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 Alternative Healthcare Solutions Llc during CMS and state inspections, most recent first.
An RN was observed leaving the medication cart unlocked and unattended while administering meds to residents, and an unsecured basket attached to the cart contained supplements, syringes, needles, and saline flush syringes that were readily accessible to unauthorized individuals. The Head Nurse stated that the drawers have locks and must remain closed.
Improper food storage was observed in the kitchen during an inspection with the kitchen coordinator. Food was stored in cardboard boxes and placed less than 18 inches from the ceiling in the refrigerator, with condensation noted. The facility policy addressed proper refrigerator storage and ceiling clearance, but it did not specify that food could not be stored in cardboard boxes.
Food handling practices were not maintained according to professional standards. Cold foods placed near the [NAME] table were observed at 46 degrees Fahrenheit, and the table’s proximity was noted to affect the food temperature. Dust particles and poor organization were also observed in the dry storage area. An interview with the clinical dietitian confirmed the production area layout had been discussed, including separating hot and cold foods, and that cold foods were being placed last so heat would not affect them.
QAPI committee meetings did not show consistent participation by the DON and Administrator, and there was no evidence that their feedback and data system monitoring were included in each meeting. One meeting lacked DON participation and related reporting, while another lacked Administrator participation and related reporting. The QAPI officer stated an alternate designated member could present those reports if the DON or Administrator did not attend.
The facility failed to maintain a QAPI committee with the required members participating in committee meetings. Review of QAPI meeting records showed one meeting without evidence of DON participation and another without evidence of Administrator participation. The QAPI officer stated that the Administrator, DON, Infection Control Officer, and Medical Director are required QAPI members and that an alternate should represent any unavailable member.
Improper Hand Hygiene During Medication Administration: An RN was observed entering residents' rooms, touching the door handle, curtains, and a table, then donning gloves and administering meds without performing hand hygiene after contact with the residents' surroundings. The report notes CDC guidance that hand hygiene should be performed after touching the patient's surroundings, before donning gloves, and before resident contact.
A kitchen freezer was observed to be condensing, and it was noted to be at risk of affecting the integrity and safety of the food.
Resident records were left exposed on top of a med cart during a med pass for multiple residents, including a newly admitted resident. An RN left the cart and entered rooms to give meds while vital signs sheets and Kardex records with resident information remained visible in the hallway; the RN said she used the documents to confirm vital signs and left them on the cart while administering meds.
Failure to document a smoking care plan for a resident who smoked daily while receiving treatment for a right foot ulcer. The resident said he informed staff on admission that he smoked cigars every afternoon, was told smoking was prohibited inside the building, and agreed to use a designated smoking area with staff accompaniment. Progress notes showed daily smoking trips with recreation staff at 1:00 PM, but the DON stated no comprehensive care plan addressing smoking habits and safety measures was developed or implemented, and there was no evidence of an IDT discussion or formal smoking schedule in the care plan.
A resident was observed with a wound on the left foot, and the record showed an Ultracet order was increased from 1 tab to 2 tabs after the resident requested more pain medication. The MD agreed to the change, but did not document a progress note or justification for the order change, despite the facility’s Pain Management protocol requiring accurate documentation of prescription justification.
Failure to Document Psychotropic Medication Education and Consent: A resident with major depression, schizophrenia, and bipolar disorder was prescribed Abilify along with other psychotropic meds, but the record lacked documentation that the risks and benefits were discussed with the resident and/or family and lacked informed consent for antipsychotic use. The pharmacist confirmed the psychotropic use was identified, but the recommendations, risks, and benefits were not documented.
The facility failed to ensure that care and management of PICC lines were provided by competent and trained nursing staff, affecting two residents. The DON confirmed that the competence of 12 nurses providing care to residents with PICC lines had not been assessed in 2024, and no evidence of competence certification was provided during the survey.
The facility failed to provide sufficient support personnel for the food and nutrition service, leading to the Dietitian using a TSA for dishwashing duties, which complicated kitchen operations.
The facility failed to comply with required sink compartment sanitations. Staff did not know the required temperatures for each compartment, and the sanitizing solution concentration in the third compartment was 600 ppm instead of the required 200 ppm.
The facility failed to comply with its policy on the use and storage of foods brought by family and visitors. Snacks in the residents' refrigerator were found without the required labels, including initials, room number, and date.
The facility failed to maintain equipment in a safe operating condition. Observations revealed broken plastic coverings on electrical cords of two residents' beds, a broken ABHR dispenser, and a broken window shade cover lying on the floor in different rooms.
The facility failed to maintain a safe, clean, and comfortable environment. Three residents complained about cold room temperatures, and a review of the temperature log showed that temperatures exceeded the established parameters. Additionally, peeling paint due to water damage was observed in one room.
The facility failed to develop a baseline care plan for a resident with a power central line, necessary for antibiotic therapy. Despite the resident having the central line upon admission, the care plan did not include instructions for its local care. The Nursing Supervisor acknowledged the omission, although nursing personnel were providing local care and changing bandages every 72 hours.
The facility failed to ensure care for a PICC line and a power central line was performed according to a physician order for two residents. Both residents were admitted with these vascular access devices, and nursing staff provided local care and changed bandages every 72 hours without formal orders in place.
Unsecured Medication Cart and Accessible Supplies
Penalty
Summary
The facility failed to ensure medications and supplements were protected from unauthorized access. During medication administration observations on 05/21/2026 at 8:40 AM, an RN was observed leaving the medication cart unlocked and unattended while administering medications to residents. Further observation showed a four unsecured basket attached to the medication cart containing supplements, syringes, needles, and saline flush syringes that were readily accessible to unauthorized individuals. During an interview on 05/21/2026 at 8:55 AM, the Head Nurse stated that the drawers have locks, so they must remain closed.
Improper Refrigerator Food Storage
Penalty
Summary
Food storage practices in the kitchen were found to be improper during an observation with the kitchen coordinator. On May 20, 2026, at 9:02 AM, food was observed stored in cardboard boxes and placed less than 18 inches from the ceiling in the refrigerator, with condensation noted. The report states that these storage conditions affected food safety and that the nutritional value of the food was not being ensured due to the improper storage. The facility policy, Safety in Receiving and Storing Food, addressed the correct distance from the ceiling and proper use and storage in the refrigerator, but it did not specify that food could not be left stored in cardboard boxes.
Food Handling and Storage Deficiencies
Penalty
Summary
Food was not stored, prepared, distributed, and served in accordance with professional standards. During observation on 05/21/2026 at 11:00 AM, cold foods placed in the production process near the [NAME] table were measured at 46 degrees Fahrenheit, and the report noted that the table’s proximity affected the cold foods and their temperature. In the dry storage area, dust particles and poor organization were observed in the dry warehouse. During an interview on May 20, 2026 at 2:28 PM, the clinical dietitian stated that relocating the production area had been discussed, with hot food planned for the right side and cold food for the left side, and that the engineer confirmed the relocation was feasible because a shorter refrigerator was needed. The dietitian also instructed that cold foods be placed last so heat would not affect their integrity.
QAPI Committee Meetings Lacked Required DON and Administrator Participation
Penalty
Summary
The facility failed to assure that QAPI program feedback and data system monitoring performed by the DON and Administrator were included in every committee meeting. Review of trimestral QAPI committee meetings for 2025 and 2026 showed that the 09/25/25 meeting did not evidence participation by the DON and did not include evidence that the DON’s feedback and data system monitoring were presented. The 06/27/25 QAPI committee meeting attendance list did not demonstrate participation by the Administrator and did not include evidence that the Administrator’s feedback and data system monitoring were presented. During interview on 05/21/26 at 11:55 am, the QAPI officer stated that if the Administrator or DON did not participate in each committee meeting, an alternate designated member could present a report with that person’s feedback and data system monitoring related to QAPI activities, and acknowledged that this was not established in that specific way in the QAPI rules and regulations.
QAPI Committee Lacked Required Member Participation
Penalty
Summary
The facility failed to maintain a QAPI committee with participation of the required members established in 483.75(g)(1). Review of the trimestral QAPI committee meetings for 2025 and 2026 showed that the 09/25/25 meeting did not evidence participation of the DON, and the 06/27/25 attendance list did not demonstrate participation of the Administrator. Review of the QAPI rules and regulations updated in January 2026 with the QAPI officer showed that the Administrator, DON, Infection Control Officer, and Medical Director were required members of the QAPI committee. During interview, the QAPI officer stated that these required members must participate in each committee meeting and that an alternate person should represent any required member who is unavailable.
Improper Hand Hygiene During Medication Administration
Penalty
Summary
The facility failed to implement and maintain an effective infection prevention and control program by not ensuring proper hand hygiene during medication administration. On 05/21/2026, during observation from 8:52 AM through 9:40 AM, a Registered Nurse entered residents' rooms 704, 706, and 708, touched the door handle to open the room door, touched curtains and a table, and then donned gloves and administered medications without performing hand hygiene after contact with the door handle, curtains, and table. The report states that, according to CDC hand hygiene guidance, hand hygiene should be performed after touching the patient's surroundings, before donning gloves, and before resident contact.
Kitchen Freezer Not Maintained in Proper Condition
Penalty
Summary
The facility failed to maintain the kitchen freezer in proper condition. During observation on 05/20/2026 at 9:00 a.m., the freezer was observed to be condensing, and it was noted to be at risk of affecting the integrity and safety of the food.
Resident Records Left Visible During Medication Pass
Penalty
Summary
The facility failed to maintain the confidentiality of residents' clinical information when identifiable resident documents were left exposed and unattended on top of a medication cart during a medication administration pass for 5 of 5 residents observed, including Resident #17, Resident #20, Resident #25, Resident #26, and a new resident admitted late in the afternoon to room [ROOM NUMBER]B. During the medication pass from 8:05 AM until 8:45 AM, the RN left the medication cart and entered residents' rooms to administer medications while resident vital signs sheets and medication Kardex records containing residents' information remained on top of the cart and were visible in the hallway. When interviewed, the RN stated that she used the documents during the medication pass to confirm residents' vital signs and left them on top of the cart while giving medications.
Failure to Document Smoking Care Plan
Penalty
Summary
Facility failed to document a smoking plan of care for a resident who was receiving services and smoked while admitted. The resident was an [AGE]-year-old male admitted with a diagnosis of an ulcer on the right foot and reported that he was receiving local care and IV antibiotic therapy for the ulcer. During interview, he stated that he was a daily cigar smoker, that he informed the facility of his smoking status on admission, and that he was told smoking was prohibited in the building and that designated smoking areas would be used with staff accompaniment to prevent accidents. The resident stated that he was told about nicotine replacement therapy options but was not being forced to quit smoking, and that he agreed he could adjust to the smoking schedule prepared by the facility. Review of progress notes showed that he went to the designated smoking area with recreational therapy at 1:00 PM daily, and a schedule form identified the responsible personnel and time. The DON stated that safety measures and smoking habits were considered when the schedule was prepared, but a comprehensive plan of care addressing smoking habits and safety measures was not developed or implemented. No evidence was provided that the interdisciplinary team discussed the resident's wish to smoke while receiving services or that a smoking schedule was developed and implemented as part of a care plan.
Failure to Document Medication Change Justification
Penalty
Summary
The facility failed to meet professional standards of quality for 1 resident, RR#25, related to wound care observation and medication documentation. On May 21, 2026, RR#25 was observed with a wound on the left foot. The record also showed that on May 17, 2026, the physician changed the resident’s Ultracet order from 1 tablet to 2 tablets after the resident asked the doctor and the nursing supervisor if the medication could be increased, but the physician did not provide a justification for the change in the assessment and did not write a progress note for the order change. The facility’s Pain Management protocol states that accurate documentation, including justification for medical prescriptions, is important.
Failure to Document Psychotropic Medication Education and Consent
Penalty
Summary
The facility failed to document education regarding the risks and benefits of antipsychotic medication and failed to document informed consent for its use for one resident reviewed for psychotropic medications. Resident #28, a 61-year-old female admitted with diagnoses of right total knee replacement, major depression, schizophrenia, and bipolar disorder, had a pharmacist medication regimen review completed on 05/14/2026. A medical order dated the same day included Abilify 10 mg daily, Trazodone 100 mg at bedtime, Cymbalta 60 mg daily, and Vistaril 25 mg every 12 hours as needed for anxiety. During record review, there was no note or statement showing that the risks and benefits of high-risk psychotropic medications were discussed with the resident and/or family member, and no documentation of consent for antipsychotic use. The pharmacist stated during interview that the resident told him she used Abilify for depression, and that the medication orders were placed after the review, but the recommendations, risks, and benefits were not documented when the psychotropic medication use was identified.
Failure to Ensure Competent PICC Line Care
Penalty
Summary
The facility failed to ensure that care and management of peripherally inserted central catheter (PICC) lines were provided by competent and trained nursing staff, affecting two residents with PICC lines. During an interview with the Director of Nursing (DON), it was revealed that the competence certification and skills of nursing personnel interacting with residents who had PICC lines were not performed in 2024. Despite requests for competence certification information, no evidence was provided during the survey procedures. The DON confirmed that the competence of 12 nurses providing care to residents with PICC lines had not been assessed in 2024.
Insufficient Support Personnel in Food and Nutrition Service
Penalty
Summary
The facility failed to provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. During an interview with the Dietitian, it was revealed that the facility did not have a designated dishwasher position covered. As a result, the Dietitian had to use a TSA (Temporary Staff Assistant) for dishwashing duties, which made the kitchen operations difficult.
Non-Compliance with Sink Compartment Sanitations
Penalty
Summary
The facility failed to comply with the required sink compartment sanitations as per their policy and procedure. During a visual inspection and staff interview, it was observed that the staff working the three-compartment sink did not have knowledge of the required temperatures for each compartment. Specifically, the first compartment should be at 110°F, the second at 75°F, and the third at least 75°F with a sanitizing solution concentration of 200 ppm. However, the concentration measurement in the third compartment was found to be 600 ppm, which is significantly higher than the required 200 ppm, indicating overuse of the sanitizing agent.
Non-Compliance with Food Storage Policy
Penalty
Summary
The facility failed to comply with its policy regarding the use and storage of foods brought to residents by family and other visitors. The policy, ND-0003 Almacenaje de los alimentos en la nevera de los residentes, requires that all food in the refrigerator be identified with the resident's initials, room number, and date. During a review conducted on 04/17/2024, it was observed at approximately 1:30 PM that some snacks, including juice, desserts, and vegetables (carrots), in the residents' refrigerator were not labeled with the required information.
Failure to Maintain Safe Equipment
Penalty
Summary
The facility failed to maintain equipment in a safe operating condition. During an observational tour, it was noted that the electrical cords on the beds of two residents in a specific room had broken plastic coverings. Additionally, an alcohol-based hand rub (ABHR) dispenser was found to be broken in another room. Furthermore, a window shade cover was observed to be broken and lying on the floor in a different room.
Failure to Maintain Safe and Comfortable Environment
Penalty
Summary
The facility failed to promote a safe, clean, comfortable, and homelike environment for its residents. During an observational tour, three residents in rooms 706A, 708A, and 709A complained about cold temperatures in their rooms. A review of the room temperature log for 04/14/24 revealed that daily measurements exceeded the established parameters of 71 to 81 degrees. Additionally, it was observed that the wall behind the door in one room had peeling paint due to water damage. The facility's policy on room temperatures stated that rooms should be maintained between 71 to 81 degrees, and no patients with skin lesions were admitted at the time of the survey, which would have required different temperature settings.
Failure to Develop Baseline Care Plan for Central Line
Penalty
Summary
The facility failed to develop and implement a baseline care plan for a resident with a power central line in the right subclavian, which was necessary for administering antibiotic therapy. The deficiency was identified during a record review and interviews with the Nursing Supervisor and the resident. The resident, a male with a diagnosis of Lumbar Discitis and Osteomyelitis, was admitted to the facility for a 90-day antibiotic therapy regimen. Despite the resident having the power central line upon admission, the baseline care plan did not include instructions for its local care. The Nursing Supervisor acknowledged the omission, stating that the care plan was not developed because the central line was inserted at another facility. However, the nursing personnel were providing local care and changing bandages every 72 hours on an ongoing basis.
Failure to Ensure Physician Orders for PICC and Power Central Line Care
Penalty
Summary
The facility failed to ensure care provided to a peripherally inserted central catheter (PICC) and a power central line was performed in accordance with a physician order. This deficiency was identified in two residents. One resident, a male admitted with a diagnosis of intraspinal abscess and granuloma, had a PICC line in his left arm for antibiotic therapy. Upon review, it was found that there was no physician order for the care of the PICC line. The Nursing Supervisor confirmed that the resident had the PICC line upon admission and that nursing personnel provided local care and changed bandages every 72 hours without a formal order in place. The resident corroborated this information during an interview, stating that he was admitted with the PICC line and received regular care from the nursing staff. Another resident, a male admitted with a diagnosis of lumbar discitis and osteomyelitis, had a power central line in the right subclavian for antibiotic therapy. Similarly, there was no physician order for the care of this power line. The Nursing Supervisor acknowledged the absence of an order and mentioned that the resident had the power line upon admission, with nursing staff providing local care and changing bandages every 72 hours. The resident confirmed that he was admitted with the power line and received regular care from the nursing staff. Both cases highlight the facility's failure to ensure that care for these vascular access devices was performed according to a physician's order, as required.
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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 San Juan
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Multy Medical Skilled Nursing Facility | 2.3 mi | ★★★★★ | 13 | 0 |
| Centro De Cuidado Prolongado San Lucas | 3.5 mi | ★★★★★ | 23 | 0 |
| Millennium Institute For Advance Nursing Care Inc | 4.8 mi | ★★★★★ | 4 | 0 |
| Centro Medico Wilma N Vazquez Snf | 21.4 mi | ★★★★★ | 18 | 1 |
| Ryder Memorial Hospital Inc | 25.8 mi | ★★★★★ | 0 | 0 |
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