Below average — CMS composite of the measures below.
Past the typical resurvey interval — a standard survey could occur at any time
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Camdenton Windsor Estates during CMS and state inspections, most recent first.
Facility staff discharged a resident to a hospital and then refused to allow the resident to return, without having an emergency discharge policy in place. Staff documented an immediate discharge notice stating the facility could no longer meet the resident’s needs and listed the hospital as the discharge destination. The administrator stated the resident would not be accepted back due to safety concerns for other residents and acknowledged that the hospital was not an acceptable discharge location. A care plan coordinator notified the hospital social worker by email that the facility would not readmit the resident, resulting in an inappropriate emergency discharge notice and failure to ensure the transfer/discharge met the resident’s needs and preferences.
Staff did not review or revise care plans for three residents after they experienced falls, despite facility policy requiring updates following changes in condition. The MDS Coordinator, responsible for care plan updates, had not added new interventions after the falls, and interviews confirmed that care plans were not promptly revised to reflect these incidents.
Staff did not complete or document required neurological checks for two residents with severe cognitive impairment following unwitnessed falls, as mandated by facility policy. Despite clear procedures for post-fall neurological assessments, records and interviews confirmed the absence of documentation and completion of these checks.
A facility failed to report an allegation of physical abuse involving a resident with severe cognitive impairment to the DHSS within the required two-hour timeframe. A CNA reported that an RN hit the resident and threw a sheet over their head, but the report was made to the administrator later in the afternoon. The CNA was unaware of the immediate reporting requirement and was educated on their responsibility to notify management promptly.
The facility did not document the administration of the pneumococcal vaccine for six out of eight sampled residents, despite having signed consents. This lapse occurred even though CDC guidelines recommend specific vaccination protocols based on age and prior vaccine history. One resident was diagnosed with pneumonia following chest congestion, underscoring the potential risks. The DON acknowledged delays in vaccine delivery due to conflicting information from the pharmacy and an allergic resident causing a specific vaccine order to be canceled. Staff emphasized the importance of documentation and obtaining consents upon admission, while the MD highlighted the need for timely vaccine administration to prevent respiratory infections.
Facility staff failed to ensure pureed food items were reheated to proper temperatures and did not follow puree recipes. Hot foods were not held at 140°F or greater during meal service, and hot food on room trays for three residents was not maintained at 120°F at the time of delivery. Staff were unaware of the appropriate food temperatures and did not take corrective actions when food was served below the required temperature.
The facility staff failed to implement complete water management policies to prevent Legionnaire's Disease and did not consistently follow proper hand hygiene protocols, leading to potential infection risks for residents.
Facility staff failed to maintain a clean and homelike environment by not properly cleaning resident rooms and common areas. Observations showed debris and dirty floors, and the Housekeeping Supervisor used visibly dirty mop water to clean various areas, which could spread germs and cause infections. Staff interviews confirmed that mop water should be changed every three rooms or when visibly dirty.
Facility staff failed to accurately document MDS assessments for several residents, including the use of BiPAP/CPAP machines, rejection of care behaviors, and anticoagulant medications. Interviews revealed a lack of awareness and understanding regarding proper MDS coding and the classification of medications.
Facility staff failed to develop and implement comprehensive care plans for four residents, leading to undocumented oxygen use, missing podus boot applications, unaddressed weight loss risk, and lack of BiPAP and hospice care documentation. Staff interviews and observations confirmed these deficiencies.
Facility staff failed to ensure residents who were unable to complete their own ADLs received necessary care and services to maintain good personal hygiene. Four residents were observed with unkempt hair and facial hair despite care plans indicating preferences for being clean-shaven. Staff interviews confirmed that residents were expected to receive showers twice a week, but documentation and observations indicated this standard was not consistently met.
Facility staff failed to lock medication and treatment carts and did not store medications and chemicals safely. Observations showed unattended carts with accessible medications and chemicals, and interviews confirmed that staff were aware of the policies but did not adhere to them. The facility lacked a specific chemical storage policy, and issues with cart locks had been reported but not addressed.
Facility staff failed to store oxygen/nebulizer masks and tubing properly, leading to potential contamination for six residents. Additionally, two residents lacked orders for oxygen therapy. Staff interviews revealed a lack of knowledge and adherence to proper procedures, highlighting systemic issues in the facility's handling of respiratory care equipment.
Facility staff failed to accurately count controlled medications for two residents and did not remove expired medications and supplies. An LPN admitted to taking shortcuts, and expired items were found in the medication storage room. The DON and administrator confirmed that proper procedures were not followed.
The facility failed to provide an appropriate 30-day discharge notice and did not allow a resident to return after hospital discharge. The resident's medical record lacked the required discharge notice, and the facility decided not to readmit the resident due to additional information about the resident's history and behaviors.
Improper Emergency Discharge and Refusal to Readmit Resident
Penalty
Summary
Facility staff failed to ensure an appropriate and safe transfer/discharge for a resident when they discharged the resident to a hospital and refused to allow the resident to return. Record review showed the resident had been admitted to the facility in early February and was discharged to the hospital on 02/23/26. On 3/3/26 at 11:52 A.M., staff documented in the progress notes that they spoke with the resident’s guardian regarding a notice of immediate discharge because the facility could no longer meet the resident’s needs, and an Immediate Discharge Notice dated 3/3/26 indicated the resident would discharge to the hospital. The facility did not have a policy for emergency discharge, and the administrator stated on 3/3/26 at 10:09 A.M. that the resident would not be accepted back due to safety concerns for other residents and acknowledged awareness that the hospital was not an acceptable discharge location. The care plan coordinator reported emailing the hospital social worker to inform them that the facility would not accept the resident back, effectively using the hospital as the resident’s discharge destination without appropriate notice or planning to meet the resident’s needs and preferences for a safe transfer/discharge. These actions and omissions, including the lack of an emergency discharge policy, the issuance of an immediate discharge notice listing the hospital as the discharge location, and the administrator’s refusal to readmit the resident, led to the deficiency related to failure to provide an appropriate emergency discharge notice and to ensure the transfer/discharge met the resident’s needs and preferences.
Failure to Update Care Plans After Resident Falls
Penalty
Summary
Facility staff failed to review and revise the comprehensive care plans for three residents who experienced falls. According to the facility's policy, care plans are to be updated with measurable goals and interventions as changes occur in a resident's condition, including after falls. For each of the three residents, documentation showed that after they sustained falls—some resulting in injury and others not—there were no new interventions added to their care plans. The MDS Coordinator, responsible for updating care plans, stated that due to assisting with resident care, they had not had the opportunity to update the care plans following these incidents. The administrator and DON both indicated that they would expect new interventions to be added after each fall, depending on the circumstances. Interviews with staff confirmed that the care plan is intended to guide care and should be updated after changes such as falls. In one case, the MDS Coordinator was unaware of a resident's fall, and in another, staff provided education to the resident but did not document a new intervention in the care plan. The facility census at the time was 49, and the sampled residents had varying levels of cognitive impairment and histories of both injury and non-injury falls. The lack of timely care plan updates following these events constituted the deficiency.
Failure to Complete and Document Neurological Checks After Unwitnessed Falls
Penalty
Summary
Facility staff failed to complete and document neurological checks for two residents who experienced unwitnessed falls, as required by facility policy. The policy mandates neurological assessments for seventy-two hours following an unwitnessed fall or head injury, with specific intervals for checks and documentation in the medical record. For both residents, who had severe cognitive impairment and a history of falls, there was no documentation in event reports or progress notes indicating that neurological checks were performed after their unwitnessed falls. Interviews with staff, including an LPN, the MDS Coordinator, the administrator, and the DON, confirmed that neurological checks should have been completed and documented for residents after unwitnessed falls. However, staff were unaware of the missing documentation for these two residents, and the DON only identified and addressed a separate missed assessment. The required neurological assessments for these two incidents were not completed or documented as per facility policy.
Failure to Timely Report Alleged Abuse
Penalty
Summary
The facility staff failed to report an allegation of physical abuse involving a resident with severe cognitive impairment to the Department of Health and Senior Services (DHSS) within the required two-hour timeframe. The incident involved a Certified Nurse Aide (CNA) who reported that a Registered Nurse (RN) hit the resident and threw a sheet over their head. The CNA reported the incident to the administrator later in the afternoon, which was beyond the mandated reporting period. The facility's investigation policy requires all allegations of abuse to be reported to the State Survey Agency and, if applicable, law enforcement within two hours. Interviews revealed that the CNA was unaware of the immediate reporting requirement and only reported the incident when they first had contact with the administrator. The administrator confirmed that the CNA did not know to report allegations of abuse immediately and stated that the CNA was educated on their responsibility to notify management as soon as abuse was witnessed. The RN confirmed that staff are directed to notify upper management and the State agency within two hours of reported or observed abuse.
Pneumococcal Vaccine Documentation Lapses Identified
Penalty
Summary
The facility failed to document the administration of the pneumococcal vaccine for six out of eight sampled residents, despite CDC guidelines recommending specific vaccination protocols based on age and prior vaccine history. Medical records for Residents #8, #14, #21, #25, #33, and #38 did not contain documentation of staff offering or administering the pneumococcal vaccine, even though signed consents were present for vaccine administration. Notably, Resident #25 was diagnosed with pneumonia after being diagnosed with chest congestion, highlighting the potential consequences of missed vaccinations in this population. During interviews, the Director of Nursing (DON) acknowledged the delay in vaccine delivery, with conflicting information on the expected arrival dates provided by the pharmacy. The DON also mentioned an allergic resident causing a specific vaccine order to be canceled. The facility's staff, including the DON, Licensed Practical Nurse (LPN), Business Office Manager (BOM), and Administrator, emphasized the importance of documentation and the responsibility of obtaining consents for vaccinations upon admission. The Medical Director (MD) stressed the expectation for timely vaccine administration for long-term care residents to prevent potential outcomes like pneumonia or upper respiratory infections.
Failure to Maintain Proper Food Temperatures and Follow Puree Recipes
Penalty
Summary
Facility staff failed to ensure pureed food items were reheated to proper temperatures and did not follow puree recipes. Observations showed that hot foods were not held at 140 degrees Fahrenheit or greater during meal service. Additionally, hot food on room trays for three residents was not maintained at 120 degrees Fahrenheit at the time of delivery. Staff, including nurse aides and certified nursing assistants, were unaware of the appropriate food temperatures and did not take corrective actions when food was served below the required temperature. The facility's policy indicated that food should be at least 120 degrees Fahrenheit, but this was not consistently followed. Resident #27, who had moderately impaired cognition and required set-up assistance for eating, received food that was below the required temperature. The resident's stuffing, turkey, and green beans were all served at temperatures below 120 degrees Fahrenheit, and the nurse aide did not offer to reheat the food or provide a new tray. Resident #25, who was cognitively intact and also required set-up assistance, received ham that was below the required temperature. The nurse aide acknowledged the food was below 120 degrees Fahrenheit but did not take corrective action. Resident #105, who was cognitively intact and required set-up assistance, received a dinner tray with food below the required temperature, and the nurse aide did not reheat the food. The facility's dietary staff also failed to follow proper procedures for reheating and holding pureed food items. Observations showed that pureed meatloaf, scalloped potatoes, and bread were not reheated to the required 165 degrees Fahrenheit and were held at temperatures below 140 degrees Fahrenheit. The cook did not check the temperatures of the food before placing them on the steam table and did not follow the puree recipes. The dietary manager confirmed that the cook was responsible for ensuring proper food temperatures and consistency but acknowledged that the food items were not prepared correctly. The administrator stated that food should be 140 degrees Fahrenheit when served to residents, but this standard was not met.
Inadequate Water Management and Hand Hygiene Practices
Penalty
Summary
The facility staff failed to develop and implement complete policies and procedures for the inspection, testing, and maintenance of the facility's water system to inhibit the growth of waterborne pathogens and reduce the risk of an outbreak of Legionnaire's Disease. The maintenance director was unaware of whether the public water supply was treated or if the facility had any disinfectants as part of the water system. Additionally, the maintenance director did not check the water for disinfectant or chlorine levels, and the water management program did not include policies or procedures related to control measures or disinfectant levels. Facility staff also failed to perform proper hand hygiene for two residents. One nurse assistant performed catheter care on a resident but did not follow proper hand hygiene protocols, such as washing hands after touching potentially contaminated surfaces and before providing care. Similarly, a licensed practical nurse performed wound care on a resident but did not follow proper hand hygiene procedures, including turning off the faucet with their elbow instead of using a paper towel. Another certified nurse assistant failed to perform proper hand hygiene while providing perineal care to a resident. The CNA did not wash their hands between glove changes and touched various surfaces and the resident with soiled gloves. Interviews with staff, including the Director of Nursing and the Quality Assurance nurse, revealed that staff were aware of the proper hand hygiene protocols but did not consistently follow them, leading to potential risks of infection and cross-contamination.
Failure to Maintain Clean and Homelike Environment
Penalty
Summary
Facility staff failed to provide a clean, homelike, and comfortable environment by not maintaining resident rooms and common areas. Observations revealed debris on the floors outside multiple rooms and dirty floors in resident-occupied rooms. Additionally, there were multiple stains and black marks on the walls and floors of some resident rooms. The Housekeeping Supervisor acknowledged that some marks on the walls needed painting, which was a task for the maintenance team. Further observations showed that the Housekeeping Supervisor used dark brown, visibly dirty mop water to clean various areas, including the MDS office, staff bathroom, hallway, clean utility room, and resident-occupied rooms. Interviews with housekeeping staff, a CNA, an LPN, the Housekeeping Supervisor, the DON, and the Corporate QA nurse confirmed that mop water should be changed every three rooms or when visibly dirty. The use of dirty mop water was recognized as a practice that could spread germs and cause infections. The Housekeeping Supervisor admitted to being unaware of using dirty water for cleaning.
Inaccurate MDS Documentation
Penalty
Summary
Facility staff failed to document a complete and accurate Minimum Data Set (MDS) assessment for several residents. Specifically, staff did not accurately code for the use of Bi-level Positive Airway Pressure (BiPAP) or Continuous Positive Airway Pressure (CPAP) machines for three residents. For instance, one resident's care plan indicated the use of a BiPAP machine at night, but this was not reflected in the MDS assessment. Similarly, another resident's MDS assessment did not document the use of a CPAP machine, despite observations and care plans indicating its use at night. Additionally, the facility staff did not accurately document a resident's rejection of care behaviors in the MDS assessment, even though multiple nurse's notes and interviews confirmed the resident's refusal of showers and other care activities. The MDS assessments also failed to accurately code the use of anticoagulant medications for two residents. The staff incorrectly identified Clopidogrel as an anticoagulant, which led to inaccurate MDS coding. Interviews with the Director of Nursing (DON), MDS Coordinator, and other staff revealed a lack of awareness and understanding regarding the correct classification of Clopidogrel and the importance of accurate MDS documentation. The facility did not have a specific policy for MDS assessments and relied on the Resident Assessment Instrument (RAI) manual for guidance. The MDS Coordinator, who is responsible for completing the MDS assessments and care plans, admitted to not being aware that Clopidogrel is an antiplatelet medication and not an anticoagulant. The DON and other staff members also confirmed that the MDS assessments should accurately reflect the use of oxygen, BiPAP, CPAP, and anticoagulant medications.
Failure to Develop and Implement Comprehensive Care Plans
Penalty
Summary
The facility staff failed to develop and implement a comprehensive person-centered care plan for four residents out of 14 sampled residents. Resident #6, who was assessed as cognitively intact and diagnosed with sleep apnea, did not have an order for oxygen documented in the care plan despite using oxygen at night. The Director of Nursing and Licensed Practical Nurse confirmed the absence of a current oxygen order and the resident's refusal to use CPAP, preferring oxygen instead. This discrepancy was observed during multiple interviews and record reviews, highlighting a lack of proper documentation and care planning for the resident's oxygen use. Resident #14, assessed as cognitively intact and dependent on staff for all Activities of Daily Living (ADLs), was at risk for pressure ulcers. Despite having an order for a podus boot to be worn at all times, the care plan did not document this requirement. Observations on multiple occasions showed the resident without the podus boot, and staff failed to apply it even after providing care. Interviews with various staff members, including CNAs and LPNs, confirmed the expectation that the podus boot should be documented and applied as per the care plan, which was not adhered to. Resident #21, assessed as cognitively intact and requiring setup assistance for eating, experienced significant weight loss over several months. The care plan did not address the resident's risk for weight loss or include any interventions. Interviews with the resident and staff revealed that the resident often ate in their room, but the care plan lacked necessary documentation to manage the weight loss risk. Similarly, Resident #25, with diagnoses including obesity, sleep apnea, and acute bronchospasm, had an order for BiPAP at bedtime, which was not documented in the care plan. Observations and staff interviews confirmed the presence of the BiPAP machine and the need for its inclusion in the care plan, which was not done. Lastly, Resident #33, with severe cognitive impairment and on hospice care, did not have hospice care directions documented in the care plan despite being admitted to hospice services. Interviews with staff consistently indicated that the care plans should be individualized and updated with all relevant information, which was not the case for these residents.
Failure to Provide Necessary ADL Assistance
Penalty
Summary
Facility staff failed to ensure residents who were unable to complete their own activities of daily living (ADLs) received the necessary care and services to maintain good personal hygiene. Specifically, staff did not provide hair care and assist residents with facial hair for four residents out of fourteen sampled. The facility's policies did not adequately address the frequency and procedures for hair care, facial hair care, and nail care, contributing to the deficiency observed by surveyors. Resident #14, who was cognitively intact but dependent on staff for all ADLs, was observed multiple times with long chin hairs despite expressing a preference to be clean-shaven. The resident's care plan did not include directions for facial hair preference, and shower documentation repeatedly lacked records of shaving being completed. Similarly, Resident #24, who was severely cognitively impaired and dependent on staff for all ADLs, was observed with facial hair on several occasions, despite a care plan indicating a preference for being clean-shaven. Resident #33, also severely cognitively impaired and requiring maximum assistance for personal hygiene, was observed with unkempt hair and facial hair approximately half an inch long on multiple occasions. The resident's care plan indicated a preference for being clean-shaven, but shower documentation did not reflect that shaving was completed. Resident #50, who was severely cognitively impaired and dependent for all ADLs, was observed with greasy, disheveled hair and unshaved facial hair on several occasions, despite a care plan that indicated a preference for being clean-shaven or having facial hair as needed. Interviews with staff confirmed that residents were expected to receive showers twice a week, but documentation and observations indicated that this standard was not consistently met.
Failure to Lock Medication and Housekeeping Carts
Penalty
Summary
Facility staff failed to lock medication and treatment carts and did not store medications and chemicals safely. Observations showed a Certified Medication Technician (CMT) left a medication cart unattended with pills on top, and a treatment cart was found unlocked and unattended at the nurse's station. Interviews with staff, including a Licensed Practical Nurse (LPN) and the Director of Nursing (DON), confirmed that medication and treatment carts should be locked when not attended, and medications should not be left on top of the carts. The CMT admitted to leaving the medication on top of the cart due to being busy with other tasks, acknowledging the potential danger to residents who wander and get into things. Housekeeping carts were also found unlocked and unattended with bottles of toilet bowl cleaner on them. Multiple observations showed housekeeping carts left in various locations, including near resident rooms and the dining room, with chemicals accessible to residents. Interviews with housekeeping staff, the Housekeeping Supervisor, and the Maintenance Director revealed that the carts' locks were not functioning properly, and the issue had been reported but not yet addressed. Staff acknowledged that chemicals should be locked up to prevent residents from accessing them and potentially getting harmed. The facility's policy on the storage of medication directed that all medications must be stored in locked cabinets, rooms, or carts, and that poisonous substances and hazardous compounds must be kept in locked containers away from residents. However, the facility did not have a specific chemical storage policy. The Administrator and DON reiterated that all medication and treatment carts, as well as housekeeping carts with chemicals, should be locked when not attended to ensure resident safety.
Improper Storage and Lack of Orders for Respiratory Care Equipment
Penalty
Summary
Facility staff failed to store oxygen/nebulizer masks and tubing in a manner to prevent infection-causing contaminants for six residents. Observations showed that oxygen tubing was not dated, and BiPAP and CPAP machines and masks were not stored in bags. Additionally, nebulizer masks and tubing were found not dated and not stored in bags, leading to potential contamination. These deficiencies were observed across multiple residents' rooms, indicating a systemic issue in the facility's handling of respiratory care equipment. Staff also failed to ensure that two residents had orders for oxygen therapy. For instance, Resident #6 was observed using oxygen at night without a current order for oxygen in their Physician Order Sheet (POS). Similarly, Resident #105, who was on continuous oxygen, did not have an order for oxygen in their POS. This lack of proper documentation and orders for oxygen therapy further highlights the facility's failure to adhere to proper respiratory care protocols. Interviews with staff, including CNAs, LPNs, and the Director of Nursing (DON), revealed a lack of knowledge and adherence to the facility's policies regarding the storage and maintenance of respiratory care equipment. Staff were unaware of the proper procedures for storing oxygen tubing, nebulizer masks, and CPAP/BiPAP machines, leading to inconsistent practices and potential risks of infection for the residents. The DON and other staff members acknowledged the deficiencies and the potential for resident infections due to improper storage and handling of respiratory care equipment.
Failure to Accurately Count Controlled Medications and Remove Expired Supplies
Penalty
Summary
Facility staff failed to accurately count controlled medications for two residents. For Resident #13, the controlled medication record indicated 27 Hydrocodone APAP 5-325 mg tablets, but observation showed 28 tablets. Similarly, for Resident #16, the record indicated five tablets, but observation showed six tablets. An LPN admitted to taking shortcuts and not counting the actual pills due to being in a hurry. The DON and the administrator confirmed that staff should count both the cards and the pills at each shift change and notify the DON if the count is incorrect, which did not happen in this case. Additionally, the facility staff failed to remove and destroy expired medications and medical supplies. Expired items found in the medication storage room included Clearlax Polyethylene Glycol 3350 Powder and 51-25 gauge safety needles. The LPN responsible for monitoring the medication room admitted to not knowing that needles could expire and was unsure how the expired items were missed. The DON and the administrator confirmed that staff should check medication rooms and carts for expired medications weekly, which was not done properly in this instance.
Failure to Provide Appropriate Discharge Notice and Readmission
Penalty
Summary
The facility staff failed to provide an appropriate 30-day discharge notice for a resident and did not allow the resident to return to the facility after being discharged from the hospital. The facility's Discharge/Transfer of Resident policy requires staff to explain the transfer and reason to the resident and/or representative and provide a copy of the transfer or discharge notice. In the case of an emergency transfer, the notice form may be completed later but as soon as possible. However, the resident's medical record did not contain an emergency or 30-day discharge notice prior to discharge, and the resident was not provided with an acceptance of admission to an alternative facility. The resident was admitted to the facility and received intravenous (IV) antibiotic medication but became weak and unsteady, leading to an order to send the resident to the emergency room. The facility staff decided not to readmit the resident, citing the inability to meet the resident's needs due to additional information received about the resident's history of drug use, wound care, and behaviors. Interviews with the facility's social services designee, administrator, and LPN revealed that the hospital had not initially provided complete information about the resident's medical history and behaviors. The hospital social worker confirmed that the resident remained in the emergency department, and placement had not yet been found for 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 34 citations issued within 25 miles in the last 12 months — including the 2 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 Camdenton
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Ozark Rehabilitation & Health Care Center | 17.9 mi | ★★★★★ | 0 | 0 |
| Lake Regional Health Systems | 18 mi | ★★★★★ | 3 | 0 |
| Laurie Care Center | 18.2 mi | ★★★★★ | 0 | 0 |
| Hermitage Nursing & Rehab | 19 mi | ★★★★★ | 13 | 1 |
| Arrowhead Senior Living Community | 19.2 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.