Above average — CMS composite of the measures below.
A standard survey is most likely before around November 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 Legend Healthcare And Rehabilitation - Greenville during CMS and state inspections, most recent first.
The facility did not ensure pharmaceutical services were provided to meet each resident's needs and failed to employ or obtain the services of a licensed pharmacist, resulting in a lack of required pharmaceutical oversight.
A hospice aide provided care to a resident on EBP for a Foley catheter and wound without the required gown, placed soiled linen in a roommate’s wheelchair, and did not perform hand hygiene after glove removal before handling clean linens. In a separate observation, a CNA provided incontinent care to another resident with severe cognitive impairment and urinary incontinence without changing gloves when moving from dirty to clean tasks. The DON stated staff were expected to follow EBP, bag soiled linens, and perform hand hygiene after glove removal.
A medication cart containing various medications and insulins was left unlocked and unattended in a hallway by an RN, allowing easy access to its contents by anyone passing by. The RN acknowledged forgetting to secure the cart, and the DON confirmed that facility policy requires medication carts to be locked when unattended.
Failure to provide nail care and personal hygiene assistance for a resident with severe cognitive impairment and diabetes. The resident was observed in bed with long, discolored fingernails and residue under the nails, while CNA staff said they were responsible for nail care and one CNA had not noticed the issue. The DON stated nail care should be done as needed, nails should be observed daily, and nurses were responsible for trimming nails of diabetic residents.
A resident with an indwelling Foley catheter was transferred by two CNAs using a mechanical lift, but the drainage bag was attached above the resident’s bladder instead of being kept below bladder level. Urine was observed flowing back toward the bladder during the transfer. The resident had dementia, overactive bladder, and required extensive to total assistance with transfers. Staff interviews confirmed the bag should have remained below bladder level, and the DON stated the practice placed residents at risk for UTI and cross contamination.
A resident with severe cognitive impairment sustained a bruise and skin tear after being verbally and physically abused by another cognitively impaired resident, who demanded toilet paper and grabbed the resident's arm. The incident was witnessed by a CNA, who intervened and separated the residents. Documentation and staff interviews confirmed the event and the facility's policy on abuse prevention.
A resident with significant mobility limitations and a history of falls was transferred using a mechanical lift by a single nurse aide, contrary to facility policy and the resident's care plan, resulting in the resident sliding out of the sling and being lowered to the floor. The aide was unaware that two staff were required for such transfers, and the resident was sent to the hospital for evaluation after reporting pain.
A facility failed to ensure a resident's care plan accurately reflected their DNR status, leading to a discrepancy between the care plan and physician orders. Despite having a DNR order, the care plan indicated the resident wished to be a full code. Interviews with staff revealed a lack of clarity in managing and verifying code status information, contributing to the deficiency.
Four student nurse aides worked full-time without certification beyond the allowed four-month period. Despite completing initial training, they were not certified and worked independently in various halls. The DON mistakenly believed refresher courses extended their certification period, which is not allowed.
The facility failed to ensure secure medication storage, as observed in two medication carts where controlled medications were found with broken blister pack seals. RN A and MA C, responsible for these carts, were unaware of the breaches, which were not detected during shift change counts. The DON confirmed that such breaches should lead to medication disposal, as per facility policy.
The facility failed to accommodate the dietary preferences and needs of several residents, including not providing snacks for dialysis patients, serving meals with restricted ingredients, and not communicating meal options effectively. This led to deficiencies in dietary services, impacting residents' satisfaction and nutritional intake.
The facility's kitchen failed to meet food safety standards, with issues including unlabeled food items, improper storage of dented cans, and failure to check food temperatures before serving. These actions, acknowledged by the Dietary Manager and Dietitian, could lead to foodborne illness risks for residents.
The facility failed to provide proper catheter care for three residents, leading to potential infection risks. A resident's catheter bag was placed above the bladder during a transfer, causing urine backflow. Another resident's catheter bag was improperly positioned during wound care, and a third resident's catheter bag was in contact with the floor. Staff acknowledged the errors, understanding the risk of infection from improper catheter positioning.
The facility failed to label and date insulin pens and vials on a medication cart, violating professional principles for drug labeling and storage. One insulin pen was found without a label and with an expired opened date, and another for a resident was found without an opened date. The facility's policy requires outdated or improperly labeled medications to be removed, but this was not followed, potentially leading to the use of ineffective medication.
The facility failed to maintain proper infection control practices during incontinence care for three residents. CNAs did not perform hand hygiene after removing soiled gloves and before donning clean ones, posing a risk of infection. Despite being proficient in hand hygiene, staff admitted to lapses in procedure, highlighting a need for adherence to the facility's infection control policy.
A resident with a history of stroke and hemiplegia did not receive the prescribed right hand splint as per physician orders on multiple occasions. Despite the Treatment Administration Record being signed off, observations showed the splint was not applied, and staff interviews revealed confusion about responsibility for its application. The facility's policy emphasized the importance of such interventions to prevent a reduction in range of motion.
Failure to Provide Pharmaceutical Services and Licensed Pharmacist Oversight
Penalty
Summary
The facility failed to provide pharmaceutical services to meet the needs of each resident and did not employ or obtain the services of a licensed pharmacist. This deficiency was identified during the survey process, indicating that the required pharmaceutical oversight and services were not in place for residents as mandated.
Infection Control Lapses During Resident Care
Penalty
Summary
The facility failed to maintain its Infection Prevention and Control Program for two residents observed for infection control. One resident had dementia, an indwelling Foley catheter, and a pressure ulcer on the right sacrum and was on Enhanced Barrier Precautions. During a bed bath, a hospice aide wore gloves but no gown, did not recognize that the resident was on Enhanced Barrier Precautions, and stated she was not aware of the signage outside the room. After the bath, she placed soiled linen in the roommate’s wheelchair, later moved it to the nightstand, and did not perform hand hygiene after removing gloves before handling clean linens and repositioning pillows and sheets. The hospice aide stated she thought the resident was not in isolation and said she only needed gloves. She also stated she did not realize she needed to wash her hands after removing gloves and acknowledged she should have placed the soiled sheet in a plastic bag. The LVN stated the resident was on Enhanced Barrier Precautions because of the wound and Foley catheter, and the DON stated residents with an implanted medical device and/or open wound had to be on Enhanced Barrier Precautions, soiled linens should be bagged and not placed on furniture or another resident’s wheelchair, and staff were to perform hand hygiene after glove removal. A second resident with severely impaired cognition, urinary incontinence, and maximal assistance needs for toileting hygiene was observed receiving incontinent care. The CNA wore gloves throughout the task, wiped the resident’s peri-area and buttocks, removed the soiled brief, and placed the clean brief under the resident while still wearing the same soiled gloves. The CNA stated she should change gloves and perform hand hygiene when moving from dirty to clean. The DON stated staff were expected to remove gloves and sanitize hands when going from dirty to clean, and that failure to do so could lead to cross-contamination and spread of infection.
Medication Cart Left Unlocked and Unattended
Penalty
Summary
A medication cart assigned to hall 300 was observed parked in the hallway with its drawers facing outward and left unlocked. The centralized, metal, round lock on the cart was protruding, indicating it was not secured, and the drawers could be easily opened. The cart contained various over-the-counter medications, blister packs, and insulins. During this time, several staff and residents passed by the unlocked cart. Approximately five minutes later, an RN returned to the cart after responding to a resident's call light and acknowledged that he had forgotten to lock the cart before leaving it unattended. In interviews, the RN admitted to forgetting to secure the cart and recognized that leaving it unlocked allowed anyone, including residents, staff, and visitors, to access the medications. The DON confirmed that medication carts are required to be locked at all times when unattended to prevent unauthorized access. Review of the facility's policy on medication storage, revised in May 2021, reflected that drugs and biologicals should not be left unsecured or unattended, and that medication carts must be kept locked when not in use.
Failure to Provide Nail Care and Personal Hygiene Assistance
Penalty
Summary
The facility failed to provide the necessary services for a resident who was unable to carry out activities of daily living to maintain good grooming and personal hygiene. Resident #10, a female with diagnoses including type 2 diabetes mellitus, cognitive communication deficit, and need for assistance with personal care, had a BIMS score of 0 indicating severe cognitive impairment and required maximal assistance with personal hygiene per the MDS assessment. Her care plan identified an ADL self-care performance deficit and included staff assistance with ADLs and personal hygiene. During observation, Resident #10 was found lying in bed with both hands showing fingernails approximately 0.3 cm long, extending from the fingertips, discolored tan, and with brownish residue underneath. She was confused and her responses did not make sense. In interview, CNA M stated CNAs and nurses were responsible for cleaning and cutting residents' nails, and CNA A stated she had not noticed the resident's nails and would do it right then. The DON stated nail care should be completed as needed and every time aides washed residents' hands, nails should be observed daily, nurses were responsible for trimming nails of diabetic residents, and long and dirty nails could be an infection control issue and cause skin breakdown if scratching.
Foley Drainage Bag Positioned Above Bladder During Transfer
Penalty
Summary
The facility failed to ensure appropriate care for a resident with an indwelling Foley catheter when CNA N and CNA P did not keep the drainage bag below the resident’s bladder during a mechanical lift transfer from wheelchair to bed. Resident #55 was a cognitively intact female with diagnoses including dementia, overactive bladder, and need for assistance with personal care. Her MDS reflected that she required extensive to total assistance with transfers and had a Foley catheter, and her care plan identified an indwelling catheter related to overactive bladder with interventions to monitor, record, and report signs and symptoms of UTI. During observation, CNA P unhooked the catheter bag from the wheelchair and attached it to the top bar of the mechanical lift above the resident’s bladder while the resident was raised, with urine observed flowing back toward the bladder. The bag was later moved to the side of the bed after the transfer. In interviews, CNA P stated she was trained to keep the catheter bag in a privacy bag and ensure tubing was not kinked, but was unsure where the bag should be positioned during transfer; CNA N stated the drainage bag should have been held below bladder level. The DON stated that not keeping the Foley bag below the bladder placed residents at risk for UTI and cross contamination, and the facility policy required the drainage tubing to be maintained below the level of the bladder.
Failure to Protect Resident from Verbal and Physical Abuse by Another Resident
Penalty
Summary
The facility failed to ensure a resident's right to be free from abuse when one resident was subjected to verbal and physical abuse by another resident. The incident involved a resident with dementia, muscle weakness, and cognitive communication deficit, who was severely cognitively impaired according to the BIMS score. This resident was found with a bruise and skin tear on the left upper arm after another resident, also severely cognitively impaired and diagnosed with Alzheimer's, psychotic disorder with delusions, and Parkinson's disease, grabbed the resident's arm during an altercation. The aggressor was heard making a profane demand for toilet paper before physically grabbing the other resident, resulting in injury. Staff documentation and interviews confirmed that the incident was witnessed by a CNA, who reported hearing the verbal outburst and then observed the physical contact. The CNA intervened by instructing the aggressor to let go, after which the residents were separated. The injured resident's arm was assessed, cleaned, and treated according to protocol. Progress notes indicated that the injured resident was later found sleeping without acute distress, and there was no evidence of prior physical or verbal behaviors towards others in the recent assessment period for either resident. The facility's policy on freedom from abuse, neglect, and exploitation emphasizes the right of each resident to personal privacy and protection from abuse. The policy also outlines the need for identifying and intervening in situations where abuse is more likely to occur, including ensuring adequate and competent staffing. Despite these policies, the incident occurred, and staff interviews revealed expectations for immediate intervention and reporting in cases of resident-to-resident altercations.
Mechanical Lift Transfer Performed by Single Staff Member Results in Resident Fall
Penalty
Summary
A deficiency occurred when a nurse aide (NA) performed a mechanical lift transfer alone, contrary to facility policy and the resident's care plan, resulting in a fall. The resident involved had multiple diagnoses, including contractures of both knees, lack of coordination, Parkinson's disease, muscle weakness, and required assistance with personal care. The resident was assessed as cognitively intact but dependent for transfers, with a care plan specifying the use of a mechanical lift with two-person assistance due to a history of falls and poor balance. On the day of the incident, the NA transferred the resident from bed to wheelchair using a mechanical lift without a second staff member present. During the transfer, the resident was not properly positioned in the lift sling, causing her to be at an angle and subsequently slide out of the sling. The NA lowered the resident to the floor and sought help. The resident reported pain and was sent to the hospital for evaluation, though no injuries were noted at the time. Interviews confirmed that the NA was not aware of the requirement for two staff members during mechanical lift transfers and that the facility's policy and the Director of Nursing's expectations were not followed. The facility's Safe Transfers policy and the resident's care plan both required two caregivers for mechanical lift transfers to ensure safety, but this protocol was not adhered to during the incident.
Inconsistent Code Status in Resident Care Plan
Penalty
Summary
The facility failed to develop and implement a comprehensive person-centered care plan for a resident, specifically regarding the resident's code status. The resident, a male with diagnoses including dementia, Alzheimer's, heart failure, and hypertension, had a documented Do-Not-Resuscitate (DNR) order effective from June 4, 2024. However, the care plan last revised on November 20, 2024, incorrectly indicated that the resident wished to be a full code. This discrepancy between the care plan and the physician orders could lead to confusion and mismanagement of the resident's care preferences. Interviews with facility staff, including the Director of Nursing (DON), Licensed Vocational Nurse (LVN), and MDS Coordinator, revealed a lack of clarity and consistency in how code status information was managed and verified. The DON acknowledged that the facility did not have a care plan policy and expected the orders and care plan to match, including the resident's code status. The MDS Coordinator stated that the care plans should be checked for accuracy seven days after completing an MDS, and the code status should be consistent across the MDS, care plan, and physician orders. However, the facility's electronic medical record (EMR) system and care plan processes did not ensure this consistency, leading to the identified deficiency.
Non-Certified Nurse Aides Working Independently
Penalty
Summary
The facility failed to ensure that nurse aides who had been employed for more than four months were certified and competent to provide care to residents. Specifically, four student nurse aides (NA B, NA C, NA D, and NA E) were found to be working full-time without having completed the necessary training and competency evaluation program approved by the state. These nurse aides were hired between December 2023 and March 2024, and despite having completed initial training, they had not obtained certification within the required four-month period. Interviews with the nurse aides revealed that they were working independently in various halls of the facility, providing care to residents without the necessary certification. The Director of Nursing (DON) acknowledged that the nurse aides were not certified but believed they could work independently because they had completed training. The DON was under the impression that the aides could extend their certification period by attending refresher courses, which is not permissible. The facility's operations manager confirmed that these individuals were considered full-time staff. The facility's job description for nursing assistants emphasized the need for certification and compliance with federal, state, and local regulations, which was not adhered to in this case.
Medication Management Deficiency in LTC Facility
Penalty
Summary
The facility failed to provide adequate pharmaceutical services to meet the needs of each resident, specifically in the management of medication carts. During a review of two medication carts, it was found that medications were stored in unsecure containers, which could lead to drug diversion and residents not receiving the intended therapeutic benefits. On Nurses Cart Hall 300, a blister pack for a resident's controlled pain medication was found with a broken seal, and the pill was taped over inside the blister. RN A, responsible for this cart, was unaware of when or how the seal was broken and did not notice the issue during the narcotics count at shift change. Similarly, on Med Aide Cart Hall 400, a blister pack for another resident's controlled anxiety medication was also found with a broken seal and the pill taped over. MA C, responsible for this cart, was also unaware of the broken seal and did not notice it during the shift change count. The Director of Nursing (DON) stated that broken seals should result in the medication being discarded, as keeping them poses a risk of drug diversion and infection control issues. The facility's policy requires that medications in unsecure containers be immediately removed and disposed of, but this was not adhered to in these instances.
Failure to Accommodate Dietary Preferences and Needs
Penalty
Summary
The facility failed to accommodate the dietary preferences and needs of several residents, leading to deficiencies in dietary services. Resident #66, who is dependent on renal dialysis, reported that the facility did not provide snacks for her dialysis sessions, nor did they hold her breakfast, resulting in her having to wait until lunch to eat. This was corroborated by LVN H, who confirmed that since November 2023, the facility had not been providing snacks specifically for residents going to dialysis, despite it being outlined in their care plans. Resident #250, who has a dietary restriction of no pork, was served a meal containing pepperoni, which she could not eat. The resident had informed the facility staff of her preference, but the dietary manager and RN A were unaware of this restriction. The dietary manager, who was new to the position, admitted to not being familiar with the kitchen policies and acknowledged that the previous manager had not been providing residents with preference sheets. Resident #1 expressed dissatisfaction with the portion sizes of meals and the lack of second servings when requested. The dietary manager stated that residents could change portion sizes and that second helpings were provided after all residents had been served. However, Resident #1 reported never receiving a meal ticket outlining meal options and alternatives, indicating a communication gap between the dietary staff and residents. CNA F confirmed that residents eating in their rooms were only informed of the menu if they asked, further highlighting the lack of proactive communication regarding meal options.
Food Safety Deficiencies in Facility Kitchen
Penalty
Summary
The facility failed to adhere to professional standards for food service safety in its only kitchen, as observed during a survey. The deficiencies included improper labeling and dating of food items in the refrigerator, freezer, and dry storage areas. Specifically, a one-gallon Ziplock bag of orange mashed food was found unlabeled in the refrigerator, and the Dietary Manager admitted to discarding it due to the lack of labeling. This oversight was acknowledged by the Dietary Manager, who stated that all food items should be labeled and dated to ensure proper identification and to minimize the risk of foodborne illness. Additionally, the facility did not properly segregate dented cans from the main dry storage area. During the inspection, three cans of butterbeans and one can of chicken broth were found dented and stored with other canned goods. The Dietary Manager was aware of the dented cans but had not yet removed them, acknowledging that such cans could lead to contamination and pose a health risk to residents. The Dietitian also confirmed that dented cans should be stored separately to prevent accidental use and potential foodborne illness. Furthermore, the Dietary Manager failed to check the temperature of chicken noodle soup before serving it to residents during a lunch meal service. The soup was heated for about two minutes and then served without a temperature check, which the Dietary Manager admitted was an oversight due to the rush of serving lunch. The Dietitian emphasized the importance of measuring food temperatures to prevent foodborne illness. The facility lacked a specific food storage policy, relying instead on the Texas Food Establishment rules for guidance.
Inadequate Catheter Care Leads to Infection Risk
Penalty
Summary
The facility failed to provide appropriate catheter care for three residents, leading to potential risks of urinary tract infections. For Resident #52, CNAs D and E did not maintain the foley catheter drainage bag below the bladder during a mechanical lift transfer, causing urine to flow back toward the bladder. Both CNAs acknowledged their mistake, understanding that the improper positioning of the catheter bag could lead to infection. The Director of Nursing (DON) confirmed that the catheter bag should always be kept below the bladder to prevent such risks. Resident #70 experienced a similar issue when RN P placed the catheter bag on the bed, above the bladder, during wound care. This action resulted in urine flowing back toward the bladder. RN P admitted to knowing the correct procedure and recognized that failing to keep the catheter bag below the bladder could cause an infection. The facility's policy on catheter care emphasizes the importance of maintaining the catheter bag below the bladder to prevent catheter-associated urinary tract infections. For Resident #85, the catheter bag was observed in contact with the floor while the resident was in a wheelchair. Both CNA Q and RN J acknowledged that the catheter bag should not touch the floor due to the increased risk of infection. The DON reiterated that the catheter bag should always be off the ground and below the bladder. Resident #85 had a history of urinary infections, and the improper handling of the catheter bag could exacerbate this issue.
Improper Labeling and Dating of Insulin in Medication Cart
Penalty
Summary
The facility failed to properly label and date insulin pens and vials on the 300 Hall medication cart, which is a violation of accepted professional principles for drug labeling and storage. Specifically, one Novolin R insulin pen was found without a label and with an expired opened date, and a Humulin N insulin pen for a resident was found without an opened date. These deficiencies were identified during an observation and were confirmed through interviews with RN A and the Director of Nursing (DON), who acknowledged the importance of labeling and dating insulin to ensure its effectiveness. The resident involved was a female with a diagnosis of type 2 diabetes mellitus and elevated blood pressure, who had a BIMS score indicating intact cognition. The facility's policy on medication access and storage requires that outdated or improperly labeled medications be removed and disposed of immediately. However, the facility did not adhere to this policy, as evidenced by the presence of insulin pens and vials without proper labeling and dating, which could potentially lead to the use of ineffective medication.
Inadequate Hand Hygiene Practices During Incontinence Care
Penalty
Summary
The facility failed to maintain an effective Infection Prevention and Control Program, as evidenced by multiple instances of improper hand hygiene practices by Certified Nursing Assistants (CNAs) during incontinence care for three residents. Resident #78, a severely cognitively impaired male with cerebral infarction and chronic kidney disease, was observed receiving incontinence care from CNA D, who did not perform hand hygiene after removing soiled gloves and before donning clean ones. This lapse occurred despite CNA D's acknowledgment of the importance of hand hygiene to prevent infection and cross-contamination. Similarly, Resident #13, a moderately cognitively impaired female with multiple sclerosis and overactive bladder, was subjected to inadequate infection control practices by CNA F. During the provision of incontinence care, CNA F failed to perform hand hygiene after removing gloves and before handling clean items, such as a new brief and gown. CNA F admitted to not being aware of the need to change gloves and perform hand hygiene between handling soiled and clean items, which poses a risk of infection. Resident #51, a severely cognitively impaired male with paraplegia and chronic respiratory failure, also experienced improper hand hygiene practices. CNA L did not perform hand hygiene after removing soiled gloves and before putting on clean gloves during incontinence care. Despite being proficient in hand hygiene, CNA L admitted to forgetting the procedure due to nervousness. The Director of Nursing (DON) and Assistant Director of Nursing (ADON) confirmed the facility's policy requiring hand hygiene before and after care, and when transitioning from dirty to clean tasks, to prevent infection and cross-contamination.
Failure to Apply Prescribed Splint for Resident
Penalty
Summary
The facility failed to ensure that Resident #44 received treatment and care in accordance with professional standards of practice and the comprehensive person-centered care plan. Resident #44, a male with a history of aphasia, hemiplegia on the right side, and cerebral vascular accident, was observed without his prescribed right hand splint on multiple occasions. The care plan and physician orders specified that the splint should be worn daily from 8 a.m. to 2 p.m. to maintain function and prevent further contractures. On 06/04/24 and 06/05/24, observations revealed that Resident #44 did not have the splint on his right hand as required. Despite the Treatment Administration Record (TAR) being signed off by RN C, indicating the splint was applied, observations showed the resident's hand was clenched in a tight fist without the splint. Interviews with staff, including CNA H, RN C, and CNA I, revealed a lack of clarity and communication regarding the responsibility for applying the splint. CNA H and CNA I were unaware or not informed of the need to apply the splint, and RN C assumed it had been placed without verifying. The Director of Nursing (DON) and Assistant Director of Nursing (ADON) confirmed that nurses were responsible for ensuring the splint was in place and should not sign off on the TAR if it was not. The facility's policy on Resident Mobility and Range of Motion emphasized the importance of interventions like splints to prevent a reduction in range of motion. The failure to apply the splint as ordered could lead to a decline in mobility and worsening of contractures for Resident #44.
What surveyors are citing around you — mapped
All 10 risk areas, ranked with evidence
Repeat citations, what's rising near you, and quality measures — ranked so department heads know exactly where to look first.
Illustrative
What surveyors actually found near you
We read the 79 citations issued within 25 miles in the last 12 months — including the 2 immediate-jeopardy cases — and tell you exactly what happened, in plain English, matched to your record.
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
A prioritized, do-first checklist
Every risk area becomes concrete audit steps drawn from real citations at facilities like yours — run them this week, before your window opens.
Illustrative
Risk indicators are statistical estimates from public CMS data — not predictions, findings, or compliance advice.
Nursing homes near Greenville
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Greenville Gardens | 2 mi | ★★★★★ | 14 | 0 |
| Briarcliff Health Center Of Greenville | 2.1 mi | ★★★★★ | 15 | 1 |
| Greenville Health & Rehabilitation Center | 2.2 mi | ★★★★★ | 2 | 0 |
| Royse City Medical Lodge | 11.7 mi | ★★★★★ | 6 | 0 |
| Avir At Commerce | 13.8 mi | ★★★★★ | 19 | 0 |
Every risk area ranked, a do-first checklist, and your local survey patterns
Built specifically for Legend Healthcare And Rehabilitation - Greenville.
100% money-back within 48 hours.
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.