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 Milford Meadows Care Center during CMS and state inspections, most recent first.
The facility failed to submit an investigation to the State Agency within the required timeframe after an altercation between two residents. One resident had anoxic brain damage and schizoaffective disorder with a BIMS of 9, and the other had cerebral infarction, unspecified dementia, and generalized anxiety disorder with a BIMS of 12; both used wheelchairs. APS was notified, but the completed investigation was not submitted to DHHS until 9 working days after the event, and the Admin could not produce earlier grievance/complaint logs during survey.
The facility failed to ensure food safety and kitchen sanitation, as cooking and holding temperatures were not consistently recorded, dishwashing temperatures were inadequate, and kitchen cleanliness was lacking. Staff served microwaved soup without checking temperatures, potentially affecting resident safety.
The facility failed to implement proper infection control measures, including Enhanced Barrier Precautions (EBP) signage and PPE usage, and neglected proper hygiene for medical equipment. Staff were observed carrying linens against their bodies, contrary to policy, and catheter care was performed without proper hand hygiene. Additionally, CPAP masks and oxygen tubing were not cleaned or replaced as required, indicating a lack of adherence to infection control protocols.
The facility failed to serve meals to 25 residents in their rooms using non-disposable dishware, instead using Styrofoam containers and plastic utensils, which did not uphold the residents' rights to dignity and a homelike environment. This practice was confirmed by the Dietary Manager and Administrator, despite the facility's policies emphasizing respect and dignity for residents.
The facility failed to maintain comfortable sound levels, disturbing residents' sleep with loud music played in the sitting area near the nurse's station. Despite complaints from several residents, the music volume remained high, with residents often singing into a microphone. Staff confirmed the issue, but the facility did not take adequate steps to address the noise, violating residents' rights to a comfortable environment.
A facility failed to follow best practices for wound care for a resident with chronic ulcers and diabetes. An LPN was observed cleansing a wound incorrectly and using the same dressing to dry the wound and toes. Mupirocin was applied to multiple wounds without prior cleansing. The resident's care plan included specific wound care orders, but these were not followed during the observed treatment.
A facility failed to ensure proper behavior monitoring for a resident on multiple psychotropic medications. Despite the resident's psychiatric instability, as noted by a physician, the facility did not document behaviors or interventions effectively. Staff interviews confirmed that the process for behavior documentation was not followed, with missing details in Progress Notes for observed behaviors.
A resident's pressure ulcer was not properly monitored, leading to deterioration. The facility failed to adhere to its skin policy, resulting in a stage 3 ulcer with infection. Staff interviews confirmed the absence of the wound nurse contributed to inadequate care.
Late Submission of Investigation After Resident Altercation
Penalty
Summary
The facility failed to submit an investigation to the State Agency within five working days after a reported altercation between two residents. The incident involved Resident 1, who had diagnoses including anoxic brain damage and schizoaffective disorder and a BIMS score of 9, and Resident 2, who had diagnoses including cerebral infarction, unspecified dementia, and generalized anxiety disorder and a BIMS score of 12. Both residents used wheelchairs for mobility. A review of the facility’s submitted investigation, Report #1165231, showed that Adult Protective Services was notified of the occurrence on 1/24/2026 at 4:01 PM and that the completed investigation was submitted to DHHS on 2/05/2026. Survey review of the calendar showed that five working days after the incident would have been 1/30/2026, making the submission 9 working days after the event. The Administrator stated on 5/13/2026 that a new log had been started in March and that logs for 2025 and earlier in 2026 could not be produced during the survey visit.
Deficiencies in Food Safety and Kitchen Sanitation
Penalty
Summary
The facility failed to ensure that food was cooked and served at safe temperatures, as required by professional standards and guidelines. Observations and record reviews revealed that the facility did not consistently record cooking and holding temperatures for meals, including mechanically altered diets such as pureed and mechanical soft foods. On multiple occasions, temperatures were not recorded for various meals, and during an observation, a cook did not check the final cooking temperatures of food items before serving them to residents. This failure to monitor and record temperatures could potentially lead to foodborne illnesses among residents. Additionally, the facility did not maintain proper dishwashing temperatures, which are crucial for sanitizing kitchen equipment and preventing contamination. Observations showed that the dishwashing machine did not reach the required minimum temperatures for washing and rinsing, as specified by the equipment manual and facility policy. Despite a sign indicating the necessary temperature range, the staff did not ensure that the machine reached the minimum required temperature before using it to clean kitchen equipment. The facility also failed to maintain a clean and sanitary environment in the kitchen. Observations revealed that light covers and a ceiling fan in the kitchen had a moderate amount of gray fuzzy substance on them, indicating a lack of regular cleaning. Furthermore, staff members served microwaved soup to residents without checking the temperature to ensure it was safe to consume. These deficiencies in food handling, equipment sanitization, and kitchen cleanliness could potentially affect the health and safety of all residents consuming food from the facility's kitchen.
Infection Control and Equipment Hygiene Deficiencies
Penalty
Summary
The facility failed to implement proper infection control measures, particularly regarding Enhanced Barrier Precautions (EBP) for residents colonized or infected with multidrug-resistant organisms (MDROs). Interviews with staff revealed a lack of appropriate signage indicating the necessary personal protective equipment (PPE) for visitors and staff when caring for residents under EBP. Staff were unsure how visitors would know what PPE to wear, and it was confirmed that visitors do enter resident rooms, contrary to some staff beliefs. The facility's policy required signage on room doors, but this was not consistently followed. Additionally, staff were observed carrying linens against their bodies, which is against the facility's policy to prevent cross-contamination. Interviews confirmed that linens should be carried away from the body, but this practice was not consistently adhered to by staff. The facility's linen policy did not provide guidance on this matter, indicating a gap in training or policy enforcement. The facility also failed to maintain proper hygiene and care for residents' medical equipment. For instance, a resident's catheter care was performed without proper hand hygiene and eye protection, and the CPAP mask and oxygen tubing for another resident were not cleaned or replaced as per the facility's policy. Observations showed that the CPAP mask had visible debris, and the oxygen tubing was hardened and not dated, indicating neglect in routine maintenance and cleaning procedures. These deficiencies highlight a lack of adherence to established infection control protocols and policies, potentially compromising resident safety.
Deficiency in Resident Dining Experience
Penalty
Summary
The facility failed to ensure that food and beverages were served to residents in a manner that upheld their rights to dignity and a homelike environment. Specifically, 25 residents who received their meals in their rooms were served using disposable dishware and cutlery, such as Styrofoam containers and plastic utensils. This practice was observed on multiple occasions, and it was confirmed by both the Dietary Manager and the facility's Administrator that this was the standard procedure for room service meals. The facility's policies, including the Resident Rights policy and the Resident Handbook, emphasize the importance of treating residents with respect, kindness, and dignity. However, the use of disposable dishware for room service meals contradicts these policies, as it does not provide a homelike dining experience. The deficiency was identified through observations and interviews, highlighting a failure to align the facility's practices with its stated commitment to resident dignity and rights.
Facility Fails to Maintain Comfortable Sound Levels
Penalty
Summary
The facility failed to maintain comfortable sound levels, violating residents' rights to a safe and homelike environment. Observations revealed that loud music was consistently played in the sitting area near the nurse's station, which could be heard throughout the facility, disturbing residents in their rooms. This issue was particularly evident during early morning hours when many residents were trying to sleep. Despite complaints from several residents, the music volume remained excessively high, with residents 52 and 54 often singing into a microphone, further exacerbating the noise level. Multiple residents, including those with varying levels of cognitive function, expressed their discomfort and inability to sleep due to the loud music. Resident 36, who was cognitively intact, had complained to the administration about the noise but reported that no action was taken. Similarly, Resident 16, who also had a high cognitive score, attempted to address the issue directly with Resident 52 but was met with resistance. The resident also reported the problem to the administration, yet the situation persisted, forcing them to keep their room door closed to mitigate the noise. Interviews with staff confirmed the loud music issue, with the Assistant Director of Nursing acknowledging the problem but noting that only one formal complaint had been received. The facility's Administrator also confirmed that the music was played too loudly in the mornings. Despite these acknowledgments, the facility did not take adequate steps to address the noise levels, resulting in a failure to uphold the residents' rights to a comfortable and respectful living environment.
Failure to Follow Best Practices in Wound Care
Penalty
Summary
The facility failed to adhere to best practices for wound care for one of the residents, leading to a deficiency. During an observation, an LPN was seen cleansing a resident's right plantar wound by rubbing from toes to mid-foot across the wound multiple times, rather than using the recommended circular motion from the center of the wound outward. Additionally, the LPN used the same 4x4 dressing to dry the wound that had been used to dry around the resident's toes, which is not in line with best practices. The LPN also applied Mupirocin ointment to multiple wounds on the resident's left leg without cleansing them first, and did not treat each wound separately. The resident involved had a history of non-pressure chronic ulcers on both feet, Type 2 Diabetes Mellitus, abnormal coagulation, and venous insufficiency. The resident was cognitively intact and independent in most activities of daily living except for bathing and eating. The resident's care plan included interventions for skin integrity and wound care as ordered by the provider. The LPN confirmed during an interview that the wounds were not cleansed because the resident had showered that morning, and acknowledged the incorrect method of cleansing the right plantar wound.
Inadequate Behavior Monitoring for Psychotropic Medication Use
Penalty
Summary
The facility failed to ensure proper behavior monitoring to support the use of multiple psychotropic medications for a resident. The resident, who was cognitively intact with a BIMS score of 13/15, was taking several psychotropic medications, including Buspirone, Duloxetine, Lexapro, Lamictal, and Ativan, for conditions such as anxiety, depression, and bipolar disorder. Despite a physician's note declining a gradual dose reduction due to psychiatric instability, the facility did not adequately document the resident's behaviors or the effectiveness of interventions, as required by their policy. Interviews with the Assistant Director of Nursing and other staff confirmed that the facility's process for documenting behaviors was not followed. The nursing aides were responsible for documenting behaviors in the Point Click Care system and reporting them to the charge nurse, who was supposed to document further details and interventions in the Progress Notes. However, a review of the Task: Behavior charting revealed instances of wandering behavior without corresponding Progress Notes, indicating a lack of detailed documentation and monitoring necessary to justify the continued use of psychotropic medications.
Failure to Monitor and Manage Pressure Ulcer
Penalty
Summary
The facility failed to adequately monitor and manage a pressure ulcer for one resident, leading to a deterioration of the wound. The resident, who was admitted to the facility in November 2020, developed a fluid-filled blister on the right heel, which was identified as a possible pressure-related injury. Despite the initial identification and request for a treatment order, there was a significant delay in receiving the order, and the wound was not properly monitored or measured from mid-April to early May. During this period, the wound progressed to a stage 3 pressure ulcer with signs of infection, including increased slough and maceration of the surrounding skin. Interviews with facility staff, including the Director of Nursing, Assistant Director of Nursing, and a Licensed Practical Nurse, revealed that the facility did not adhere to its skin policy and procedure, which required weekly wound measurements and updates to the responsible party and provider. The absence of the wound nurse during this critical period contributed to the lack of proper wound care and monitoring, resulting in the wound's deterioration. The facility's failure to follow professional standards of practice and ensure consistent wound care led to the identified 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 128 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 Milford
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Eventide Crete | 11.1 mi | ★★★★★ | 6 | 0 |
| Ridgewood Rehabilitation & Care Center | 11.1 mi | ★★★★★ | 0 | 0 |
| Emerald Nursing & Rehab Lancaster Llc | 16.7 mi | ★★★★★ | 5 | 0 |
| Heartland Ridge Care Center | 17.1 mi | ★★★★★ | 0 | 0 |
| Sumner Place | 17.5 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.