Above average — CMS composite of the measures below.
Past the typical resurvey interval — a standard survey could occur at any time
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 Casa De Ramana Rehabilitation Center during CMS and state inspections, most recent first.
The facility failed to provide readily accessible grievance forms for residents, affecting seven out of 13 residents during a Resident Council meeting. Although policy stated forms should be available on each floor, they were instead kept in a file cabinet behind the nurses' station, requiring residents to request them from staff. This hindered residents' ability to file complaints anonymously, as acknowledged by the Administrator.
A facility failed to accurately complete a Level I PASARR for a resident with Bipolar Disorder, leading to the omission of a necessary Level II evaluation. The resident had a history of emergency psychiatric services, but the screening incorrectly indicated no mental illness or recent psychiatric hospitalization. The facility's policy requires a Level II evaluation for suspected serious mental illness, which was not conducted.
A resident with muscle weakness and cognitive impairments was not assisted with ambulation after being discontinued from PT services due to insurance issues. Despite a care plan indicating the need for staff assistance with a rolling walker, facility staff failed to provide the necessary support, as confirmed by documentation and staff interviews.
A resident with significant medical conditions and a left-hand contracture was not provided with necessary personal hygiene assistance, resulting in untrimmed and dirty fingernails, including a potential fungal infection. Despite the resident's need for partial to moderate assistance, facility staff failed to ensure regular nail care, and there was a lack of communication and awareness among staff regarding the resident's needs.
A facility failed to complete the required MDS entry tracking record for a resident readmitted after a hospital discharge. The resident, diagnosed with Striatonigral Degeneration and Adult Failure to Thrive, was discharged with return anticipated but lacked an entry tracking record upon reentry. The MDS Coordinator admitted the oversight, noting the absence of a specific policy for MDS assessments, relying instead on the RAI manual.
A facility failed to accurately code the MDS assessment for a resident, leading to a misrepresentation of limb restraint usage. The resident, with conditions like hemiplegia and hydrocephalus, used a custom wheelchair with bilateral leg straps as a positioning device. The MDS assessment incorrectly indicated restraint use in bed, while observations showed no restraints in bed, and the MDS nurse confirmed the error.
A resident with moderate cognitive impairment was improperly restrained in a tilt-back wheelchair by two CNAs using a blanket tied behind the chair to prevent disrobing. This restraint, intended to preserve dignity, was left in place for at least three hours until discovered by another staff member. The facility's policy on physical restraints was not followed, as the restraint was used for staff convenience rather than the resident's safety.
A resident with moderate cognitive impairment was left unattended and secured in a wheelchair for several hours after a CNA tied a blanket around them to prevent disrobing. Despite witnessing the incident, another CNA did not report it, and the nurse on duty was unaware. The situation was discovered by an OT, revealing a failure to follow the facility's abuse prevention policy.
Grievance Forms Not Readily Available to Residents
Penalty
Summary
The facility failed to ensure that grievance or complaint forms were readily available to residents during their stay, affecting seven out of 13 residents who attended a Resident Council group meeting. The facility's policy indicated that residents should have access to these forms on every floor, located at bulletin board areas and near elevators. However, during a tour and interviews conducted by the surveyor, it was observed that the forms were not available in the designated wall-mounted folders on any of the three nursing units. Instead, the forms were kept in a file cabinet behind the nurses' station, requiring residents to request them from nursing staff. During a group meeting, several residents expressed concerns about the unavailability of grievance forms, stating that they had to ask nursing staff for the forms to file a complaint. The facility's Administrator acknowledged that the forms should have been readily accessible on each floor to allow residents to file complaints anonymously, but they were not. This lack of accessibility to grievance forms hindered residents' ability to voice their concerns without involving staff, contrary to the facility's stated policies.
Failure to Complete Accurate PASARR Screening
Penalty
Summary
The facility failed to accurately complete a Level I Preadmission Screening and Resident Review (PASARR) for a resident, which is necessary to determine if a resident has an intellectual or developmental disability and/or serious mental illness requiring further evaluation. Specifically, the facility did not correctly document that the resident had a diagnosis of Bipolar Disorder and had received emergency psychiatric services within the last two years. This oversight resulted in the failure to conduct a required Level II PASARR Evaluation. The resident was admitted with diagnoses including Bipolar Disorder, Anxiety Disorder, and Major Depressive Disorder. Despite this, the PASARR Level I Screening inaccurately indicated that the resident did not have a documented mental illness or require psychiatric hospitalization in the past two years. The facility's policy mandates that individuals suspected of having a serious mental illness be referred for a Level II evaluation, which was not done in this case. The social worker acknowledged the error, noting that a new Level I PASARR should have been completed and a Level II evaluation requested.
Failure to Assist Resident with Ambulation Post-PT Discontinuation
Penalty
Summary
The facility failed to maintain or improve the functional mobility of a resident who was discontinued from Physical Therapy (PT) services due to a lack of insurance coverage. The resident, who was admitted with diagnoses including muscle weakness, Wernicke's Encephalopathy, Metabolic Encephalopathy, and Cognitive Communication Deficit, required assistance with ambulation. Despite the care plan indicating that the resident could ambulate with the assistance of one staff member and a rolling walker, the facility staff did not provide the necessary assistance after PT services were discontinued. Observations and interviews revealed that the resident was not assisted with ambulation by the staff, as confirmed by the Certified Nurses Aide (CNA) Clinical Flow Sheet Documentation, which showed no ambulation in October and November 2024. The Rehabilitation Director and the Director of Nursing (DON) were unaware that the resident had not been assisted with ambulation, and the CNAs did not understand the resident's plan of care. This lack of action led to a deficiency in providing adequate care and services to maintain the resident's ability to perform activities of daily living.
Failure to Provide Adequate Personal Hygiene Assistance
Penalty
Summary
The facility failed to provide necessary assistance with activities of daily living (ADLs) for a resident who required partial to moderate assistance with personal hygiene. The resident, who was cognitively intact and had a history of significant medical conditions including hemiplegia and hemiparesis, was observed with untrimmed and dirty fingernails, including a potential fungal infection on one nail. Despite the resident's inability to independently manage personal hygiene due to a left-hand contracture, the facility staff did not ensure regular cleaning and trimming of the resident's nails, as was required by the facility's ADL Support Guideline. Interviews with the nursing and rehabilitation staff revealed a lack of awareness and communication regarding the resident's nail care needs. The nurse on duty was unaware of the potential fungal infection and the condition of the resident's nails, while the rehabilitation staff did not recall reporting the issue to nursing despite observing the need for nail care. The Director of Nursing acknowledged that nail trimming and cleaning should be performed as needed and during weekly skin inspections, but there was no evidence that the resident had refused such care. This oversight in providing essential personal hygiene assistance contributed to the deficiency identified by the surveyors.
Failure to Complete MDS Entry Tracking Record for Readmitted Resident
Penalty
Summary
The facility failed to complete the required Minimum Data Set (MDS) entry tracking record for a resident who was readmitted to the facility after being discharged to an acute care hospital with the expectation of return. The Centers for Medicare and Medicaid Services (CMS) Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual mandates that an entry tracking record must be completed every time a resident is admitted or readmitted to a nursing home. This record must be completed within 7 days after the admission or reentry and submitted no later than the 14th calendar day after the entry. However, for this resident, no entry tracking record was found in their clinical record following their readmission. The resident in question was initially admitted to the facility with diagnoses including Striatonigral Degeneration and Adult Failure to Thrive. They were discharged to the hospital and subsequently readmitted to the facility three days later. Despite the requirement, the facility did not complete the entry tracking record upon the resident's return. During an interview, the MDS Coordinator acknowledged that the entry tracking record should have been completed but was not. The facility lacked a specific policy and procedure for the completion of MDS assessments and tracking, relying instead on the RAI manual as a guide.
Inaccurate MDS Coding for Limb Restraint Usage
Penalty
Summary
The facility failed to ensure that the Minimum Data Set (MDS) assessments were accurately coded for a resident, leading to a deficiency in the documentation of limb restraint usage. Specifically, the MDS assessment for a resident did not accurately reflect the use of limb restraints while the resident was in their wheelchair and out of bed, but incorrectly indicated the use of restraints while in bed. This discrepancy was identified during a survey when the resident was observed without limb restraints while in bed, contradicting the MDS assessment. The resident in question was admitted with diagnoses including hemiplegia, hydrocephalus, and left foot drop, and utilized a custom wheelchair with bilateral leg straps as a positioning device. The care plan and physician's orders specified the use of these straps to prevent falls and facilitate participation in the community, with instructions to release and reposition the straps regularly. However, the MDS assessment failed to accurately document this usage, leading to a misrepresentation of the resident's restraint status during the observation period. The MDS nurse acknowledged the error, confirming that the resident did not use limb restraints while in bed.
Resident Restrained with Blanket for Staff Convenience
Penalty
Summary
The facility failed to ensure that a resident was free from the use of physical restraints imposed for staff convenience. On a specific date, during the overnight shift, two CNAs transferred a moderately cognitively impaired resident into a tilt-back wheelchair. One of the CNAs placed a blanket across the resident's torso and lap area and tied it behind the wheelchair, securing it snugly in place. This action was taken to prevent the resident from disrobing, a behavior noted in the resident's history. The resident was left in this restrained position for at least three hours until discovered by a staff member on the following shift. The facility's policy on the use of physical restraints indicates that restraints should only be used for the safety and well-being of residents and only after other alternatives have been unsuccessful. The policy defines a physical restraint as any method or device that restricts a resident's freedom of movement and cannot be easily removed by the resident. In this case, the blanket tied behind the wheelchair met the criteria for a physical restraint, as it restricted the resident's movement and was not easily removable by the resident. Interviews with staff revealed that CNA #1 tied the blanket to preserve the resident's dignity, as the resident frequently disrobed. CNA #2 witnessed the action but did not report it to the nurse on duty. The nurse, who was unaware of the restraint, had been in the room after the incident but did not notice the blanket was tied. The incident was only discovered when an occupational therapist attempted to reposition the resident's wheelchair. The facility's investigation concluded that the action was technically a restraint, despite the CNA's intention to maintain the resident's dignity.
Failure to Report and Address Resident Restraint
Penalty
Summary
The facility failed to implement and follow its Abuse Policy for a resident with moderate cognitive impairment. On the morning of August 14, 2024, a Certified Nurse Aide (CNA) placed a blanket across the resident's lap and torso, securing it by tying it behind the wheelchair. This action was taken to prevent the resident from disrobing, as the resident had a behavior of frequent disrobing. However, this act resulted in the resident being left unattended and secured in the wheelchair for at least three hours until discovered by another staff member. The facility's policy mandates that any staff observing suspected abuse must remove the resident from danger immediately and report the incident to a licensed nurse. Despite witnessing the incident, a second CNA did not report it to the nurse or administration. The nurse on duty was unaware of the situation as it was not communicated to her by either CNA. The incident was only discovered when an Occupational Therapist attempted to reposition the resident's wheelchair and found the blanket tied tightly, preventing the resident from self-rising. Interviews with the involved staff revealed that the CNA who tied the blanket believed it was the best way to maintain the resident's dignity. However, the second CNA, who questioned the action, failed to report it. The Director of Nurses confirmed that the incident was not reported to the administration as required by the facility's policy, highlighting a breakdown in communication and adherence to the abuse prevention guidelines.
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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 Framingham
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Carlyle House | 0.7 mi | ★★★★★ | 2 | 0 |
| St Patrick's Manor | 1.2 mi | ★★★★★ | 0 | 0 |
| Bethany Skilled Nursing Facility | 1.5 mi | ★★★★★ | 0 | 0 |
| Eliot Center For Health And Rehabilitation | 2.6 mi | ★★★★★ | 1 | 0 |
| Oak Knoll Rehabilitation And Healthcare Center | 3.3 mi | ★★★★★ | 2 | 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.