Above average — CMS composite of the measures below.
The next survey window likely opens around February 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 Aspire Senior Living Advance during CMS and state inspections, most recent first.
The facility failed to have an appropriate diagnosis for one resident's antipsychotic order and failed to limit another resident's PRN antipsychotic order to 14 days. One resident received quetiapine for depression despite diagnoses including Parkinson's disease with dyskinesia, and another resident had haloperidol PRN for hallucinations with no stop date. The DON, Administrator, and MD stated psychotropic meds should have an appropriate diagnosis and PRN antipsychotics should have a 14-day stop date.
A resident with type 2 DM had repeated missed Lantus doses despite an order for bedtime insulin, and staff interviews showed confusion about why the insulin was held and no physician notification for the blood sugars. In a separate event, the DON performed wound care for a resident with venous insufficiency and chronic leg ulcers but omitted ordered skin prep and mupirocin during treatment of the heel and posterior leg wounds.
Failure to individualize care plans for residents with dementia: The facility did not ensure that two residents with dementia had care plans that addressed their dementia-related needs, including specific problems, interventions, goals, or activity needs. One resident had diagnoses of unspecified dementia and Alzheimer's disease with moderate cognitive impairment, and another had dementia with hallucinations, restlessness, agitation, and fluctuating cognitive impairment. Staff interviews confirmed the care plans should have reflected dementia and personalized interventions, and the Activity Director stated the facility did not have specialized activities for dementia residents.
Improper Labeling and Use of Expired Medications: An opened methadone concentrate bottle for a resident was found undated on the med cart, and the controlled med record showed it was administered multiple times after the 90-day expiration period. An opened tuberculin PPD multidose vial was also found undated in the med storage refrigerator, despite staff stating multi-dose vials should be dated when opened and discarded when expired.
Unsanitary food storage and equipment cleaning: Surveyors found food particles, grime, and buildup in the microwave, air fryer, and reach-in cooler, along with unlabeled or improperly dated food items, an uncovered cabbage, opened condiments without dates, and a dented can. Dietary staff said they had not cleaned the microwave or air fryer and were unsure when cleaning was required, while the Dietary Mgr and Admin acknowledged labeling, dating, covering, and cleaning expectations.
Failure to Disinfect Glucometers per Policy: A CMT performed blood glucose testing for four residents using two glucometers and wiped each device with a disinfecting wipe without allowing the required wet contact time before air drying. The facility policy and manufacturer instructions required the glucometer to be thoroughly disinfected after each use, and the CMT stated he/she was not aware of the wet contact time. The DON and Administrator stated staff were expected to disinfect glucometers per policy and wipe instructions.
The facility failed to provide timely written notification to residents and/or their representatives regarding hospital transfers, as required by policy. Three residents experienced multiple transfers without documented written notification. Interviews revealed a misunderstanding of the policy, with paperwork being left in the resident's room upon return rather than provided at the time of transfer.
The facility did not inform three residents or their representatives of the bed hold policy at the time of hospital transfer, as required by their policy. The Social Services Director left the paperwork in the resident's room instead of providing it at the time of transfer, contrary to the Administrator's expectations.
The facility failed to accurately code the MDS for three residents, leading to discrepancies in their medical records. A resident's admission MDS did not document several diagnoses and medications, another resident's quarterly MDS inaccurately indicated anticoagulant use, and a third resident's annual MDS omitted diagnoses and a fall. Interviews revealed an expectation for accurate MDS coding, but no policy was provided to ensure this.
The facility failed to assess and document the use of bed rails for five residents, including those with cognitive intactness and varying mobility needs. Despite observations of bed rail use, there was no documentation of assessments or informed consent explaining the risks and benefits. The facility also lacked a policy on bed rails, and interviews with the DON and Administrator confirmed the expectation for such documentation, which was not met.
A facility failed to provide a personalized care plan for a resident with dementia, omitting specific problems, interventions, or goals for dementia care. Observations showed the resident was mobile in a wheelchair, and interviews with staff confirmed the oversight in care planning.
The facility failed to ensure appropriate diagnoses for psychotropic medication use in two residents within the sample and one outside the sample. A resident was prescribed quetiapine without a proper diagnosis, while another had an incorrect diagnosis entered into the electronic medical record. A third resident was prescribed haloperidol with a pharmacy recommendation for renewal every 14 days. Interviews confirmed the inappropriateness of the diagnoses, and the facility lacked a policy for appropriate psychotropic medication diagnosis.
A facility failed to maintain a medication error rate below five percent, resulting in an 11.11% error rate due to improper insulin pen priming. A CMT did not prime insulin pens before administering insulin to three residents with type 2 diabetes, contrary to facility policy. Interviews revealed the CMT was unaware of the priming requirement, while other staff confirmed the expectation to prime insulin pens.
The facility failed to label and store medications properly, affecting all residents. Observations revealed opened vials of Tubersol without dates and several insulin pens not dated when opened. Staff interviews confirmed that medications should be dated and checked regularly, aligning with the facility's policy.
The facility failed to maintain proper infection control practices and TB screening. Staff did not adhere to glove use and enhanced barrier precautions during care activities, such as wound and catheter care. Observations showed inadequate hand hygiene and glove changes during incontinence care. Additionally, the facility did not ensure proper TB screening for residents upon admission, as required by policy.
Facility staff did not post the required DHSS hotline and SSA contact information in an accessible manner for residents and their representatives. Observations showed the absence of this information, and interviews with residents and staff revealed a lack of awareness or incorrect assumptions about its posting. The Administrator confirmed that the hotline number should be posted.
The facility failed to provide the required twelve hours of annual in-service education for CNAs, affecting one CNA who only received eight hours. The DON and Administrator confirmed the expectation of twelve hours annually, but no policy was provided.
Inappropriate diagnosis for one antipsychotic order and PRN antipsychotic without required stop date
Penalty
Summary
The facility failed to have an appropriate diagnosis for an antipsychotic medication for one resident and failed to limit a PRN antipsychotic medication to 14 days for another resident. The report states that the facility policy required psychotropic medications to be used only when a practitioner determined they were appropriate for a resident's specific, diagnosed, and documented condition, and that PRN antipsychotic orders were limited to 14 days with no exceptions. For Resident #16, the medical record showed diagnoses of drug induced dyskinesia, polyneuropathy, Parkinson's disease with dyskinesia, and depression. The resident had an order for quetiapine 25 mg by mouth one time a day for depression. A monthly medication review requested that the quetiapine dosage be decreased, but the diagnosis of depression was not addressed. The report states the facility failed to have an appropriate diagnosis for the quetiapine. For Resident #27, the medical record showed diagnoses including dementia with mood disturbance, major depressive disorder, anxiety, neurocognitive disorder with Lewy bodies, epilepsy, pain, agitation and restlessness, fibromyalgia, hallucinations, and Parkinson's disease. The resident had an order for haloperidol 0.5 mg by mouth every 6 hours PRN for hallucinations with no stop date. A pharmacy note requested the prescriber address the order, and the physician responded to continue the PRN haloperidol for psychosis, but no stop date was added. During interviews, the DON, Administrator, and Medical Director stated they expected psychotropic medications to have an appropriate diagnosis and PRN antipsychotics to have a 14-day stop date.
Failure to Follow Physician Orders for Insulin and Wound Care
Penalty
Summary
The facility failed to follow physician orders when administering Lantus for a resident with type 2 diabetes mellitus. The resident had an order for Lantus 8 units subcutaneously at bedtime, but the Medication Administration Record showed multiple missed doses across October 2025 through February 2026. The missed administrations were documented on numerous dates, including one missed dose in October, six in November, 10 in December, 14 in January, and nine in February, with blood sugar values recorded on those dates. During interview, RN A said insulin should be given as ordered and stated that if the resident's blood sugar was under 70, a snack would be given and then the Lantus would be administered. RN A did not know why the resident's Lantus was held other than maybe nursing judgment. The Medical Director stated physician orders should be followed as ordered and that if there was a concern about an order, the physician should be notified for clarification. LPN D stated he/she did not hold the resident's Lantus and believed the medication was charted incorrectly, saying the doses shown as not administered had actually been given. LPN D also stated he/she did not notify the physician regarding the resident's blood sugars. The facility also failed to follow wound care orders for another resident with venous insufficiency, non-pressure chronic ulcers of both lower legs, and peripheral vascular disease. The resident had orders for wound cleansing with Vashe, skin prep to the peri wound, mupirocin ointment, calcium alginate silver dressing, ABD pad, and gauze wrap for multiple wounds. During observation, the DON provided treatment to the left heel wound but did not apply the skin prep to the peri wound or the mupirocin ointment as ordered, and did not apply skin prep to the left posterior leg wound as ordered. The DON stated she forgot to apply the skin prep and mupirocin ointment to the resident's left leg and heel as ordered.
Failure to Individualize Care Plans for Residents With Dementia
Penalty
Summary
The facility failed to ensure that residents diagnosed with dementia had personalized care plans that addressed their medical, nursing, psychosocial, and activity needs. For Resident #5, the medical record showed an admission date of 03/04/25 and diagnoses of unspecified dementia and Alzheimer's disease. The quarterly MDS dated 01/05/26 identified dementia and moderate cognitive impairment, but the care plan revised 12/30/25 did not address dementia, did not include specific problems, interventions, or goals for dementia care, and did not address specific problems, interventions, or goals for activities for a resident diagnosed with dementia. For Resident #27, the medical record showed diagnoses of dementia, hallucinations, restlessness, and agitation. The quarterly MDS showed dementia, cognitive impairment, and fluctuating inattention, disorganized thinking, and altered level of consciousness. The care plan reviewed 02/26/25 failed to address dementia and did not include specific problems, interventions, or goals for dementia care or for activities for a resident diagnosed with dementia. During interviews, the MDS Coordinator said the care plan should address dementia with personalized interventions, the Administrator said she would expect the care plan to reflect a diagnosis of dementia, and the Activity Director said the facility did not have any specialized activities for dementia residents.
Improper Labeling and Use of Expired Medications
Penalty
Summary
Medications and biologicals were not labeled in accordance with accepted practices for one resident and one medication storage area. Resident #27 had an order for methadone concentrate 10 mg/ml, 0.5 ml by mouth every 1 hour as needed for pain, with a start date of 12/03/24 and no adverse reactions identified related to its use. On observation of the 200 Hall medication cart, an opened bottle of methadone concentrate 10 mg/ml with 17 ml remaining was found not dated for the resident. Review of the controlled medication count sheet showed the bottle was first used on 04/16/25 and doses were administered repeatedly after the 90-day expiration date, including 13 administrations beyond the expiration date of 07/15/25. In the medication storage room refrigerator, an opened tuberculin purified protein derivative 1 ml multidose vial was observed not dated. Facility staff stated the tuberculin solution should be dated when opened and discarded when expired per the box directions and manufacturer guidance, and the Administrator stated multi-dose vials should be dated when opened and discarded when expired. The Administrator and DON also stated expired medications should not be administered to residents.
Unsanitary food storage and equipment cleaning
Penalty
Summary
The facility failed to store and distribute food under sanitary conditions. Review of facility policies showed requirements for cleaning food contact surfaces and refrigeration units, inspecting and properly storing food on receipt, labeling and dating refrigerated food and leftovers, and discarding previously cooked foods after three days in refrigeration at 41 degrees Fahrenheit or lower. The February 2026 Dietary Cleaning List showed no documentation that the bottom of the fridge was cleaned daily from 02/19/26 through 02/28/26, with 10 of 28 missed opportunities, no documentation for weekly duties for the month of February with four of four missed opportunities, and no listing for the microwave and air fryer. Observations of the kitchen on 02/24/26 and 02/27/26 showed food particles and brown grime inside the microwave, a black buildup and food crumbs in the air fryer basket, and grime and food particles on the air fryer handle. Unlabeled or improperly labeled items were observed, including a container of shell noodles without a label or date, a container of brown sugar without a label or date, baking powder without a date, white sugar incorrectly labeled as brown sugar and dated 01/25/26, a dented can of black-eyed peas, and an opened bag of shelled pecans without a date opened. In the reach-in cooler, surveyors observed food particles and a dried brown substance on the floor, an uncovered head of cabbage that was shriveled and brown in spots, opened bottles of ranch dressing and heavy-duty mayonnaise without dates opened, and a bottle labeled sweet pickle relish containing a white substance with green particles. Dietary staff stated they had not cleaned the air fryer or microwave and were not sure when they needed to be cleaned, while the Dietary Manager and Administrator acknowledged that items removed from original packaging should be labeled and dated, dented cans should not be used, food should be covered, and equipment should be cleaned per the schedule.
Failure to Disinfect Glucometers per Policy
Penalty
Summary
The facility failed to follow infection prevention measures when staff did not properly disinfect the glucometer used for blood glucose testing for four sampled residents. The facility policy required blood glucometers to be cleaned and disinfected after each use and according to the manufacturer's instructions for multi-resident use. The manufacturer's instructions for the Quintet AC Blood Glucose Meter and Super Sani-Cloth required the meter to be thoroughly wiped, allowed to remain wet for two minutes, and then air dried after each use. During observation, a CMT performed blood glucose testing for Residents #18, #28, #4, and #1 using two glucometers from the medication room. After each resident's testing, the CMT wiped the glucometer with a Super Sani-Cloth but did not allow the surface to remain wet for two minutes. The CMT stated he/she had been taught to wipe the glucometer down and use another glucometer while the first one air dried and was not aware of a wet contact time. The DON stated she expected staff to wrap the glucometer with a Super Sani-Cloth for the wet contact time on the wipe label, and the Administrator stated glucometers should be disinfected per facility policy.
Failure to Provide Timely Written Notification of Hospital Transfers
Penalty
Summary
The facility failed to provide timely written notification to residents and/or their representatives regarding transfers or discharges to a hospital, as required by their policy. This deficiency was identified for three residents out of a sample of 12, with a facility census of 34. The facility's policy, dated March 2015, mandates that the reason for transfer be explained to the resident or their representative, and a signed transfer or discharge notice be provided. In cases of emergency transfers, the notice may be completed later but should be done as soon as possible. However, for Residents #1, #28, and #32, there was no documentation indicating that they or their representatives were informed in writing of their transfers to the hospital at the time of the transfers. Resident #1 experienced multiple transfers to the hospital between February and July 2024, yet there was no evidence of written notification for any of these instances. Similarly, Resident #28 was transferred to the hospital in January 2024 without documented written notification. Resident #32 was transferred multiple times between April and June 2024, also without written notification. Interviews with the Social Services Director and the Administrator revealed a misunderstanding of the policy, with the Social Services Director indicating that the paperwork was left in the resident's room upon their return, rather than being provided at the time of transfer.
Failure to Inform Residents of Bed Hold Policy
Penalty
Summary
The facility failed to inform residents and/or their legal representatives of the bed hold policy at the time of transfer to the hospital for three residents out of a sample of twelve. The facility's policy requires that residents be notified of the bed hold policy at admission and again prior to a hospital transfer or therapeutic leave. In cases of emergency transfer, the policy mandates that written notification be provided within 24 hours of the transfer. However, for Residents #1, #28, and #32, there was no documentation indicating that they or their representatives were informed in writing of the bed hold policy at the time of their transfers to the hospital. Interviews with facility staff revealed a misunderstanding or misapplication of the policy. The Social Services Director indicated that the bed hold policy paperwork was filled out but not given to the resident until it was confirmed that the resident would be admitted to the hospital, leaving the paperwork in the resident's room for when they returned. The Administrator, however, stated that the expectation was for the bed hold notice to be given to the resident and/or their representative at the time of the transfer. This discrepancy in practice contributed to the failure to comply with the facility's policy and regulatory requirements.
Inaccurate MDS Coding for Residents
Penalty
Summary
The facility failed to accurately code the Minimum Data Set (MDS) for three residents, leading to discrepancies in their medical records. Resident #6's admission MDS did not document diagnoses of hypertension, hypothyroidism, and seizure disorder, nor did it include hypoglycemic medication, despite these being present in the medical record. Resident #11's quarterly MDS inaccurately indicated the resident was receiving an anticoagulant, although the order for Eliquis had been discontinued, and no current order for an anticoagulant was present. Resident #32's annual MDS failed to document diagnoses of GERD and cerebral infarction, as well as a fall that occurred on 09/12/24. Interviews with the facility's Administrator and MDS Coordinator revealed an expectation that the MDS should accurately reflect the residents' current conditions. However, the facility did not provide a policy regarding MDS accuracy, contributing to the inaccuracies found in the assessments of the sampled residents. The facility census at the time was 34, and the deficiencies were identified in 3 out of 12 sampled residents.
Failure to Assess and Document Bed Rail Use
Penalty
Summary
The facility failed to appropriately assess and document the use of bed rails for five residents, including four sampled residents and one outside the sample. The residents involved were cognitively intact and had varying levels of mobility and fall risks. However, the facility did not conduct bed rail assessments or obtain informed consent explaining the risks and benefits of bed rail use for these residents. Observations showed that these residents were using bed rails, but their medical records lacked necessary documentation, and the facility did not provide a policy regarding bed rails. Resident #1, who was cognitively intact and required supervision with bed mobility, was observed using bed rails without documented assessments or informed consent. Similarly, Resident #2, who was independent with bed mobility but had a history of dementia and repeated falls, used bed rails without proper documentation. Resident #3, with a left below-knee amputation, used a halo bar for mobility assistance, yet there was no documentation of bed rail assessments or informed consent. Resident #7 had an order for bed rails but lacked documentation of assessments and consent, and Resident #28, who was dependent on bed mobility due to a stroke and other conditions, also used bed rails without the necessary documentation. Interviews with the DON and Administrator confirmed the expectation for assessments and informed consents, which were not met in these cases.
Failure to Address Dementia in Resident Care Plan
Penalty
Summary
The facility failed to provide a personalized plan of care for a resident diagnosed with dementia, which is necessary to ensure appropriate services and promote the resident's highest level of functioning and psychosocial needs. The resident's medical record indicated a diagnosis of unspecified dementia and a cognitive communication deficit. However, the care plan did not address dementia, nor did it include specific problems, interventions, or goals for dementia care or activities tailored to the resident's condition. Observations showed the resident was able to self-propel in a wheelchair around the dining room and nurse's station, and was also seen sitting in the dining room. Interviews with the Director of Nursing, the Administrator, and the MDS coordinator confirmed that dementia should have been addressed in the care plan, indicating a lapse in the facility's care planning process for residents with dementia.
Inappropriate Diagnosis for Psychotropic Medication Use
Penalty
Summary
The facility failed to ensure an appropriate diagnosis for the use of psychotropic medications for two residents within the sample and one resident outside the sample. Resident #9 was prescribed quetiapine for unspecified dementia without behavioral disturbance and anxiety disorder, but there was no documentation of an appropriate diagnosis for the medication. Similarly, Resident #11 was prescribed quetiapine for unspecified dementia without behaviors, which was noted by the pharmacy as an inappropriate diagnosis. Despite this, the physician did not address the need for a correct diagnosis. Resident #15 was prescribed haloperidol for hallucinations and paranoia, with a pharmacy recommendation for renewal every 14 days, which was documented by the physician. Interviews with the Director of Nursing and the Administrator confirmed that unspecified dementia without behaviors is not an appropriate diagnosis for antipsychotic medication. Physician K acknowledged that the diagnosis for Resident #11 was incorrect in the electronic medical record, suggesting a clerical error. The facility did not provide a policy regarding the appropriate diagnosis for psychotropic medication, contributing to the deficiency in ensuring proper medication management for residents.
Medication Error Due to Improper Insulin Pen Priming
Penalty
Summary
The facility failed to maintain a medication error rate of less than five percent, resulting in an error rate of 11.11% for three residents out of 12 sampled. The errors were related to the administration of insulin without priming the insulin pens as required by the facility's policy. Specifically, the Certified Medication Technician (CMT) D did not prime the insulin pens with two units before administering the insulin to Residents #1, #8, and #32, all of whom had a diagnosis of type 2 diabetes mellitus and were receiving insulin as part of their treatment. During observations, CMT D administered insulin to the residents without performing the necessary priming step, which was confirmed through interviews. CMT D admitted to never priming insulin pens before, while the Licensed Practical Nurse (LPN) E and the Director of Nursing (DON) both stated that they expected insulin pens to be primed before administration. The Administrator also confirmed the expectation for insulin pens to be primed prior to administration, indicating a lapse in adherence to the facility's medication administration policy.
Medication Labeling and Storage Deficiency
Penalty
Summary
The facility failed to properly label and store medications, which had the potential to affect all residents. During an observation of the medication room refrigerator, two opened vials of Tubersol were found without an opened date, contrary to the manufacturer's recommendation that the medication be discarded 30 days after opening. Additionally, two unopened vials of nafcillin with an expiration date of 12/2023 were found in the medication room STAT safe. Further observations of the medication cart revealed several insulin pens, including Lantus, insulin lispro, insulin aspart, and basaglar, that were opened but not dated. Interviews with facility staff, including a Certified Medication Technician (CMT), a Licensed Practical Nurse (LPN), the Director of Nursing (DON), and the Administrator, confirmed that multi-dose vials and insulin pens should be dated when opened, and medication expiration dates should be checked regularly. The CMT and LPN indicated that they checked medication dates as they were used and weekly, while the DON and Administrator expected expiration dates to be checked at least monthly. The facility's policy on the storage of medications, although undated, stated that no discontinued or outdated medications should be used and that multi-dose vials should be discarded within 28 days of opening unless otherwise specified by the manufacturer.
Infection Control and TB Screening Deficiencies
Penalty
Summary
The facility failed to maintain proper infection control practices during care activities for several residents. Observations revealed that staff did not adhere to the facility's policies on glove use and enhanced barrier precautions. For instance, during wound care for a resident, a CNA did not wear a gown as required by the enhanced barrier precautions. Similarly, during catheter care for another resident, a CNA also failed to wear a gown, despite signage indicating the need for such precautions. In addition to the issues with barrier precautions, the facility did not ensure proper hand hygiene and glove changes during incontinence care. Observations showed that CNAs did not change gloves or perform hand hygiene between different stages of care, such as moving from dirty to clean tasks. This was evident in the care provided to multiple residents, where CNAs touched clean items with potentially contaminated gloves or bare hands. The facility also failed to conduct proper tuberculosis screening for residents upon admission. The medical records of several residents lacked documentation of the two-step TB testing, which is required by the facility's policy. Interviews with staff, including the Administrator and DON, confirmed that some residents did not receive the necessary TB testing, and staff were expected to follow guidelines for infection control, which were not adhered to in these instances.
Failure to Post Required Hotline Information
Penalty
Summary
Facility staff failed to post the required contact information for the Department of Health and Senior Services (DHSS) hotline and the State Survey Agency (SSA) in a manner accessible to residents and their representatives. Observations conducted from November 19 to November 21, 2024, revealed that the facility did not display the name, address, and toll-free telephone number for the DHSS Abuse and Neglect Hotline or the SSA information. During a group interview, six residents expressed that they were unaware of how to find the state hotline number and had not seen it posted. Interviews with facility staff, including a Licensed Practical Nurse (LPN), a Certified Nursing Assistant (CNA), and the Social Services Designee (SSD), indicated a lack of awareness or incorrect assumptions about the posting of the hotline number. The Administrator acknowledged that the DHSS Abuse and Neglect Hotline number should be posted.
Deficiency in CNA In-Service Training Hours
Penalty
Summary
The facility failed to ensure that Certified Nurse Assistants (CNAs) received the required twelve hours of in-service education annually, specifically affecting one out of two sampled CNAs, referred to as CNA B. CNA B's in-service record indicated a hire date of September 1, 2021, and showed only eight hours of annual in-service training for the period from November 2023 through November 2024, which is less than the required twelve hours. During interviews, both the Director of Nursing (DON) and the Administrator confirmed that CNAs were expected to attend at least twelve hours of in-service training annually. However, the facility did not provide a policy regarding in-service training, contributing to the deficiency.
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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 Advance
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Chaffee Nursing Center | 15 mi | ★★★★★ | 0 | 0 |
| Prairie View Skilled Nursing | 15.1 mi | ★★★★★ | 0 | 0 |
| Puxico Nursing And Rehabilitation Center | 16.6 mi | ★★★★★ | 5 | 0 |
| Stonebridge Marble Hill | 18 mi | ★★★★★ | 7 | 0 |
| Crowley Ridge Care Center | 20.3 mi | ★★★★★ | 0 | 0 |
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