Above 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 Meadowbrook Care Center during CMS and state inspections, most recent first.
A resident with cancer, hip fracture, and anxiety disorder developed fever, shivering, and low O2 sat, and the MD ordered labs plus a chest x-ray. Nursing documented the order was sent to the x-ray vendor, but the record showed no evidence the x-ray was completed, and there was no documented follow-up when it was missed. The resident later became confused and uncontrollably shaky, was transferred to the hospital, and was admitted with pneumonia.
A survey revealed a discrepancy in the controlled drug count on Unit 1B, where an LPN failed to document the administration of an Oxycodone tablet for a resident, resulting in a mismatch between the controlled substance record and the blister pack. The facility's policy mandates immediate documentation to ensure accountability and security.
The facility's assessment inaccurately documented the need for 57 CNAs during the day shift, which was identified as a typographical error. The Administrator acknowledged the discrepancy, stating the number did not reflect the actual staffing needs based on residents' acuity levels. A revised assessment later indicated that 39 CNAs were required.
A resident with Chronic Obstructive Pulmonary Disease and other conditions was observed receiving oxygen therapy without a physician's order, contrary to facility policy. Staff interviews revealed a lack of awareness regarding the absence of the necessary order, highlighting a failure to maintain medical records in accordance with professional standards.
The facility failed to transmit MDS assessments to CMS within the required 14-day period for three residents. One resident's discharge assessment was 132 days late, another's quarterly assessment was 16 days late after an initial rejection, and a third's discharge assessment was 90 days late. The facility's policy lacked a specified timeframe for transmission, and the DON was unaware of the process, which was the responsibility of the MDS Coordinators.
Missed Chest X-Ray Order for Febrile Resident
Penalty
Summary
The facility failed to ensure that a chest x-ray ordered for a resident with fever was obtained in a timely manner. The resident had diagnoses including cancer, hip fracture, and anxiety disorder, and the admission MDS documented a BIMS score of 11, indicating moderate cognitive impairment. On 03/09/2026, the resident was observed flushed, shivering, febrile at 101.9 degrees Fahrenheit, with elevated blood pressure and an oxygen saturation of 92% on room air. The physician was notified and ordered blood work, urinalysis, urine culture and sensitivity, and a chest x-ray. A physician order documented a chest x-ray to be obtained that night, and nursing notes later documented that laboratory results were pending, with abnormal urinalysis and blood test results reviewed with the physician. A physician assistant later documented that the resident was awake, alert, and oriented to person and place with periods of forgetfulness, denied respiratory and urinary symptoms, and had stable respiratory status, while noting that chest x-ray and urine culture and sensitivity results would be followed up for further intervention. However, the medical record contained no evidence that the chest x-ray was completed as ordered. The resident later developed shaking uncontrollably and confusion, and the family requested transfer to the hospital, where the resident was admitted with pneumonia. Interviews with nursing leadership and the x-ray vendor indicated the requisition had been sent, but the vendor could not locate it and there was no documentation of follow-up in the medical record regarding the missed x-ray. The Director of Nursing stated the x-ray was not done and that the order should have been completed within 24 hours, but no progress notes documented the communication with the physician or the vendor regarding the missed test.
Controlled Drug Count Discrepancy
Penalty
Summary
During a recertification survey, it was found that the facility failed to accurately maintain an account of controlled drugs on Unit 1B. Specifically, the count of Oxycodone tablets documented in the controlled substance record did not match the actual number of tablets present in the blister pack for a resident. The facility's policy requires that all controlled drugs be subject to special receipt, handling, storage, disposal, and record keeping to ensure accountability and security. However, during an observation, it was noted that the controlled drug record sheet indicated 29 tablets remaining, while the blister pack contained only 28 tablets. The discrepancy was attributed to an oversight by an LPN who administered a 5-milligram Oxycodone tablet to the resident but failed to record the administration on the controlled drug record sheet. The resident's medication administration record was signed, indicating the medication was administered as ordered. Interviews with the Nurse Educator and the Director of Nursing Services confirmed that the procedure requires nurses to document the removal of controlled medication immediately on the controlled drug record sheet to ensure the narcotic count matches.
Inaccurate Facility Assessment of CNA Staffing Needs
Penalty
Summary
The facility failed to ensure that its facility-wide assessment accurately reflected the necessary resources to care for residents competently during day-to-day operations. Specifically, the assessment incorrectly documented the need for 57 Certified Nurse Aides (CNAs) during the day shift, which included 39 facility staff and 18 agency staff. Upon review, the Administrator acknowledged that this number was a typographical error and did not accurately represent the actual number of CNAs required based on the residents' needs and acuity levels. The Administrator admitted that the information should have been accurate and up-to-date when the assessment was reviewed in May 2024. A revised assessment was later provided, indicating that 39 CNAs were required for the day shift.
Resident Received Oxygen Without Physician's Order
Penalty
Summary
The facility failed to maintain medical records in accordance with accepted professional standards and practices, as evidenced by the case of a resident receiving oxygen therapy without a physician's order. The resident, who was admitted with diagnoses including Chronic Obstructive Pulmonary Disease, Heart Failure, and Acute Kidney Failure, was observed receiving 2 liters of oxygen per minute via a nasal cannula on multiple occasions. Despite the facility's policy requiring a physician's order for oxygen therapy, there was no documented evidence of such an order for this resident. Interviews with facility staff, including a Licensed Practical Nurse (LPN) and the Unit Manager, revealed that the staff were unaware of the lack of a physician's order for the resident's oxygen therapy. The LPN admitted to not checking the resident's physician's orders and acknowledged that they should have verified the presence of an order before administering treatments. The Director of Nursing Services also confirmed that a physician's order should have been in place for the resident receiving oxygen therapy.
Delayed MDS Assessment Submissions
Penalty
Summary
The facility failed to ensure that all completed Minimum Data Set (MDS) assessments were electronically transmitted to the Centers for Medicare and Medicaid Services (CMS) within the required 14-day timeframe. This deficiency was identified during a recertification survey for three residents. Specifically, one resident's discharge MDS assessment was submitted 132 days late, another resident's quarterly MDS assessment was submitted 16 days late after an initial rejection, and a third resident's discharge MDS assessment was submitted 90 days late. The facility's policy on MDS assessments, last revised in 2019, did not specify the timeframe for transmitting assessments. Interviews revealed that the Director of Nursing Services was unaware of the MDS transmission process, which was the responsibility of the MDS Coordinators. One of the MDS Coordinators admitted to not ensuring the timely submission of the assessments, leading to the significant delays in transmission.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Freeport
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| South Shore Rehabilitation And Nursing Center | 0.2 mi | ★★★★★ | 10 | 0 |
| Mount Sinai South Nassau T C U | 1.9 mi | ★★★★★ | 1 | 0 |
| Oceanside Care Center Inc | 2.6 mi | ★★★★★ | 5 | 0 |
| Rockville Skilled Nursing & Rehabilitation Center, | 3 mi | ★★★★★ | 0 | 0 |
| The Grand Pavilion For Rhb & Nrsg At Rockville Ctr | 3.1 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.