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 Liberty Commons during CMS and state inspections, most recent first.
Grievance Process Not Fully Communicated to Residents: The facility’s grievance policy did not include residents’ or representatives’ right to file grievances anonymously, and posted grievance information did not explain where grievance forms were available or how to submit them anonymously. In a resident group meeting, 11 of 11 residents said they were unaware they could file anonymously, had not seen grievance forms, and believed they had to tell staff about concerns. The ADM stated residents were expected to report concerns to staff, who would then obtain and complete a grievance form on the resident’s behalf.
Resident Council grievances were not addressed or resolved in a timely manner. Residents raised concerns that CNAs were rushing during care, using ear buds while providing care, and staff were talking loudly outside rooms at night and waking them up, but the grievance book and subsequent council minutes did not show follow-up or resolution. During a group meeting, residents said the concerns were still ongoing, and the Administrator stated the issues had not been brought through the grievance process.
Unnecessary PRN Ativan Use Without Required Documentation: A resident with anxiety disorder and severe cognitive impairment had PRN Ativan orders extended beyond the 14-day limit without the required physician or extender documentation of a clinical rationale. The record showed multiple PRN Ativan orders for anxiety/agitation, including an order extension noted in a physician progress note, but the chart did not contain documentation of an evaluation or rationale for continued use, which the Unit Manager and DON both confirmed during interview.
A facility failed to follow ordered care for three residents. One resident with multiple pressure ulcers did not have weekly skin assessments documented after the last recorded check, another resident with dysphagia and severe cognitive impairment was repeatedly observed lying flat despite an order to keep the HOB at 30 to 45 degrees, and a third resident who became apneic and had no palpable pulse was pronounced dead without a physician order for RN pronouncement. The DON and unit staff acknowledged the missed documentation and order compliance issues.
A facility failed to consistently implement ordered fall precautions for several residents with cognitive impairment, weakness, and fall histories. Surveyors found missing or disconnected bed and chair alarms, absent fall mats, and repeated unwitnessed falls when required supervision and interventions were not in place. The DON acknowledged that the care plan interventions were not being followed as documented.
Failure to monitor and document significant weight loss: A resident with cerebral infarction, malnutrition, abnormal wt loss, cognitive impairment, and a mechanically altered diet had poor intake of oral supplements and lost 5.27% of body weight in one month. The record lacked updated nutrition assessments, dietitian notes, and nursing/MD/NP documentation addressing the wt loss, and the dietitian said she was unaware of the significant decline when it occurred.
Unsecured Medication Cart and Topical Treatments: An unlocked, unattended med cart was observed outside a dining room while an LPN supervised residents inside, and multiple topical treatments were found unsecured at the bedside in 9 of 16 rooms on a memory-impaired unit. The DON and Unit Manager confirmed that med carts should be locked when unattended and that topical treatments should be secured.
Failure to notify MD of significant weight loss. A resident with cerebral infarction, moderate protein-calorie malnutrition, and abnormal weight loss lost 5.27% of body weight in one month, with continued decline afterward. The record did not show MD/NP notification or progress note documentation of the weight loss, and staff interviews confirmed the loss was identified through weights but not promptly communicated to the physician.
A resident with dementia had CPAP orders requiring the mask and tubing to be stored in a plastic bag when not in use, but surveyors repeatedly observed the CPAP mask and tubing left on the bedside nightstand, resting on a telephone and open to air. Nurses and the DON stated CPAP equipment should be stored in a dated plastic bag when not in use.
The facility failed to ensure proper storage and labeling of medications, leaving carts unlocked and medications unlabeled with expiration dates. A Unit Manager left a cart unattended, and opened medications like Lantus insulin and timolol eye drops were not labeled with opening or expiration dates. Nurses were unsure of labeling requirements, and the DON acknowledged incorrect processes for test strip expiration dating.
The facility failed to maintain an effective infection prevention and control program during a COVID-19 outbreak. Staff, including a CNA, worked while symptomatic, exposing residents to the virus. The facility did not follow CDC testing guidelines for exposed residents, with inconsistencies in testing dates and documentation. Additionally, a nurse improperly handled medications, increasing contamination risk.
A resident with a history of malignant neoplasms and COPD did not receive medications per physician's orders. Nurse #1 administered only one puff of Asmanex instead of two and failed to instruct the resident to rinse their mouth afterward. The nurse admitted to being nervous under observation, and the DON confirmed the need to follow physician's orders.
A legally blind resident was found with unauthorized medications at their bedside without a proper assessment of their ability to self-administer. The facility's policy requires such an assessment, which was not conducted. The resident, with chronic kidney disease and heart failure, self-administered eye drops and antacids without physician orders or proper storage. Staff were unaware of the medications, and no assessment was done to ensure safe self-administration.
A resident requiring supplemental oxygen for comfort was found with nasal cannula tubing resting on the floor, exposing it to contaminants, and the oxygen concentrator was dusty. The resident, who was legally blind, needed staff assistance to manage the equipment. Staff acknowledged the tubing should have been stored properly and the concentrator cleaned regularly, but there was no specific order for these actions.
Grievance Process Not Fully Communicated to Residents
Penalty
Summary
The facility failed to ensure that residents were fully aware of the grievance process and their right to file grievances anonymously. Review of the facility’s undated policy titled "Grievances & Resolution of Other Issues" showed that it did not indicate residents or their representatives had the right to file grievances anonymously. During unit tours, a posted document titled "Grievances" stated that residents had the right to file a grievance in writing or orally and may do so anonymously, but it did not identify the availability or location of grievance forms or explain where or how to submit forms anonymously. During a resident group meeting with 11 residents in attendance, all 11 said they were not aware of their right to file a grievance anonymously. They stated that if they had an issue, they had to tell a staff member, and they reported they had not seen grievance forms anywhere and did not know of any place to submit them anonymously. The Administrator, who identified himself as the Grievance Officer, reviewed the policy and stated it did not include the right to file grievances anonymously. He explained that residents or their representatives were expected to tell a staff member their concern, and if it could not be addressed right away, staff would obtain a grievance form from the social worker and complete it on the resident’s behalf; he stated residents did not have access to grievance forms to complete and submit on their own anonymously.
Resident Council Grievances Not Addressed
Penalty
Summary
The facility failed to ensure grievances brought forward through Resident Council were addressed and promptly resolved. Review of the Resident Council policy showed the council was intended to provide residents a forum to discuss concerns and communicate with staff, and the grievance policy stated complaints were to be investigated promptly and the aggrieved party informed within established timeframes. However, Resident Council Minutes from 8/28/25 showed residents voiced concerns that CNAs were rushing and wanted them to slow down, and the grievance book did not show that this concern was addressed, acted upon, or followed up on. Minutes from 9/30/25 and 10/30/25 also did not show any follow-up or resolution of that concern. Resident Council Minutes from 11/20/25 showed residents raised additional concerns that CNAs were using ear buds while providing care and that staff were talking in the middle of the night outside residents’ rooms and waking them up. The grievance book did not show these concerns were addressed, acted upon, or followed up on, and the 12/30/25 Resident Council Minutes did not show follow-up on the concerns from the prior meeting. During a group meeting on 1/7/26, 11 residents said there had been no follow-up to concerns raised in the 8/28/25 and 11/20/25 meetings, and they reported that CNA rushing, loud staff conversations at night and early morning, and ear buds during care were still issues. During interview, the Administrator reviewed the concerns and stated they were not brought forward through the grievance process and he was not aware they were still a problem.
Unnecessary PRN Ativan Use Without Required Documentation
Penalty
Summary
The facility failed to ensure that Resident #84’s drug regimen was free from unnecessary psychotropic medication use when PRN Ativan orders were extended beyond the 14-day limit without documentation of a clinical rationale by the physician or physician extender. Resident #84 was admitted in June 2023 and had diagnoses including anxiety disorder. The resident’s MDS assessment dated 1/6/26 indicated severe cognitive impairment with a BIMS score of 7 out of 15 and that psychotropic medication was administered. The medical record showed an Ativan 0.5 mg every 6 hours PRN order for anxiety for 14 days beginning 4/19/25, followed by a 30-day PRN Ativan order on 4/29/25, but the record did not show documentation of the required evaluation or rationale for extending the PRN use. A physician progress note dated 8/29/25 stated to extend the PRN Ativan order for another 30 days for anxiety/agitation, but there was no current PRN Ativan order in place at that time, and the last PRN order had been initiated on 4/29/25 for 30 days. The record also showed an Ativan 0.5 mg every 6 hours PRN order for anxiety/agitation for 180 days starting 10/2/25, and again there was no documentation of a clinical rationale for extending the PRN order. During interviews, the Unit Manager and DON both stated that the record did not contain documentation showing an evaluation or clinical rationale for continued use and extension of PRN Ativan.
Failure to follow ordered skin checks, positioning, and death pronouncement requirements
Penalty
Summary
The facility failed to provide care and services consistent with professional standards for Resident #109 by not completing weekly skin assessments as ordered. The resident was admitted in November 2025 with diagnoses including a pressure ulcer of the right buttock, sepsis, and severe protein-calorie malnutrition. The resident’s MDS showed cognitive intactness with a BIMS score of 13 out of 15 and documented five unstageable pressure ulcers and a surgical wound present on admission, with pressure ulcer care being provided. The care plan included weekly skin assessment, and the physician’s order required a weekly skin check documented every Friday evening shift. The medical record for Resident #109 did not include weekly skin check documentation after 12/12/25, and there was no documentation that the resident refused the assessments after that date. During interviews, the resident stated wound care was being performed for a buttocks wound. The Unit Manager confirmed the resident was followed by a consulting wound physician, that the last weekly skin assessment she could find was documented on 12/12/25, and that the assessments should have been completed every week. The DON also stated the weekly skin assessment should have been completed and documented in the medical record. The facility also failed to follow a physician’s order for Resident #84 to keep the head of the bed elevated at 30 to 45 degrees and not lie flat. Resident #84 had diagnoses including dysphagia following cerebral infarction, GERD, and shortness of breath, and the MDS showed severe cognitive impairment with a BIMS score of 7 out of 15 and substantial to maximal assistance needed for bed mobility. The surveyor observed the resident in bed multiple times with the head of bed flat, including while asleep and awake, despite the order for elevation. Nursing documentation on the January 2026 MAR/TAR indicated the head of bed was positioned between 30 and 45 degrees at the same times the surveyor observed it flat. A nurse and the Unit Manager acknowledged the head of bed was supposed to be elevated but was not, and the DON stated it should have been elevated and accurately documented according to the physician’s order. The facility further failed to obtain a physician’s order for RN pronouncement of death for Resident #138. The resident was admitted in December 2025 with diagnoses including a displaced fracture of the medial condyle of the right tibia and a history of falls. A nursing progress note documented that the resident developed shortness of breath and chest pain while working with therapy, was assessed, found to have no palpable pulse, became apneic, and was pronounced dead at 10:20 A.M. The medical record did not show that an order for RN pronouncement of death had been obtained. The DON reviewed the record and stated that a physician’s order for RN pronouncement was not obtained as required.
Failure to Implement Fall Alarms and Supervision
Penalty
Summary
The facility failed to provide adequate supervision and to implement fall-related interventions for four residents with documented fall risk and cognitive or physical impairments. The report states that the facility did not consistently use ordered alarms or fall mats, and in one case did not maintain effective interventions after repeated unwitnessed falls. The deficiencies involved residents with altered mental status, Alzheimer’s disease, severe cognitive impairment, hemiplegia/hemiparesis after stroke, weakness, and histories of falls. For one resident with moderate cognitive impairment and a history of falls, the care plan and Kardex required a seat/chair alarm when out of bed without direct supervision. After a fall in which the resident stood from a wheelchair and fell before a gait belt could be applied, no alarms were in place. After another unwitnessed fall in the resident’s room, the chair alarm was again not in place. Nursing staff and the DON acknowledged that the alarm should have been in place and had not been removed from the care plan. For another resident with severe cognitive impairment and a history of falls, the care plan required a personal alarm without direct supervision. The resident fell while seated in a recliner in the dayroom after scooting toward the edge and losing balance, and there was no chair alarm in place. The DON stated the alarm was not transferred when the resident moved from the wheelchair to the recliner, and the resident should have been supervised in the dayroom. A third resident with right-sided hemiplegia and hemiparesis, severe cognitive impairment, and a history of falls had multiple falls between April 2025 and January 2026. The care plan and Kardex included interventions such as a motion sensor in bed, a personal alarm, assistance back to bed after meals, wheelchair brake use, and fall mats. The record showed several falls occurred when these interventions were not in place, including times when the resident was left alone in the room, when the bed motion sensor was not in place, when the personal alarm was not in the wheelchair, and when only one mat was observed despite the expectation of mats on both sides of the bed. The DON stated that for three of the five falls, staff did not implement the interventions in place for the resident’s fall risk. For a fourth resident with weakness, moderate cognitive impairment, substantial to maximum ADL assistance needs, and a history of falls, the care plan required a bed alarm, low bed with mats, and a seat/chair alarm when out of bed in a wheelchair. Survey observations showed the bed alarm cord was disconnected from the alarm box and lying on the floor, no mats were present beside the bed, and no seat alarm was in place while the resident sat in a positioning chair. The unit manager stated it was the responsibility of staff to ensure the mats were in place and the bed alarm was connected and functioning, and the DON stated staff should implement fall care plan interventions at all times.
Failure to Monitor and Document Significant Weight Loss
Penalty
Summary
The facility failed to monitor and address the nutritional status of one resident who had an unplanned significant weight loss. The resident was admitted with diagnoses including cerebral infarction, moderate protein-calorie malnutrition, and abnormal weight loss, and the most recent MDS showed cognitive impairment with a BIMS score of 3 out of 15, a mechanically altered diet, and the need for staff supervision while eating. The resident also had physician orders for a moist ground diet, oral nutritional supplements, and weekly weights. The resident’s weight record showed a decline from 239.0 lbs. to 226.4 lbs. over one month, which represented a 5.27% weight loss. The resident continued to lose weight after that point, with weights documented at 226.0 lbs. and then 221.6 lbs. The MARs also showed poor intake of the Mighty Shake supplement, with 50% or less intake documented repeatedly, and several refusals of Ensure. The facility’s policy stated that significant weight loss should be reported and addressed, and that the dietitian should review weight trends and document negative trends. Despite the weight loss and ongoing poor intake, the record did not show additional nutrition assessments after the initial 12/1/25 assessment, and there were no dietitian progress notes after 11/26/25. The medical record also lacked documentation from nursing, the MD, or the NP addressing the significant weight loss. During interviews, nursing staff stated that weight loss would typically trigger follow-up and notification, while the dietitian said she was unaware of the significant weight loss on 12/22/25 and had not completed documentation since the resident’s readmission. The DON stated that the medical record should reflect documentation of the resident’s weight loss.
Unsecured Medication Cart and Topical Treatments
Penalty
Summary
The facility failed to ensure drugs and biologicals were stored in accordance with currently accepted professional principles. On 1/8/26 at 8:30 A.M., the surveyor observed an unlocked, unattended medication cart positioned outside the main dining room on the Oyster Pond unit, which serves memory impaired residents. Nurse #1 was supervising residents in the dining room, but the medication cart was not in her line of sight, and no other staff were nearby. During the observation period, a visitor, maintenance staff, housekeeping staff, and activity staff walked by the unlocked cart. Nurse #1 later stated that she was responsible for the cart and forgot to lock it before going into the dining room and leaving it unattended. The facility also failed to secure topical treatments on the Oyster Pond North unit. On 1/6/26 at 9:00 A.M. and again on 1/8/26 at 11:42 A.M., the surveyor and Unit Manager #3 observed multiple topical products left at the bedside in 9 of 16 resident rooms on the unit, which serves memory impaired residents. Items observed unsecured and easily accessible included Desitin cream, PeriShield with zinc oxide, shaving cream, and Biofreeze in multiple rooms. Unit Manager #3 stated that the topical treatments found in residents' rooms should be secured and not left at the bedside.
Failure to Notify Physician of Significant Weight Loss
Penalty
Summary
The facility failed to notify the physician of a significant change in condition for one resident, specifically a 5.27% weight loss over one month. The resident was admitted with diagnoses including cerebral infarction, moderate protein-calorie malnutrition, and abnormal weight loss. The medical record showed a weight of 239.0 lbs. after return from hospitalization, followed by 226.4 lbs. one month later, with continued loss to 226.0 lbs. and then 221.6 lbs. The facility’s policy required notification of the attending or on-call physician for a significant change in condition and required significant weight loss to be reported to the nurse supervisor, with physician and health care proxy notification. The record did not indicate notification of the MD or NP regarding the significant weight loss, and the MD/NP progress notes did not document the weight loss. During interviews, nursing staff stated that weight loss is typically identified through the medical record, then brought to the unit manager or dietitian, with physician notification and documentation expected. The dietitian stated she reviewed weights weekly and was not aware of the resident’s significant weight loss until later review, and she had not notified the physician because she was waiting for a reweight. The DON stated weights are reviewed weekly by the dietitian and that physician notification of weight loss should be documented in the medical record.
CPAP Equipment Left Unstored
Penalty
Summary
Provide and implement an infection prevention and control program was deficient for one resident, who was admitted in August 2025 with diagnoses including dementia. The resident had physician orders dated 8/12/25 for CPAP use at night, including filling the water chamber with distilled water to the fill line before use and storing the CPAP parts and tubing in a plastic bag when not in use. Surveyors observed the resident’s CPAP mask and tubing left on the bedside nightstand resting on a telephone and left open to air on 1/6/26 at 9:26 A.M. and 12:51 P.M., on 1/7/26 at 8:41 A.M. and 12:16 P.M., and on 1/8/26 at 8:04 A.M. During interviews, Nurse #3, Nurse #4, and the DON stated that CPAP equipment should be stored in a dated plastic bag when not in use and after cleaning.
Medication Storage and Labeling Deficiencies
Penalty
Summary
The facility failed to ensure that all medications were stored and labeled according to accepted professional principles. Specifically, medication carts were left unlocked and unattended, and medications were not properly labeled with expiration dates once opened. On one occasion, a Unit Manager left a medication cart unlocked and unattended while retrieving an over-the-counter medication, acknowledging the oversight during an interview. The Director of Nursing confirmed that medication carts should be locked when unattended. Additionally, the facility did not label medications with shortened expiration dates once opened. During a review of the Oyster Pond medication cart, a bottle of Assure Platinum glucometer test strips was found opened and unlabeled with the date of opening or expiration. The Unit Manager was unsure of the labeling requirements and the duration for which the test strips remained viable. Similar issues were observed with the Pleasant Bay East and North medication carts, where opened vials of Lantus insulin and timolol maleate eye drops were not labeled with the date of opening or expiration. Nurses acknowledged the oversight and expressed uncertainty about the labeling requirements and the duration of medication viability. The Director of Nursing admitted that the facility's process for labeling test strip bottles was incorrect, as they were using the manufacturer's expiration date instead of the 90-day period post-opening. The DON also confirmed that Lantus insulin is only good for 28 days after opening, and although unsure about the eye drops, acknowledged that they should have been labeled with the date of opening. The purpose of these short expiration dates is to maintain medication potency and prevent contamination.
Infection Control Deficiencies During COVID-19 Outbreak
Penalty
Summary
The facility failed to maintain an effective infection prevention and control program during a COVID-19 outbreak. Staff members, including a Certified Nurse Assistant (CNA), reported to work while experiencing symptoms consistent with COVID-19, such as nasal congestion, headache, and shortness of breath. The CNA worked a shift while symptomatic and only tested for COVID-19 after feeling progressively worse, resulting in a positive test. This action exposed several residents to the virus, as the CNA had close contact with them during her shift. The facility's policy required symptomatic staff to test for COVID-19 before starting work, but there was no evidence that the CNA was educated on this requirement. The facility also failed to adhere to COVID-19 testing guidelines for residents following known exposure. Nine residents were exposed to COVID-19 positive staff members, but the facility did not conduct testing in accordance with the Centers for Disease Control and Prevention (CDC) guidance. The residents were not tested within the recommended timeframe of 24 hours after exposure and every 48 hours thereafter. The facility's records showed inconsistencies in testing dates and a lack of documentation for some scheduled tests, indicating a failure to follow the established testing protocol. Additionally, the facility did not ensure proper handling of medications to prevent potential transmission of pathogens. During a medication administration, a nurse picked up pills that had fallen onto a resident's bedding with her bare hands and administered them without performing hand hygiene or wearing gloves. This action violated infection control practices and increased the risk of contamination. The nurse acknowledged the mistake, and the Director of Nursing confirmed that the medications should have been disposed of and replaced.
Medication Administration Deficiency
Penalty
Summary
The facility failed to ensure professional standards of practice were followed in the administration of medications for a resident. Specifically, the nursing staff did not administer medications per the physician's orders and manufacturer's recommendations. The facility's policy on medication administration emphasizes the importance of the 'Five Rights' and a triple check process to ensure the correct administration of medications. However, during an observation, Nurse #1 administered only one puff of Asmanex Twisthaler to a resident instead of the prescribed two puffs and did not instruct the resident to rinse their mouth after inhalation, as required by the physician's orders and the manufacturer's guidelines. The resident involved had a history of malignant neoplasms and chronic obstructive pulmonary disease, and was cognitively intact. The physician's orders specified that the resident should receive two puffs of Asmanex daily and rinse their mouth afterward to reduce the risk of candidiasis. During the survey, Nurse #1 initially administered only one puff and failed to offer water for rinsing. Upon the surveyor's intervention, the nurse administered the second puff. The nurse admitted to being nervous under observation and acknowledged the oversight. The Director of Nursing confirmed that staff should adhere to physician's orders for medication administration.
Failure to Ensure Safe Medication Administration for Legally Blind Resident
Penalty
Summary
The facility failed to provide a safe environment free from accident hazards for a resident who was legally blind. The resident was found with unauthorized medications at the bedside, including Refresh artificial tears and TUMS antacids, without a proper assessment of their ability to self-administer these medications. The facility's policy requires an assessment of a resident's mental and physical capabilities before allowing self-administration of medications, which was not conducted in this case. The resident, who was admitted with chronic kidney disease stage 3 and chronic diastolic heart failure, was observed with medications on their overbed tray table. The resident claimed to self-administer the medications as needed, despite being legally blind and unable to specify the dosage or frequency of use. There was no physician's order for the eye drops, and the antacids were not authorized for bedside storage or self-administration. Interviews with facility staff, including a nurse and the unit manager, revealed a lack of awareness about the medications at the resident's bedside. The staff admitted that no assessment had been conducted to determine the resident's capability to self-administer medications safely. The Director of Nursing confirmed that an assessment should have been performed and that medications should be stored securely, but this was not done for the resident in question.
Failure to Maintain Sanitary Conditions for Oxygen Equipment
Penalty
Summary
The facility failed to provide necessary respiratory care and services for a resident, specifically in maintaining oxygen equipment in sanitary conditions. The resident, who was cognitively intact but legally blind, required supplemental oxygen for comfort due to shortness of breath. Observations revealed that the nasal cannula tubing was left on the floor, exposing it to potential contaminants, and was not stored in the protective bag as per facility policy. Additionally, the oxygen concentrator was observed to be dusty, indicating a lack of regular cleaning. Interviews with the resident and staff confirmed that the resident needed assistance with the oxygen equipment due to impaired vision and inability to operate it independently. Nurse #5 acknowledged that the tubing should not have been on the floor and should have been stored properly, and that the concentrator should be wiped down regularly. However, there was no specific order for cleaning the concentrator, and the Director of Nursing confirmed that while the machines do get dusty, there was no directive to clean them on an as-needed basis.
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What surveyors actually found near you
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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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Illustrative
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Nursing homes near North Chatham
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Cape Cod Post Acute Care | 3.1 mi | ★★★★★ | 0 | 0 |
| Regalcare At Harwich | 6.3 mi | ★★★★★ | 7 | 0 |
| Windsor Nursing & Retirement Home | 11.2 mi | ★★★★★ | 6 | 0 |
| Mayflower Place Nursing & Rehabilitation Center | 15.3 mi | ★★★★★ | 8 | 0 |
| Pavilion , The | 18.5 mi | ★★★★★ | 0 | 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.