Above average — CMS composite of the measures below.
A standard survey is most likely before around September 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 Preston Residence during CMS and state inspections, most recent first.
An ABHR dispenser was found installed directly above a light switch, an ignition source, in a resident room. The Director of Maintenance confirmed the noncompliant placement, which did not meet NFPA 101 requirements for ABHR dispenser installation.
A surge suppressor was found supplying power to a coffee machine in the Break Room, which was confirmed by the Director of Maintenance. This use of a surge suppressor for a high draw appliance did not comply with NFPA requirements for electrical equipment and power cord usage.
Surveyors found that the emergency preparedness plan did not include required staff names and contact information, as confirmed by document review and an interview with the Director of Maintenance.
Surveyors found that the facility did not provide documentation confirming that fire doors had been inspected within the required 12-month period. The Director of Maintenance confirmed that records of these inspections were not available.
Surveyors found that the facility did not have documentation to verify that a continuous 4-hour exercise of the emergency generator had been performed within the required 36-month period. The Director of Maintenance confirmed the absence of these records, resulting in a deficiency related to emergency electrical system maintenance.
A resident with End Stage Renal Disease did not have this diagnosis accurately documented on their Quarterly MDS assessment, as confirmed by staff and clinical record review.
A resident with acute CHF and acute kidney failure had a physician-ordered daily fluid restriction, with specific amounts assigned to nursing and dining services per shift. The resident's daily fluid intake was not recorded for ten days, and the DON confirmed that the fluid restriction orders were not followed.
Two residents did not receive appropriate medication management: one was given pain medication without documented attempts at non-pharmaceutical interventions, and another received an anti-psychotic without documented monitoring for side effects. The DON confirmed these omissions during interviews.
The facility did not implement Enhanced Barrier Precautions for two residents with specific medical needs, such as a suprapubic catheter and a central line with a surgical wound. Observations showed no PPE or signage outside their rooms, and the DON confirmed the lack of precautions, which are essential to prevent the spread of multidrug-resistant organisms.
Improper Placement of ABHR Dispenser Above Ignition Source
Penalty
Summary
A deficiency was identified when an alcohol-based hand rub (ABHR) dispenser was observed to be installed directly above a light switch, which is considered an ignition source, in Resident Room 336. This placement does not comply with NFPA 101 requirements, which prohibit ABHR dispensers from being installed within one inch of an ignition source. The Director of Maintenance confirmed the location of the dispenser during the surveyor's observation. The deficiency affected one of three smoke compartments within the facility component. No additional information regarding the medical history or condition of the resident in Room 336 was provided in the report.
Plan Of Correction
1. The wall-mounted hand sanitizer dispenser cited was moved on 6/25/25 to a non-outlet, non-switch wall. 2. All dispenser locations were verified to be appropriately mounted on a non-outlet, non-switch wall. 3. All current and new dispensers' locations will be audited once weekly for one month, and bi-weekly for two months. This will be added to the Quarterly PM. 4. All results will be reported to QAPI on a quarterly basis until satisfied that the cited deficient practice has been rectified. 5. The completion date is 8/24/25.
Improper Use of Surge Suppressor for High Draw Appliance
Penalty
Summary
A deficiency was identified when a surge suppressor was observed supplying electrical power to a coffee machine in the Break Room. This observation was made during a facility inspection and was confirmed in an interview with the Director of Maintenance. The use of a surge suppressor for a high draw appliance, such as a coffee machine, does not comply with the requirements for electrical equipment and power cord usage as outlined by NFPA standards. The facility failed to monitor and ensure proper use of surge suppressors in accordance with these regulations.
Plan Of Correction
1. The surge protector was removed on 6/25/25. 2. A facility-wide inspection was conducted to ensure no other surge protectors were inappropriately used on 7/1/25. 3. An audit will be conducted 1 x weekly for 1 month and bi-weekly for 2 months. 4. The audits will be reported to QAPI quarterly or until the deficient practice has been rectified. Education regarding surge protectors will be completed by 7/18 and provided at new employee orientation and annually thereafter. 5. The completion date is 8/24/25. K 0920
Missing Staff Contact Information in Emergency Preparedness Plan
Penalty
Summary
Surveyors determined that the facility failed to include the names and contact information of staff within the physical copy of the emergency preparedness plan. During a document review, it was found that this required information was missing from the plan, which is intended to serve the entire component of the facility. The absence of this information was confirmed during an interview with the Director of Maintenance. This deficiency was identified during a Medicare/Medicaid Recertification Survey. The survey specifically noted that the physical emergency preparedness plan did not contain the necessary staff contact details as mandated by federal regulations. No information about residents or their medical conditions was included in the findings.
Plan Of Correction
1. The name/contact list was located in the original EOP binder. 2. The EOP phone list will be updated as needed or should personnel change. 3. The EOP is reviewed on an annual basis and the contact list will be verified as current. 4. The Facilities Director will verify monthly that the list remains current and document on the audit sheet. This will be maintained in the EOP and reported to the Safety Committee on a monthly basis. 5. The completion date is 9/25/25.
Failure to Document Annual Fire Door Inspections
Penalty
Summary
The facility failed to provide documentation verifying that fire doors had been inspected within the previous 12 months, as required by NFPA 101 and NFPA 80 standards. During an observation and document review, surveyors requested records of annual fire door inspections, but the facility was unable to produce documentation confirming that these inspections had occurred. An interview with the Director of Maintenance confirmed the absence of such documentation for the required period. No information regarding specific residents, their medical history, or their condition at the time of the deficiency was included in the report.
Plan Of Correction
The Fire Door inspection documentation was verified to exist and to have occurred in the last 12 months for the date of 11/12/24. The Fire Door inspections will be conducted annually. Annual inspections will be scheduled through the work order system and maintain NFPA compliance. A notification will be generated through this work order system (TELS). Inspections will be monitored through the work order system for completion and documentation reported to QAPI as completed. An audit of the Life Safety Book will be completed annually to ensure compliance. The completion date is 8/24/25.
Lack of Documentation for 4-Hour Emergency Generator Exercise
Penalty
Summary
The facility failed to provide documentation verifying that a continuous 4-hour exercise of the emergency generator had occurred within the previous 36 months. During a document review, surveyors were unable to locate records confirming that this required test had been completed as mandated by NFPA 110 standards. The absence of this documentation was confirmed during an interview with the Director of Maintenance, who acknowledged that there was no record available to demonstrate compliance with the 4-hour generator exercise requirement. This deficiency affects the entire emergency electrical system component, as the required maintenance and testing procedures are essential for ensuring the generator's reliability in supplying power during emergencies. The lack of documentation means there is no evidence that the generator's performance and endurance have been adequately tested within the specified timeframe.
Plan Of Correction
The 4-hour generator load test has been completed as of 7/2/25. The 4-hour generator load test will be conducted every 36 months. The 4-hour generator load test will be scheduled through the work order system to maintain compliance. The scheduled load tests will be monitored through the work order system for compliance and reported to QAPI as completed. An annual audit will be completed and filed in the Life Safety Book to ensure compliance. The completion date is 8/24/25.
Inaccurate MDS Assessment Documentation
Penalty
Summary
The facility failed to ensure the accurate completion of Minimum Data Set (MDS) assessments for one resident. Clinical record review showed that a resident with a diagnosis of End Stage Renal Disease did not have this diagnosis documented on their Quarterly MDS assessment dated March 17, 2025. This omission was confirmed during an interview with a licensed employee, who acknowledged that the MDS was inaccurately completed. The deficiency was identified through both clinical record review and staff interview.
Failure to Follow Physician's Fluid Restriction Orders
Penalty
Summary
The facility failed to follow physician's orders for fluid restriction for one resident diagnosed with acute congestive heart failure and acute kidney failure. The physician's order specified a daily fluid restriction of 2000cc, divided equally between nursing and dining services, with specific amounts allocated for each shift. However, a review of the Medication Administration Record showed that the resident's daily fluid allotment was not recorded for a period of ten days. This lapse was confirmed by the Director of Nursing during an interview, indicating that the physician's orders regarding fluid restriction were not adhered to as required by facility policy.
Failure to Use Non-Pharmaceutical Interventions and Monitor Side Effects
Penalty
Summary
The facility failed to ensure that non-pharmaceutical interventions were attempted prior to administering pain medication for one resident. Specifically, a resident with an order for Oxycodone 10 mg every eight hours as needed for moderate to severe pain received the medication on multiple occasions, but there was no evidence in the clinical record that non-pharmaceutical interventions were tried before administering the medication. This was confirmed by the Director of Nursing during an interview, who acknowledged that such interventions were not attempted prior to giving the pain medication. Additionally, the facility did not monitor for side effects during the use of anti-psychotic medication for another resident. This resident, diagnosed with Alzheimer's Dementia, unspecified mood disorders, and anxiety disorder, had an order for Quetiapine 25 mg at bedtime and received the medication daily. However, review of the Medication Administration Record and progress notes showed no documentation of side effect monitoring while the anti-psychotic was administered. The Director of Nursing confirmed in an interview that there was no documentation of side effect monitoring for this medication.
Failure to Implement Enhanced Barrier Precautions
Penalty
Summary
The facility failed to implement Enhanced Barrier Precautions for two residents requiring such measures. Resident 69, who had a suprapubic catheter, and Resident 120, who had a central line and a left knee surgical wound, were not provided with the necessary personal protective equipment (PPE) or signage indicating their need for Enhanced Barrier Precautions. Observations over four days revealed the absence of PPE outside their rooms, and interviews confirmed the lack of precautions. The Director of Nursing acknowledged that these residents were not on Enhanced Barrier Precautions, which is a requirement to prevent the transmission of multidrug-resistant organisms during high-contact care activities.
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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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How nearby facilities compare on the same public inspection record.
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| Twin Pines Health Care Center | 4.3 mi | ★★★★★ | 8 | 0 |
| Oxford Health Center | 6.1 mi | ★★★★★ | 3 | 0 |
| Kendal At Longwood | 9.6 mi | ★★★★★ | 0 | 0 |
| Autumn Lake Healthcare At Calvert Manor | 9.9 mi | ★★★★★ | 4 | 0 |
| Complete Care At Brackenville Llc | 10 mi | ★★★★★ | 4 | 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.