the facility's log, violating the grievance policy. The LPN educated one aide but did not take further action, potentially causing psychological harm to the resident.
An LPN in a facility failed to prime insulin pens before administering doses to two residents with diabetes, leading to medication errors. The lack of priming, which is necessary to ensure the correct insulin dose, was acknowledged by the LPN after the incidents.
The facility failed to implement consistent infection control measures for two residents. A CNA did not assist a resident with dementia in performing hand hygiene after using the toilet. An LPN did not wear a gown or perform hand hygiene between glove changes while changing a PEG tube dressing for a resident under enhanced barrier precautions.
Failure to Follow Transfer Protocols Resulting in Resident Injury
Penalty
Summary
The facility failed to protect a resident from neglect during a transfer, resulting in a fall with injury. The resident, who had multiple diagnoses including congestive heart failure, bilateral lower leg lymphedema, and diabetes, was care planned and assessed as requiring a two-person assist or use of a Hoyer mechanical lift for transfers. Documentation in the resident's care plan and physical therapy reports indicated that extensive two-person assistance was necessary for all transfers, and these requirements were communicated to the interdisciplinary team. Despite these documented needs, a CNA assisted the resident alone during a transfer from a chair to standing, contrary to the care plan and physical therapy recommendations. During this transfer, the resident's knee buckled, resulting in a fall that caused a fracture requiring hospitalization and surgical repair. The CNA was aware of the resident's transfer status but chose to proceed without the required assistance, leading to the incident.
Failure to Provide 8 Consecutive Hours of RN Coverage Daily
Penalty
Summary
The facility failed to ensure the presence of a registered professional nurse (RN) for at least 8 consecutive hours per day, as required by regulations. Review of the nursing schedule from 11/23/25 through 12/13/25 showed that on multiple dates, including 11/23/25, 11/29/25, 11/30/25, 12/6/25, 12/7/25, and 12/13/25, there were either no consecutive RN hours or no RN coverage at all. Specifically, on 12/7/25, there was no RN on duty. During an interview, the DON stated she was unaware that the required 8 hours of RN coverage must be consecutive and confirmed the absence of an RN on 12/7/25. This deficiency had the potential to affect all residents in the facility who may require a higher level of nursing assessment or intervention, as there was not consistent RN coverage as mandated.
Failure to Follow Resident Transfer Care Plan Results in Injury
Penalty
Summary
The facility failed to ensure that a comprehensive, person-centered care plan was developed and implemented to meet the needs and preferences of a resident with multiple diagnoses, including congestive heart failure, bilateral lower leg lymphedema, and diabetes. The resident's care plan specified that transfers should be performed using a Hoyer mechanical lift or with the assistance of two staff members, as directed by Physical Therapy and documented in the care plan. However, on the date of the incident, a CNA assisted the resident from her chair to standing without the required second staff member, contrary to the care plan instructions. During this transfer, the resident's knee buckled, resulting in a fall and subsequent injury. The resident was sent to the emergency room and diagnosed with a fracture of the right distal knee, which required surgical repair. Staff interviews confirmed that the CNA was aware of the resident's two-person transfer status but chose to proceed alone, leading to the incident.
Failure to Follow Provider Orders for Pain Medication Administration
Penalty
Summary
Nurses at the facility failed to follow provider orders for pain medication administration, as evidenced by medication administration records (MARs) and staff interviews. For three residents with multiple diagnoses including fractures and a history of falls, pain medications were given outside the prescribed pain level ranges. Specifically, one resident received oxycodone for pain levels below the ordered threshold on multiple occasions, while another was given ibuprofen and oxycodone for pain levels not matching the provider's specified range. A third resident was administered oxycodone for pain levels above the ordered range on two consecutive occasions. The Director of Nursing (DON) confirmed that nurses did not follow provider orders and acknowledged that resident preference does not supersede provider orders. These actions were identified through record review and staff interviews, demonstrating a failure to ensure that nursing services met professional standards of quality as required.
Medication Storage and Security Deficiencies
Penalty
Summary
Surveyors observed multiple failures in the facility's medication storage and handling practices. One medication cart was found unlocked and unattended for several minutes, contrary to facility expectations that carts remain locked when not in the nurse's sight. An LPN admitted to leaving the cart unsecured and also reported a routine practice of storing refused, prepared medications in the cart for later administration, instead of disposing of them as required. Additionally, the LPN was seen leaving a prepared liquid medication unattended on top of the medication cart while retrieving another medication from a separate room, leaving the medication unsupervised. Further deficiencies were identified in the medication storage room, where the refrigerator used for narcotic storage was found unlocked and unmonitored. Inside the refrigerator, a black metal box containing Lorazepam was not permanently affixed, as required for controlled substances. The DON and CNM confirmed these practices, with the DON stating that the expectation was for all controlled substances to be securely stored and for medications to never be left unattended or stored improperly.
Failure to Maintain Hand Hygiene During Insulin Administration
Penalty
Summary
The facility failed to maintain proper infection prevention and control practices during medication preparation and administration. Specifically, an LPN was observed preparing a resident's insulin at the medication cart, donning gloves, and then touching the resident's insulin pens and the resident's door with gloved hands without performing hand hygiene prior to donning gloves or before administering the insulin injections. Hand hygiene was only performed after glove removal and prior to leaving the resident's room. During an interview, the LPN acknowledged that hand hygiene should have been performed prior to donning gloves after entering the resident's room and before administering the injections. The DON, with the CNM present, confirmed that the expectation is for nurses to perform hand hygiene and don fresh gloves after entering a resident's room and prior to administering injections.
Deficiencies in Kitchen Sanitation and Food Storage
Penalty
Summary
The facility failed to maintain a clean and sanitary kitchen environment, as observed during inspections. In the dry food pantry, baking trays, pots, and pans were stored on shelves adjacent to a water heater pipe with flaking insulation, resulting in debris on the shelves and floor. Additionally, several food items, including a box of cornmeal, refrigerated green onions, frozen bread loaves, and veggie sausage patties, were found undated, contrary to the facility's Food Storage policy. The policy requires date marking on all high-risk foods to ensure they are consumed, sold, or discarded by the appropriate date. Further inspection revealed issues with the freezer, where ice cream containers had lids that were not fully closed, and ice droplets were noted on the ceiling above them. A large amount of ice was also found inside a plastic bin containing wrapped frozen bread, with ice droplets on the ceiling above the bin and a cardboard box on the top shelves of the freezer. The Nutritional Services Director acknowledged that the freezer door did not close well, leading to ice build-up and melting incidents. The storage shelves affected by pipe insulation particles contained unused pots, pans, and baking containers that should have been stored elsewhere.
Failure to Document and Address Resident Grievance
Penalty
Summary
The facility failed to properly document and address a grievance reported by a resident, which is a violation of the resident's rights to voice grievances without discrimination or reprisal. The grievance policy of the facility, updated on September 28, 2022, requires that grievances be promptly investigated and resolved, with documentation of the date received, steps taken to investigate, and corrective actions. However, in the case of Resident #135, who was admitted with multiple diagnoses including a fracture of the left thigh and Parkinson's disease, this process was not followed. The resident reported an incident where she was told by two aides to urinate in her pad instead of being assisted to the bathroom, which she found distressing. Despite reporting the incident to an LPN, the grievance was not documented in the facility's grievance log for September 2024. The LPN acknowledged being informed of the incident and stated that one of the aides was educated on appropriate language and behavior, but did not believe further action was necessary. This lack of documentation and inadequate response to the grievance had the potential to cause psychological harm to the resident, as her concerns were not formally acknowledged or addressed according to the facility's policy.
Failure to Prime Insulin Pens Leads to Medication Errors
Penalty
Summary
The facility failed to ensure residents were free from medication errors, specifically in the administration of insulin. This deficiency was observed in two residents with diabetes, who were administered insulin without the proper priming of the insulin pens. Priming is necessary to remove air from the needle and cartridge, ensuring the correct dose is delivered. The American Diabetes Association and the Insulin Lispro Kwikpen guidelines both recommend priming before each injection to ensure full dose administration. In the observed incidents, an LPN administered insulin to two residents without priming the insulin pens. For one resident, the LPN replaced the needle and dialed the pen to the prescribed units for both Insulin Lispro and Lantus but did not prime the pens before injection. Similarly, for the second resident, the LPN followed the same procedure without priming the pens. When questioned, the LPN admitted to not priming the pens and acknowledged that priming should have been done before administering the insulin doses.
Infection Control Deficiencies in Resident Care
Penalty
Summary
The facility failed to consistently implement infection control measures, as observed in the care of two residents. Resident #85, who was admitted with multiple diagnoses including dementia, was assisted by a CNA to the bathroom. After using the toilet, the CNA did not assist the resident in performing hand hygiene, despite acknowledging that it should have been done. This oversight was a direct violation of the facility's hand hygiene policy, which mandates handwashing after personal use of the toilet. In another instance, Resident #83, who had a feeding tube and was under enhanced barrier precautions, did not receive proper infection control measures during a dressing change. An LPN was observed changing the dressing on the resident's PEG tube site without wearing a gown, as required by the signage on the resident's door. Additionally, the LPN did not perform hand hygiene between glove changes during the procedure, stating that her hands were clean and only the gloves were dirty. The Infection Preventionist later confirmed that a gown should have been worn and hand hygiene should have been performed between glove changes.
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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 Meridian
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Meridian Meadows Transitional Care | 1.2 mi | ★★★★★ | 26 | 0 |
| Life Care Center Of Treasure Valley | 3.1 mi | ★★★★★ | 0 | 0 |
| Creekside Transitional Care And Rehabilitation | 3.6 mi | ★★★★★ | 0 | 0 |
| Timber Springs Transitional Care | 4.4 mi | ★★★★★ | 19 | 0 |
| Cascadia Of Boise | 4.9 mi | ★★★★★ | 11 | 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 August 2026) and official state health department websites.