Above 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 Life Care Center Of Stoneham during CMS and state inspections, most recent first.
Homelike Environment Not Maintained in Resident Rooms: Surveyors observed widespread damage in resident rooms on the 1st and 2nd floors, including chipped and peeling paint, gouged walls, cracked and peeling furniture, missing drawer handles, stained ceiling tiles, and damaged baseboards. An interview with the Maintenance Director showed he was not aware of room updates or furniture replacement needs, and the Administrator stated there were no plans or purchase orders to address the condition of the rooms or furniture.
Medication Labeling and Storage Deficiencies: A surveyor found inhalers, eye drops, and liquid protein left in carts and hallways without proper labels or dates opened, and some items were stored in an accessible vital sign cart rather than a locked area. An RN and another nurse acknowledged the unlabeled items and stated the inhalers had been forgotten and the eye drops should have been labeled with the date opened.
Failure to Monitor Pacemaker/Defibrillator per Orders and Record: A resident with severe cognitive impairment and a pacemaker/defibrillator had a bedside monitor, but the clinical record lacked physician orders for monitoring, the programmed heart rate, or cardiology involvement. Staff were unsure how the device was being monitored, and the care plan referenced monitoring a programmed heart rate without documentation of that rate in the record.
A resident experienced an unwitnessed fall and was found on the floor by staff. Despite the resident's complaints of pain, Nurse #1 did not assess for injuries and instead moved the resident without calling for emergency assistance. The incident was not documented or reported to the oncoming staff, leading to a delay in care. The resident was later diagnosed with a hip fracture at the hospital.
A resident experienced an unwitnessed fall and was found in pain, but the nurse failed to assess, document, or report the incident. The resident was later diagnosed with a hip fracture at the hospital. The facility's policy for fall management was not followed, leading to a delay in medical intervention.
A resident experienced an unwitnessed fall and was found in pain by a CNA, who repeatedly requested a nurse's assessment. The nurse failed to perform a pain assessment, administer medication, or notify a physician, despite the resident's clear expressions of pain. The resident was later diagnosed with a hip fracture at the hospital. The facility did not adhere to its pain management policies, leading to a delay in appropriate medical intervention.
The facility employed a nurse under a state waiver without verifying her graduation from a board-approved nursing program, as required by state law. The nurse, who graduated from a Florida university, lacked an active Massachusetts nursing license, and the facility did not obtain independent verification of her educational credentials. The DON and Corporate Recruiter acknowledged the oversight, and the nurse had worked over 670 hours without proper verification.
The facility failed to maintain a dignified existence for residents needing meal assistance. A staff member was overheard referring to residents as 'feeders' while assisting a resident with their meal. The facility's policy emphasizes treating residents with dignity, including avoiding such labels. The DON confirmed that using the term 'feeders' is not dignified.
The facility failed to develop and implement comprehensive care plans for three residents, resulting in deficiencies. A resident with severe cognitive impairment did not have a care plan for a new skin tear, while another lacked a plan for ADL needs. Additionally, a cognitively intact resident at risk for pressure ulcers did not receive weekly skin checks as required.
A resident with a fracture and muscle weakness was observed with dirty fingernails over several days, despite requiring extensive assistance with ADLs. The resident, who was cognitively intact and did not refuse care, reported not receiving help with nail cleaning. Staff interviews confirmed that nail care should be part of daily ADL care, yet it was not provided, resulting in a deficiency.
A resident with severe cognitive impairment was found with an unlabeled bandage covering a skin tear on their hand. The facility failed to notify the physician or responsible party, obtain a treatment order, or document an assessment of the skin tear, contrary to their policy. The resident's care plan and medical records lacked documentation of the skin tear or treatment.
A resident with an unstageable pressure ulcer on the right heel did not receive the necessary treatment as ordered by the physician. Despite orders to wear Prevalon boots while in bed, the resident was observed multiple times without them. Interviews with staff confirmed the boots were not applied, and the Director of Nursing expected staff to follow orders and document any refusals, which was not done.
The facility failed to ensure proper hand hygiene in its food service operations. A diet aide was observed not washing hands after removing gloves and contaminating clean hands by turning off the water with them. This improper practice was repeated multiple times, despite the Food Service Director's confirmation that staff should follow proper hand washing techniques.
The facility failed to maintain accurate medical records for two residents. One resident, with severe cognitive impairment and a pressure ulcer, was documented as wearing Prevalon boots, but observations showed otherwise. Another resident, also with severe cognitive impairment, had a skin tear that was not documented in the skin assessment, despite being observed with a bandage. The DON confirmed the inaccuracies in documentation.
A resident with advanced Alzheimer's and chronic constipation did not have a comprehensive care plan addressing their medical needs, despite receiving multiple bowel medications and interventions. The facility's policies required a person-centered care plan, but the resident's plan lacked goals, outcomes, and interventions for constipation and abdominal pain. Interviews with staff confirmed the resident's ongoing issues and the use of interventions like a Foley catheter for gas relief, yet these were not documented in the care plan.
A resident with a history of constipation and abdominal distention received inadequate care due to the nursing staff's lack of competency in rectal tube procedures. The facility did not stock rectal tubes, leading to the use of a Foley Catheter instead. Nursing staff were unfamiliar with the procedure and did not document it properly, despite having a policy in place. The facility also failed to provide necessary training, contributing to the deficiency.
Homelike Environment Not Maintained in Resident Rooms
Penalty
Summary
The facility failed to maintain a homelike setting in resident rooms on the first and second floor nursing units. On the first floor, surveyors observed multiple rooms with chipped paint, peeling or bubbling laminate on nightstands and bureaus, missing drawer handles, scuffed or gouged walls, rubber baseboard pulling away from the wall, peeling paint in bathrooms, stained ceiling tiles, and a broken or missing top drawer on a nightstand. Specific observations included rooms 102, 103, 104, 106, 111, 112, 115, 116, 117, 118, 120, and 124, where the condition of walls, furniture, bathrooms, and ceiling tiles showed visible wear and damage. On the second floor, surveyors observed cracked and peeling red vinyl chair seats, gouged or scraped walls behind and in front of beds, a bathroom wall patched without paint, a cracked and peeling dresser top, missing laminate on a nightstand, and a pushed-in baseboard under a sink. These conditions were observed in rooms 200, 204, 205, 208, 210, 211, 215, 216, 221, 222, 223, 224, and 225. During interview, the Maintenance Director said he did daily rounds but was not aware of room updates or reports of furniture needing replacement, and that not all staff had access to the TELS communication system. The Administrator said he had no plans in place or purchase orders to fix the condition of the furniture or resident rooms.
Medication Labeling and Storage Deficiencies
Penalty
Summary
Drugs and biologicals used in the facility were not labeled in accordance with currently accepted professional principles and were not stored in a locked area inaccessible to residents and visitors. The facility policy titled Storage and Expiration Dating of Medications and Biologicals, revised 6/30/25, stated that medications and biologicals should be securely stored in a locked cabinet, cart, or medication room and should have an expiration date on the label. On 9/17/25 at 8:59 A.M., a surveyor observed a mobile vital sign cart in the WN unit hallway containing one Arnuity Ellipta inhaler and one Anoro Ellipta inhaler in the basket, with no nurse present. The surveyor also observed a Wixela inhaler on the WN unit medication cart without a label or date of when opened, another Wixela inhaler without a date of when it was opened, and a bottle of Lantanoprost eye drops left on top of the medication cart in the hallway without a patient label or date when opened. On the WS unit medication cart, the surveyor observed one bottle of Prosource without a date opened, two bottles of Pataday eye drops open without a date of when opened, one bottle of artificial tears without a label or date of when opened, one bottle of Prednisolone eye drops without a date of when opened, and one bottle of Ofloxacin antibiotic eye drops open without a date. During interview, Nurse #2 stated the inhalers had been forgotten in the basket and the eye drops should have been labeled correctly, and Nurse #3 stated the eye drops should have been labeled with the date opened and was not aware that Prosource had an expiration date after opening.
Failure to Monitor Pacemaker/Defibrillator per Orders and Record
Penalty
Summary
The facility failed to implement appropriate monitoring for a resident with a pacemaker/defibrillator implant. The resident was admitted with diagnoses including cognitive communication deficit and Parkinson’s disease, and the MDS showed severe cognitive impairment with a BIMS score of 4 out of 15. On observation, a pacemaker monitor was seen on the resident’s bedside table, and the resident was unable to participate in the interview process because of cognitive status. The care plan identified the resident as having a pacemaker defibrillator implant related to atrial fibrillation and included interventions for vital signs as ordered, observation and reporting of signs and symptoms of altered cardiac output or pacemaker malfunction, and teaching to avoid items that interfere with pacemaker activity. Review of the clinical record did not show physician orders related to monitoring, the programmed heart rate, or cardiology involvement. The facility was unable to provide a copy of the pacemaker policy that was in effect before the revised policy dated 9/17/25. During interviews, a nurse stated she was unsure how the device was being monitored and believed there should be physician orders for monitoring and vital signs. The unit manager stated the resident had a monitor at the bedside and the office would contact the facility if anything was wrong, and both the unit manager and DON said there should be physician orders related to monitoring the resident’s pacemaker. The unit manager also stated the care plan indicated monitoring a programmed heart rate, but there was no documentation in the record of the resident’s programmed heart rate.
Neglect in Resident Fall Incident
Penalty
Summary
The facility failed to protect a resident from neglect during an incident that occurred overnight. A resident experienced an unwitnessed fall and was found on the floor by staff. Despite the resident's complaints of pain and visible distress, Nurse #1 did not assess the resident for injuries. Instead, Nurse #1 picked the resident up from the floor, placed them in a wheelchair, and then transferred them back to bed without conducting any assessment or calling for emergency medical assistance. Certified Nurse Aide (CNA) #1 reported the resident's pain to Nurse #1, who dismissed the concerns and did not take any further action. Nurse #1 completed his shift without documenting the incident or notifying the oncoming staff about the fall. As a result, the day shift staff were unaware of the fall and unable to provide appropriate care when the resident continued to express severe pain. The resident was later transferred to the hospital, where they were diagnosed with a left hip fracture. The facility's policies on abuse and neglect, as well as resident rights, were not followed. The Director of Nurses (DON) confirmed that there was no documentation of the fall, no nursing assessment, and no notification to the physician or facility management. The lack of immediate action and proper reporting by Nurse #1 led to a delay in the resident receiving necessary medical care.
Failure to Assess and Document Resident Fall
Penalty
Summary
The facility failed to provide care and services that met professional standards of nursing practice for a resident who experienced an unwitnessed fall during the overnight shift. Despite the resident crying out in pain, Nurse #1 did not perform any assessment before moving the resident from the floor to a wheelchair and then to the bed. Nurse #1 also failed to document the fall, complete an incident report, or inform the oncoming nursing staff about the incident and the resident's complaints of pain. The resident, who had a history of falls and other medical conditions such as rhabdomyolysis, hypertension, and orthostatic hypotension, was later found by the day shift staff to be in severe pain. The resident was subsequently transferred to the hospital, where a left hip fracture was diagnosed. The facility's policy required a thorough assessment before moving a resident after a fall, documentation of the incident, and notification of the physician and family, none of which were followed by Nurse #1. Interviews with staff revealed that Nurse #1 was unresponsive to the resident's pain and did not follow the facility's procedures for fall management. The CNA who found the resident on the floor reported that Nurse #1 dismissed her concerns and did not perform any assessments. The Unit Manager and Director of Nursing confirmed that there was no documentation or assessment completed by Nurse #1, and the incident was not communicated to the oncoming staff, leading to a delay in appropriate medical intervention for the resident.
Failure in Pain Management After Resident Fall
Penalty
Summary
The facility failed to provide appropriate pain management for a resident who experienced an unwitnessed fall during the overnight shift. The resident was found on the floor by a CNA, crying out in pain, and the CNA immediately called for assistance from a nurse. Despite the resident's clear expressions of pain and the CNA's repeated requests for the nurse to assess the resident, the nurse did not perform a pain assessment, administer any pain medication, or notify the physician about the resident's condition. As a result, the resident continued to experience severe pain and was later diagnosed with a left hip fracture after being transferred to the hospital. The resident had a history of medical conditions including rhabdomyolysis, hypertension, orthostatic hypotension, bradycardia, and a history of falls. The resident's care plan included interventions for pain management, such as anticipating the need for pain relief and responding immediately to complaints of pain. However, on the night of the incident, the nurse did not adhere to these interventions, and there was no documentation of any actions taken to address the resident's pain. The resident's medication administration record indicated that the resident had only requested pain medication once prior to the incident, and no new orders were obtained to manage the acute pain following the fall. The incident report and subsequent interviews revealed that the nurse dismissed the CNA's concerns and failed to follow the facility's policies for assessing and managing changes in a resident's condition. The nurse did not document the fall, notify the physician, or complete a pain assessment, which led to a delay in appropriate medical intervention. The resident was eventually transferred to the hospital, where a displaced proximal left femoral subtrochanteric fracture was diagnosed, requiring surgical intervention.
Failure to Verify Nursing Credentials
Penalty
Summary
The facility failed to ensure that professional staff were licensed, certified, or registered in accordance with applicable state laws. Specifically, the facility employed a nurse under a state waiver without verifying that the nurse had graduated from a board-approved nursing program. The Department of Public Health Circular Letter outlines that individuals practicing under a waiver must have graduated from a board-approved nursing program, and the facility must independently verify this information. However, the facility did not obtain independent verification or official documentation from the nursing education program to confirm the nurse's completion of a board-approved program. During the survey, it was revealed that the nurse in question, who had graduated from Nova Southwestern University in Florida, did not have an active nursing license in Massachusetts. The Director of Nurses (DON) and the Corporate Recruiter acknowledged the lack of verification and documentation in the nurse's personnel file. The DON admitted that the nurse should not have been working at the facility without proper verification of her educational credentials. The nurse had worked over 670 hours at the facility without the necessary confirmation of her qualifications.
Failure to Maintain Resident Dignity During Meal Assistance
Penalty
Summary
The facility failed to maintain a dignified existence for residents requiring assistance with meals. During an observation, a staff member was overheard yelling into the hallway to another staff member to assist with breakfast, referring to residents as 'feeders.' This occurred while the staff member was assisting a resident with their meal in the resident's room. The facility's policy on dignity, reviewed on 9/25/23, emphasizes treating residents with dignity and respect, including addressing them by their chosen name or pronoun and avoiding labels such as 'feeders.' During an interview, the Director of Nurses confirmed that referring to residents as 'feeders' is not dignified.
Failure to Develop and Implement Comprehensive Care Plans
Penalty
Summary
The facility failed to develop and implement comprehensive person-centered care plans for three residents, leading to deficiencies in their care. For one resident with severe cognitive impairment, the facility did not create a care plan for a new skin tear on the left hand, despite the presence of an unlabeled and undated bandage observed over several days. The Director of Nursing acknowledged that a care plan should have been developed for the skin tear and its treatment. Another resident, also with severe cognitive impairment, did not have a care plan addressing their specific Activities of Daily Living (ADL) needs, such as assistance with lower body care. The Director of Nursing confirmed that a care plan should have been developed for the resident's ADL needs. Additionally, a third resident, who is cognitively intact and at risk for pressure ulcers, did not receive the weekly skin checks as outlined in their care plan. The facility's policy required weekly skin assessments, but records showed only one skin check was completed, with no documentation of refusal by the resident.
Failure to Provide Necessary Nail Care for Resident
Penalty
Summary
The facility failed to provide necessary nail care for a resident who was unable to perform activities of daily living independently. The resident, admitted with a fracture of the right femur and muscle weakness, was observed multiple times with a dark black substance under the fingernails of the left hand. Despite being cognitively intact and not exhibiting any refusal of care behaviors, the resident reported not receiving assistance with cleaning their nails, which was confirmed by observations over several days. Interviews with facility staff, including a CNA and a nurse, revealed that nail care should be part of the daily ADL process, and there was no documentation of the resident refusing care. The resident's care plan indicated a need for extensive assistance with personal hygiene, yet the necessary nail care was not provided, leading to the deficiency noted by the surveyors.
Failure to Document and Treat Resident's Skin Tear
Penalty
Summary
The facility failed to implement standards of quality care for a resident with severe cognitive impairment, who was dependent on staff for activities of daily living. The resident was observed with an unlabeled and undated bandage on their left hand, which covered a skin tear. The facility did not notify the physician or responsible party about the new skin tear, did not obtain a treatment order, and failed to document an assessment of the skin tear. The facility's policy required a head-to-toe inspection upon admission and weekly thereafter, with documentation of any new skin alterations, obtaining treatment orders, and notifying the physician and responsible party. The resident's medical record did not indicate any physician's order for the treatment applied to the skin tear, nor was there any documentation of the skin tear in the most recent skin integrity update assessment or the physician's visit note. The care plan for the resident also lacked any mention of the skin tear or treatment. The Director of Nursing confirmed that the necessary steps, such as creating a risk report, notifying the physician, obtaining treatment orders, notifying the responsible party, and documenting these actions, were not taken.
Failure to Provide Ordered Pressure Ulcer Care
Penalty
Summary
The facility failed to ensure that a resident with pressure ulcers received necessary treatment and services to promote healing and prevent new ulcers from developing. The resident, who was admitted in July 2024, had an unstageable pressure ulcer on the right heel and was diagnosed with Type II Diabetes. The physician had ordered the resident to wear Prevalon boots while in bed or not walking, starting from mid-July 2024. However, observations on multiple occasions in September 2024 revealed that the resident was in bed without the Prevalon boots, and none were found in the room. The resident's care plans included interventions for the pressure ulcer, such as treatment as ordered and the use of Prevalon boots. Despite these interventions, the resident was repeatedly observed without the boots. Interviews with the CNA and the nurse responsible for the resident's care confirmed that the boots were not applied as required. The Director of Nursing stated that staff should follow medical orders and document any refusal by the resident to wear the boots, but there was no documentation of such refusals.
Improper Hand Hygiene in Food Service
Penalty
Summary
The facility failed to adhere to professional standards of practice for food service safety by not ensuring proper hand hygiene among its staff. During an observation of the breakfast tray line, a diet aide was seen rolling flatware into napkins while wearing gloves. After removing the gloves, the aide did not wash his hands before touching various surfaces, including a food truck and a door handle, and then left the kitchen. Upon returning, the aide washed his hands but contaminated them by using his clean hands to turn off the water, before putting on new gloves and resuming his task. This improper hand hygiene practice was repeated multiple times, as the diet aide left the kitchen with the food truck on two more occasions, each time failing to perform hand hygiene after glove removal. The aide continued to wash his hands improperly by turning off the water with clean hands, leading to contamination. The Food Service Director confirmed that staff are expected to wash their hands after removing gloves and to use proper hand washing techniques, including using a paper towel to turn off the water.
Inaccurate Medical Record Documentation for Residents
Penalty
Summary
The facility failed to maintain accurate medical records for two residents, leading to discrepancies in documentation. For one resident, who was admitted with an unstageable pressure ulcer and severe cognitive impairment, nurses documented in the Treatment Administration Record (TAR) that the resident wore Prevalon boots while in bed. However, multiple observations over several days showed the resident in bed without the boots, and they were not found in the room. The nurse responsible for the resident acknowledged the discrepancy, noting that the boots should have been on as per the night nurse's documentation. For another resident with severe cognitive impairment and a history of falls, a skin assessment inaccurately documented the absence of a skin tear, despite the presence of a bandage on the resident's left hand. Observations revealed a skin tear under the bandage, which was not recorded in the assessment. The Director of Nursing confirmed that the skin assessment should have accurately noted the skin tear, highlighting a failure in maintaining accurate medical records.
Failure to Implement Comprehensive Care Plan for Constipation Management
Penalty
Summary
The facility failed to develop and implement a comprehensive care plan for a resident with multiple medical issues, including advanced Alzheimer's, chronic constipation, and abdominal pain. Despite the resident's physician orders for various bowel medications and interventions, the care plan did not address these needs. The facility's policies required a person-centered care plan that included goals, outcomes, and interventions, but this was not reflected in the resident's care plan. The resident was admitted with several diagnoses, including sepsis, acute renal failure, and hypertension, and was receiving multiple medications for constipation. The resident's medical records indicated a history of chronic constipation and abdominal distention, yet the care plan did not include these issues or the interventions being used, such as the insertion of a Foley catheter for gas relief. Interviews with facility staff, including the Nurse Practitioner and Nurse Manager, confirmed the resident's ongoing issues with constipation and abdominal discomfort, and the use of bowel medications and rectal interventions. The Director of Nurses acknowledged that the resident's care plan was incomplete and did not include the necessary interventions for constipation and abdominal pain. The DON stated that it was the responsibility of the nursing staff, including the MDS Nurse and Nurse Unit Managers, to ensure that care plans are accurate and up-to-date. However, the care plan failed to reflect the resident's medical needs and the interventions being implemented, leading to a deficiency in the facility's care planning process.
Nursing Staff Competency Deficiency in Rectal Tube Procedure
Penalty
Summary
The facility failed to ensure that nursing staff were competent in the process of inserting a rectal tube, as evidenced by the handling of a case involving a resident with a history of constipation and abdominal distention. The resident had a physician's order for a rectal tube insertion, but due to the unavailability of rectal tubes, an 18 French Foley Catheter was used instead. The Charge Nurse, who was unfamiliar with the procedure and had not reviewed the facility's policy, performed the insertion with assistance from a Nurse Practitioner. The facility did not stock rectal tubes, and the Charge Nurse did not document the procedure, relying on the Nurse Practitioner to do so. Further interviews revealed that other nursing staff, including Nurse #1 and Nurse #2, were also unfamiliar with the procedure and the facility's policy on rectal tube insertion and removal. They confirmed that the facility did not have rectal tubes in supply and used Foley Catheters as a substitute. Nurse #1 admitted to not consulting with other nurses or reviewing the policy before performing the procedure. There was a lack of documentation in the resident's progress notes regarding the insertion and removal of the Foley Catheter, as well as the resident's response to the procedure. The Staff Development Coordinator acknowledged that the facility had not provided education or skills training related to rectal tubes, despite having a policy in place. The Director of Nurses confirmed the existence of the policy and the expectation for nursing staff to be knowledgeable about it and document procedures performed. However, the facility's failure to stock rectal tubes and the lack of documentation and training contributed to the deficiency in care provided to the resident.
What surveyors are citing around you — mapped
All 10 risk areas, ranked with evidence
Repeat citations, what's rising near you, and quality measures — ranked so department heads know exactly where to look first.
Illustrative
What surveyors actually found near you
We read the 1,342 citations issued within 25 miles in the last 12 months — including the 4 immediate-jeopardy cases — and tell you exactly what happened, in plain English, matched to your record.
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.
Illustrative
A prioritized, do-first checklist
Every risk area becomes concrete audit steps drawn from real citations at facilities like yours — run them this week, before your window opens.
Illustrative
Risk indicators are statistical estimates from public CMS data — not predictions, findings, or compliance advice.
Nursing homes near Stoneham
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Melrose Healthcare | 0.9 mi | ★★★★★ | 0 | 0 |
| Regalcare At Glen Ridge | 1.4 mi | ★★★★★ | 35 | 0 |
| Elmhurst Healthcare (the) | 1.5 mi | ★★★★★ | 0 | 0 |
| Regalcare At Courtyard-medford | 1.9 mi | ★★★★★ | 2 | 0 |
| Greenwood Nursing & Rehabilitation Center | 2.1 mi | ★★★★★ | 0 | 0 |
Every risk area ranked, a do-first checklist, and your local survey patterns
Built specifically for Life Care Center Of Stoneham.
100% money-back within 48 hours.
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.