Citations Summary
Feb 2022 – Jan 202612 Inspections Conducted
8
No citations found
67% of all inspections
4
Resulted in citations
33% of all inspections
27 Total Citations — state avg: 23
Issued across those 4 inspections
21Standard Health
6Life Safety Code
Severity of Citations
How serious were those 27 citations?
0
Minor potential harm
All corrected ✓
0
No actual harm
None in this period
Inspection Details
Surveys with Citations Only▼
Standard Health Citations
Comprehensive Assessments & Timing
Standard Health Citation — quality of care
Develop/implement Comprehensive Care Plan
Standard Health Citation — quality of care
Encoding/transmitting Resident Assessments
Standard Health Citation — quality of care
Label/store Drugs And Biologicals
Standard Health Citation — quality of care
Life Safety Code Citations
Subdivision Of Building Spaces - Smoke Barrie
Life Safety Code Citation — NFPA requirements
▼
Standard Health Citations
Develop/implement Comprehensive Care Plan
Standard Health Citation — quality of care
Free From Abuse And Neglect
Standard Health Citation — quality of care
Label/store Drugs And Biologicals
Standard Health Citation — quality of care
Life Safety Code Citations
Cooking Facilities
Life Safety Code Citation — NFPA requirements
▼
Standard Health Citations
Develop/implement Comprehensive Care Plan
Standard Health Citation — quality of care
Investigate/prevent/correct Alleged Violation
Standard Health Citation — quality of care
Maintains Effective Pest Control Program
Standard Health Citation — quality of care
Notify Of Changes (injury/decline/room, Etc. )
Standard Health Citation — quality of care
Quality Of Care
Standard Health Citation — quality of care
Responsibilities Of Providers; Required Notif
Standard Health Citation — quality of care
Safe/functional/sanitary/comfortable Environ
Standard Health Citation — quality of care
Life Safety Code Citations
Development Of Communication Plan
Life Safety Code Citation — NFPA requirements
Electrical Systems - Essential Electric Syste
Life Safety Code Citation — NFPA requirements
Electrical Systems - Essential Electric Syste
Life Safety Code Citation — NFPA requirements
Gas Equipment - Cylinder And Container Storag
Life Safety Code Citation — NFPA requirements
Hazardous Areas - Enclosure
Life Safety Code Citation — NFPA requirements
Sprinkler System - Maintenance And Testing
Life Safety Code Citation — NFPA requirements
Subdivision Of Building Spaces - Smoke Barrie
Life Safety Code Citation — NFPA requirements
Subsistence Needs For Staff And Patients
Life Safety Code Citation — NFPA requirements
▼
Standard Health Citations
Reporting - National Health Safety Network
Standard Health Citation — quality of care
Severity Scale Reference
Level 0 — No Harm Potential
Level 2 — Minor Potential Harm
Level 3 — Actual Harm
Level 4 — Immediate Jeopardy
Complaints
Feb 2022 – Jan 2026Below state average. This facility received 37.3 complaints per 100 beds vs. a statewide rate of 55.0. 6 citations resulted from those complaints (5.1 per 100 beds vs. 3.0 statewide).
Total Complaints
44
55,221 statewide
Per 100 Occupied Beds
37.3
55.0 state avg
On-Site Inspections
17
8,103 statewide
Citations Issued
6
5.1 per 100 beds · avg 3.0
Facility-Reported Incidents
34%
55% statewide
| Citations by Category | This Facility |
|---|---|
| Administration | 0 |
| Dietary Services | 1 |
| Other Services | 0 |
| Physical Environment | 6 |
| Quality of Care | 14 |
| Resident Rights | 3 |
| Total | 24 |