Below average — CMS composite of the measures below.
Past the typical resurvey interval — a standard survey could occur at any time
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 Brookside Rehab & Nursing Center during CMS and state inspections, most recent first.
Facility staff did not provide adequate supervision for three residents with severe cognitive and behavioral impairments, resulting in repeated incidents such as a resident ingesting fecal material, aggressive altercations between residents, and multiple instances of residents entering others' rooms and engaging in physical confrontations. Despite staff awareness of these behaviors, care plans and clinical records lacked documentation of effective interventions or consistent supervision strategies, and staff interviews confirmed insufficient monitoring, particularly during periods of low staffing.
The facility failed to provide adequate nursing staff, resulting in multiple incidents where residents with cognitive and behavioral challenges were not properly supervised. One resident repeatedly engaged in unsafe behaviors such as ingesting fecal material, while others were involved in physical altercations and inappropriate room entries. Staff interviews confirmed that insufficient staffing, especially on weekends and during high census, made it impossible to provide the necessary supervision and care.
A resident with severe cognitive impairment developed a bruise and pain in the left leg, prompting an X-ray that revealed a femur fracture. Although the X-ray company reported the positive finding to facility staff, there was no documentation that the physician was notified of the results on the same day, resulting in a delay in medical intervention.
Staff did not review or revise the comprehensive care plan for a resident with severe cognitive impairment and behavioral issues involving playing with and ingesting fecal material. Despite multiple staff observations and documentation of these behaviors, the care plan lacked interventions to address them, and CNAs and an LPN were unaware of any plan to prevent or manage the behavior.
A resident with severe cognitive impairment developed a bruise and pain in her leg, prompting staff to order an X-ray. The X-ray revealed a femur fracture, but there was a delay in the facility receiving and acting on the results, as staff did not follow up with the X-ray company in a timely manner. This resulted in a delay in the resident being evaluated and treated for the fracture.
Failure to Provide Adequate Supervision and Prevent Accident Hazards
Penalty
Summary
Facility staff failed to provide adequate supervision and address accident hazards for three residents with significant cognitive and behavioral impairments. One resident with severe cognitive impairment and a history of bipolar disorder and dementia was repeatedly observed by staff to play with and ingest fecal material. Despite these behaviors being known to multiple CNAs and an LPN, there was no evidence in the care plan or clinical record of interventions or supervision strategies to prevent this behavior, nor was there documentation of the incidents or communication of a plan to staff. Another resident with dementia, bipolar disorder, and depression exhibited ongoing aggressive and disruptive behaviors, including grabbing another resident by the shirt collar, entering other residents' rooms, and engaging in physical altercations. Although staff and administration were aware of these behaviors, interventions such as room changes and one-on-one supervision were not implemented until after multiple incidents had occurred. Staff interviews confirmed that supervision was inconsistent, and there was no documentation of decision-making regarding supervision or timely implementation of interventions to prevent further incidents. A third resident was involved in multiple resident-to-resident altercations, including slapping, hitting, and entering other residents' rooms and beds. The care plan only indicated to monitor the resident closely, but staff interviews revealed that supervision was insufficient, especially when staffing levels were low. The clinical record documented repeated incidents of aggression and inappropriate room entry, with staff acknowledging the difficulty in providing adequate supervision to prevent these events. The facility's policy required individualized safety interventions and communication to staff, but these measures were not consistently documented or implemented for the residents involved.
Failure to Provide Sufficient Nursing Staff for Resident Supervision
Penalty
Summary
Facility staff failed to provide sufficient nursing staff to meet the needs of several residents, resulting in multiple incidents involving inadequate supervision and resident safety concerns. For one resident with severe cognitive impairment and a history of bipolar disorder and dementia, staff did not provide adequate supervision to prevent the resident from playing with and ingesting fecal material. The care plan did not address these behaviors, and there was no documentation of interventions or supervision strategies to prevent recurrence. Staff interviews confirmed that insufficient staffing, particularly on weekends, made it impossible to provide the necessary supervision for this resident. Another resident with aggressive behaviors was not provided with adequate supervision following an incident where the resident grabbed another resident by the shirt collar. Despite ongoing behavioral issues, including physical altercations and threats toward other residents and visitors, interventions such as room changes and one-on-one supervision were delayed and not implemented until after further incidents occurred. Staff interviews indicated that there were not enough staff to monitor residents effectively, especially those with a history of aggression, and that supervision was inconsistent and insufficient to prevent further incidents. A third resident was involved in multiple resident-to-resident altercations, including slapping, hitting, and entering other residents' rooms and beds. Documentation showed repeated incidents over several months, with staff unable to provide adequate supervision due to insufficient staffing levels. Staff interviews consistently reported that low staffing, particularly during high census periods and weekends, resulted in larger assignments for each CNA and less time to supervise residents, making it difficult to prevent such incidents. The facility's own policy requires sufficient numbers of staff to provide care and services in accordance with resident care plans, but this standard was not met.
Failure to Timely Notify Physician of Positive X-ray Results
Penalty
Summary
Facility staff failed to notify the physician in a timely manner regarding the X-ray results of a resident who was admitted with multiple diagnoses, including dementia and severe cognitive impairment. The resident was found with a bruise on the left leg and reported pain to touch. Initial actions included notifying the medical doctor and the after-hours provider, as well as the resident's power of attorney. Orders were given for an X-ray of the left hip and lower leg, which was performed the following day. The X-ray results revealed a comminuted, angulated, intertrochanteric fracture of the left femur. According to the X-ray company, the facility was notified of the positive finding on the same day the X-ray was performed, and a registered nurse was reportedly informed. However, a review of the clinical record showed no documentation that the physician was notified of the X-ray results on that day. Nursing staff interviews confirmed that there was no evidence of physician notification on the day the results were received. The delay in notifying the physician resulted in a lack of timely medical intervention for the resident's fracture. The deficiency was identified through clinical record review and staff interviews, which highlighted the absence of required documentation and communication regarding the significant change in the resident's condition.
Failure to Update Care Plan for Resident's Ingestion of Fecal Material
Penalty
Summary
Facility staff failed to review or revise the comprehensive care plan for one resident to address behaviors involving playing with and ingesting fecal material. The resident, who was admitted with diagnoses including bipolar disorder and dementia, was assessed as severely cognitively impaired according to the most recent MDS. Despite documentation in a psychiatric note and multiple staff observations of the resident engaging in these behaviors, the care plan dated several months after these incidents did not include interventions or strategies to address them. Interviews with CNAs and an LPN confirmed that the resident frequently removed and ingested feces, even after being toileted, and that staff were not aware of any specific plan to prevent or manage this behavior. The LPN, after reviewing the care plan, acknowledged that it did not address the resident's behavior. Administrative staff were informed of these findings, and no additional information was provided prior to the survey exit.
Delay in Acting on X-ray Results for Resident with Fracture
Penalty
Summary
Facility staff failed to provide timely care and services for a resident with severe cognitive impairment who developed a bruise on her left leg. The resident, diagnosed with dementia and unable to make daily decisions, was found with a bruise and pain to touch. Staff notified the physician and after-hours provider, and ice was applied for pain as needed. The resident was monitored for pain, and an X-ray was ordered later that evening to assess the injury. The X-ray, performed the following day, revealed a comminuted, angulated, intertrochanteric fracture of the left femur. According to the X-ray company, the facility was notified of the positive finding the same day, but the nurse on duty did not recall receiving the call. The facility did not document receipt of the X-ray results until the next morning, at which point the nurse practitioner was notified and the resident was subsequently sent to the hospital for evaluation and treatment. Interviews with staff confirmed that the facility's protocol required nurses to follow up with the X-ray company if results were not received by the end of the day. Both the LPN and RN interviewed agreed that the nurse should have called the X-ray company for the results and acknowledged that there was a delay in treatment for the resident. The delay in acting on the X-ray results led to a delay in the resident receiving appropriate evaluation and treatment for her fracture.
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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.
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Nursing homes near Warrenton
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Poplar Hill Health And Rehab | 1.3 mi | ★★★★★ | 10 | 0 |
| Lake Manassas Health & Rehabilitation Center | 8.5 mi | ★★★★★ | 5 | 1 |
| Gainesville Health And Rehab Center | 11.6 mi | ★★★★★ | 0 | 0 |
| Manassas Health And Rehab Center | 16 mi | ★★★★★ | 9 | 0 |
| Birmingham Green | 18.6 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.