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 Claru Deville Nursing Center during CMS and state inspections, most recent first.
Two residents with psychiatric diagnoses and histories of self-harm were able to access and ingest AA batteries, resulting in ER transfers, while required 15-minute checks were not documented and staff lacked clear procedures or training. Additionally, a resident with a history of ingesting harmful items accessed an unlocked utility room containing safety razors, plastic bags, and hot coffee, and other environmental hazards were observed unsecured. The facility did not have a policy on accidents/incidents, and staff interviews revealed inconsistent monitoring and lack of formal guidance.
A facility failed to protect residents from abuse and neglect, particularly in a secured behavioral unit. A resident was physically abused by a CNA, and residents were deprived of necessary goods and services. The facility's punitive behavior management approach and lack of staff training contributed to the deficiency, affecting residents with complex medical histories.
The facility failed to uphold resident rights and dignity by placing three residents in a secured unit without proper evaluation and implementing a punitive actions and consequences program. Residents faced restrictions such as loss of smoke breaks, personal belongings, and contact with family, often without physician evaluation. These measures, approved by guardians, led to feelings of humiliation and discomfort among residents, with staff acknowledging the potential for escalated behaviors.
The facility failed to provide adequate behavioral health care and services to residents on a secured behavior unit, resulting in the enforcement of a negative consequences program that was not tailored to individual needs. Residents with mental health diagnoses were subjected to loss of privileges and other punitive measures without appropriate behavior plans or crisis intervention strategies, leading to distress and potential escalation of behaviors.
The facility did not implement a Quality Assurance and Performance Improvement (QAPI) program, lacking policies, documentation, and meetings necessary for improving healthcare processes and residents' quality of life. Interviews with the ADON and Administrator revealed the absence of a QAPI policy, plan, and committee members, despite recognizing the need for a formal approach. The Administrator, DON, and ADON expected to have a QAPI policy, plan, and program to monitor and address quality deficiencies, including Performance Improvement Plans (PIPs) and quarterly meetings with required members.
The facility failed to develop and implement a QAPI program to address quality deficiencies, affecting all 74 residents. Interviews revealed the absence of QAPI meetings, policies, or plans, despite the administration's acknowledgment of the need for a formal approach.
The facility failed to conduct quarterly QAA/QAPI committee meetings with the required members and did not provide a QAPI policy or documentation. Interviews revealed that the ADON admitted to not holding QAPI meetings, and the Administrator confirmed the absence of a QAPI policy or plan. The facility's leadership expressed an expectation to have a QAPI policy, plan, and program to monitor quality deficiencies and hold meetings with required members.
The facility failed to implement a Legionella risk management process and did not maintain proper infection control practices during peri care and wound care for residents. The Water Management Program was not followed, and staff did not adhere to hand hygiene and Enhanced Barrier Precautions (EBP) protocols, leading to deficiencies in infection prevention.
The facility failed to provide adequate staff training and competencies to meet the behavioral health needs of residents on a secured behavior unit. Residents with complex mental health issues were subjected to a punitive actions and consequences program without individualized care plans, leading to feelings of humiliation and discomfort. Staff interviews revealed a lack of specialized training and oversight, contributing to the deficiency.
A facility failed to complete a Level I PASARR for a resident with dementia, traumatic brain injury, and schizoaffective disorder upon admission. The absence of this federally mandated assessment was confirmed by the ADON and administration, who acknowledged the expectation for such screenings. The facility also lacked a policy for PASARR.
The facility failed to clean BiPAP and CPAP machines according to manufacturer's guidelines for two residents, leading to a deficiency. One resident reported infrequent cleaning of their CPAP machine, while another stated their BiPAP machine had never been cleaned. Observations confirmed no records of cleaning or tubing changes. Staff interviews revealed inconsistencies in cleaning schedules and procedures, with no formal system in place for maintaining these machines.
The facility exceeded the acceptable medication error rate, reaching 12% due to improper insulin pen use. An RN failed to prime insulin pens as per manufacturer's instructions for three residents, affecting their diabetes management. The DON confirmed the expectation for proper priming.
Two residents with mental health issues were involved in a physical altercation due to one resident's agitation over their position in line. The altercation resulted in injuries to both residents, highlighting a failure in the facility's abuse prevention policy.
The facility failed to properly notify residents and their representatives in writing of transfers to the hospital, as required by policy. For three residents, the facility did not provide essential information such as the reason for transfer, location, and appeal rights. Interviews with staff revealed that paperwork was sent with residents via EMS without retaining copies, leading to inadequate documentation and notification.
The facility failed to inform residents and their representatives of the bed hold policy during hospital transfers. Documentation for three residents lacked necessary signatures and details, and staff interviews revealed that no copies of the bed hold policy were retained at the facility. This led to a deficiency in compliance with the facility's policy.
The facility failed to maintain RN coverage for at least eight consecutive hours per day, seven days a week, affecting all 68 residents. Staffing sheets showed no RN coverage on several days, and agency RNs were not replaced when unavailable. Efforts to recruit RNs were hindered by competition with agency pay rates.
Failure to Prevent Self-Harm and Secure Hazardous Items for Residents with Psychiatric Diagnoses
Penalty
Summary
The facility failed to provide adequate protective oversight and maintain an environment free from accident hazards for residents with psychiatric diagnoses and a history of self-harm on a secured behavioral unit. Two residents with documented histories of self-injurious behavior, including battery ingestion, were able to access and swallow AA batteries on separate occasions, resulting in emergency room transfers and medical interventions. In one instance, a resident reported ingesting batteries obtained from another resident, while another resident, after making threats of self-harm, ingested batteries from a personal radio. Documentation of required 15-minute checks for one of these residents was not provided, and staff interviews revealed inconsistent understanding and implementation of monitoring protocols, with some staff unaware of the need for documentation or lacking training on the procedures. Additionally, the facility environment was not adequately secured to prevent access to hazardous items. During an observation, a resident with a history of ingesting harmful items was able to open an unlocked clean utility room containing safety razors, plastic grocery bags, and hot coffee carafes. Other hazards, such as a bucket of mop water with cleaning chemicals and tubes of toxic acrylic paint, were also accessible in resident areas. Staff interviews confirmed that doors to hazardous areas were left unlocked and that staff were expected to lock them but did not consistently do so. The facility did not provide a policy regarding accidents or incidents, and staff interviews indicated a lack of clear procedures for determining and documenting resident monitoring levels, such as 15-minute checks or 1:1 supervision. Decisions about monitoring were left to the charge nurse's discretion, and there was no formal policy or training provided to guide staff actions. This lack of structured oversight and environmental controls contributed to repeated incidents of self-harm and exposure to accident hazards among residents with known risks.
Failure to Protect Residents from Abuse and Neglect
Penalty
Summary
The facility failed to protect residents from abuse and neglect, particularly in the secured behavioral unit, affecting three residents. One resident was subjected to physical abuse by a CNA who physically forced the resident to the ground and restrained them, causing humiliation. This incident was part of a broader issue where residents were deprived of necessary goods and services, such as being forced to sleep on a mattress on the floor, leading to physical discomfort. The facility's policy on abuse and neglect was not effectively implemented, as evidenced by the presence of a punitive 'Actions and Consequences' list posted in a resident's bathroom. This list outlined various actions and corresponding consequences, such as losing smoke breaks or snack cart privileges, which were applied to residents for behaviors like arguing or refusing medication. This approach to behavior management was not aligned with the residents' rights to participate in their care and be free from abuse, as it imposed disciplinary measures that could be considered abusive. The residents involved had complex medical histories, including diagnoses of bipolar disorder, schizophrenia, and nicotine dependence, which contributed to their behavioral challenges. The facility's failure to administer prescribed nicotine replacement therapies further exacerbated these challenges. Additionally, the lack of proper training for staff, particularly agency staff, in handling behavioral incidents and the use of physical restraint, contributed to the deficiency. The facility's inadequate response to these issues resulted in an Immediate Jeopardy situation, indicating a serious threat to the health and safety of the residents.
Failure to Uphold Resident Rights and Dignity
Penalty
Summary
The facility failed to ensure and promote an environment that maintained or enhanced each resident's quality of life, recognizing their rights and allowing them to exercise these rights without coercion, interference, discrimination, or reprisal. Three residents were placed in a secured unit without proper evaluation for appropriate placement, and their rights were removed based on directives from their guardians. The facility's actions included implementing a program where residents' privileges, such as smoke breaks and personal belongings, were taken away as consequences for certain behaviors, which was perceived as punitive by some staff and residents. Resident #11, diagnosed with bipolar disorder, schizophrenia, and nicotine dependence, was subjected to a list of actions and consequences that included losing smoke breaks and personal items for behaviors such as arguing or refusing medication. The resident expressed feeling humiliated by these measures, particularly after an incident where they punched a staff member and subsequently lost smoking privileges. The resident's care plan indicated that these measures were approved by the guardian, but there was no physician evaluation to determine the appropriateness of these interventions. Resident #61, with diagnoses including schizophrenia and oppositional defiant disorder, experienced similar restrictions, including limited contact with family and removal of personal belongings. The resident was observed wearing a hospital gown as a consequence of self-harming behavior, which they reported made them feel bad. Resident #68, diagnosed with borderline intellectual functioning and borderline personality disorder, also faced restrictions such as wearing a hospital gown and having their mattress placed on the floor as a consequence of self-harming behavior. Both residents expressed feelings of embarrassment and discomfort due to these measures. The facility lacked a formal tracking tool for behaviors and consequences, and there was no physician evaluation to assess the benefit of these interventions for the residents' mental health.
Failure to Provide Adequate Behavioral Health Care
Penalty
Summary
The facility failed to provide necessary behavioral health care and services to residents on the secured behavior unit, impacting their physical, mental, and psychosocial well-being. The facility did not develop resident-specific interventions or behavior plans as indicated by pre-admission behavioral health screenings. Instead, a program of negative consequences was enforced for residents exhibiting certain behaviors, which included the loss of privileges such as smoke breaks and snack carts. This approach was not tailored to individual needs and lacked a crisis intervention plan. Resident #11, diagnosed with bipolar disorder and schizophrenia, was subjected to an actions and consequences list that resulted in the loss of smoke breaks and other privileges following altercations with staff. The resident expressed feelings of humiliation due to these consequences. Similarly, Resident #61, with a history of schizophrenia and oppositional defiant disorder, experienced self-harming behavior and was made to wear a hospital gown as a consequence, which the resident found distressing. The facility did not provide a behavior plan or crisis intervention plan for this resident, despite the Level II screening recommendations. Resident #68, with borderline intellectual functioning and a history of self-harm, was also subjected to the actions and consequences program. The resident was made to wear a hospital gown and sleep on a mattress on the floor as a result of self-harming behavior. The facility did not provide the necessary support services or behavior plans as indicated by the Level II screening. Interviews with staff revealed that the actions and consequences program could escalate behaviors, and there was no tracking tool for behaviors, leading to inconsistent enforcement of consequences.
Lack of QAPI Program Implementation
Penalty
Summary
The facility failed to implement a Quality Assurance and Performance Improvement (QAPI) program, which is essential for improving healthcare processes and residents' quality of life. The facility, with a census of 74 residents, did not have a QAPI policy or any documentation related to such a program. Interviews revealed that the Assistant Director of Nursing (ADON) acknowledged the absence of QAPI meetings. The Administrator admitted to lacking a QAPI policy, plan, or a list of committee members, although he recognized the need for a more formal approach. Furthermore, the Administrator, Director of Nursing (DON), and ADON collectively expressed the expectation of having a QAPI policy, plan, and a program to monitor and address quality deficiencies, including Performance Improvement Plans (PIPs) and quarterly meetings with required members such as the Medical Director, Administrator, DON, Infection Preventionist, and two other staff members.
Lack of QAPI Program and Policy
Penalty
Summary
The facility failed to ensure the Quality Assessment and Assurance/Quality Assurance Performance Improvement (QAA/QAPI) committee developed and implemented an appropriate plan of action to correct identified quality deficiencies. This deficiency had the potential to affect all 74 residents in the facility. The facility did not provide a QAPI policy or any documentation related to a QAPI program. During interviews, the Assistant Director of Nursing (ADON) admitted that they do not have QAPI meetings, and the Administrator acknowledged the absence of a QAPI policy or plan, despite knowing the need for a more formal approach. The Administrator, Director of Nursing (DON), and ADON collectively expressed the expectation to have a QAPI policy, plan, and a program to monitor and track quality deficiencies, along with Performance Improvement Plans (PIPs) for those deficiencies.
Failure to Conduct QAPI Meetings and Maintain Required Documentation
Penalty
Summary
The facility failed to conduct quarterly Quality Assessment and Assurance/Quality Assurance Performance Improvement (QAA/QAPI) committee meetings with the required members. The facility, with a census of 74, did not provide a QAPI policy or any documentation related to a QAPI program. During interviews, the Assistant Director of Nursing (ADON) admitted that they do not hold QAPI meetings. The Administrator also confirmed the absence of a QAPI policy or plan and acknowledged the need for a more formal approach. Additionally, the Administrator, Director of Nursing (DON), and ADON expressed an expectation to have a QAPI policy, plan, and program to monitor and track quality deficiencies, including Performance Improvement Plans (PIPs) for those deficiencies, and to hold QAPI meetings at least quarterly with the required members, such as the Medical Director, Administrator, DON, Infection Preventionist, and two other staff members.
Failure to Implement Infection Control and Legionella Risk Management
Penalty
Summary
The facility failed to implement a risk management process specific to Legionnaires' disease, which could potentially affect all residents, staff, and the public. The facility's Water Management Program to Reduce Legionella Growth Policy was not followed, as there was no water management committee in place, and the Maintenance Director did not conduct a checklist for monthly water management inspections. The Maintenance Director only performed random water temperature checks, which were within range, but did not address other necessary inspections to prevent Legionella growth. In addition, the facility did not maintain proper infection control practices during peri care for a resident. Two CNAs failed to wash or sanitize their hands between glove changes while providing peri care, and they did not wash or sanitize their hands after removing gloves and before leaving the resident's room. This lack of adherence to hand hygiene protocols was observed during the care of a resident, and the CNAs admitted to not following proper procedures due to the resident's impatience and personal nerves. Furthermore, the facility did not implement Enhanced Barrier Precautions (EBP) during wound care for another resident. An RN did not follow EBP guidelines, as there was no sign regarding EBP or PPE located near or outside the resident's door. The RN also failed to use a barrier for clean supplies and did not wash hands before and after providing wound care. The Administrator, DON, and ADON acknowledged that they expected staff to follow proper hand hygiene and EBP protocols, but these were not adhered to during the observed care.
Deficiency in Behavioral Health Competency and Training
Penalty
Summary
The facility failed to provide staff with the necessary competencies and skills to meet the behavioral health needs of residents on the secured behavior unit. This deficiency was observed through the lack of specialized training for staff working on the unit, as well as the absence of policies or procedures regarding staffing needs and criteria for admission to the unit. The facility's failure to implement a mental health behavior training program for staff further contributed to the deficiency, affecting the care and safety of residents. Three residents were specifically highlighted in the report, each with complex behavioral and mental health needs. One resident, diagnosed with bipolar disorder and schizophrenia, was subjected to a punitive actions and consequences list that included the loss of privileges such as smoke breaks and snack carts for various behaviors. This resident expressed feelings of humiliation due to these consequences. Another resident, with a history of schizophrenia and oppositional defiant disorder, was observed wearing a hospital gown as a consequence of self-harming behavior, which made the resident feel bad and embarrassed. The third resident, with borderline personality disorder and a history of self-harm, was also made to wear a hospital gown and sleep on a mattress on the floor as a consequence of self-harming behavior, leading to feelings of embarrassment and physical discomfort. Interviews with staff revealed that the actions and consequences program was in place without proper training or oversight, and some staff felt that the consequences could escalate resident behaviors. The Director of Nursing acknowledged the lack of written policies for the behavior unit and the absence of required training for staff before working on the unit. The facility's reliance on a punitive system without individualized care plans or interventions to monitor and protect residents from abuse contributed to the deficiency, impacting the well-being of all residents on the secured behavioral unit.
Failure to Complete PASARR for Resident
Penalty
Summary
The facility failed to complete a Level I Preadmission Screening and Resident Review (PASARR) for a resident upon admission, as required by federal mandate. The resident, who was part of a sample of 18 residents, had diagnoses including dementia, traumatic brain injury, and schizoaffective disorder-bipolar type. Despite these conditions, there was no documentation of the necessary Level I pre-screening in the resident's medical record. Interviews with the Assistant Director of Nursing and the facility's administration confirmed that the PASARR was not completed, and they acknowledged the expectation for such assessments to be conducted prior to admission. Additionally, the facility did not provide a policy for PASARR, indicating a lack of procedural adherence in this area.
Failure to Clean BiPAP and CPAP Machines as per Guidelines
Penalty
Summary
The facility failed to adhere to the manufacturer's guidelines for cleaning BiPAP and CPAP machines for two residents, leading to a deficiency. Resident #39, diagnosed with obstructive sleep apnea and insomnia, was observed using a CPAP machine without any record of cleaning or tubing changes. The resident reported that the machine was cleaned infrequently by the nursing staff. Similarly, Resident #46, who has sleep apnea and uses a BiPAP machine, stated that the machine had never been cleaned to their knowledge. Observations confirmed the absence of any dates indicating the last cleaning or tubing/filter changes for both residents. Interviews with facility staff revealed inconsistencies in the cleaning schedule and procedures for BiPAP and CPAP machines. A CNA mentioned that the machines were filled with distilled water every shift and cleaned every two to three days, but had no experience with the cleaning process. A registered nurse stated that the cleaning was done during the night shift, while the DON and ADON acknowledged the lack of a formal system for cleaning and maintaining the machines. An LPN mentioned that filters and tubing were changed weekly, but there was no specific cleaning protocol in place. The facility's policy on oxygen administration did not address the use of BiPAP and CPAP machines, contributing to the deficiency.
Medication Error Rate Exceeds Acceptable Threshold
Penalty
Summary
The facility failed to maintain a medication error rate of less than five percent, resulting in an error rate of 12%. This was observed during medication administration, where three errors were made out of 25 opportunities. The errors involved the improper use of insulin pens for three residents, two of whom were part of the sample and one who was not. Specifically, the Registered Nurse (RN) failed to prime the insulin pens with two units of insulin as per the manufacturer's instructions before administering the medication to the residents. The observations revealed that the RN did not follow the correct procedure for priming the Humalog KwikPen and NovoLog FlexPen, which is essential for accurate dosing. During interviews, the RN admitted to not priming the pens as required, and the Director of Nursing and Assistant Director of Nursing confirmed that they expected insulin pens to be primed according to the manufacturer's instructions. This deficiency affected the care of residents with diabetes, as the facility's policy did not address the use of insulin pens, potentially impacting the management of their condition.
Failure to Prevent Resident Altercation
Penalty
Summary
The facility failed to protect residents from abuse when two residents were involved in a verbal and physical altercation. The incident occurred when one resident became agitated and verbally aggressive due to their position in line to see the unit coordinator. This resident, who has a history of aggressive behaviors and mental health diagnoses, including bipolar disorder and PTSD, threatened another resident. The second resident, who also has a history of mental health issues, attempted to calm the first resident, which escalated into a physical fight. During the altercation, the first resident charged at the second resident, grabbing their hair and not letting go. In response, the second resident struck the first resident in the face multiple times and poked them in the eyes. Both residents ended up on the ground, and staff intervened to separate them. The first resident was sent to the emergency room for evaluation due to injuries sustained during the fight, including redness and a small scrape on the eyelid. The second resident suffered a bald spot from hair being pulled out, bruising on the hand, and a small abrasion on the elbow. The facility's policy on abuse prevention was not effectively implemented, as evidenced by the failure to prevent the altercation between the two residents. Despite the presence of staff and the facility's policy to protect residents from harm, the situation escalated to physical violence. The incident highlights the need for better management of residents with behavioral issues and more effective intervention strategies to prevent such occurrences.
Failure to Notify Residents and Representatives of Transfers
Penalty
Summary
The facility failed to properly notify residents and their representatives in writing of a facility-initiated transfer to the hospital for three residents. The facility's policy on discharge and transfer requires that residents and their representatives be informed of the transfer, including the reason for the transfer, the location to which the resident is being transferred, and their right to appeal. However, the facility did not adhere to these requirements for the three residents involved. For Resident #1, the Emergency Transfer Notice was sent a day after the transfer and lacked critical information such as the specific reason for the transfer, the location of the transfer, and details about the right to appeal. Additionally, the notice was not signed by facility staff. Resident #2's medical record showed no documentation of written notification to the resident or their representative regarding the transfer to the hospital. Similarly, Resident #3's Emergency Transfer Notice was missing essential information, including the reason for the transfer, the location, and appeal rights, and was also unsigned. Interviews with facility staff, including a Registered Nurse, the Director of Nursing, the Social Service Director, and the Administrator, revealed that the facility's process involved sending paperwork with the resident via Emergency Medical Services without retaining copies at the facility. The staff indicated that notifications and bed hold policies were mailed to guardians or responsible parties, but no copies of the transfer notices were kept or sent to the representatives, leading to a lack of proper documentation and notification as required by the facility's policy.
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. The facility's policy requires notification of the bed hold policy upon admission, at the time of transfer, and during non-covered therapeutic leave. However, for the three residents sampled, there was no documentation that the residents or their representatives were informed of the bed hold policy at the time of their hospital transfers. Specifically, the records for these residents lacked signed authorizations for bed hold, did not address the daily rate amount, and were not signed by either the resident, their representative, or a facility representative. Interviews with facility staff revealed that while the bed hold policy and transfer paperwork are sent with the resident to the hospital, no copies are retained at the facility. The Registered Nurse mentioned that the paperwork is sent with the Emergency Medical Services, but no copies are made. The Director of Nursing confirmed that no copies of the transfer or bed hold notices are made at the time of discharge, and the Social Services Director stated that they send the bed hold policy to the guardian or representative to sign and return, but do not follow up if it is not returned. This lack of documentation and follow-up led to the deficiency noted in the report.
RN Staffing Deficiency
Penalty
Summary
The facility failed to ensure that a Registered Nurse (RN) was scheduled for at least eight consecutive hours per day, seven days a week, as required by regulations. This deficiency had the potential to affect all 68 residents in the facility. A review of the Nursing Daily Staffing Sheets for the period from April 1, 2024, to May 1, 2024, revealed that there was no RN scheduled for several days, specifically from April 13 to April 14, April 17 to April 18, and April 26 to April 27. On some occasions, an agency RN was scheduled but called in, and no replacement was found. Overall, there was no RN coverage for six out of the 31 days reviewed. Interviews with facility staff, including an RN and the Administrator, highlighted the challenges in maintaining consistent RN coverage. The RN mentioned working Monday through Thursday and one full weekend a month, while the Administrator acknowledged the absence of a formal RN coverage policy and the reliance on agency staff to fill gaps. The Director of Nursing (DON) stated that she is always on call and attempts to arrange agency staff when necessary. Despite efforts to recruit RNs through various channels, including online advertisements and outreach to student nurses, the facility struggled to compete with agency pay rates, contributing to the staffing deficiency.
What surveyors are citing around you — mapped
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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 22 citations issued within 25 miles in the last 12 months — 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
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Illustrative
Risk indicators are statistical estimates from public CMS data — not predictions, findings, or compliance advice.
Nursing homes near Fredericktown
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Madison Medical Center | 1 mi | ★★★★★ | 5 | 0 |
| St Francois Manor | 15.7 mi | ★★★★★ | 4 | 0 |
| Farmington Presbyterian Manor | 17 mi | ★★★★★ | 0 | 0 |
| Southbrook Nursing Center | 17.5 mi | ★★★★★ | 4 | 0 |
| Baptist Homes Of Arcadia Valley | 17.6 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.