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 Shalom Gardens Health & Rehabilitation during CMS and state inspections, most recent first.
An LPN found a full-code resident unresponsive, but no immediate assessment, CPR, or other life-saving measures were started before the resident was pronounced deceased. The resident had multiple serious diagnoses, severely impaired cognition, and scheduled meds/treatments were not given that day. An RN later documented no pulse, no respirations, cold extremities, and no signs of life, while interviews with the DON, administrator, and nursing staff did not explain why CPR was not initiated.
A resident with multiple serious diagnoses, including stroke with hemiplegia, dysphagia with gastrostomy, respiratory failure, diabetes, HTN, and GERD, was left without a nurse on the unit when a scheduled nurse did not report and the open slot was not filled. No nursing assessments, meds, or treatments were documented that morning, and the resident was later found unresponsive, without pulse or respirations, and pronounced deceased without CPR being initiated.
Facility staff failed to update care plans for three residents after documented falls and behavioral changes. One resident’s fall intervention was listed as a concave mattress, but the mattress was not in place and the resident instead had an alternating pressure mattress due to skin impairment. Two other residents had documented falls with no corresponding fall interventions added to the care plan, and another resident had repeated agitation, yelling, cursing, refusal of care and meds, and tearfulness documented in progress notes without behaviors or interventions reflected in the care plan.
An LPN failed to administer multiple ordered meds/treatments to a resident with stroke, DM, HTN, respiratory failure, dysphagia, and GERD during a delayed med pass when the unit was short staffed, and the MAR showed the ordered 9:00 a.m. meds were not given. Staff also failed to document descriptive wound assessments for another resident’s bilateral thigh gunshot wounds; notes and provider entries recorded the wounds and dressing changes, but did not describe wound size, appearance, drainage, odor, or surrounding skin as required by the facility’s wound care policy.
Failure to Notify RP After Reported Fall: A resident reported a fall to staff and OT, and an LPN documented no injury and stable VS, but there was no documentation that the RP was notified. An RN and the ADON stated that falls require assessment and notification of the physician and RP, and the ADON acknowledged that post-fall assessments were not completed and the care plan was not updated.
Failure to Complete Post-Fall Assessment After Reported Fall: A resident reported a fall, but staff did not complete the required post-fall assessments. RN and DON interviews confirmed that the event should have triggered assessment and notification, and the record showed only an initial note with vital signs and no further documented VS, neuro checks, or skin assessments after the reported fall.
A resident with Parkinson's disease, epilepsy, neuropathy, dementia, and moderate cognitive impairment was not given ordered doses of gabapentin and carbidopa-levodopa. MAR review showed missed doses, while nursing notes documented that gabapentin was not available and that the NP was notified. However, Omni-cell review showed the medications were available, and the DON stated nurses were expected to check the Omni-cell first when meds were not on the cart.
An unlocked medication cart was repeatedly observed unattended on Unit One, including in the hallway and at the nurse's station, with residents and staff nearby. An LPN stated she did not know who moved the cart and later acknowledged it should have been locked, and an RN also acknowledged the cart should have been locked when she left it unattended. Facility policy stated medication carts must remain locked unless directly supervised.
A resident with a history of stroke and dysphagia experienced a choking incident during a meal, but the facility failed to provide immediate emergency care. The LPN on duty, unfamiliar with the unit, attempted ineffective abdominal thrusts, and the emergency cart was not used. The resident became unresponsive and later expired, with staff citing the resident's DNR status as a reason for not continuing treatment. The facility's policy for choking incidents was not followed, and documentation did not support the actions taken.
The facility staff failed to follow physician orders for three residents, resulting in deficiencies in care. A resident with cellulitis did not have a wound dressing changed as ordered, another resident with severe cognitive impairment missed multiple medication doses, and a third resident with leg ulcers did not receive prescribed Lidocaine patches for pain management. These failures highlight a lack of adherence to the six rights of medication administration.
A resident with Multiple Sclerosis and other conditions did not receive scheduled showers during a three-week stay in an LTC facility. Despite being alert and requiring extensive assistance with ADLs, the resident reported not receiving any showers, except for one offer which was declined. The facility's policy required showers twice a week, but records showed missing documentation for nine shifts. Interviews with staff confirmed the expectation for regular hygiene care, yet the necessary services were not provided or documented.
A resident with a Traumatic Brain Injury had an ingrown hair follicle causing irritation on the groin area, which was not reported to the physician in a timely manner. The resident's RP informed an LPN about the issue, but it was not communicated to the physician until a week later, leading to a delay in treatment. The deficiency was noted during a survey and discussed with facility leadership.
A resident with bilateral leg ulcers and leg pain did not receive Lidocaine patches as prescribed, due to a transcription error in the MAR. The patches were scheduled only once daily instead of twice, and were often omitted, leaving the resident without adequate pain relief. LPNs acknowledged the error and noted the resident's frequent pain complaints. The facility's administration was informed of the issue.
Two residents in an LTC facility did not receive their prescribed medications due to failures in the medication management process. One resident, with severe cognitive impairment, missed doses of Protonix, Boost, and Mucinex, while another resident did not receive her OTC supplements for nine days. Interviews revealed a lack of communication and adherence to procedures among the nursing staff and pharmacy, leading to these deficiencies.
Failure to Initiate CPR for Full-Code Resident
Penalty
Summary
Facility staff failed to provide basic life support, including CPR, for a resident who had a physician order for full code status requiring CPR in the event of cardiac or respiratory arrest. The resident had diagnoses including cerebral infarction with hemiplegia, aphasia, dysphagia with gastrostomy, respiratory failure with hypoxia, diabetes, hypertension, insomnia, and GERD, and the MDS assessed the resident as having severely impaired cognitive skills. The resident was later pronounced deceased, but the clinical record showed no immediate assessment, no vital signs obtained by the first nurse who found the resident unresponsive, and no CPR or other life-sustaining measures initiated when the resident was found without pulse or respirations. The record documented that an LPN found the resident unresponsive during the morning shift and notified others instead of assessing the resident and starting CPR. The LPN documented that the resident was touched, found unresponsive, and that the CNA and DON were contacted, but there was no documentation of blood pressure, pulse, respirations, or code status being addressed at that time. An RN from another unit later documented that the resident was found unresponsive in bed, with no spontaneous respirations, no palpable carotid pulse, no heart sounds, cold extremities, and no signs of life, and pronounced the resident deceased at 12:30 p.m. The RN documented no CPR efforts and no explanation for why CPR was not initiated. The resident’s record also showed that scheduled medications and treatments for the day were not administered before the resident was found unresponsive, including insulin, aspirin, Plavix, esomeprazole, lisinopril, carvedilol, polyethylene glycol, baclofen, amoxicillin, and an albuterol nebulizer treatment. Interviews with the RN, current DON, current administrator, and former administrator did not provide an explanation for why CPR was not started when the resident was found unresponsive and without pulse or respirations. The former administrator stated the resident was known to be full code and described signs of rigor mortis when he later entered the room, but no staff member documented that CPR was not initiated because of rigor mortis. Surveyors identified immediate jeopardy related to the failure to initiate CPR for the resident.
Insufficient Nursing Staffing and Lack of Assessment Before Resident Death
Penalty
Summary
The facility failed to provide sufficient nursing staff for assessment and monitoring of one resident, and there was no licensed nurse assigned to the resident’s unit on the day shift when the resident later was found unresponsive. Staffing schedules documented that a second nurse scheduled for the unit did not report, and the open nurse slot was not filled before the resident was found at 12:30 p.m. without pulse or respirations and was pronounced deceased without initiation of CPR. The resident had diagnoses that included cerebral infarction with hemiplegia, aphasia, dysphagia with gastrostomy, respiratory failure with hypoxia, diabetes, hypertension, insomnia, and GERD. The resident’s MDS assessed severely impaired cognitive skills. The clinical record showed that the resident had been seen by the nurse practitioner for respiratory congestion and had orders for an antibiotic and nebulizer treatment, along with scheduled medications for stroke prevention, blood pressure control, constipation, dysarthria, GERD, diabetes, and respiratory treatment. The record showed no nursing assessments, medication administration, or treatment documentation for the resident on the morning of the event. The night shift nurse documented care through 7:00 a.m., but there was no nursing documentation until the resident was found unresponsive around 12:30 p.m. A nurse who worked on the unit documented that the second nurse did not show up, that medication pass was interrupted, and that after completing med pass she found the resident unresponsive. The nurse did not document vital signs, a full assessment, CPR, or the resident’s code status. Another nurse later documented that the resident was found unresponsive, had no spontaneous respirations, no palpable pulse, no heart sounds, and was pronounced deceased at 12:30 p.m.
Failure to Update Care Plans for Falls and Behavioral Symptoms
Penalty
Summary
Facility staff failed to review and revise the comprehensive person-centered care plans for three residents after changes in condition and documented events. For Resident #15, the care plan listed a concave mattress as the intervention for a fall on 3/9/26, but an observation on 5/5/26 found the resident’s bed had an alternating pressure mattress instead of the concave mattress. The Assistant Director of Nursing stated the concave mattress had been considered but was not placed on the resident’s bed, that the alternating pressure mattress was in place due to skin impairment, and that the concave mattress should have been implemented after the fall. The ADON also acknowledged the care plan should have been updated to include the fall interventions. For Resident #23, progress notes documented a fall on 3/19/26 when the resident was found sitting on the floor in front of her wheelchair after reaching for a snack, and another fall on 4/16/26 when the resident reported falling earlier in the day. The record review showed no falls or fall interventions were added to the care plan after either event, and the ADON acknowledged the care plan was not updated. For Resident #24, staff observed the resident yelling and cursing about facility staff, and the clinical record documented agitation, yelling, screaming at staff, cursing, refusal of care and medications, wanting medications explained, and tearfulness. The care plan did not include these behaviors or any related interventions, and the ADON stated the resident was awaiting evaluation by the nurse practitioner and in-house psychiatric provider, while acknowledging the care plan had not been updated.
Missed Medications and Incomplete Wound Assessments
Penalty
Summary
Facility staff failed to follow physician orders for medications and treatments for one resident with a history of cerebral infarction with hemiplegia, aphasia, dysphagia with gastrostomy, respiratory failure with hypoxia, diabetes, hypertension, insomnia, and GERD. The resident’s record showed orders for multiple scheduled 9:00 a.m. medications and treatments, including lispro insulin, aspirin, Plavix, esomeprazole, lisinopril, carvedilol, polyethylene glycol, baclofen, albuterol nebulizer treatment, amoxicillin, and zinc oxide to the buttocks. The medication administration record documented that these medications and treatments were not administered as scheduled. An LPN documented that the unit was short a nurse, that medication pass was interrupted and delayed, and that she completed med pass around 12:30 p.m. before being told to start the second cart and complete blood sugars. Facility leadership reviewed the missed medications and treatments and acknowledged that the resident’s morning care was provided by a CNA, but there was no documentation that the ordered medications or treatments were given. The ADON stated the schedule showed an open nurse position on the unit that morning and that two nurses were required on the unit to provide needed care and medication administration. The ADON also stated that if a nurse was not available, nurse managers, the infection preventionist, the ADON, or the DON were expected to work so required care would be provided, but she was not sure why someone was not assigned to administer medications for the resident that morning. Facility staff also failed to document thorough assessments of another resident’s gunshot wounds to both thighs. The resident was admitted with gunshot wounds to the front of both thighs, and the admission assessment and nursing note identified the wounds but did not describe their appearance, size, drainage, odor, or surrounding skin condition. Physician orders later directed daily wound care with cleansing, iodoform packing, and gauze/ABD dressing changes, and the treatments were documented as completed daily. However, daily skilled nursing notes, weekly skin assessments, and provider notes repeatedly documented that the resident had thigh wounds or intact dressings without descriptive wound assessments. The facility’s wound care policy required wounds to be assessed on admission and at each dressing change with documentation of wound appearance, odor, drainage, dressing type, and any concerns, but no such descriptive assessments were documented in the record.
Failure to Notify Responsible Party After Reported Fall
Penalty
Summary
Facility staff failed to notify the resident’s responsible representative after the resident reported a fall. During interviews, an RN stated that when a fall is reported, the resident should be assessed and the physician and responsible representative should be notified, and that if a resident reports a fall it should be treated as a fall with post-fall assessments completed. The ADON stated that the resident’s fall occurred on 4/15/26, that post-fall assessments were not completed, that agency staff were involved, and that the staff member failed to complete the required fall assessments. She also acknowledged that the responsible party should have been notified but was not, and that the care plan was not updated following the fall. Clinical record review showed that on 4/16/26 the resident told staff and OT that she had fallen the prior day, describing that she fell “out there,” dragged herself up, and that “some girl” helped her up. An LPN documented that the resident reported falling earlier in the day the day before, denied injury, and had vital signs taken with no skin concerns noted. The record contained no documentation that any staff member notified the responsible representative of the reported fall, and the care plan had no recorded fall for that day or any interventions. Facility documentation stated that the nurse will notify the resident’s physician/practitioner or physician on call when there is an accident or incident involving the resident or a significant change in condition.
Failure to Complete Post-Fall Assessment After Reported Fall
Penalty
Summary
The facility failed to assess a resident after a reported fall for Resident #23. Staff interviews showed that when a fall is reported, the resident should be assessed and the physician and responsible representative notified, and that if a resident reports a fall it should be treated as a fall with post-assessments completed. The assistant director of nursing stated that Resident #23’s fall occurred on 4/15/26 and that post-fall assessments were not completed because agency staff were involved and the staff member failed to complete the required assessments. Clinical record review showed that on 4/16/26 the resident told staff she had fallen, first stating she fell “this morning” and later stating she fell “the night before” and that “some woman got her up.” Another note documented that the resident reported to OT that she had a fall yesterday, said she fell earlier in the day, and stated she was not hurt; vital signs were recorded at that time and no skin concerns were noted. After that initial note, there was no documentation of post-fall assessments for the resident, including no documented vital signs, neurological checks, or skin assessments following the reported fall. The facility’s fall policy stated that a fall includes a resident found on the floor or a resident who would have fallen if not caught, and that a fall without injury is still a fall.
Medication Not Given Despite Availability
Penalty
Summary
Facility staff failed to ensure that a resident was free from significant medication errors by not administering available medications as ordered. The resident was admitted with diagnoses including Parkinson's disease, epilepsy, coronary artery disease, neuropathy, anxiety disorder, major depressive disorder, dementia, and dysphagia. The most recent MDS coded the resident with a BIMS score of 10 out of 15, indicating moderate cognitive impairment, and coded the resident as dependent on staff for all aspects of care, including mobility and ADLs. Clinical record review showed orders for carbidopa-levodopa and gabapentin. The MAR showed gabapentin was not given on 6/19/26 at 9:00 AM and 7:00 PM. Nursing notes documented that the 9:00 AM gabapentin dose was not available and that the NP was made aware with no new orders, and that the NP was to reorder; the 7:00 PM gabapentin dose was documented as on order. The MAR also showed that on 6/22/26 the resident did not receive two doses of carbidopa-levodopa, with the 8:00 AM and 12:00 PM doses coded as not given in the nurses' note. Review of the Omni-cell contents showed gabapentin 100 mg and 300 mg, as well as carbidopa-levodopa 25-100 mg, were available for use. The DON stated that the facility's expectation was for nurses to first check the Omni-cell when medication was not on the cart.
Unattended, Unlocked Medication Cart Observed on Unit One
Penalty
Summary
Medications were not securely stored on Unit One when surveyors observed an unattended, unlocked medication cart in the hallway. On 5/4/26 at 2:30 pm, the cart was positioned sideways in the middle of the hallway with no nurse present at or within sight of it, while residents and staff were nearby. During the observation, LPN5 stated she did not know who moved the cart into the middle of the hallway and said she usually keeps it at the doorway of the resident's room. A second observation on 5/4/26 at 2:45 pm found the same medication cart sitting unlocked at the nurse's station while LPN5 was away from it and walking around the hallway. Residents and staff were again nearby. LPN5 stated it was her first day at the facility and acknowledged that the cart should have been locked. On 5/5/26 at 4:11 pm, surveyors observed another unlocked medication cart on Unit One with no staff present on the floor to secure it, and RN4 stated she had gone down the hall to speak with a resident and acknowledged the cart should have been locked when she was away from it. Facility policy reviewed by surveyors stated medication storage areas, including carts, must remain locked at all times unless directly supervised.
Failure to Provide Emergency Care During Choking Incident
Penalty
Summary
The facility failed to provide emergency treatment and care in accordance with professional standards for a resident who experienced a choking incident. The resident, who had a history of diabetes, stroke, and dysphagia, was observed choking during a meal. Despite the presence of staff, the resident was not immediately assisted in the dining room, and emergency procedures were not properly executed. The resident was removed from the dining room and taken to the nurse's station, where a large amount of food was removed from their mouth, but the resident became unresponsive and later expired. The Licensed Practical Nurse (LPN) on duty, who was unfamiliar with the residents and working on the unit for the first time, attempted to perform abdominal thrusts while pushing the resident's wheelchair but admitted that the effort was ineffective. The emergency cart, which contained necessary equipment such as a suction machine and oxygen, was not retrieved during the incident. The facility's policy for handling choking incidents was not followed, as no immediate treatment was provided in the dining room, and the resident's condition was not promptly addressed. Interviews with staff revealed a lack of coordination and adherence to emergency procedures. The Director of Nursing (DON) and other staff members acknowledged the failure to provide timely emergency care, citing the resident's Do Not Resuscitate (DNR) status as a reason for not continuing treatment after the resident became unconscious. However, the facility's documentation did not support the actions taken during the incident, and there was no evidence of proper emergency care being administered according to the facility's policy.
Failure to Follow Physician Orders for Three Residents
Penalty
Summary
The facility staff failed to follow physician orders for three residents, leading to deficiencies in care. For one resident with cellulitis, the staff did not change a wound dressing on the right lower extremity as ordered by the physician. The dressing, which was supposed to be changed daily, was observed to have not been changed for two days. This oversight was brought to the attention of the staff by the resident's family member, prompting a revision of the wound care orders. Another resident, who had severe cognitive impairment and required extensive assistance with daily activities, did not receive medications and treatments as prescribed by the physician. The Medication and Treatment Administration Record revealed multiple instances where medications were not administered on the specified dates. The facility's nursing standards, which emphasize adherence to the six rights of medication administration, were not followed, resulting in the omission of necessary medications. A third resident, suffering from bilateral leg ulcers and pain, did not receive Lidocaine pain patches as ordered. The patches were intended to be applied twice daily but were only scheduled once per day and were often omitted entirely. The resident reported persistent leg pain and inadequate pain management. Interviews with LPNs confirmed a transcription error in the medication administration record, leading to the resident being without the prescribed pain relief. The facility's adherence to nursing standards was again called into question, as the six rights of medication administration were not consistently followed.
Failure to Provide Scheduled Showers and Document Care
Penalty
Summary
The facility staff failed to provide necessary services to maintain personal hygiene for a resident who required extensive assistance with activities of daily living (ADLs). The resident, who was admitted with diagnoses including Multiple Sclerosis, Pulmonary Embolism, and Urinary Tract Infection, was coded as continent of bowel and bladder and had a BIMS score indicating no cognitive impairment. Despite the facility's policy requiring showers twice a week and bed baths on other days, the resident reported not receiving any showers during a three-week stay, except for one offer which was declined due to feeling unwell. The Unit Manager was unaware of the missed showers, and a review of records showed missing documentation for nine shifts since admission. Interviews with CNAs revealed that care was documented in the Point of Care system at the end of each shift, yet there was no documentation of showers being provided as scheduled. The Director of Nursing and Administrator confirmed the expectation for residents to receive showers twice a week and bed baths on other days, with all care documented. The facility's policy on ADLs emphasized providing appropriate care and assistance with hygiene, including bathing, at least twice weekly. Despite these policies, the facility failed to document or provide the necessary hygiene care for the resident, as confirmed by the lack of records and staff interviews.
Failure to Report and Assess Skin Condition
Penalty
Summary
The facility staff failed to ensure proper assessment and reporting of a skin condition on a resident's groin area. The resident, who has a diagnosis of Traumatic Brain Injury and intact cognitive abilities, was noted to have an ingrown hair follicle causing irritation. The resident's Responsible Party (RP) reported the issue to a Licensed Practical Nurse (LPN) a week prior, but the condition was not communicated to the physician until a later date. During an initial tour, the RP and a Certified Nursing Assistant (CNA) showed the area to another LPN, who then notified the Nurse Practitioner (NP). The NP assessed the area and prescribed an antibiotic. An interview with the LPN who initially saw the resident revealed that she did not report the condition, assuming the CNA would inform the resident's nurse. This lack of communication and failure to follow the facility's protocol for skin monitoring and reporting changes led to a delay in treatment. The deficiency was discussed with the facility's Administrator, Director of Nursing, and Corporate Consultant, but no further comments were made.
Inadequate Pain Management for Resident with Leg Ulcers
Penalty
Summary
The facility staff failed to provide adequate pain management for a resident with bilateral leg ulcers and leg pain, as prescribed by a physician. The resident, who was admitted with multiple diagnoses including end-stage renal disease, peripheral vascular disease, and heart failure, had a physician's order for Lidocaine patches to be applied twice daily for pain relief. However, the medication administration record (MAR) only scheduled the patches to be applied once daily at 9:00 AM, and they were not applied consistently. The patches were omitted entirely on several days, and the evening doses were never scheduled, leaving the resident without the prescribed pain relief. Interviews with LPNs revealed that the transcription of the physician's order was incorrect, leading to the resident not receiving the pain patches as ordered. The LPNs acknowledged the mistake and noted that the resident often complained of leg and back pain. They also mentioned that Tylenol was available for pain relief, but admitted it was not adequate for all types of pain. The facility's Administrator and Director of Nursing were informed of these findings but had no additional information to provide.
Medication Availability Deficiency in LTC Facility
Penalty
Summary
The facility staff failed to acquire and administer medications as ordered for two residents, leading to deficiencies in pharmaceutical services. For one resident, the facility did not ensure the availability of medications such as Protonix, Boost supplement, and Mucinex, despite having Pantaprazole available in bulk. The resident, who had severe cognitive impairment and required extensive assistance, did not receive the necessary medications due to a lack of communication and coordination between the nursing staff and the pharmacy. Interviews with the LPN, Unit Manager, and Director of Nursing revealed that the staff did not follow the proper procedures for obtaining medications from the on-site STAT box or notifying the physician for alternative orders. Another resident did not receive her over-the-counter medications, including Apple Cider Vinegar, Beet Root, and Biotin, for nine consecutive days. This resident, who had intact cognitive abilities, was informed by the staff that she needed to bring her vitamins from home as the facility did not have them available. Interviews with the RN and LPN indicated that the Director of Nursing was responsible for ordering OTC medications, but there was a lack of awareness and communication regarding the resident's needs. The deficiencies were identified through observations, clinical record reviews, staff interviews, and facility document reviews. The facility's failure to ensure the availability and administration of medications as ordered by physicians highlights a breakdown in the medication management process, affecting the residents' care and well-being.
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Illustrative
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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.
Illustrative
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Illustrative
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Nursing homes near Richmond
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Canterbury Rehabilitation And Healthcare Center | 0.8 mi | ★★★★★ | 20 | 2 |
| Lakewood Manor | 1 mi | ★★★★★ | 0 | 0 |
| Cedarfield Pinnacle Living | 2.3 mi | — | 0 | 0 |
| Our Lady Of Hope Health Center | 2.4 mi | ★★★★★ | 2 | 0 |
| The Laurels Of University Park | 2.9 mi | ★★★★★ | 1 | 0 |
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