Above average — CMS composite of the measures below.
The next survey window likely opens around March 2027
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 Interfaith Care Center during CMS and state inspections, most recent first.
A resident with CVA history and atrial fibrillation was receiving apixaban, but the care plan and provider orders did not include monitoring for bruising or bleeding. Staff interviews confirmed that anticoagulant monitoring should include watching for bleeding and bruising, and the facility’s medication monitoring policy identified enhanced monitoring for anticoagulants.
A resident with severe cognitive impairment and a care plan directing staff to respect her treatment decisions was administered morphine after refusing it, with staff physically restraining her to do so. Multiple staff witnessed and reported the incident, which involved a nurse instructing a nursing assistant to hold the resident's hands down while medication was given, in violation of the resident's rights and facility policy prohibiting restraints.
A resident with severe cognitive impairment and multiple diagnoses was physically restrained by staff and administered morphine against her wishes, despite her care plan directing staff to respect her treatment decisions and provide reassurance if she refused care. Staff interviews and documentation confirmed that a nurse instructed another staff member to hold the resident's hands while medication was given, and witnesses reported the nurse dismissed the resident's distress. The incident was not in accordance with facility policy, and the nurse involved was no longer employed at the facility.
A resident with severe cognitive impairment and a high risk for exploitation was physically restrained and given medication against her wishes by staff, with the incident witnessed and documented by other staff members. Despite the resident's distress and the facility's policy requiring immediate reporting of suspected abuse, the DON did not report the incident to the state agency, citing a lack of malicious intent.
A resident with severe cognitive impairment was physically restrained and given morphine against her wishes by an RN, despite her care plan directing staff to respect her treatment decisions. Staff reported the incident, but the DON did not interview the involved nurse or follow up with the resident or other staff, and no immediate protective actions were taken. The facility's abuse prevention policy requiring immediate investigation and protection was not followed.
A facility failed to assess smoking safety for a resident who was a current smoker with a history of depression, chronic pain, and syncope. Despite being informed of the non-smoking policy, the resident was witnessed smoking on and off the property without a proper assessment of their smoking safety. Interviews with staff confirmed the lack of smoking assessments, posing a risk to the resident's safety.
Anticoagulant Monitoring Not Included in Care Plan or Orders
Penalty
Summary
The facility failed to implement appropriate monitoring for a resident receiving an anticoagulant medication. The resident had an admission MDS identifying intact cognition, cerebral infarction due to unspecified occlusion or stenosis of the right carotid arteries, atrial fibrillation, and use of an anticoagulant medication. The resident’s CAA worksheet noted that daily use of anticoagulants increases the risk for bruising and skin injury and can extend wound healing time, but the care plan dated 1/29/26 only included a focus on stroke and directions to give medications as ordered and monitor/document side effects and effectiveness. The care plan did not identify monitoring for bruising or bleeding, and the provider orders also did not reflect such monitoring. An order dated 4/19/26 prescribed apixaban 5 mg twice daily for atrial fibrillation. During interviews, an LPN stated anticoagulant monitoring should include watching for bleeding and ensuring related labs were done, but could not find that monitoring on the TAR. An RN stated residents on coumadin, Eliquis, or any anticoagulant should have bleeding and bruising monitoring, and the DON stated residents on anticoagulants needed monitoring because bleeding may not stop and the provider would need to be updated. The facility policy on Medication Monitoring stated high-risk medication monitoring for anticoagulants includes enhanced monitoring such as INR monitoring.
Failure to Honor Resident's Right to Refuse Medication and Avoid Restraint
Penalty
Summary
A resident with diagnoses including malignant neoplasm of the breast, hypertension, dementia, depression, and anxiety, and who was assessed as having severe cognitive impairment, was administered morphine despite expressing refusal. The resident's care plan identified her as high risk for exploitation and directed staff to allow her to make decisions about her treatment as able, including respecting refusals of medication. On the day of the incident, the resident was observed calling out and refusing medication, verbally expressing 'no' and physically turning her head away. Despite this, a registered nurse instructed a nursing assistant to hold the resident's hands down while morphine was administered orally against her will. Multiple staff members reported the incident, noting the resident's distress and the nurse's actions, including laughing at the resident's complaints. The facility's policy prohibits the use of restraints and emphasizes the use of the least restrictive interventions. Documentation and interviews confirmed that the resident's right to refuse medication was not honored, and physical restraint was used to administer medication, contrary to both the resident's care plan and facility policy.
Failure to Ensure Resident's Right to Refuse Restraints and Medication
Penalty
Summary
A deficiency occurred when staff failed to ensure a resident's right to remain free from physical restraints, as required by facility policy and federal regulations. The incident involved a resident with severe cognitive impairment, a history of dementia, depression, anxiety, and malignant neoplasm of the breast. The resident's care plan specifically directed staff to allow her to make decisions about her treatment as able, and to provide reassurance and return later if she refused care or medication. Despite these directives, staff held the resident's hands and administered morphine against her expressed wishes. Multiple staff interviews and employee statements confirmed that the resident was yelling for help and expressing distress, stating she was 'sick of being tied down.' A registered nurse instructed another staff member to hold the resident's hands down while morphine was administered orally, despite the resident's verbal refusal and physical resistance. Witnesses reported that the nurse laughed at the resident's distress and dismissed her complaints, further contributing to the resident's sense of fear and lack of safety. Documentation and interviews indicated that the resident rarely required as-needed pain medication and was generally able to communicate her needs. Staff acknowledged that restraining a resident to administer medication was inappropriate and not in accordance with facility policy. The nurse involved was an agency staff member and was no longer working at the facility at the time of the investigation.
Failure to Report Alleged Abuse Involving Physical Restraint and Forced Medication
Penalty
Summary
The facility failed to report an allegation of abuse to the state agency after a resident with severe cognitive impairment, multiple diagnoses including dementia, and a care plan indicating high risk for exploitation was physically restrained and administered medication against her wishes. Documentation and staff interviews revealed that the resident, who had a history of calling out and refusing medications, was held down by staff at the direction of an RN while being given pain medication, despite her verbal refusal and attempts to turn her head away. The resident expressed distress, stating she was tired of being tied down, and staff observed the RN laughing at her while she was upset. The Director of Nursing (DON) was informed of the incident by staff who were upset about the manner in which the medication was administered. The DON acknowledged that holding a resident's hands down to administer medication constituted a restraint but did not report the incident to the state agency, as the on-call nurse believed there was no malicious intent. This inaction was contrary to the facility's Abuse Prevention Plan, which requires immediate reporting of suspected abuse or maltreatment.
Failure to Investigate and Protect After Alleged Abuse and Improper Medication Administration
Penalty
Summary
The facility failed to thoroughly investigate an allegation of abuse involving a resident with severe cognitive impairment, who was physically restrained and administered morphine against her wishes. The resident, who had diagnoses including malignant neoplasm of the breast, hypertension, dementia, depression, and anxiety, was identified as being at high risk for exploitation and unable to accurately report abuse. Staff statements indicated that the resident was yelling for help and refused medication, but a registered nurse instructed staff to hold the resident's hands down and administered the medication despite her resistance. The nurse also made dismissive remarks when the resident expressed distress about being restrained. Despite being informed of the incident and staff concerns, the DON did not interview the nurse involved or follow up with the resident or other staff present during the incident. The nurse continued to work the following day, and no immediate protective measures were implemented for the resident or others. The facility's abuse prevention policy required immediate protection and investigation, including suspension of the alleged perpetrator and assessment of the alleged victim, but these steps were not followed after the incident.
Failure to Assess Smoking Safety for Resident
Penalty
Summary
The facility failed to assess smoking safety for a resident who was a current smoker. The resident, who was cognitively intact, had a history of depression, chronic pain, difficulty walking, and syncope. Despite being identified as a current everyday smoker upon admission, the resident's care plan did not include any information about their smoking status or safe smoking interventions. The medical record lacked any smoking assessments prior to a specific date, and the facility's smoking policy was reviewed with the resident upon admission. However, the resident was witnessed smoking in the facility parking lot and across the street after outings, indicating a lack of proper assessment and supervision. Interviews with facility staff, including a nursing assistant, a registered nurse, and the director of nursing, confirmed that the facility was non-smoking and that residents were informed of this policy upon admission. Despite this, the resident was not assessed for smoking safety upon admission or after being observed smoking. The director of nursing acknowledged that smoking assessments were not being completed for residents identified as smokers, which posed a risk to resident safety. The facility recognized the importance of smoking assessments to ensure resident safety, even when residents smoked off the property.
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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 Carlton
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| The North Shore Estates Llc | 11.5 mi | ★★★★★ | 16 | 0 |
| Dove Healthcare - Superior | 14.2 mi | ★★★★★ | 3 | 0 |
| Viewcrest Health Center | 14.7 mi | ★★★★★ | 0 | 0 |
| Twin Ports Health Services | 15.4 mi | ★★★★★ | 4 | 0 |
| Villa Marina Health And Rehabilitation Center | 16.6 mi | ★★★★★ | 9 | 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.