Above average — CMS composite of the measures below.
The next survey window likely opens around April 2027
Estimate from public CMS data, current as of October 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Laurels Of Massillon, The during CMS and state inspections, most recent first.
Food was not consistently served at appetizing temperatures or with acceptable quality. Several residents reported bland, tasteless, undercooked, mushy, or cold meals, and one resident said he ordered take-out because of the food. During tray line and test tray observations, Dietary staff verified that hot items such as chicken patties, roasted potatoes, and green beans were served at temperatures that were lukewarm or below the DM’s stated ideal range for hot foods.
Infection control practices were not followed during medication administration and catheter care. An RN did not perform observed hand hygiene between resident contacts, after removing PPE, or before continuing medication pass, and contaminated equipment was placed on the med cart without cleaning. During catheter care, a CNA placed supplies on an unprotected bedside table, used items that had contacted the table, changed gloves without hand hygiene, and handled catheter drainage equipment and bathroom fixtures before completing hand hygiene.
Ceiling Damage and Worn Recliner Not Maintained in Good Repair: A leaking pipe repair left a large opening in the 100-hall ceiling and the drywall remained cut out in the common area during observation. A resident with AFib, DM2, CKD, and need for assistance with personal care also had a facility-supplied recliner with substantial peeling material on the headrest and arm areas; the resident said it had been that way since admission, and the Maintenance Director and Administrator verified the condition.
Smoking Area Trash Disposal Policy Not Followed: The facility failed to implement its smoking policy in the designated outdoor smoking area when more than 10 cigarette butts were observed in a non-flame resistant trash can with combustible trash. The Maintenance Director verified the finding, and the smoking policy stated that ashtrays would be available for resident use but did not specify non-combustible containers.
Failure to Implement Nutritional Interventions for Weight Loss: A resident admitted with moderate protein calorie malnutrition, COPD, and fractures had poor intake documented on nutritional screenings and an RD recommended a house supplement for nutrition and weight maintenance. No MD order was entered for the supplement, the resident then had significant weight loss on weekly weights, and the record showed no evidence the MD/NP were notified or that any nutritional intervention was implemented before discharge.
Failure to Notify Provider of Significant Weight Loss: A resident with moderate protein calorie malnutrition, COPD, and recent fractures had a significant wt loss after admission, dropping from 152 lb to 144.3 lb within 8 days. Although dietary staff documented the wt loss and a supplement recommendation, there was no documentation that the MD or NP was notified, and no provider-ordered interventions were found in the record.
A resident with diabetes, CKD, MDD, paroxysmal AFib, and HTN consented to receive the COVID-19 vaccine, but the vaccine was neither ordered nor administered. The resident’s cognition was intact, and an ADON confirmed the missed order and administration after consent was obtained.
A resident with significant physical and communication impairments did not receive a comprehensive, individualized care plan to address her needs. Staff were unaware of proper wheelchair fit and necessary equipment, leading to discomfort and fear of falling, while recommended communication strategies and tools were not implemented or provided, resulting in ongoing frustration for the resident.
A resident receiving wound care for a coccyx wound was exposed from the upper back to the ankles while two nurses performed the procedure without pulling the privacy curtain. The resident's roommate was present and able to see the exposed areas, in violation of facility policy requiring privacy during care.
A resident with multiple complex medical conditions did not have a comprehensive, person-centered care plan that addressed all needs and preferences. The care plan failed to include interventions for repeated refusals of incontinence care, sensitivity to light during nighttime care, preference for certain staff, and reluctance to use a wheelchair due to fear of falling. Staff interviews confirmed these issues were ongoing and not addressed in the care plan.
A resident with cognitive impairment and multiple medical conditions did not consistently receive bathing as scheduled or according to her preference for showers. Staff provided bed baths due to the resident's fear and discomfort with the shower chair, but this was not addressed in the care plan or consistently documented. Nursing staff were unaware of missed scheduled baths and the resident's issues with the shower chair, and required documentation and communication of refusals were lacking.
A resident with significant communication impairments did not receive speech therapy as frequently as prescribed in their treatment plan due to the lack of a full-time speech therapist. Documentation and interviews revealed inconsistent therapy sessions, unclear caregiver training, and absence of recommended communication tools, resulting in ongoing communication difficulties and frustration for the resident.
A resident with significant medical needs was prescribed and administered Macrobid for a urinary tract infection, despite lab results indicating the presence of Klebsiella pneumoniae, which was not sensitive to this antibiotic. The facility's antibiotic stewardship policy required the use of lab results to guide antibiotic selection, but this protocol was not followed, resulting in the administration of an ineffective medication.
A resident with a history of traumatic brain injury and cognitive dysfunction eloped from the facility despite being under one-on-one supervision. The resident exhibited aggressive and agitated behavior, leading staff to allow him to close his door for privacy. During this time, he manipulated the window mechanism to exit the facility. The elopement was discovered when staff found the room unoccupied and the window open. The resident was later found at a local business and returned without injury.
A facility failed to conduct tuberculosis screening for a resident upon admission, as required by their policy. The resident, admitted with anxiety, depression, and hypertension, did not receive the necessary Mantoux test until after a readmission. The Director of Nursing confirmed the oversight, which was identified during a non-compliance investigation.
The facility failed to issue refunds to discharged residents in a timely manner, affecting two residents. A resident was due a refund of $1,572.00, which was paid almost six weeks late. Another resident was due a refund of $8,548.60, which was also paid late. The facility's policy requires refunds within 30 days of discharge, which was not followed.
Food Served at Unappetizing Temperatures and Quality
Penalty
Summary
The facility failed to ensure residents received appetizing food served at palatable temperatures. Seven residents interviewed reported concerns with the quality of meals, including food described as bland, tasteless, undercooked, mushy, unappealing, and served cold. One resident stated the food was especially undercooked on weekends, another said he had to order take-out because of the taste, and another reported not receiving fresh fruit except bananas and that hot foods were sometimes served cold. Other residents reported bland food, overcooked vegetables, and hot foods served cold. During observations of the lunch tray line and test tray service, food temperatures were measured and verified by Dietary staff. Chicken patties, roasted potatoes, and green beans were observed at temperatures of 189 degrees F, 169 degrees F, and 181 degrees F on the tray line. A new pan of roasted potatoes was later observed coming out of the oven at 167 degrees F and placed for lunch tray line service. When a test tray was taken from the kitchen to the dining room on an open cart and then checked, the chicken patty measured 107 degrees F and was lukewarm, the roasted potatoes measured 92 degrees F and were lukewarm, and the green beans measured 123 degrees F and were warm. The Dietary Manager verified these findings and stated hot foods should ideally be served between 120 and 130 degrees F.
Infection Control Lapses During Medication Pass and Catheter Care
Penalty
Summary
The facility failed to ensure infection control practices were implemented correctly during medication administration for three residents and during urinary catheter care for one resident. During medication pass observations, an RN exited one resident’s room without observed hand hygiene, donned PPE, administered medications, removed PPE without hand hygiene, and then moved directly to another resident’s medication administration. The RN also entered another resident’s room, performed a finger stick and glucometer reading, administered medications, and then placed the contaminated glucometer on the medication cart without cleaning it before continuing medication administration for another resident. During that process, a pill dropped onto the medication cart, was picked up with a glove, and added back into the medication cup before the medications were crushed and administered. The resident involved in the catheter care observation had diagnoses including amyotrophic lateral sclerosis, obstructive and reflux uropathy, urine retention, and prostate cancer. The resident was cognitively intact, dependent on staff for toileting hygiene, and had an indwelling urinary catheter. Physician orders directed catheter insertion site care every shift, and the care plan identified risk for urinary tract infection related to the catheter. During the observation, the CNA placed a basin and linens directly on the bedside table without a barrier, used items that had been in direct contact with the bedside table during catheter and perineal care, and changed gloves multiple times without hand hygiene between glove changes. The CNA also emptied the urinary catheter drainage bag, carried the graduate to the bathroom, and then handled the basin, sink faucet handles, and basin rinsing without changing gloves before completing hand hygiene at the end. The CNA stated the bedside table was not cleansed or disinfected before the basin or linens were placed on it and was unaware that hand hygiene was to be used after removing contaminated gloves before putting on new ones. Facility policies reviewed stated that hand hygiene was to be performed before and after resident contact, after contact with objects in resident rooms, after removing PPE, and after direct resident contact even if gloves are used; medication administration policy also required sanitary dispensing and disposal of any medication that contacted the medication cart.
Ceiling Damage and Worn Recliner Not Maintained in Good Repair
Penalty
Summary
The facility failed to maintain the ceiling on the 100-hall in good repair after a leaking pipe repair left a large hole and a 12-inch by 18-inch section of drywall cut out of the ceiling in the resident common area/day room. A service invoice showed the pipe repair was scheduled on 04/14/26 and completed on 05/08/26, but observations on 05/11/26 and 05/12/26 found the ceiling opening still present. During the 05/12/26 observation, the Maintenance Director verified the drywall had been cut out for the pipe repair and had not yet been repaired. This affected the 42 residents living on the 100 hall and was identified during review of the physical environment for a census of 134 residents. The facility also failed to ensure Resident #154's room furniture was in good repair. Resident #154 was admitted with diagnoses including atrial fibrillation, diabetes mellitus type two, chronic kidney disease, and need for assistance with personal care. The resident stated the facility supplied a recliner and reported the outer material on the front of the chair arms was peeling. Observations showed substantial peeling of the material covering the back head rest area and the front of the chair arms, and the recliner remained in the same condition on a later observation. The resident said the recliner had been in that condition since admission and was concerned about it. The Maintenance Director verified the recliner had substantial peeling, and the Administrator stated the facility was responsible for inspecting and replacing facility-supplied recliners and verified the resident should not have been supplied a recliner with peeling material.
Smoking Area Trash Disposal Policy Not Followed
Penalty
Summary
The facility failed to ensure its smoking policy was developed and implemented to promote smoking safety in the designated smoking area. During observation on 05/12/26 at 10:07 A.M., more than 10 cigarette butts were found disposed of inside a non-flame resistant trash can with combustible trash in the designated outdoor smoking area. The Maintenance Director verified at the time of the observation that the cigarette butts were being discarded in the non-flame resistant trash can instead of in non-combustible containers. Review of the facility’s Smoking Policy, revised 06/16/25, showed that smoking was to occur only in designated outdoor areas and that ashtrays would be available for resident use, with staff permitted to empty ashtrays as needed; the policy did not specify the use of non-combustible containers. The issue affected four identified smoker residents.
Failure to Implement Nutritional Interventions for Significant Weight Loss
Penalty
Summary
The facility failed to ensure nutritional interventions were implemented to maintain the nutritional status of Resident #148, who was admitted with diagnoses including moderate protein calorie malnutrition, COPD, a wedge compression fracture of L1, and a displaced fracture of the medial malleolus of the left tibia. The resident was ordered a regular diet with regular texture and regular consistency liquids, and the admission weight was 152.0 pounds. Early documentation noted trace edema to both lower extremities on 09/10/25, no edema on 09/11/25, and nutritional risk screenings on 09/12/25 and 09/15/25 identified moderate decrease in food intake and moderate protein calorie malnutrition while the resident remained at 152 pounds. An initial nutritional evaluation on 09/16/25 documented varied meal intakes and recommended a house supplement of 120 ml twice daily for nutrition and weight maintenance, but no physician order was added for the supplement. The resident then had a weekly weight of 142.6 pounds on 09/17/25 and a re-weight of 144.3 pounds on 09/18/25, reflecting significant weight loss. The record contained no evidence that the physician or NP were notified of the re-weight or confirmed weight loss, and no nutritional intervention was documented before the resident discharged home. The RD later documented the significant weight loss after discharge, and the DT confirmed the supplement recommendation was never ordered.
Failure to Notify Provider of Significant Weight Loss
Penalty
Summary
The facility failed to notify the physician or nurse practitioner of Resident #148’s significant weight loss. Resident #148 was admitted on 09/09/25 with diagnoses including moderate protein calorie malnutrition, COPD, a wedge compression fracture of the first lumbar vertebra, and a displaced fracture of the medial malleolus of the left tibia. The resident’s admission weight was 152.0 pounds on 09/10/25, and nursing documentation noted trace edema to both lower extremities that day, with no edema noted on 09/11/25. Nutritional risk screenings on 09/12/25 and 09/15/25 documented a weight of 152 pounds, moderate decrease in food intake, and moderate protein calorie malnutrition. The initial nutritional evaluation on 09/16/25 noted varied meal intake and recommended a house supplement 120 ml twice daily for nutrition and weight maintenance. A weekly weight on 09/17/25 showed the resident weighed 142.6 pounds, reflecting a 6.2% loss in seven days, and a re-weight on 09/18/25 showed 144.3 pounds, reflecting a 5.1% loss in eight days. Review of the medical record found no documentation that the physician or nurse practitioner was notified of the re-weight and significant weight loss, and there was no evidence of physician-ordered interventions related to that re-weight. A dietary progress note entered on 09/28/25, after the resident had discharged from the facility, documented the significant weight loss and that the resident would be re-evaluated if re-admitted. The DON later confirmed there was no evidence the physician or nurse practitioner had been notified of the re-weight and significant weight loss.
Failure to Order and Administer Consented COVID-19 Vaccine
Penalty
Summary
The facility failed to ensure Resident #48 was vaccinated for COVID-19 after she consented to receive the vaccine. Resident #48 was admitted on 01/20/2025 and had diagnoses including diabetes mellitus with diabetic chronic kidney disease, major depressive disorder, paroxysmal atrial fibrillation, and hypertension; her annual MDS 3.0 indicated her cognition was intact. Review of the Consent/Declination of COVID-19 Vaccination form showed that she consented to be vaccinated on 11/26/25. However, review of physician orders from November 2025 through May 2026 showed the COVID-19 vaccine was not ordered, and review of the MAR for the same period showed it was not administered. An interview with the Assistant DON on 05/12/26 confirmed the facility failed to order and administer the vaccine after the resident consented.
Failure to Accommodate Resident's Physical and Communication Needs
Penalty
Summary
The facility failed to provide a comprehensive, resident-centered treatment plan to accommodate the physical and communication needs of a resident with multiple complex diagnoses, including encephalopathy, type 2 diabetes, aphasia, hemiplegia, and cognitive impairment. Occupational therapy notes indicated ongoing issues with wheelchair fit and support, with the resident expressing fear of falling and discomfort due to improper leg support. Staff interviews revealed uncertainty about the appropriateness of the wheelchair, lack of awareness of the resident's concerns, and inconsistent use of necessary equipment such as a properly sized footbox. Observations confirmed the resident's legs were inadequately supported, and staff resorted to using pillows as a makeshift solution. In addition to physical needs, the resident's communication challenges were not adequately addressed. Speech therapy discharge recommendations included specific strategies and training for staff to facilitate communication, such as using visual aids and concrete directions. However, interviews with staff indicated a lack of awareness or training on these techniques, and the resident reported ongoing frustration with her ability to communicate. The care plan included interventions for impaired communication, but the resident was not provided with communication tools until after surveyor intervention. Throughout the period reviewed, there was a lack of coordination and follow-through among therapy, nursing, and direct care staff regarding both the resident's physical and communication needs. Staff were unclear about the equipment provided, the training received, and the interventions required to support the resident's well-being and dignity. These deficiencies resulted in the resident not achieving or maintaining her highest level of well-being, as evidenced by her fear, discomfort, and frustration.
Failure to Provide Privacy During Wound Care Procedure
Penalty
Summary
During a wound care procedure for a resident admitted with congestive heart failure and morbid obesity, two nurses assisted the resident in removing her incontinence brief and turning her on her side. This action resulted in the resident being exposed from her upper back to her ankles. The resident was cognitively intact and shared the room with another resident, who was present and able to see the exposed areas during the procedure. The privacy curtain between the two beds was not pulled prior to the start of the wound care, contrary to the facility's Clean Dressing Change policy, which requires privacy to be provided before beginning such procedures. The oversight was only addressed after a surveyor inquired about the curtain, at which point the nurse confirmed that the curtain should have been used to provide privacy.
Failure to Develop and Implement Comprehensive Person-Centered Care Plan
Penalty
Summary
The facility failed to develop and implement a comprehensive, person-centered care plan that addressed all of a resident's needs. The resident in question had multiple complex diagnoses, including encephalopathy, type 2 diabetes, aphasia, generalized anxiety disorder, chronic pain syndrome, cerebral infarction, dysphagia, hemiplegia, and major depressive disorder. The care plans on record addressed some needs, such as functional deficits, incontinence, and neurological status, but did not include interventions for several specific issues. Notably, there was no care plan or intervention for the resident's repeated refusals of incontinence care, sensitivity to light during nighttime care, preference for certain staff, or desire to sleep through scheduled care times. Additionally, an intervention for a bowel and bladder program was listed, but the resident was never actually on such a program. Interviews with staff and the resident revealed ongoing issues that were not addressed in the care plan. The resident frequently refused incontinence care, especially at night, citing discomfort and a dislike of being woken up or having lights turned on. The resident also expressed a preference for certain caregivers and would refuse care from others, particularly male staff. Staff confirmed these refusals and noted that documentation of refusals was done under behavior monitoring, but these behaviors were not specifically addressed in the care plan. The Director of Nursing acknowledged that interventions for these specific refusals and preferences were not included in the care plan. Additionally, the resident had concerns about the use and fit of her wheelchair, expressing fear of falling and discomfort with the equipment provided. Occupational therapy notes indicated ongoing assessment and modification of the wheelchair, but interviews with staff revealed uncertainty about whether the wheelchair fit properly or was appropriate for the resident's needs. There was no care plan in place to address the resident's fear of using the wheelchair or her reluctance to get out of bed, despite these being ongoing issues. This lack of comprehensive, individualized planning resulted in the resident's needs and preferences not being fully addressed.
Failure to Provide Scheduled and Preferred Bathing for Dependent Resident
Penalty
Summary
Facility staff failed to ensure that a resident who was dependent on staff for activities of daily living (ADLs) received bathing in accordance with her preferences and scheduled care. The resident, who had significant medical conditions including encephalopathy, type 2 diabetes, aphasia, chronic pain syndrome, hemiplegia, and cognitive impairment, required substantial to maximal assistance for bathing and personal hygiene. The care plan indicated a preference for showers and required staff to report refusals of ADL care to the nurse. However, the care plan did not address the resident's use of or fear of the shower chair. Documentation of bathing was inconsistent and did not specify the type of bathing provided. The resident was not bathed on several scheduled days, and behavior monitoring records did not clarify which care was refused. Interviews revealed that the resident preferred showers but was afraid of or experienced pain with the shower chair, resulting in bed baths being provided instead. Staff interviews confirmed that the resident was not consistently bathed as scheduled and that refusals or issues with bathing were not always communicated or documented as required. The Unit Manager and DON were unaware of the resident's discomfort with the shower chair and the missed scheduled baths. Facility policy required showers or baths to be scheduled according to person-centered care, but this was not consistently followed for the resident in question.
Failure to Provide Prescribed Speech Therapy Services
Penalty
Summary
The facility failed to provide a resident with the specialized rehabilitative services of speech therapy as required by the resident’s plan of treatment. The resident, who had a history of encephalopathy, aphasia, dysarthria, cerebral infarction, dysphagia, hemiplegia, and cognitive impairment, was admitted with significant communication challenges. The speech therapy plan called for treatment five times a week for six weeks, but documentation showed inconsistent delivery of services, with the resident receiving therapy fewer times than prescribed in several weeks. The speech therapy discharge summary included recommendations for ongoing strategies and caregiver training to support the resident’s communication needs. However, interviews with the Rehabilitation Director revealed uncertainty about what specific training was provided to caregivers, which caregivers received it, and whether any visual aids or communication tools were supplied to the resident. The Rehabilitation Director also confirmed that the lack of a full-time speech therapist led to irregular therapy sessions, as services were only provided when a therapist was available. The resident expressed ongoing frustration and difficulty with communication, both with family and caregivers, and indicated a need for additional speech therapy. Observations during interviews confirmed the resident’s communication struggles and emotional distress related to these challenges. The deficiency was identified during a complaint investigation and affected one resident reviewed for therapy services.
Inappropriate Antibiotic Prescribing for UTI
Penalty
Summary
A resident with multiple complex medical conditions, including encephalopathy, diabetes, aphasia, and hemiplegia, was admitted to the facility and later experienced a change in condition. Following abnormal urinalysis results, the on-call physician was notified and a verbal order was given for Macrobid, an antibiotic, to be administered. The resident received at least one dose of Macrobid as documented in the medication administration record. However, subsequent review by a certified nurse practitioner revealed that Macrobid did not cover the organisms identified in the resident's urine culture, specifically Klebsiella pneumoniae, which was not sensitive to Macrobid according to the sensitivity testing. The facility's policy on antibiotic stewardship requires the use of antibiograms and lab results to guide appropriate antibiotic selection. Despite this, the initial antibiotic prescribed was not effective against the identified bacteria. The Assistant Director of Nursing confirmed that Macrobid did not meet the criteria for administration in this case. This failure to ensure the resident was ordered an appropriate antibiotic for a urinary tract infection constituted a deficiency, as it did not align with the facility's established protocols for infection control and antibiotic stewardship.
Resident Elopement Due to Inadequate Supervision
Penalty
Summary
The facility failed to provide adequate supervision to prevent the elopement of a resident, identified as Resident #131, who had a history of traumatic brain injury, depression, and hypertension. Upon admission, the resident was noted to be at risk for exit-seeking and wandering due to cognitive dysfunction and impulsivity. Despite having a care plan that included the application of a wanderguard and one-on-one supervision, the resident managed to elope from the facility. On the day of the incident, the resident exhibited agitation and aggressive behavior, including verbal insults and sexually inappropriate actions towards staff. The resident was placed under one-on-one supervision with 15-minute checks, but due to increasing agitation, the supervising staff allowed the resident to close his door, believing it would help him calm down. During this time, the resident manipulated the window mechanism in his room, removed the screen, and exited the facility. The elopement was discovered when staff noticed the resident was missing from his room and the window was open. The facility initiated its elopement policy, notified the police, and began a search. The resident was found at a local business and returned to the facility without injury. Interviews revealed that the resident had prior knowledge of how to manipulate the window mechanism, which contributed to his ability to elope despite the supervision measures in place.
Failure to Conduct Tuberculosis Screening on Admission
Penalty
Summary
The facility failed to ensure that residents were screened for tuberculosis upon admission, affecting one resident out of three reviewed for tuberculosis screening. The resident in question was admitted with diagnoses including anxiety, depression, and hypertension. Upon review of the resident's medical records and physician's orders for August 2024, it was found that there were no orders for tuberculosis screening, and the medication administration record confirmed that the screening was not administered after admission. An interview with the Director of Nursing verified that the tuberculosis screening for the resident was not completed after her admission in August 2024 and was only conducted after a readmission in October 2024. The facility's policy, dated January 2023, required all first-time residents to be screened for tuberculosis on admission using a Mantoux test, which was not adhered to in this case. This deficiency was identified during a non-compliance investigation under Complaint Number OH00160053.
Delayed Refunds to Discharged Residents
Penalty
Summary
The facility failed to issue refunded monies to discharged residents in a timely manner, affecting two residents out of three reviewed for refunds. Resident #145, who was a private pay resident, was admitted and later discharged, with a final payment made on 03/13/24. After settling the facility balance, a refund of $1,572.00 was due by 04/13/24 but was only approved on 05/17/24 and paid out on 05/22/24, almost six weeks late. The administrator confirmed the delay during an interview. Similarly, Resident #160, also a private pay resident, was discharged with a final payment made on 07/01/23. A refund of $8,548.60 was due by 07/30/23 but was approved on 07/26/23 and paid out on 08/04/23, indicating a late payment. The Business Office Manager confirmed this delay. The facility's policy requires refunds to be issued within 30 days of discharge, which was not adhered to in these cases.
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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 Massillon
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Amherst Meadows Skilled Nursing And Rehab | 1.6 mi | ★★★★★ | 0 | 0 |
| Meadow Wind Health Care Center | 1.7 mi | ★★★★★ | 14 | 0 |
| Hanover Healthcare Center | 2.1 mi | ★★★★★ | 16 | 0 |
| Altercare Of Nobles Pond, Inc | 2.8 mi | ★★★★★ | 12 | 0 |
| Rose Lane Nursing And Rehabilitation | 3.1 mi | ★★★★★ | 15 | 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 October 2026) and official state health department websites.