Average — CMS composite of the measures below.
The next survey window likely opens around November 2026
Estimate from public CMS data, current as of October 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Sunnyside Healthcare Center during CMS and state inspections, most recent first.
Failure to supervise residents and follow care plan interventions led to a resident-to-resident altercation in the dining room. One resident with Down Syndrome, PTSD, anxiety, and moderately impaired cognition had a history of prior dining room altercations and a care plan intervention for staff to help with a clothing protector, while another resident with Alzheimer’s disease, dementia, and severely impaired cognition was observed passing out clothing protectors and other items to residents without staff present. Staff stated the care needs were not visible on the Kardex and the dining room was not adequately supervised.
The facility failed to honor resident choice regarding shower times when it eliminated the shower aide role and reassigned showers to NAs, splitting them between day and evening shifts without consulting residents. A resident who was independent with ADLs but had moderately impaired cognition reported being moved to evening showers without being asked, despite preferring daytime showers. Another resident with post-stroke paralysis and moderately impaired cognition was routinely awakened early for showers, although their representative stated the resident preferred to sleep in and bathe in the afternoon; an NA confirmed this resident’s shower was always done first, before breakfast. A third resident with diabetes, paraplegia, and depression, who was cognitively intact and required substantial assistance, reported being informed of the staffing change but not given any choice between day or evening showers, despite assessments indicating that making choices about customary routines and activities was very important to all three residents.
The facility did not ensure residents were involved in decisions about their restorative and therapy services when frequencies and durations were reduced. One resident with diabetes and paraplegia, who had intact cognition and required assistance with ADLs, had an AROM program reduced from six to three sessions per week and reported not being informed of the change or the shortening of sessions. Another resident with post-stroke left-sided weakness, lung disease, and HTN had an AROM program similarly reduced, while the resident’s representative stated they had been told at a care conference that services were being provided daily and were not informed of any changes. These actions were inconsistent with the facility’s policy requiring resident participation in person-centered care planning, including changes to the type, amount, frequency, and duration of care.
A resident with rheumatoid arthritis and spinal compression fractures, who required extensive assistance with ADLs, had a standing q6h narcotic pain medication order but experienced multiple missed doses when the facility ran out of the medication. The resident reported significant pain and stated staff told them the pharmacy would not refill the narcotic until a new prescription was obtained and that no backup dose was available from the emergency supply. An LPN and the DON confirmed that the established refill process—requesting refills when seven doses remained and using emergency backup narcotics with a pharmacy authorization code if needed—was not followed, and confusion with the pharmacy order prevented timely access to the narcotic medication.
PASRR screening was not reviewed and validated before admission for three residents with diagnoses including anxiety, dementia, and substance use disorder, and required Level 2 referrals were not sent when positive Level 1 findings were identified. Records showed the residents were admitted with psychotropic medications, and staff stated PASRRs were reviewed after residents arrived rather than before admission.
Unsafe Food Storage, Dating, and Cooling Practices: Surveyors found multiple thawed meats, cooked foods, and dry goods in the kitchen that were unlabeled, undated, expired, or stored improperly, including hot food placed directly into the refrigerator. Staff stated meats should have been dated with pull and use-by dates, cooked food should be labeled, and there was no cooling process before refrigeration. Additional observations showed contaminated storage conditions and personal items kept with clean dishes and food supplies.
Staff failed to follow infection control practices during meal service, wound care, toileting, and catheter care. Staff members entered resident rooms and moved between residents without proper hand hygiene, used the same gloves across dirty and clean tasks, handled wound supplies and dressings without changing gloves, and provided care to a resident with an indwelling catheter without the required gown and gloves for EBP. The DON and Infection Preventionist stated the expected hand hygiene, glove change, and PPE processes were not followed.
Grievances were not promptly resolved or communicated to the resident or RR for two residents. One resident with dementia had missing personal items, including sweaters and a pillow, and the RR said they were not updated and had not received reimbursement even though the grievance log noted the items were not found. Another resident with intact cognition reported a missing delivered package and vape device, but staff did not complete follow-up to identify the source of the grievance or resolve the concern.
Psychotropic medications were not monitored with resident-specific behaviors, and informed consent was not obtained for one resident before antidepressants were given. One resident with dementia, anxiety, and insomnia received multiple psychotropic meds without documented sleep-pattern monitoring, individualized behavior tracking, or side-effect monitoring, and the RR said they were not informed or asked to sign consent for duloxetine and trazodone. A second resident with anxiety had sertraline increased and buspirone added without documented behaviors supporting the changes, while staff documented only vague behavior monitoring and acknowledged they did not know behaviors had to be specific to each resident.
Incomplete Care Plans for Catheter and PICC Line Care: Two residents had missing care plan directions for key treatments and devices. One resident with BPH and a retention catheter had no catheter care or monitoring interventions in the care plan, and another resident with a PICC line had a soiled, loose dressing with no documented last change date and no PICC-related goals or interventions in the care plan. Staff interviews confirmed the care planning was missed.
Failure to Provide Daily Hearing Aid Use: A resident with Alzheimer disease and impaired cognition was supposed to wear hearing aids daily, but was repeatedly observed without them and had to cup their hands behind their ears to hear staff. The CC said the resident’s confusion was worse without the hearing aids, while staff stated the devices were kept on the nurse’s cart and were to be placed each morning and removed at bedtime.
A resident receiving IV antibiotics had a PICC line with a dressing that was saturated and falling off, and the dressing had not been changed as required. Staff confirmed weekly dressing changes, daily site monitoring, and documentation of external catheter length and arm circumference were expected, but these steps were missed and baseline measurements were not known.
A resident with spondylosis and kyphosis, who was at risk for pressure injuries and spent long periods sitting in a recliner, developed new skin breakdown on the buttock and lower spine. Staff observed open areas and a scabbed area, but the scheduled skin assessment and lower spine monitoring were not completed, no new orders were obtained, and the new skin issues were not documented in progress notes or reported to the RR or provider.
A resident with an indwelling catheter, moderate cognitive impairment, and diagnoses including CHF, diabetes, BPH, and UTI was observed during mechanical lift transfers with the catheter drainage bag hung above bladder level. On two occasions, NAs placed the bag on the sling during transfers, and urine was seen flowing back into the bladder; the DON stated the bag should be kept at or below bladder level to avoid UTI risk.
Unsafe and Unsanitary Facility Environment: The laundry room had a hole in the drywall with debris on the floor, the 100-hall shower room had broken caulking, black growth, and a moldy odor, and water damage extended into the adjacent weight room where lift batteries were being charged in a wet area. The weight machine was uneven, and multiple Hoyer and sit-to-stand lifts were observed dirty with food crumbs, grime, dust, and dried residue, with staff stating there was no cleaning schedule for the equipment.
Three residents with various medical conditions, all cognitively intact and at least partially independent with eating, consistently received meals that were not hot, with food and plates arriving cold. Residents reported their concerns to dietary staff and filed grievances, but the issue persisted. Staff confirmed awareness of the problem and cited lack of equipment and funding as contributing factors, resulting in meals not being served at a safe and appetizing temperature.
A broken pipe under the kitchen floor led to restroom water backing up into the kitchen, resulting in unsanitary conditions. Staff used a shop vac to remove water from a soiled catch basin, with exhaust blowing onto open meal carts, and were unable to maintain proper dishwashing and sanitation. The Infection Preventionist was not involved in planning, and the kitchen was deemed unsanitary by staff.
A resident with multiple health conditions and moderate cognitive impairment was served meals on paper plates with a plastic spork for an extended period, reportedly due to a broken dishwasher. The resident expressed distress and a loss of dignity as a result. The DON was unaware of the use of disposable mealware and stated that decisions regarding meal service items were handled by the kitchen.
Two residents with physical impairments affecting their hands were unable to eat independently after the facility switched to plastic sporks and disposable dishware due to a kitchen issue. Both residents, who were cognitively intact and previously able to eat with metal or regular plastic utensils, reported difficulty and dissatisfaction with the sporks. Staff were aware of the complaints but had limited alternatives, and facility leadership was not fully informed about the ongoing use of disposable items.
The facility failed to maintain a sanitary environment by not consistently cleaning vents and changing filters in dining rooms, hallways, the kitchen, and the laundry room. Observations showed significant dust and dirt buildup, with some vents having spider webs and broken slats. Staff interviews revealed inadequate cleaning schedules, and records showed inconsistencies in maintenance documentation. The administrator acknowledged the need for more frequent monitoring and cleaning.
Two residents in an LTC facility received opioid pain medications without proper documentation of administration and effectiveness. One resident, receiving end-of-life care, had no record of morphine administration, while another recovering from surgery had incomplete documentation for oxycodone. The lack of documentation hindered the facility's ability to assess pain management effectiveness.
A visually impaired resident experienced psychosocial harm after being moved to a new room without proper orientation or consideration of their preferences. The resident, who had a history of anxiety and depression, struggled with the unfamiliar layout, leading to frustration and a decline in their usual activities. Staff noted the resident's increased sadness and frustration, and the resident's representative expressed dissatisfaction with the facility's handling of the room change.
A facility experienced a 12% medication error rate due to errors by an LPN, including incorrect dosing and failure to administer medications on time. One resident received an incorrect dose of Vitamin D, while another did not receive Colchicine or Zofran as prescribed. The DON noted that LNs should order refills timely and seek assistance if behind.
The facility failed to maintain a safe and sanitary kitchen environment, with ceiling damage and floor hazards posing risks of cross-contamination and foodborne illness. Staff acknowledged the issues but lacked a system for preventive maintenance.
A resident with blindness and anxiety was moved to a different room without prior written or verbal notification to them or their representative. The facility's policy requires notification and consent before room changes, but this was not documented or followed, as confirmed by interviews with staff and the resident's representative.
A resident reported rough handling by a night shift NA, but the facility failed to log or report the allegation to the State Agency. Despite the resident informing a day shift NA, and the issue being discussed with an LPN, the Social Service Director and DON were unaware of the incident, indicating a failure in the reporting process.
A resident reported rough handling by a night shift NA, describing the staff as rude. Despite informing a NA and an LPN, no investigation was initiated, and management was not informed. The facility's policy requiring investigation and staff removal was not followed.
A resident with severely impaired cognition signed a binding arbitration agreement without the involvement of their legal representative, contrary to facility policy. Staff interviews confirmed the resident's inability to understand the agreement, and the resident's representative, who held power of attorney, was not informed of the agreement.
The facility failed to implement infection control measures for Legionella, as evidenced by incomplete maintenance of water heaters and ice machines. Over ten months, required tasks were neglected, leading to mold-like biofilm growth in the ice machine. Staff interviews revealed a lack of awareness and involvement in the Water Management Plan, with the Maintenance Director and Assistant admitting to not following protocols. The Administrator and Infection Preventionist acknowledged the deficiencies.
Failure to Supervise Dining Room Residents and Follow Care Plan Interventions
Penalty
Summary
The facility failed to provide supervision and implement care plan interventions to prevent a resident-to-resident altercation for 2 of 8 residents reviewed for avoidable accidents. The report states that the facility’s policy required resident safety and supervision to prevent accidents, with interventions identified through assessment and communicated to relevant staff, but those interventions were not consistently available to staff or followed in practice. Resident 1 had diagnoses including Down Syndrome, PTSD, and anxiety, with moderately impaired cognition and assistance needs for ADLs and showering. Resident 2 had diagnoses including Alzheimer’s disease and dementia, with severely impaired cognition and assistance needs for ADLs. The record showed Resident 1 had multiple prior dining room-related resident-to-resident altercations, and a behavior management intervention directed staff to help Resident 1 obtain a clothing protector when entering the dining room for meals. The facility investigation documented that Resident 2 was passing out clothing protectors in the dining room and attempted to place one on Resident 1’s lap, after which Resident 1 slapped Resident 2 on the arms. An observation later showed Resident 2 moving around the dining room obtaining sugar packets, napkins, and silverware from the cabinet area and giving them to other residents while no staff were present in the dining room. Staff interviews indicated the dining room was supposed to have supervision, but staff were not aware of the care plan interventions for either resident because the intervention for Resident 1 did not populate on the Kardex, and Resident 2’s need for supervision was not identified for staff in the dining room.
Failure to Honor Resident Choice in Shower Scheduling
Penalty
Summary
The facility failed to honor residents' rights to self-determination and choice regarding shower times when it changed the shower schedule and eliminated the dedicated shower aide. The facility's Resident Rights policy from 02/2021 stated that residents had the right to a dignified existence and self-determination. Despite this, when the Director of Nursing Services and the Administrator implemented a change effective 03/01/2026, requiring NAs to perform showers on their own residents and splitting showers between day and evening shifts due to budget cuts and staffing changes, residents were not consulted or given a choice between day and evening showers. The Director of Nursing Services acknowledged that residents were not given a choice and stated they assumed residents would not want evening showers and that the workload needed to be split between shifts. The Administrator also stated residents should have been given a choice and was not aware that they had not been consulted. Resident 1, admitted with a right knee dislocation, anxiety, and a need for assistance with personal care, had a comprehensive assessment dated 01/06/2026 showing independence with ADLs, moderately impaired cognition, and that it was very important for them to make choices about customary routines and activities. Resident 1 reported they were not informed of the shower schedule change, were assigned to evening showers, and preferred daytime showers, stating they wished staff had asked their preference. Resident 2, admitted with left-sided weakness/paralysis after a stroke, lung disease, and high blood pressure, was dependent on one to two staff for ADLs, had moderately impaired cognition, and also had an assessment indicating it was very important to make choices about routines and activities. Resident 2’s representative reported staff woke the resident early for showers, which the resident disliked, and that the resident preferred to sleep in and shower in the afternoon; a NA confirmed they had always completed this resident’s shower first, before breakfast. Resident 3, admitted with diabetes, paraplegia, and depression, required substantial assistance for showers, was cognitively intact, and had an assessment indicating the importance of making choices about routines and activities. Resident 3 stated they were told the shower aide would no longer provide showers and that they were not given a choice of day or evening showers.
Failure to Involve Residents in Changes to Restorative Care Plans
Penalty
Summary
The facility failed to ensure residents were provided the opportunity to participate in decisions about their care and treatment, specifically related to restorative nursing and therapy services. Facility policy dated 03/2022 stated that residents had the right to participate in the development and implementation of their comprehensive person-centered care plan, including determining the type, amount, frequency, and duration of care, receiving the services in the care plan, and seeing and signing the care plan after significant changes. For one resident with diabetes, paraplegia, and depression, whose comprehensive assessment showed intact cognition and a need for partial to maximum assistance with ADLs, the medical record documented a restorative nursing AROM program at a frequency of six times per week. The care plan, initiated on 10/30/2025, was later modified on 03/05/2026 to reduce the AROM frequency to three times per week. During interview, this resident reported frustration about the change in therapy services, stating they were not informed of the reduction from six to three days per week and that session length had been cut from 30 minutes to 20 minutes. A second resident, with left-sided weakness/paralysis after a stroke, lung disease, and hypertension, was assessed as dependent on one to two staff for ADLs and having moderately impaired cognition. This resident’s care plan showed an AROM program initiated at six times per week, which was also reduced to three times per week on 03/05/2026. In an interview, the resident’s representative stated that at a recent care conference they were told the resident was receiving restorative nursing services every day, but they did not know if that was occurring and were not informed of any changes in services. These findings showed that changes in restorative/AROM frequency and duration were made without informing or involving the residents or their representative as required by the facility’s person-centered care planning policy.
Failure to Ensure Continuous Availability of Ordered Narcotic Pain Medication
Penalty
Summary
The facility failed to provide pharmaceutical services to ensure accurate acquiring, receiving, dispensing, and administering of drugs for one resident. The resident had rheumatoid arthritis and a history of spinal compression fractures, required maximum assistance for activities of daily living, and had intact cognition. A physician’s order dated 10/01/2025 directed that a narcotic pain medication be administered every six hours for rheumatoid arthritis. Review of the January 2026 MAR showed multiple missed doses of this narcotic pain medication on 01/27/2026 and 01/28/2026, as well as the midnight dose on 01/29/2026. During observation and interview, the resident reported that the facility did not have their narcotic pain medication available, resulting in six missed doses, and described pain throughout their body, including hands, back, feet, and elbows. The resident stated staff told them the medication had run out and the pharmacy would not refill it until a new prescription was written, and that there was no backup supply available from the emergency supply. Staff interviews confirmed that the facility’s processes for refilling and administering medications were not followed. An LPN explained that the standard process was to request refills when the medication card reached the blue section, indicating seven doses remaining, and that if a medication ran out before the refill arrived, a dose could be obtained from the emergency backup supply using a pharmacy authorization code. For this resident, the LPN stated there was a problem receiving the narcotic from the pharmacy, and although the provider was contacted and a new prescription sent, staff were unable to obtain an authorization code from the pharmacy due to confusion with the order, resulting in the resident going without the narcotic pain medication until the pharmacy resolved the issue. The DON stated that narcotic refills were to be requested at least seven days before the resident ran out and acknowledged that the process for refilling and administering medications was not followed. The Administrator stated that licensed nurses were responsible for communicating with the provider and pharmacy to ensure residents had needed medications and to request refills before medications were depleted.
PASRR Screening and Level 2 Referral Delays
Penalty
Summary
The facility failed to review and validate PASRR accuracy prior to admission and failed to ensure required Level 2 referrals were sent when residents had positive Level 1 PASRR findings for mental illness or intellectual/developmental disability screening. Review of the facility policy showed every resident was to be screened for mental illness or ID prior to admission, and if a Level 2 referral was required, it had to be completed prior to admission by the designated authority. For Resident 62, records showed diagnoses including substance use disorder and anxiety, with psychotropic medications on admission. A Level 1 PASRR dated 06/23/2025 showed no SMI indicators and no Level 2 referral, but a later Level 1 PASRR dated 06/27/2025 identified anxiety as an SMI indicator and required a Level 2 referral; the referral was not sent until 07/25/2025. For Resident 33, records showed diagnoses including dementia, anxiety, and insomnia, with psychotropic medications on admission. A Level 1 PASRR dated 11/05/2025 showed no SMI indicators and no Level 2 referral prior to admission, while a later PASRR dated 11/14/2025 identified anxiety, dementia, and a substance use disorder and required a Level 2 referral; the referral was not sent until 11/26/2025. For Resident 8, records showed dementia with agitation, anxiety, heart complications, severe cognitive impairment, and psychotropic medications. A Level 1 PASRR dated 04/22/2025 showed no SMI indicators and required a Level 2 evaluation, but the referral had not been completed; a later PASRR dated 05/01/2025 stated the resident was on psychotropic medications for dementia/anxiety and that a Level 2 referral would be completed, and the referral was not sent until 05/13/2025.
Unsafe Food Storage, Dating, and Cooling Practices
Penalty
Summary
The facility failed to ensure food was stored, prepared, and labeled in a sanitary manner in the kitchen. During an initial kitchen tour, surveyors observed dried white fingerprint smears on refrigerator and freezer door handles and doors. Inside the first refrigerator, there was thawed pork with juices and no use-by date, thawed chicken overfilled in a pan with blood and juices dripping into the pork below, two bags of chicken pieces with no pull date or use-by date, three 10-pound rolls of ground beef with no pull date or use-by date, and a bag of diced pork sausage with an open date of 08/18/2025 and no use-by date. Also in the refrigerator were a resident breakfast tray still warm to the touch, an unlabeled and undated container of chilaquiles still hot to the touch, scrambled eggs and ground sausage dated 12/08/2025 and still hot to the touch, and opened condiments including Thousand Island dressing and mustard without complete dating or discard information. In the second freezer, surveyors found a plastic bag of meat that was unlabeled, opened cinnamon rolls dated 03/13/2025 with no expiration or use-by date, five rolls of chorizo meat with no open date or use-by date, eight meat patties without labels or dates, and a coconut cream pie with no dates. In the dry storage area, a rack holding clean dishes also contained personal staff items, lotion bottles, binders, open bags of candy, a bottle of salsa, a pink water cup, lens cleaner, and Tums. Additional dry storage items included opened turkey gravy mix, almonds with an open date of 07/01/2025 and no expiration or use-by date, an unsealed box of corn flakes with no dates, and opened vanilla pudding pie filling with no dates. During interviews, the cook stated the thawed pork and chicken were discarded after the surveyor’s observation, but the two bags of chicken pieces were not discarded because they had been pulled from the freezer on 12/05/2025 and should have been dated. The food service manager stated meats should be pulled three days before use, dated with pull and use-by dates, and that cooked food placed in the refrigerator should be labeled and dated. The manager also stated there was no process for cooling hot food before placing it in the refrigerator. On a later kitchen visit, surveyors found thawed turkey breast lunch meat with no pull date and a use-for-dinner date of 12/09/2025, plus opened Swiss cheese and cream cheese in a refrigerator by the laundry room with open dates but no expiration or use-by dates. The administrator stated kitchen staff were expected to follow thawing and dating processes and that expired and undated foods should be checked and discarded daily.
Infection Control Failures During Resident Care and Meal Service
Penalty
Summary
The facility failed to maintain infection prevention and control practices during resident care and meal service, including hand hygiene, glove changes, and use of PPE for enhanced barrier precautions. During meal tray delivery on the 300 hall, Staff Q and Staff P entered resident rooms, handled bedside tables and meal trays, and moved from one resident room to another without performing hand hygiene before entering, after exiting, or between residents. Staff Q also used a resident’s utensils to cut up food without gloves or hand hygiene, and both staff members were observed continuing tray delivery without cleaning their hands between resident contacts. During wound care for Resident 92, who had a right below-the-knee amputation, diabetes, a moderately impaired cognition assessment, and an unhealed unstageable pressure injury to the left heel, Staff K performed care with multiple breaks in infection control technique. Staff K placed clean wound supplies on the resident’s bed without a barrier, handled soiled gauze and clean gauze together, used the same gloves while moving from the amputation incision to the heel wound, reached into a shirt pocket for a pen to label the dressing, and removed gloves without performing hand hygiene before changing to new gloves and continuing care. Staff K also exited the room to obtain pain medication, removed gloves, and did not perform hand hygiene. During toileting and skin care for Resident 60, who had kyphosis, spondylosis, intact cognition, and required substantial to maximum assistance with toileting, Staff R and Staff F did not change gloves or perform hand hygiene between dirty and clean tasks. Staff R cleaned the resident after a bowel movement, removed soiled gloves, donned new gloves without hand hygiene, and then assisted with skin care. Staff F assessed open areas, removed a wound dressing, reapplied a new patch without cleansing the area or changing gloves, and continued care with the same gloves. For Resident 44, who had a pulmonary embolism, obstructive uropathy, an indwelling catheter with a leg bag, and moderately impaired cognition, Staff U and Staff R provided personal care, catheter care, and transfers without PPE, and no EBP signage or PPE bin was posted outside the room.
Grievances Not Resolved or Communicated to Residents
Penalty
Summary
The facility failed to ensure grievances voiced by residents or resident representatives were promptly resolved through to conclusion and that residents were appropriately updated on grievance progress and outcomes for 2 of 5 residents reviewed. The facility policy titled, Grievances, stated the facility actively seeks resolution to concerns, keeps the person who filed the grievance updated on progress, and documents the grievance, investigation, findings, and follow-up communication in the grievance logbook. For Resident 8, the medical record showed admission with diagnoses including dementia, anxiety, and heart complications, and the comprehensive assessment showed severely impaired cognition with a resident representative involved in care. The resident representative reported that four sweaters and a donut-style pillow were missing from the resident’s personal belongings and stated they had not been updated on the grievance progress for months and did not know whether reimbursement would occur. The grievance log and investigations showed grievances were filed for the missing sweaters and pillow, with documentation that the items had not been found and the facility would reimburse, but Staff D, the Social Service Director and grievance officer, stated the grievance conclusion had not been completed because reimbursement had not yet occurred and the resident representative had been waiting to provide receipts. The Administrator stated the resident representative should have been reimbursed and that the grievance process was not being completed correctly. For Resident 62, the medical record showed diagnoses including stroke affecting the right side, respiratory and heart failure, and nicotine dependence, and the comprehensive assessment showed intact cognition and independence with ADLs. The resident stated they had ordered a package that was delivered to the facility but never received it, and said they reported it in writing and verbally to the activities department without any response. The grievance log contained an unknown resident grievance about a missing package and a missing vape device, but Staff D stated they did not know who wrote it and did no further follow-up to identify the resident or investigate the concern. The Activities Director stated packages were handled through the Business Office Manager and activities, and the Administrator stated further investigation should have been done on the unknown resident grievance.
Psychotropic Medications Lacked Individualized Monitoring and Consent
Penalty
Summary
The facility failed to ensure psychotropic medications had specific, person-centered behaviors monitored to show an adequate need for the medications for two residents, and failed to obtain informed consent before administering psychotropic medications for one resident. One resident was admitted with diagnoses including dementia, anxiety, and insomnia, and the comprehensive assessment showed moderately impaired cognition with no behaviors exhibited. That resident received multiple psychotropic medications, including temazepam, alprazolam, duloxetine, trazodone, and melatonin, but the November MAR did not show sleep pattern monitoring to evaluate the effectiveness of temazepam or trazodone, and the behavior monitoring and non-pharmacological interventions were not individualized or specific to the resident. Side-effect monitoring for the antidepressant and hypnotic/sedative medications did not begin until several days after the medications were started, and there was no monitoring for side effects of the anti-anxiety medications. For that same resident, the resident representative stated they were not aware the resident had started duloxetine and trazodone and had not been told about the risks and benefits or signed a consent. The resident also did not indicate knowledge of the medications. Review of the record showed informed consents were not obtained before the resident received duloxetine or trazodone. Staff stated the provider started duloxetine for anxiety and that the provider chose an antidepressant instead of the resident’s prior anxiety and sleep medications. Staff also stated they had been told in a psychotropic meeting that sleep pattern monitoring was no longer required for psychotropic use for insomnia, so they did not monitor trazodone effectiveness, and they acknowledged there were no consents in the record. A second resident admitted with anxiety and substance use diagnoses had a comprehensive assessment showing intact cognition, independence with most ADLs, no behaviors, and antidepressant use. Observations over several days showed the resident repeatedly lying in bed in a dark room, often still in night clothes and sleepy or not fully alert. The July MAR showed sertraline ordered with behavior monitoring for agitation, hallucinations, and delusions, but the documented behaviors were limited and often lacked detail, intervention, or effectiveness. The sertraline dose was later increased without a progress note showing who ordered the increase or why, and buspirone was later added for anxiety without documented change or increase in behaviors. Nursing progress notes did not document additional behaviors to support the dose increase or the addition of buspirone, and staff stated they were not aware behaviors needed to be specific to each resident.
Incomplete Care Plans for Catheter and PICC Line Care
Penalty
Summary
The facility failed to develop comprehensive, resident-centered care plans for 2 of 6 residents reviewed for care plan development. Resident 52 was admitted with diagnoses including benign prostatic hyperplasia, respiratory disease, and diabetes. The comprehensive assessment showed moderately impaired cognition, total staff assistance needed for dressing and transferring, and use of a retention catheter for urinary elimination. Physician orders from September 2025 through December 2025 included use and justification of the retention catheter related to the BPH diagnosis, but the care plan dated 10/20/2025 contained no directions for care and monitoring of the retention catheter. During interview, the Resident Care Manager stated the catheter care plan had not been developed because it had been overlooked. Resident 30 was admitted with diagnoses including a bone infection after right and left partial foot amputation with surgical aftercare. The comprehensive assessment showed the resident was receiving antibiotic therapy, had moderately impaired cognition, and could make needs known. During observation, the resident was seen with a PICC line in the right upper arm; the dressing was soiled, falling off, and had no date or time noted for the last dressing change. The resident stated the last PICC dressing change had been done two to three weeks earlier. The care plan last completed 10/14/2025 had no resident-focused goals or interventions related to the PICC line. Staff interviews confirmed the PICC line had not been care planned, and one staff member also stated the resident's CPAP device should have been care planned but was not.
Failure to Provide Daily Hearing Aid Use
Penalty
Summary
The facility failed to provide the necessary care and services to maintain communication abilities for Resident 13, who had diagnoses including Alzheimer disease and congestive heart failure. The resident’s comprehensive assessment showed impaired cognition, use of a hearing device to enhance hearing ability, and a need for substantial staff assistance with dressing, grooming, toileting, and personal hygiene. During observation and interview, Resident 13 was found without their hearing aids while resting in their room, and the collateral contact stated the hearing aids were kept in the nurse’s cart and that the resident’s confusion was worse when they were not wearing them. On another observation, the resident was sitting in a wheelchair at the nurse’s station without the hearing aids and was seen cupping their hands behind their ears to hear staff. Staff stated the hearing aids were supposed to be worn daily, kept on the nurse’s cart, placed in the morning, and removed at bedtime, and the DON stated nurses were expected to ensure the resident had the hearing aids in daily so they could hear and communicate better with staff.
PICC Line Dressing and Monitoring Not Performed as Required
Penalty
Summary
The facility failed to ensure appropriate treatment and care were provided for a resident with a PICC line and IV antibiotic therapy. The resident was admitted with diagnoses including a bone infection after right and left partial foot amputation with surgical aftercare, and the comprehensive assessment noted moderately impaired cognition but that the resident could make needs known. The facility’s guidance required PICC dressings to be changed at least every seven days or sooner if loosened, soiled, or wet, and required monitoring of arm circumference and external catheter length with each dressing change. For Resident 30, the physician’s orders for November through December 2025 showed IV antibiotics and a PICC line replacement order, but no orders were noted for dressing-change monitoring, external catheter length, arm circumference, or weekly dressing changes. During observation, the PICC dressing was saturated with reddish/brown liquid and falling off the sides of the resident’s arm, and the external catheter length, arm circumference, and dressing-change time were not documented on the dressing. The resident stated the dressing had last been changed two to three weeks earlier. Staff interviews confirmed the dressing should have been changed weekly, daily monitoring should have occurred, and the external catheter length and arm circumference should have been measured and documented, but staff did not know the baseline measurements and acknowledged that three weekly dressing changes had been missed.
Failure to assess and document new pressure injuries
Penalty
Summary
The facility failed to assess, monitor, and treat new skin issues for Resident 60, who had diagnoses including spondylosis and kyphosis and was identified as at risk for pressure injuries. The resident’s comprehensive assessment showed they were cognitively intact, used pressure reduction devices for the chair and bed, and had not been rolled from left to right for repositioning during the assessment period. The resident also stated they had a sore on their bottom that had started small and become worse, and that the sore was very painful but relieved by pain medication. Observations showed Resident 60 sitting in a reclined chair for extended periods, positioned on their bottom with feet on the footrest, including while sleeping. Staff R stated the resident preferred to stay in the recliner chair 24 hours a day because of back and neck pain and that staff did not encourage or assist repositioning unless the resident asked. During toileting assistance, staff observed two open areas above the buttock with a scabbed area between them, and another open area on the lower spine over a bony area. A protective patch was removed from the spine area, and pink barrier cream was applied to the buttock area; there was no patch on the buttock before toileting assistance. Review of the TAR showed standing orders for a protective dressing to prevent skin opening, weekly monitoring of a red pressure area to the lower back/spine, weekly skin assessments, and buttocks ointment, but the scheduled skin assessment and lower spine monitoring were not completed and were not signed off on the TAR. There were no new orders for the newly identified skin issues, and nursing progress notes did not document the new skin issues or notification to the resident/family or provider. Staff G stated the nurse should have notified the RR and provider, obtained new orders, completed an incident report and skin assessment, and updated the care plan, and Staff A stated they were not aware of the new skin issues until after Staff G was made aware by the surveyor.
Catheter drainage bag placed above bladder during transfers
Penalty
Summary
The facility failed to ensure appropriate catheter care for Resident 52, who had an indwelling retention catheter and diagnoses including CHF, diabetes, BPH, and a UTI. The resident’s comprehensive assessment showed moderate cognitive impairment, total staff assistance with dressing and grooming, and use of a mechanical lift for transfers. Facility policy and nursing assistant reference material stated the catheter drainage bag should always be kept lower than the bladder to prevent urine from flowing back into the bladder. During an observation on 12/08/2025, two NAs prepared Resident 52 for transfer from a wheelchair to the bed using a mechanical lift. One NA unhooked the catheter drainage bag and hung it about five inches above the resident’s bladder on the transfer sling while the resident was lifted, and urine was observed flowing back into the bladder. During another observation on 12/11/2025, two NAs transferred the resident from bed to wheelchair and again hung the drainage bag about four inches above the bladder, with urine observed flowing backward from the tube into the bladder. One NA stated the bag was placed on the sling during transfers to avoid tangling. The DON stated the proper method was to keep the drainage bag at or below bladder level and that it should not be hung above the bladder to avoid UTI risk.
Unsafe and Unsanitary Facility Environment
Penalty
Summary
The facility failed to provide a safe, functional, and sanitary environment in the laundry room, the 100-hall shower room, the weight room, and multiple Hoyer and sit-to-stand lifts. In the laundry dirty linen sorting room, the Maintenance Director observed a six-inch by five-inch hole in the drywall behind a peeling rubber baseboard, with broken drywall pieces on the floor. The Maintenance Director stated the area needed to be fixed and could not be cleaned until repaired. In the 100-hall shower room, the shower stall had broken caulking around the bottom and top seams, black substance on the shower floor and tiles, and a wet moldy odor. Staff stated the shower room had been in that condition for a long time and that water seeped from the shower stall into the adjacent weight room. The wall behind the shower stall in the weight room was wet and broken in multiple places, and batteries for charging Hoyer lifts and sit-to-stand lifts were plugged into a wall outlet in the wet area, with additional batteries sitting on the wet floor. The weighing surface in the room was also uneven, with a gap between the two pieces, and Staff stated the wet floor had made it unsafe to roll residents onto it. The resident shower room on the 100 hall was still wet after use and had a musty odor. The shower walls had holes and missing sections of caulking, black growth along the seams and around support handles, and the back top section of the plastic wall was unattached with dark black growth and a mold odor behind it. The Infection Preventionist stated the black growth looked like mold, was spreading behind the shower walls, was no longer a cleanable surface, and was not safe for residents or a homelike environment. The Administrator stated the shower room was not clean or safe and that the correct process for providing a comfortable homelike environment was not being followed. Multiple Hoyer and sit-to-stand lifts observed in hallways had food crumbs, black grime, dust, and a white dried substance on them, and staff stated the equipment was supposed to be cleaned by nursing assistants, with no cleaning schedule in place.
Failure to Serve Meals at Safe and Appetizing Temperatures
Penalty
Summary
The facility failed to serve meals at a preferred temperature for three residents reviewed for food temperatures. Observations and interviews revealed that residents consistently received meals that were not hot, with food and plates often arriving cold. One resident, who was independent with ADLs and cognitively intact, reported repeated experiences of cold food, voiced concerns to the Dietary Manager, and filed a grievance, but noted that nothing was done. Another resident, dependent on staff for ADLs but independent with eating, also reported consistently cold meals, lack of plate warmers or covers, and stated that grievances had not led to any changes. A third resident, with similar dependencies and cognitive status, expressed a preference for hotter meals and reported informing staff about the issue. Staff interviews confirmed awareness of the ongoing complaints regarding cold food. The Dietary Manager acknowledged the purchase of thermal pellets intended to keep food warm but indicated that the necessary warming device had not been approved for purchase, and the kitchen lacked insulated carts. The Administrator was also aware of the issue and stated that additional parts were needed for the plate warmers, but there were insufficient funds to purchase them. Despite food leaving the kitchen at the appropriate temperature, the facility was unable to ensure that meals arrived to residents at a safe and appetizing temperature.
Unsanitary Kitchen Conditions Due to Plumbing Failure
Penalty
Summary
The facility failed to maintain a clean and sanitary environment in the Main Kitchen, as required for food preparation and storage safety. A broken pipe under the kitchen floor caused water from restrooms to back up into the kitchen through the drains, resulting in unsanitary conditions. Observations revealed a soiled catch basin with dark brown residue, folded blankets placed over drains, and a shop vac being used to remove water from the catch basin. The shop vac's exhaust was directed onto open meal delivery carts, and staff reported that the kitchen and dishwasher area were not sanitary and should not be used. The dishwasher was out of service due to drainage issues, and staff had to switch to alternative dishwashing methods, which were insufficient to keep up with meal demands. Staff interviews confirmed that the drain problem began several days prior, with backflow of water that smelled and appeared contaminated. The restrooms adjacent to the kitchen were locked and out of service, and the dishwasher could not be used without the shop vac. The Infection Preventionist was not involved in planning for cross-contamination prevention and was unaware of the extent of the issue. The Dietary Manager and other staff described the backflow as brown and gunky, and the Director of Nursing Services stated the kitchen was not sanitary. The facility's policy required maintaining a clean and sanitary food service area, which was not met due to the ongoing plumbing failure and inadequate interim measures.
Failure to Provide Dignified Dining Experience Due to Use of Disposable Mealware
Penalty
Summary
The facility failed to provide a dignified dining experience for a resident who was reviewed for dignity. The resident, who had diagnoses including heart failure, arthritis, and weakness, required substantial assistance with activities of daily living and supervision for eating, and had moderately impaired cognition but was able to express their needs. During an observation and interview, the resident was found sitting in their room, visibly upset and crying, with a Styrofoam cup of ice water and a meal served on a paper plate with a plastic spork. The resident reported feeling that their dignity was taken away due to being served meals on disposable items for an extended period, attributing this to a broken dishwasher as communicated by staff. The Director of Nursing Services (DON) was interviewed and stated they were not aware that paper products were being used for meal service and indicated that maintaining resident dignity involved staff training and the grievance process. The DON also stated they were not involved in the decision to switch to paper items, as it was considered a kitchen issue. The facility's policy on resident rights emphasized the importance of treating residents with respect, kindness, and dignity, in accordance with federal and state laws.
Failure to Provide Appropriate Eating Utensils and Dishware for Residents with Physical Limitations
Penalty
Summary
The facility failed to ensure that two residents maintained their ability to eat independently by not providing appropriate eating utensils and dishware. One resident with rheumatoid arthritis and deformed fingers reported difficulty using the provided plastic spork and Styrofoam containers, stating that these made it hard to access and eat food. This resident preferred metal silverware and found the spork unusable due to their arthritis, despite informing staff of the issue. Another resident with Parkinson's disease and neuropathy also reported being unable to use the plastic spork, stating they could feed themselves with a metal fork or, to some extent, a plastic fork, but not with the spork. Both residents were cognitively intact and had previously been able to eat independently or with minimal assistance. The use of plastic sporks and disposable dishware began after a kitchen pipe broke, rendering the dishwasher unusable. The dietary manager confirmed that regular plastic utensils ran out, leading to the exclusive use of sporks. Nursing staff were aware of resident complaints and would substitute a regular plastic fork if available, but supplies were limited. The director of nursing was not aware of the switch to disposable items, and the administrator believed the use of paper/plastic products was only for a single meal, not an ongoing practice. This lack of coordination and communication resulted in residents not receiving the necessary goods and services to maintain their ability to eat independently.
Facility Fails to Maintain Sanitary Environment Due to Inadequate Vent Cleaning
Penalty
Summary
The facility failed to maintain a sanitary and homelike environment by not consistently cleaning the heating and air exchange vents and changing the filters in various areas, including four dining rooms, three hallways, the kitchen, and the laundry room. Observations revealed significant dust and dirt buildup on vents, with some vents having visible spider webs and broken slats. The presence of built-up dust and dirt was noted in the Garden, Private, Transition Care Unit, and [NAME] dining rooms, as well as in Hallways 100, 200, and 300, and the kitchen's dry storage and dishwashing areas. In the laundry room, thick dust and lint were observed on the vents, exhaust pipes, and water piping, indicating a lack of regular cleaning. Interviews with staff revealed that the responsibility for cleaning vents was divided between housekeeping and maintenance, with maintenance being responsible for higher areas. However, the maintenance director admitted to cleaning vents only every six months and lacked a schedule for changing filters, relying instead on visual assessment. The facility's records showed inconsistencies in the documentation of cleaning and maintenance activities, with some entries lacking completion details. The administrator acknowledged that daily walkthroughs should have been conducted to identify areas needing more frequent cleaning. The maintenance director recognized the need to restructure the cleaning process to ensure more frequent monitoring and cleaning of vents and filters.
Failure to Document Opioid Administration and Effectiveness
Penalty
Summary
The facility failed to provide goods and services that met professional standards of care for two residents who were administered opioid pain medications. For Resident 3, who had severe cognitive impairment and was receiving end-of-life care, there was no documentation of morphine sulfate administration on the medication administration record (MAR) or in the nursing progress notes on the day it was given. Staff D, the LPN responsible, recalled administering the medication but did not document it, leaving no record of the resident's symptoms or the medication's effectiveness. Resident 7, who was recovering from surgery and experiencing moderate pain, also experienced a lack of proper documentation. The resident received oxycodone for pain, but Staff E, the LPN, failed to document the assessment of pain or the effectiveness of the medication in the MAR and progress notes for one of the doses. This lack of documentation made it difficult to assess the frequency and effectiveness of the pain management provided to the resident. The Assistant Director of Nursing expressed concern over the lack of documentation, as it hindered the ability to review and determine the effectiveness of pain management. The Director of Nursing acknowledged the issue and indicated that steps were being taken to address the problem, although specific corrective actions were not detailed in the report.
Failure to Accommodate Visually Impaired Resident's Needs
Penalty
Summary
The facility failed to accommodate the needs and preferences of a visually impaired resident, Resident 6, leading to psychosocial harm. Resident 6, who was legally blind and had a history of anxiety, depression, and end-stage renal disease, was moved to a new room without proper orientation or consideration of their preferences. The resident's care plan indicated a preference for room arrangements that promoted independence, such as having the bed on the right side, but the new room setup did not reflect these preferences. The resident expressed discomfort with the new environment, which was not addressed in the care plan. Resident 6 had previously expressed dissatisfaction with a roommate due to cleanliness and odor issues, leading to a request for a room change. Despite the request, the move to a new room was not handled with the necessary support, as therapy staff were not involved, and the resident was not oriented to the new environment. This lack of orientation and the unfamiliar room setup caused Resident 6 to experience difficulty navigating the space, leading to frustration and a decline in their usual activities and mood. Observations and interviews revealed that Resident 6 struggled with the new room's layout, including the bathroom and closet, which were not conducive to their needs. The resident's inability to find their way around the room independently led to a decrease in their social interactions and activities, such as walking to the dining room and listening to music. Staff noted the resident's increased frustration and sadness, and the resident's representative expressed dissatisfaction with the facility's handling of the room change, highlighting the lack of communication and support for Resident 6 during the transition.
Medication Administration Errors and Delays
Penalty
Summary
The facility failed to maintain a medication error rate below 5%, as evidenced by a 12% error rate observed during a medication pass. Staff O, a Licensed Practical Nurse, made three errors out of 25 opportunities for error. One error involved administering an incorrect dose of Vitamin D to Resident 16, who had intact cognition and was diagnosed with diabetes and vitamin D deficiency. Staff O dispensed only one tablet of Vitamin D instead of the required two tablets, resulting in an incorrect dose being administered. Another error involved Resident 32, who had moderately impaired cognition and was diagnosed with diabetes and gout. Staff O failed to administer Colchicine due to an empty medication card and did not reorder the medication in time. Additionally, Resident 32 did not receive Zofran before breakfast, as required, because Staff O was delayed in the medication pass after assisting with a difficult resident. This led to Resident 32 refusing the medication due to an upset stomach. The Director of Nursing Services acknowledged that LNs should order refills when the medication card reaches the highlighted blue column and should seek help if they fall behind in their duties.
Facility Fails to Maintain Safe and Sanitary Kitchen Environment
Penalty
Summary
The facility failed to maintain a safe, functional, and sanitary environment in the kitchen area, which posed risks of cross-contamination and foodborne illness to residents. During an observation, it was noted that the ceiling above the dishwasher hood had missing plaster and drywall, with chunks falling onto the hood. Dust balls with fuzzy black spots were also observed hanging from the ceiling over the freezers and refrigerators. Staff H, the Dietary Manager, confirmed that a water leak had caused the ceiling damage, which had been reported to maintenance and the administrator but remained unaddressed. Additionally, the kitchen floor had several areas of concern, including an open floor area in front of the sinks with exposed underflooring, which posed a tripping hazard. There were multiple seam separations in the linoleum flooring, missing flooring pieces, and accumulations of black substances in various areas. Staff F, the Maintenance Director, acknowledged responsibility for cleaning and repairing these areas but admitted that there was no operational system for preventive maintenance or scheduled repairs. The administrator also recognized the need for a kitchen project to address these issues.
Failure to Notify Resident of Room Change
Penalty
Summary
The facility failed to provide written notification of a room change to Resident 6 or their representative, as required by their policy. Resident 6, who was admitted with diagnoses including blindness and anxiety, was transferred to a different room without prior written or verbal notification to the resident or their representative. The medical record review showed no documentation of notification or the reason for the room change from 11/15/2024 to 11/19/2024. Interviews with the Resident Representative and facility staff revealed that the notification process was not followed. The Resident Representative confirmed they did not receive any notification before the room change. Staff P, the Social Service Director, stated that they usually notify and obtain consent prior to a room change, but acknowledged that the resident and/or representative had not signed the notice of room change. Staff B, the Director of Nursing Services, also confirmed that the process involves obtaining consent and making appropriate notifications before a room change.
Failure to Report Alleged Abuse
Penalty
Summary
The facility failed to report allegations of potential abuse and/or neglect to the State Agency for one resident, which placed residents at risk for unidentified abuse or neglect. The facility's policy required reporting allegations of abuse to the appropriate authority, but this was not followed in the case of a resident who reported rough handling by a night shift nursing assistant (NA). The resident, who was cognitively intact and able to communicate their needs, reported that the NA was rough during perineal care and had a mean demeanor. The resident informed a day shift NA about the incident, but no grievance or allegation was logged or reported to the State Agency. Interviews with staff revealed that the day shift NA informed an LPN about the resident's allegations, and they both discussed the incident with the resident. However, the Social Service Director and the Director of Nursing Services were unaware of the allegations, indicating a breakdown in communication and reporting processes. The Director of Nursing Services acknowledged that the concerns should have been reported to both the DNS and the State Agency, but the correct process was not followed.
Failure to Investigate Allegation of Abuse
Penalty
Summary
The facility failed to conduct a thorough investigation into an allegation of abuse involving a resident, identified as Resident 69, who was cognitively intact and able to communicate their needs. The resident reported an incident of rough handling by a night shift nursing assistant (NA), describing the staff member as rude and likening their behavior to that of a linebacker. Despite the resident's report to Staff II, a nursing assistant, and Staff JJ, an LPN, no formal grievance or investigation was initiated as required by the facility's policy. Staff II and Staff JJ both acknowledged being informed of the resident's concerns and identified the night shift NA involved as Staff KK. However, they failed to report the incident to management, which resulted in no investigation being conducted. The Director of Nursing Services and the Social Service Director confirmed they were not informed of the allegation, and the Administrator acknowledged that the correct process was not followed, as the investigation should have been initiated and the staff member in question should have been removed from duty pending the investigation.
Failure to Ensure Cognitive Capacity for Arbitration Agreement
Penalty
Summary
The facility failed to ensure that a resident had the cognitive capacity to understand the nature and implications of entering into a binding arbitration agreement. This deficiency was identified for one resident, who was admitted with diagnoses including a leg fracture, heart complications, and difficulty walking. A comprehensive assessment indicated that the resident had severely impaired cognition. Despite this, the resident signed an arbitration agreement without the involvement of a legal representative, which was contrary to the facility's policy that requires a legal representative to sign if the resident is not cognitively intact. Interviews with staff and the resident's representative revealed that the resident was confused and unaware of signing the arbitration agreement. The resident's representative, who held power of attorney, was not informed of the agreement and stated that the resident was not capable of understanding or signing documents. Staff involved in the admission process acknowledged that the resident's cognitive impairment should have necessitated the legal representative's signature on the arbitration agreement. The failure to ensure proper understanding and representation during the signing of the arbitration agreement led to the identified deficiency.
Inadequate Implementation of Infection Control Measures
Penalty
Summary
The facility failed to implement components of their infection prevention and control precautions regarding Legionella testing protocols and procedures. The facility's Water Management Plan (WMP) was not adequately followed, as evidenced by the lack of monthly flushing of water heaters and sanitization of the ice machine. Over a ten-month period, these tasks were only completed three times, leaving seven months without proper maintenance. During an inspection, a black, fuzzy, mold-like biofilm was observed on the underside of the ice collecting bin in the ice machine, indicating a failure to maintain control measures. Interviews with facility staff revealed a lack of awareness and involvement in the development and execution of the WMP. The Maintenance Director, who was not involved in the WMP's creation, admitted to not knowing the process if control measures were unmet. The Maintenance Assistant also confirmed that the ice machine was not sanitized in the past month. The facility's Administrator acknowledged that the biofilm growth showed control measures were not within acceptable ranges, and the Infection Preventionist confirmed that the ice machine appeared to have mold growth, which should have been regularly cleaned.
What surveyors are citing around you — mapped
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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 28 citations issued within 25 miles in the last 12 months — 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 Sunnyside
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Linden Post Acute | 15.4 mi | ★★★★★ | 11 | 0 |
| Emerald Care | 22.1 mi | ★★★★★ | 17 | 0 |
| Parkside Care | 27.9 mi | ★★★★★ | 36 | 0 |
| Garden Village | 31.2 mi | ★★★★★ | 2 | 0 |
| Good Samaritan Health Care Ctr | 32.1 mi | ★★★★★ | 11 | 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 October 2026) and official state health department websites.