Above average — CMS composite of the measures below.
The next survey window likely opens 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 Bridgewater Home , Inc. during CMS and state inspections, most recent first.
Failure to Include Code Status in CCPs: Surveyors found that the facility did not include residents’ current code status in their CCPs. During record review, the code status information could not be located on the care plans, and the SW stated they did not realize code status needed to be included because they believed the code status order was already part of the CCP.
Failure to Deliver Resident Mail on Saturdays: Residents reported that mail was not delivered to them on Saturdays. Staff confirmed the post office brings mail to the main desk, but no one is available in the reception area on Saturdays to receive it, and the receptionist works only Monday through Friday. The facility policy states that each resident has the right to send and receive mail.
A resident with Alzheimer’s disease and dementia had a large area of scuffed, damaged drywall beside the bed, and the issue was observed on more than one occasion. The Home Maintenance Supervisor said there was no work order for the area, and maintenance staff later patched it after the concern was identified.
Failure to Provide Transfer/Discharge Notice and Bed-Hold Policy: Two residents did not receive required written transfer/discharge information. One resident with severe cognitive impairment had no documented written notice to the representative for the hospital transfer and no evidence the bed-hold policy was provided. Another cognitively intact resident transferred for acute heart failure also had no documented bed-hold policy provided, and staff stated the policy is not typically given out upon discharge.
Inaccurate MDS coding affected two residents. One resident’s MDS listed an antiplatelet medication as an anticoagulant and failed to identify daily aspirin, despite the MAR and physician order showing aspirin use only. Another resident’s MDS documented an indwelling Foley catheter but incorrectly coded urinary continence as always continent instead of code 9. The RN responsible for MDS assessments acknowledged both coding errors.
A resident with a communication deficit related to hard of hearing had hearing aids documented in the admission assessment and MDS, but the care plan only addressed communication techniques and did not include the hearing aids or related interventions. The RN/MDS coordinator acknowledged the hearing aids should have been part of the care plan.
A resident with severe cognitive impairment and diagnoses including depression and chronic pain had a physician’s order for polyethylene glycol twice daily for constipation. Staff repeatedly held the medication because of loose stools or diarrhea, documented the holds in the eMAR and nursing notes, but did not notify the physician to obtain a hold order, despite facility policy requiring physician notification for any medication not administered.
A resident who was cognitively intact and needed assistance with transfers had an electric heater left in his room after an emergency heat outage had ended. The heater had been provided during the outage, but it remained plugged in and in use in the resident’s room until staff later identified that it had been missed when the heaters were collected.
Incomplete and inaccurate clinical records were identified for two residents. One resident with a feeding tube and NPO status had oral medication orders documented despite receiving meds via tube, while another resident’s calcium order contained conflicting dose instructions. Staff interviews confirmed the documentation errors and the inconsistent order transcription.
Infection control practices were not followed during trach care for a resident with chronic respiratory failure and other diagnoses. An LPN changed sterile gloves without hand hygiene, did not change gloves after removing soiled gauze, and then removed and inserted the inner cannula without hand hygiene or a glove change. The resident’s trach site was clean and the resident reported no difficulties during the procedure.
Failure to Include Code Status in Comprehensive Care Plans
Penalty
Summary
The facility failed to develop comprehensive care plans that included each resident’s current code status. During clinical record review, surveyors were unable to locate information on the residents’ comprehensive care plans that referenced their current code status. At the end-of-day meeting on 01/21/26, the Administrator, DON, and Infection Preventionist reviewed the issue of code status not being included on the resident’s care plan. On 01/22/26, the facility provided its policy titled, Comprehensive Person-Centered Care Planning, which stated that the facility will develop and implement a comprehensive person-centered care plan for each resident with measurable objectives and timeframes to meet the resident’s medical, nursing, mental, and psychosocial needs. During an interview on 01/22/26, the SW stated they did not realize code status needed to be included on the comprehensive care plan and believed the resident’s code status order was part of the care plan.
Failure to Deliver Resident Mail on Saturdays
Penalty
Summary
The facility failed to recognize and respect residents’ right to send and receive mail on Saturdays. During a Resident Council meeting, six residents stated that mail was not delivered to them at the facility on Saturdays. The concern was discussed with the administrator, DON, and infection preventionist at the end of day meeting on 1/21/26. Staff interviews confirmed that the mail was not being delivered to residents on Saturdays because there was no one available in the reception area to receive it. One staff member stated the post office brings mail to the main desk in the lobby, but mail is not delivered on Saturdays because no one is available to receive it, and the receptionist delivers mail to the units every day except Saturday. Another staff member stated the postal service does not deliver on Saturdays because there is no one in the reception area and the lights are out, although the post office could deliver on Saturdays if a staff member were present or if there were a mailbox to leave it in. A third staff member stated the receptionist works Monday through Friday from 9:00 AM to 5:00 PM and agreed residents could receive mail on Saturdays if someone were at the reception area. The facility policy stated that each resident has the right to send and receive mail.
Damaged Wall Area Next to Resident Bed
Penalty
Summary
The facility failed to maintain a comfortable homelike environment for Resident #105 when a large area of drywall/sheetrock next to the resident’s bed was observed to be visibly scuffed and damaged. Resident #105 had diagnoses of Alzheimer’s disease and dementia, and the quarterly MDS assessment coded the resident as moderately impaired in cognitive skills for daily decision making. The damaged wall area was first observed during the initial tour and was seen again the following day. During the end-of-day meeting with the Administrator, DON, and Infection Preventionist, the damaged drywall was reviewed. The Home Maintenance Supervisor later stated he was not aware of the area and did not have a work order for it, and Maintenance Personnel #1 was observed patching the area after the issue was identified.
Failure to Provide Transfer/Discharge Notice and Bed-Hold Policy
Penalty
Summary
The facility failed to provide written notification of the reason(s) for transfer/discharge to the resident’s representative and failed to provide the resident and/or representative with the facility bed-hold policy for two sampled residents. One resident, who had diagnoses including neoplasm of the brain, hydrocephalus, hypertension, urinary retention, and hyponatremia, had an MDS indicating severe cognitive impairment, was never/rarely understood, and had short- and long-term memory problems. The resident was transferred to the hospital, but survey review found no evidence that written notice of the reason for the transfer/discharge was provided to the resident’s representative and no evidence that the bed-hold policy was provided to the resident and/or representative. For the second resident, who had diagnoses including heart failure, venous embolism, edema, chronic kidney disease, and diabetes, the most recent quarterly MDS indicated the resident was cognitively intact. The resident was discharged to the hospital due to acute heart failure, but the clinical record did not include evidence that a written bed-hold policy was provided before leaving the facility. Staff interviews indicated nursing staff did not typically present a bed-hold policy and that discharge information was handled by the admission director, who stated that a bed-hold policy is not given out upon discharge.
Inaccurate MDS Coding for Medication Use and Urinary Continence
Penalty
Summary
The facility failed to ensure accurate MDS assessments for two residents in the survey sample. One resident, who had diagnoses including hypertension, hypothyroidism, anxiety, osteoarthritis, osteoporosis, vascular dementia, cerebral infarction, psychotic disturbance, mood disorder, chronic kidney disease, atrioventricular block, heart failure, and hypoxia, had a quarterly MDS that incorrectly documented anticoagulant use and did not identify daily aspirin as an antiplatelet medication. The clinical record showed a physician order for aspirin 81 mg daily for treatment of cerebral infarction, no order for any anticoagulant medication, and the November 2025 MAR documented daily aspirin administration with no anticoagulant administration. The RN responsible for MDS assessments stated the resident had no anticoagulant order and that aspirin was an antiplatelet medication, not an anticoagulant, and acknowledged the MDS had inaccurately categorized the aspirin. A second resident, who had diagnoses including dysphagia, neuromuscular dysfunction of the bladder, chronic respiratory failure, dementia, psychotic disturbance, mood disturbance, anxiety, dysarthria, hypertension, and depression, had a quarterly MDS that documented an indwelling urinary catheter but coded urinary continence as always continent. The clinical record included a physician order for a Foley catheter due to neuromuscular bladder dysfunction, and treatment records from October 2025 through January 2026 showed care and monitoring related to the Foley catheter. The RN responsible for MDS assessments stated the resident had an indwelling catheter and that the continence coding should have been code 9 rather than code 0.
Care Plan Not Updated to Include Hearing Aids
Penalty
Summary
The facility failed to review and revise the care plan for one resident in the survey sample to include hearing aids. Resident #56 had diagnoses including communication deficit related to hard of hearing, depression, and pulmonary embolism, and the most current MDS was a quarterly assessment with an ARD of 11/10/25. The resident was assessed as cognitively intact with a score of 13. Review of the admission assessment and Section B of the MDS documented that the resident used hearing aids, but the care plan for communication related to hearing deficit only addressed how to speak with the resident, such as facing the resident and limiting background noise, and did not include the hearing aids or any interventions related to hearing aid use and monitoring. During interview, the RN/MDS coordinator reviewed the care plan and stated that the hearing aids should have been included.
Failure to Obtain Physician Order Before Holding Polyethylene Glycol
Penalty
Summary
The facility failed to follow a physician’s order for polyethylene glycol for one resident. The resident had diagnoses including major depressive disorder, recurrent, unspecified, and other chronic pain, and the most recent MDS showed a BIMS score of 4 out of 15, indicating severe cognitive impairment. The care plan addressed antidepressant use and included monitoring and documenting adverse reactions such as constipation, fecal impaction, and diarrhea. The physician’s order directed polyethylene glycol 3350 powder, 17 grams by mouth two times a day for constipation related to incomplete defecation. The eMAR showed the medication was coded as held or otherwise not given on multiple shifts, and nursing notes documented loose stools and diarrhea as the reason for holding the medication. The record did not show that the physician was notified to obtain a hold order, and the DON confirmed staff had not called the physician for a hold order. Facility policy stated the resident’s physician should be notified of any medication that was not administered.
Portable Heater Left in Resident Room After Heat Restored
Penalty
Summary
Facility staff failed to maintain a safe room environment for one resident when a portable electric heater remained in use in the resident’s room after it was no longer needed for an emergency heat outage. The resident was cognitively intact and required the assistance of one person for safe transfers. He was observed seated in his room with an electric heater plugged into a wall outlet and positioned in the center of the room. The heater was on, and the resident stated it had been provided because he complained of cold air coming from the ceiling vent above his recliner and that he had placed it in the middle of the floor so it would not interfere with his movement in the room. The maintenance director stated the facility had distributed portable heaters during a heat outage caused by an underground water line break and that the heaters were used for about 12 hours until heat was restored. He stated maintenance staff retrieved the heaters the next morning, but the resident’s heater was missed. The LPN caring for the resident stated the heater should have been removed after the heat was repaired and said it got missed. The administrator stated all issued heaters had been accounted for and no other portable heaters were found in use.
Incomplete and Inaccurate Clinical Records for Two Residents
Penalty
Summary
The facility failed to maintain a complete and accurate clinical record for two residents. For one resident with spastic quadriplegic cerebral palsy, epilepsy, and dysphagia, the quarterly MDS indicated severe cognitive impairment and a feeding tube, and the care plan stated that all nutrition and fluids were to be provided via feeding tube. However, the clinical record contained provider orders for acetaminophen oral liquid and milk of magnesia to be given by mouth even though the resident was NPO and had an order for NPO/tube feeding with no liquids by mouth. The MARs for December 2025 and January 2026 showed neither medication had been administered, and an LPN confirmed the resident received medications via feeding tube. The DON stated there was no policy on documentation and that the expectation was for documentation to be entered correctly and per provider orders. For another resident with vitamin deficiency, osteoporosis, and muscle weakness, the most recent quarterly MDS indicated the resident was cognitively intact. During medication pass observation, an RN administered calcium 600 mg, and the order was later reviewed for accuracy. The physician order instructions documented calcium 600 mg by mouth once daily for supplement, but also included the conflicting instruction to take 900 mg by mouth once per day. The RN stated the resident had always been given 600 mg and that the order needed to be rectified because the actual dose on the physician order was 600 mg. An LPN later stated she had spoken to the physician and verified that calcium 600 mg was to be given, but the instructions had a typographical error and would be corrected.
Infection Control Lapses During Tracheostomy Care
Penalty
Summary
Infection control practices were not followed during tracheostomy care for a resident who was admitted with diagnoses including dysphagia, chronic respiratory failure, dementia, psychotic disturbance, mood disturbance, anxiety, dysarthria, hypertension, and depression. The resident’s MDS assessed the resident as cognitively intact. The clinical record included physician orders for daily tracheostomy care, including cleaning around the stoma with a saline/hydrogen peroxide mix and inserting a new sterile inner cannula daily. During observed tracheostomy care, an LPN sanitized the bedside table, donned PPE, and prepared a clean field and trach care supplies. The LPN removed and replaced sterile gloves multiple times without hand hygiene between glove changes, and after removing the soiled split gauze around the trach opening, did not change gloves or perform hand hygiene before removing the inner cannula and inserting the new inner cannula. The LPN also did not wash hands before leaving the room and only sanitized hands after exiting. The resident’s trach site was clean with no signs of infection or inflammation, and the resident reported no difficulties during the procedure.
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 51 citations issued within 25 miles in the last 12 months — including the 5 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 Bridgewater
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Blue Ridge Rehabilitation And Nursing | 5.9 mi | ★★★★★ | 2 | 0 |
| Sunnyside Presbyterian Retirement Community | 6.7 mi | ★★★★★ | 2 | 0 |
| Harrisonburg Hlth & Rehab Cntr | 7.4 mi | ★★★★★ | 7 | 0 |
| Vmrc, Complete Living Care | 8.8 mi | ★★★★★ | 0 | 0 |
| Kings Daughters Community Health & Rehab | 16.1 mi | ★★★★★ | 20 | 2 |
Every risk area ranked, a do-first checklist, and your local survey patterns
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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.