Average — CMS composite of the measures below.
A standard survey is most likely before around December 2026
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 Hamilton Arms Center during CMS and state inspections, most recent first.
A resident with Alzheimer's disease and dementia, whose son was designated as financial and healthcare POA, was switched to a new health insurance plan by facility staff after the original plan was discontinued. The Business Manager enrolled the resident in a different plan to maintain coverage but did not notify the POA, who later learned of the change from the insurance company and questioned the facility. The Administrator confirmed that the insurance change was made without informing the resident's appointed representative, resulting in a failure to honor the resident's right to representative notification.
A resident with CHF and significantly elevated BNP levels had multiple physician and NP orders for cardiology follow-up, with documentation that referrals were placed and the need for cardiology evaluation was discussed with facility staff. Despite nursing notes indicating calls to the cardiology office and messages left to schedule an appointment, there was no documentation that the consult was ever completed. The DON later reported that a cardiology visit had been scheduled but missed due to the resident being sick and could not provide supporting documentation, demonstrating a failure to carry out and document the ordered cardiology follow-up.
A resident with left-sided hemiplegia, requiring total assist for bed mobility, was left inadequately supervised during care by a CNA. The resident rolled out of bed and sustained a nondisplaced right ankle fracture, as confirmed by hospital evaluation. Facility staff and the DON confirmed that insufficient supervision during care led to the resident's fall and injury.
Two residents were inaccurately assessed as receiving anticoagulant medications in their MDS assessments, despite no evidence in their clinical records or physician orders to support this. These errors were confirmed by facility leadership through record review and staff interviews.
A resident with a pressure ulcer did not have required wound assessments, measurements, or treatment interventions documented in the clinical record, despite facility policy. Instead, staff relied on hospice documentation for monitoring and treatment, and the DON confirmed that this information was not entered into the facility's records.
Surveyors found that medications were not properly labeled and stored, including a medication refrigerator with unrecorded and elevated temperatures and an opened Lantus insulin pen on a medication cart that was not dated. Staff confirmed that these practices did not follow facility policy or regulatory requirements.
Five residents had personal refrigerators in their rooms without any temperature monitoring, cleaning logs, or evidence of maintenance according to food safety standards. The facility lacked a written policy and had not provided education to residents or families about safe food storage or refrigerator upkeep.
The facility did not follow physician orders for blood sugar checks and hypoglycemia management for two residents with diabetes and end stage kidney disease, and failed to complete required blood pressure monitoring for a resident with multiple cardiac conditions. Documentation was missing for physician notifications, timely interventions, and reassessments as required by orders.
The facility did not meet the required nurse aide staffing ratios, failing to provide the minimum number of nurse aides per residents during specific day and night shifts. The NHA confirmed the non-compliance during an interview.
The facility did not meet the required LPN to resident ratio on one day during the review period. On a specific day shift, the facility lacked the mandated minimum of one LPN per 25 residents. This was confirmed by the NHA during an interview.
The facility did not meet the required minimum nursing care hours for residents on two days, providing 3.13 and 3.07 direct care nursing hours per resident instead of the mandated 3.20 hours. This was confirmed by the NHA.
The facility did not effectively implement Enhanced Barrier Precautions (EBP) on two nursing floors. Observations revealed that resident rooms with EBP signage lacked available PPE. Interviews with staff, including an Infection Preventionist and the Nursing Home Administrator, indicated a lack of awareness and knowledge about PPE use and availability for EBP residents.
The facility did not provide necessary Medicare and Medicaid coverage notifications to residents. A resident did not receive a Notification of Medicare Non-Coverage (NOMNC), and three residents did not receive Advanced Beneficiary Notices of Non-Coverage (ABN). This was confirmed through documentation review and an interview with the Nursing Home Administrator.
A resident reported rough handling by CNAs, causing pain and anxiety. Although a grievance form was completed, the facility did not conduct an abuse investigation or report the allegation to the State Agency. The Nursing Home Administrator acknowledged the oversight.
A resident reported rough handling by CNAs, causing pain and anxiety. Although a grievance form was completed, the facility did not conduct an abuse investigation or report the allegation to the State Agency, as confirmed by the Nursing Home Administrator.
The facility failed to accurately complete MDS assessments for two residents. One resident's MDS inaccurately reported significant weight loss prior to admission, while another resident's MDS did not reflect hospice services despite a physician's order. These inaccuracies were confirmed by the Nursing Home Administrator and DON.
A resident with frequent constipation had multiple physician's orders for various medications, but the facility failed to clarify when each should be administered. Additionally, recommendations from a GI consult were not communicated to the attending physician, leading to a deficiency in care.
A resident did not receive timely dental services, including an annual exam and necessary care, despite authorization for such services. The resident reported missing fillings and issues with food getting stuck in their teeth. The DON confirmed the lack of a completed dental exam.
A resident expressed frustration over inadequate discharge preparation, lacking details on necessary durable medical equipment and follow-up care. The clinical record review showed missing information on primary care physician contacts, home health agency, and equipment arrangements, leading to a deficiency in ensuring a safe transfer.
Failure to Notify Resident Representative of Insurance Coverage Change
Penalty
Summary
The facility failed to honor a resident's right to have their appointed representative notified of changes affecting their care and finances when it changed the resident's health insurance coverage without informing the resident's power of attorney (POA). The resident had diagnoses including Alzheimer's disease and dementia, conditions that affect memory, thinking, and social abilities. The resident's profile and POA documents identified the resident's son as both financial and healthcare POA. The facility received a notification from the resident's insurance company indicating that the resident's current insurance plan was no longer offered, and subsequently enrolled the resident in a new health insurance plan. The Business Manager reported that the facility made the insurance change to ensure the resident would continue to have coverage, and confirmed that the new insurance coverage began on January 26, 2026, though the exact date of the change was not known. The Business Manager also stated that the resident's son, as POA, was notified of the change by the insurance company and then questioned the facility about why he had not been informed. The Nursing Home Administrator confirmed that the facility enrolled the resident in a different health insurance plan without notifying the POA. This sequence of actions and omissions resulted in the facility failing to ensure the resident's appointed representative was notified of the insurance coverage change.
Failure to Complete Ordered Cardiology Follow-Up for Resident With CHF
Penalty
Summary
The deficiency involves the facility’s failure to follow physician orders for cardiology follow-up for a resident with congestive heart failure (CHF) and elevated BNP levels. Physician progress notes dated November 7, 2025, documented that the resident had CHF with BNP levels in the 1000s and that a cardiology follow-up was due, with a referral placed and discussed with the facility and scheduler. A physician order dated November 6, 2025, directed a cardiology follow-up, but there was no documented evidence that this consult was completed. The resident continued to experience shortness of breath and required supplemental O2, and a new medication was ordered while CHF remained the primary assessment. On December 8, 2025, nursing progress notes documented a new NP order for cardiology follow-up for CHF, and a corresponding physician order for cardiology follow-up was entered the same day. Physician progress notes on December 10, 2025, again stated that the resident needed cardiology follow-up and that this need had been discussed with the facility for scheduling. Nursing notes on December 11, 2025, indicated that cardiology had been called twice and messages left to schedule an appointment, with staff awaiting a return call. However, there was no documented evidence that the cardiology consult ordered on December 8, 2025, and referenced on December 11, 2025, was ever completed. During an interview, the DON stated that a cardiology consult had been scheduled but the resident could not attend due to illness and was unable to provide documentation of this, resulting in a failure to ensure that the cardiology follow-up orders were followed.
Failure to Provide Adequate Supervision During Care Resulting in Resident Fracture
Penalty
Summary
A resident with a history of cerebral infarction and left-sided hemiplegia required total assistance from one staff member for bed mobility and care, as documented in the care plan and Minimum Data Set. During care, a CNA rolled the resident onto their side to change them, removed the brief, and placed it on the floor. While the CNA was momentarily distracted, the resident rolled out of bed and fell to the floor. The resident was found lying on their left arm in a semi-prone position on the right side of the bed, with visible injuries including a bump on the forehead, a bruise on the left arm, and complaints of right ankle pain. Subsequent assessment and hospital evaluation revealed the resident sustained a nondisplaced fracture of the right ankle, with X-rays indicating possible fractures of the distal fibula and tibia, as well as severe diffuse osteopenia. Facility documentation and staff interviews confirmed that the resident did not receive adequate supervision during care, which resulted in actual harm. The Director of Nursing acknowledged that staff failed to provide the necessary supervision, leading to the resident's fall and injury.
Inaccurate MDS Assessments for Medication Administration
Penalty
Summary
The facility failed to ensure accurate assessments for two residents during the review period. For one resident, the Minimum Data Set (MDS) assessment indicated that the resident was receiving an anticoagulant under Section N0415, but a review of physician orders showed no evidence that the resident was actually receiving this medication. This discrepancy was confirmed by the Director of Nursing. Similarly, another resident's admission MDS assessment indicated receipt of an anticoagulant under Section N0410, but the clinical record did not support this, and the Nursing Home Administrator confirmed the MDS was coded incorrectly. These findings were based on clinical record reviews and staff interviews, demonstrating that the facility did not accurately document medication administration in the MDS assessments for these two residents.
Failure to Document Pressure Ulcer Assessment and Treatment in Clinical Record
Penalty
Summary
The facility failed to ensure that the clinical record accurately reflected the assessment and treatment of a pressure ulcer for one resident. According to facility policy, nursing staff are required to assess and document significant risk factors for pressure ulcers, as well as provide a full assessment of any pressure sores, including location, stage, measurements, and the presence of exudates or necrotic tissue. For a resident with a physician order for wound care to the buttocks, the clinical record showed an initial skin observation assessment noting an open area on the coccyx. However, subsequent facility documentation did not include required wound assessments, measurements, or treatment interventions. Instead, the facility relied solely on hospice documentation for monitoring and treatment of the pressure ulcer, without entering this information into the resident's clinical record. The DON confirmed that the facility did not document the wound and treatments in the clinical record, as required by policy.
Medication Labeling and Storage Deficiencies
Penalty
Summary
Surveyors identified deficiencies in the facility's medication labeling and storage practices. In the second-floor low side medication room, the medication refrigerator was observed to be at 50 degrees Fahrenheit, which is above the recommended storage temperature for most medications. Additionally, the Medication Storage Monthly Temperature Log for this refrigerator had multiple days in September where temperatures were not recorded, and the temperatures that were logged consistently showed the highest allowable reading of 46 degrees Fahrenheit. These findings indicate a failure to monitor and maintain appropriate storage conditions for medications as required by facility policy and professional standards. Further, on the second-floor high side, a medication cart was found to contain an opened Lantus insulin pen that was not dated. Staff interviews confirmed that opened medications are required to be dated upon first use, and that this procedure was not followed. The Nursing Home Administrator and DON acknowledged that the medication refrigerator log was incomplete, the high temperature was not addressed, and the opened insulin pen was not properly dated, all of which are contrary to facility policy and regulatory requirements.
Failure to Monitor and Maintain Personal Refrigerators for Food Safety
Penalty
Summary
Surveyors observed that five residents had personal refrigerators in their rooms, and there was no evidence of temperature logs or monitoring for these refrigerators. Additionally, there was no documentation or indication that the refrigerators were being cleaned or maintained according to professional food safety standards. An interview with the Nursing Home Administrator confirmed that the facility did not have a written policy regarding personal refrigerators, and no education had been provided to residents or their families about safe food storage, refrigerator cleaning, or temperature monitoring. These findings indicate that the facility failed to ensure food stored in personal refrigerators was maintained in accordance with professional standards for food safety, as required by regulation.
Failure to Follow Physician Orders for Blood Sugar and Blood Pressure Monitoring
Penalty
Summary
The facility failed to follow physician's orders for blood sugar monitoring and management for two residents and for blood pressure monitoring for one resident. For one resident with end stage kidney disease and diabetes mellitus, there were multiple instances where blood sugar readings were below the physician-ordered threshold, but there was no documented evidence that the physician was notified, that a rapidly absorbed glucose was provided, or that blood sugar was rechecked within the required timeframe. Similarly, another resident with end stage kidney disease and diabetes mellitus had several low blood sugar readings, but documentation did not show that the physician was notified or that the hypoglycemic protocol was followed as ordered, including timely reassessment after intervention. Additionally, a resident with a history of stroke, coronary artery disease, heart failure, hypertension, diabetes mellitus, and high cholesterol had physician's orders for blood pressure checks twice daily. However, the medication administration record showed missing documentation for required blood pressure checks on several occasions. Interviews with the Director of Nursing confirmed that the required monitoring and notifications were not completed as ordered for these residents.
Non-Compliance with Nurse Aide Staffing Ratios
Penalty
Summary
The facility failed to meet the required nurse aide staffing ratios as per the regulation effective July 1, 2023. Specifically, the facility did not maintain a minimum of one nurse aide per 12 residents during the day and evening shifts, and one nurse aide per 20 residents overnight. During the period from January 11 to January 25, 2025, the facility was found to be non-compliant on January 19, 2025, for the day shift, and on January 22, 2025, for the night shift. The Nursing Home Administrator (NHA) confirmed during an interview on February 4, 2025, that the facility did not meet the minimum required staffing ratios on the identified dates.
Plan Of Correction
1. The facility failed to maintain nurse aide ratios on multiple days and shifts. 2. Facility will need to maintain a minimum of 1 nurse aide per 10 residents during the day, 1 nurse aide per 11 residents during the evening and 1 nurse aide per 15 residents overnight. Calculation of shift ratios will be completed and reviewed daily for accuracy by the scheduler or designee. 3. The scheduler and nursing supervisors will be educated on these ratios. For staff call offs, every effort will be made to replace the call off using resources available including communicating with staff to replace the vacancy. Staffing patterns are projected at least one week in advance to enable ongoing efforts to fill any vacant shifts. 4. Daily audits will be conducted for 1 month. Audits will be conducted by the scheduler or designee. Results of audits will be reviewed by the QAPI committee. 5. Date Certain is 4-4-25.
Failure to Meet LPN to Resident Ratio
Penalty
Summary
The facility failed to meet the required licensed practical nurse (LPN) to resident ratio on one of the fourteen days reviewed. Specifically, on January 18, 2025, during the day shift from 7:00 a.m. to 3:00 p.m., the facility did not have the mandated minimum of one LPN per 25 residents. This deficiency was confirmed during an interview with the Nursing Home Administrator (NHA) on February 4, 2025, at 1:45 p.m., who acknowledged the shortfall in meeting the staffing requirements on the specified day.
Plan Of Correction
1. The facility failed to maintain LPN ratio on January 18th, 2025. 2. The facility will need to maintain a minimum of 1 LPN per 25 residents during the day, 1 LPN per 30 residents during the evening, and 1 LPN per 40 residents overnight. Calculation of shift ratios will be completed and reviewed daily for accuracy by the scheduler or designee. 3. The scheduler and nursing supervisors will be educated on these ratios. For staff call offs, every effort will be made to replace the call off using resources available including communicating with staff to replace the vacancy. Staffing patterns are projected at least one week in advance to enable ongoing efforts to fill any vacant shifts. 4. Daily audits will be conducted for 1 month. Audits will be conducted by the scheduler or designee. Results of audits will be reviewed by the QAPI committee. 5. Date certain is 4-4-25.
Failure to Meet Minimum Nursing Care Hours
Penalty
Summary
The facility failed to meet the required minimum general nursing care hours for residents on two specific days. On January 18, 2025, the facility provided 3.13 direct care nursing hours per resident, and on January 22, 2025, it provided 3.07 direct care nursing hours per resident. These figures were below the mandated minimum of 3.20 hours of general nursing care per resident. This deficiency was confirmed during an interview with the Nursing Home Administrator (NHA) on February 4, 2025.
Plan Of Correction
1. The facility failed to maintain a minimum of 3.2 hours of direct resident care for each resident on multiple days and shifts. 2. Facility will need to maintain a PPD of 3.2 hours. Calculation of the PPD will be completed and reviewed daily for accuracy by the scheduler or designee. 3. The scheduler and nursing supervisor will be educated on the daily PPD. For staff call offs, every effort will be made to replace the call off using resources available including communicating with staff to replace the vacancy. Staffing patterns are projected at least one week in advance to enable ongoing efforts to fill any vacant shifts. 4. Daily audits will be conducted for 1 month. Audits will be conducted by the scheduler or designee. Results of audits will be reviewed by the QAPI committee. 5. Date certain is 4-4-25.
Failure to Implement Enhanced Barrier Precautions
Penalty
Summary
The facility failed to establish effective Enhanced Barrier Precautions (EBP) on two nursing floors, as observed by surveyors. On the second-floor nursing unit, a resident room had signage indicating the resident was on EBP, but there was no evidence of Personal Protective Equipment (PPE) availability. An interview with Employee E3 revealed a lack of awareness regarding the appropriate PPE for EBP residents and where to obtain it. Similarly, on the first-floor nursing unit, a resident room also lacked visible PPE despite EBP signage. Licensed Employee E4 was similarly unaware of the necessary PPE and its location. The Infection Preventionist, Licensed Employee E5, stated that staff had been educated on PPE use for EBP residents. The Nursing Home Administrator confirmed that staff should be knowledgeable about PPE location and use for EBP residents.
Failure to Provide Required Coverage Notifications
Penalty
Summary
The facility failed to provide necessary notifications regarding Medicare and Medicaid coverage to residents, as required by regulations. Specifically, a Notification of Medicare Non-Coverage (NOMNC) was not provided to one resident, and Advanced Beneficiary Notices of Non-Coverage (ABN) were not provided to three residents. This deficiency was identified through a review of facility documentation and confirmed during an interview with the Nursing Home Administrator. The lack of these notifications means that residents were not informed about their coverage status and potential financial liabilities for services not covered by Medicare or Medicaid.
Failure to Report Allegation of Abuse
Penalty
Summary
The facility failed to report an allegation of abuse involving a resident who expressed concerns about the care provided by the nursing staff. The resident, who uses a cane and rollator for ambulation and has no family support except for a significant other, reported that the CNAs were rough during repositioning, causing pain and anxiety. This information was documented during a meeting with the social services department and physical therapy. Despite the completion of a grievance form by Social Services, no abuse investigation was conducted, and the allegation was not reported to the State Agency. The Nursing Home Administrator confirmed that an investigation and report should have been made.
Failure to Investigate Abuse Allegation
Penalty
Summary
The facility failed to investigate an allegation of abuse involving a resident who expressed concerns about the care received. The resident, who ambulates with a cane and rollator, reported that the CNAs were rough during repositioning, causing pain and anxiousness. This concern was documented during a meeting with the social services department and physical therapy. Despite the grievance form being completed by Social Services, no abuse investigation was conducted, and the allegation was not reported to the State Agency. The Nursing Home Administrator confirmed that an investigation should have been conducted and reported, indicating a lapse in the facility's management of abuse allegations.
Inaccurate MDS Assessments for Two Residents
Penalty
Summary
The facility failed to accurately complete Minimum Data Set (MDS) assessments for two residents. For Resident 13, the Admission Nutrition Evaluation indicated a history of weight loss, but the MDS inaccurately reported a significant weight loss prior to admission, which was confirmed as incorrect by the Nursing Home Administrator. Resident 57's clinical record included a physician's order for hospice care, but the quarterly MDS failed to reflect that the resident was receiving hospice services, as confirmed by the Nursing Home Administrator and Director of Nursing.
Failure to Clarify and Implement Physician's Orders for Constipation Management
Penalty
Summary
The facility failed to clarify and implement physician's orders for a resident experiencing frequent constipation. The resident had multiple physician's orders for constipation management, including Colace, Dulcolax suppository, Polyethylene Glycol Powder, and Senna Plus. However, there was no order for Milk of Magnesia, which was referenced in the Dulcolax order, nor was there clarification on when each medication should be administered. Additionally, a gastrointestinal consult recommended a specific regimen involving Senna and Dulcolax, but these recommendations were not communicated to the resident's attending physician. Interviews with the Nursing Home Administrator and Director of Nursing confirmed the oversight in clarifying the physician's orders and implementing the GI consult recommendations. The clinical records did not show any action taken to address the GI consult's recommendations, leading to a deficiency in providing appropriate treatment and care according to the resident's needs and physician's orders.
Failure to Provide Timely Dental Services
Penalty
Summary
The facility failed to provide timely dental services for a resident, as evidenced by the lack of an annual dental exam and necessary dental care. The resident expressed concerns about missing fillings and the desire to have teeth pulled due to food getting stuck in the holes in their teeth. Despite authorization from the resident's responsible party for Direct Mobile Dental Services to perform an annual dental exam, x-rays, and cleanings in May 2023, there was no evidence in the clinical record that these services were provided. The Director of Nursing confirmed the absence of a completed dental exam for the resident.
Inadequate Discharge Preparation for Resident
Penalty
Summary
The facility failed to adequately prepare Resident R3 for a safe transfer or discharge from the nursing home. Resident R3, who was scheduled for discharge to home, expressed frustration and concern over the lack of information regarding necessary durable medical equipment such as a wheelchair, bedside commode, and hospital bed. The resident's clinical record indicated a Medicare cut letter stating that skilled nursing services would terminate on July 12, 2024, but the discharge planning summary assessment lacked essential details. The clinical record review revealed that the discharge summary did not include appointment or contact information for the primary care physician, nor did it provide details about the home health agency or durable equipment agency. Additionally, there were no documented discharge planning details regarding follow-up appointments, home health agency contacts, or durable medical equipment arrangements. An interview with the Director of Nursing confirmed these deficiencies, highlighting the facility's failure to ensure appropriate transfer and discharge preparation for Resident R3.
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What surveyors actually found near you
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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.
Illustrative
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Nursing homes near Lancaster
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Abbeyville Skilled Nursing And Rehabilitation Cent | 0.6 mi | ★★★★★ | 11 | 0 |
| Rose City Nursing And Rehab At Lancaster | 1.2 mi | ★★★★★ | 16 | 1 |
| Homestead Village, Inc | 1.6 mi | ★★★★★ | 2 | 0 |
| Lancaster Nursing And Rehabilitation Center | 2.1 mi | ★★★★★ | 7 | 0 |
| Calvary Fellowship Homes Inc | 2.3 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.