Goldwater Care Peoria Heights

Penalties

• Feb 13, 2026 — Fine ($346,525)
• Feb 13, 2026 — Payment Denial · payment denial 34 days
• Dec 21, 2023 — IDPH fine (Nursing Home Care Act) ($25,000)
• Dec 21, 2023 — IDPH fine (Nursing Home Care Act) ($25,000)
• Nov 30, 2023 — Fine ($181,422)
• Nov 30, 2023 — Payment Denial · payment denial 111 days

Inspection findings

1. Jun 17, 2026 Health · 3 findings
   • Serious Scope/severity G Complaint

     F0578 Resident Rights Deficiencies

     Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.

     Corrected May 12, 2026 · CMS health inspection

   • Not serious Scope/severity D Complaint

     F0620 Resident Rights Deficiencies

     Not require residents to give up Medicare or Medicaid benefits, or pay privately as a condition of admission; and must tell residents what care they do not provide.

     Corrected Jun 19, 2026 · CMS health inspection

   • Serious Scope/severity G Complaint

     F0689 Quality of Life and Care Deficiencies

     Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

     Corrected Jun 19, 2026 · CMS health inspection

2. May 27, 2026 Health · 1 finding
   • Serious Scope/severity G Complaint

     F0686 Quality of Life and Care Deficiencies

     Provide appropriate pressure ulcer care and prevent new ulcers from developing.

     Corrected Jun 10, 2026 · CMS health inspection

3. Apr 29, 2026 Health · 1 finding
   • Not serious Scope/severity E Complaint

     F0584 Resident Rights Deficiencies

     Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.

     Corrected Apr 30, 2026 · CMS health inspection

4. Apr 15, 2026 Health · 1 finding
   • Not serious Scope/severity D Complaint

     F0600 Freedom from Abuse, Neglect, and Exploitation Deficiencies

     Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

     Corrected Apr 16, 2026 · CMS health inspection

5. Feb 28, 2026 Health · 1 finding
   • Not serious Scope/severity D Complaint

     F0689 Quality of Life and Care Deficiencies

     Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

     Corrected Mar 2, 2026 · CMS health inspection

6. Feb 13, 2026 Health · 19 findings
   • Serious Scope/severity G Complaint

     F0550 Resident Rights Deficiencies

     Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

     Corrected Apr 10, 2026 · CMS health inspection

   • Not serious Scope/severity D Complaint

     F0569 Resident Rights Deficiencies

     Notify each resident of certain balances and convey resident funds upon discharge, eviction, or death.

     Corrected Feb 16, 2026 · CMS health inspection

   • Not serious Scope/severity E Complaint

     F0677 Quality of Life and Care Deficiencies

     Provide care and assistance to perform activities of daily living for any resident who is unable.

     Corrected Feb 16, 2026 · CMS health inspection

   • Not serious Scope/severity F Complaint

     F0679 Quality of Life and Care Deficiencies

     Provide activities to meet all resident's needs.

     Corrected Feb 16, 2026 · CMS health inspection

   • Serious Scope/severity G Complaint

     F0684 Quality of Life and Care Deficiencies

     Provide appropriate treatment and care according to orders, resident’s preferences and goals.

     Corrected Feb 16, 2026 · CMS health inspection

   • Serious Scope/severity J Complaint

     F0686 Quality of Life and Care Deficiencies

     Provide appropriate pressure ulcer care and prevent new ulcers from developing.

     Corrected Feb 16, 2026 · CMS health inspection

   • Not serious Scope/severity D Complaint

     F0689 Quality of Life and Care Deficiencies

     Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

     Corrected Mar 2, 2026 · CMS health inspection

   • Not serious Scope/severity D Complaint

     F0692 Quality of Life and Care Deficiencies

     Provide enough food/fluids to maintain a resident's health.

     Corrected Feb 16, 2026 · CMS health inspection

   • Serious Scope/severity J Complaint

     F0693 Quality of Life and Care Deficiencies

     Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.

     Corrected Feb 16, 2026 · CMS health inspection

   • Serious Scope/severity G Complaint

     F0697 Quality of Life and Care Deficiencies

     Provide safe, appropriate pain management for a resident who requires such services.

     Corrected Feb 16, 2026 · CMS health inspection

   • Not serious Scope/severity F Complaint

     F0725 Nursing and Physician Services Deficiencies

     Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.

     Corrected Feb 16, 2026 · CMS health inspection

   • Not serious Scope/severity F Complaint

     F0730 Nursing and Physician Services Deficiencies

     Observe each nurse aide's job performance and give regular training.

     Corrected Feb 16, 2026 · CMS health inspection

   • Not serious Scope/severity E Complaint

     F0755 Pharmacy Service Deficiencies

     Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

     Corrected Apr 10, 2026 · CMS health inspection

   • Not serious Scope/severity D Complaint

     F0760 Pharmacy Service Deficiencies

     Ensure that residents are free from significant medication errors.

     Corrected Feb 16, 2026 · CMS health inspection

   • Not serious Scope/severity D Complaint

     F0773 Administration Deficiencies

     Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results.

     Corrected Feb 16, 2026 · CMS health inspection

   • Not serious Scope/severity D Complaint

     F0777 Administration Deficiencies

     Provide or obtain x-rays/tests when ordered and promptly tell the ordering practitioner of the results.

     Corrected Feb 16, 2026 · CMS health inspection

   • Serious Scope/severity L Complaint

     F0835 Administration Deficiencies

     Administer the facility in a manner that enables it to use its resources effectively and efficiently.

     Corrected Feb 16, 2026 · CMS health inspection

   • Not serious Scope/severity F Complaint

     F0868 Administration Deficiencies

     Have the Quality Assessment and Assurance group have the required members and meet at least quarterly

     Corrected Feb 16, 2026 · CMS health inspection

   • Not serious Scope/severity F Complaint

     F0944 Administration Deficiencies

     Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program.

     Corrected Feb 16, 2026 · CMS health inspection

7. Dec 7, 2025 Health · 2 findings
   • Not serious Scope/severity D Complaint

     F0607 Freedom from Abuse, Neglect, and Exploitation Deficiencies

     Develop and implement policies and procedures to prevent abuse, neglect, and theft.

     Corrected Dec 8, 2025 · CMS health inspection

   • Not serious Scope/severity D Complaint

     F0609 Freedom from Abuse, Neglect, and Exploitation Deficiencies

     Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

     Corrected Dec 8, 2025 · CMS health inspection

8. Aug 6, 2025 Health · 2 findings
   • Not serious Scope/severity F Complaint

     F0565 Resident Rights Deficiencies

     Honor the resident's right to organize and participate in resident/family groups in the facility.

     Corrected Aug 7, 2025 · CMS health inspection

   • Not serious Scope/severity D Complaint

     F0610 Freedom from Abuse, Neglect, and Exploitation Deficiencies

     Respond appropriately to all alleged violations.

     Corrected Aug 7, 2025 · CMS health inspection

9. Dec 7, 2024 Health · 1 finding
   • Not serious Scope/severity E Complaint

     F0584 Resident Rights Deficiencies

     Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.

     Corrected Dec 13, 2024 · CMS health inspection

10. Oct 1, 2024 Fire Safety · 19 findings
    • Not serious Scope/severity F

      E0015 Emergency Preparedness Deficiencies

      Address subsistence needs for staff and patients.

      Corrected Oct 30, 2024 · CMS fire safety

    • Not serious Scope/severity E

      F0623 Resident Rights Deficiencies

      Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.

      Corrected Oct 25, 2024 · CMS health inspection

    • Not serious Scope/severity D

      F0645 Resident Assessment and Care Planning Deficiencies

      PASARR screening for Mental disorders or Intellectual Disabilities

      Corrected Oct 25, 2024 · CMS health inspection

    • Not serious Scope/severity F

      F0868 Administration Deficiencies

      Have the Quality Assessment and Assurance group have the required members and meet at least quarterly

      Corrected Oct 25, 2024 · CMS health inspection

    • Not serious Scope/severity F

      F0880 Infection Control Deficiencies

      Provide and implement an infection prevention and control program.

      Corrected Oct 25, 2024 · CMS health inspection

    • Not serious Scope/severity F

      F0881 Infection Control Deficiencies

      Implement a program that monitors antibiotic use.

      Corrected Oct 25, 2024 · CMS health inspection

    • Not serious Scope/severity E

      K0211 Egress Deficiencies

      Keep aisles, corridors, and exits free of obstruction in case of emergency.

      Corrected Apr 1, 2025 · CMS fire safety

    • Not serious Scope/severity E

      K0271 Egress Deficiencies

      Have exits that are accessible at all times.

      Corrected Oct 25, 2024 · CMS fire safety

    • Not serious Scope/severity F

      K0291 Egress Deficiencies

      Install emergency lighting that can last at least 1 1/2 hours.

      Corrected Oct 25, 2024 · CMS fire safety

    • Not serious Scope/severity E

      K0321 Smoke Deficiencies

      Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.

      Corrected Oct 30, 2024 · CMS fire safety

    • Not serious Scope/severity E

      K0324 Smoke Deficiencies

      Provide properly protected cooking facilities.

      Corrected Jan 30, 2025 · CMS fire safety

    • Not serious Scope/severity E

      K0351 Smoke Deficiencies

      Install an approved automatic sprinkler system.

      Corrected Oct 25, 2024 · CMS fire safety

    • Not serious Scope/severity E

      K0353 Smoke Deficiencies

      Inspect, test, and maintain automatic sprinkler systems.

      Corrected Nov 19, 2024 · CMS fire safety

    • Not serious Scope/severity F

      K0355 Smoke Deficiencies

      Properly select, install, inspect, or maintain portable fire extinguishes.

      Corrected Nov 8, 2024 · CMS fire safety

    • Not serious Scope/severity E

      K0363 Smoke Deficiencies

      Install corridor and hallway doors that block smoke.

      Corrected Oct 25, 2024 · CMS fire safety

    • Not serious Scope/severity F

      K0712 Miscellaneous Deficiencies

      Have simulated fire drills held at unexpected times.

      Corrected Oct 25, 2024 · CMS fire safety

    • Not serious Scope/severity E

      K0913 Gas, Vacuum, and Electrical Systems Deficiencies

      Ensure operating rooms are properly protected and written records are maintained and available for inspection.

      Corrected Oct 25, 2024 · CMS fire safety

    • Not serious Scope/severity F

      K0918 Gas, Vacuum, and Electrical Systems Deficiencies

      Have generator or other power source capable of supplying service within 10 seconds.

      Corrected Jan 3, 2025 · CMS fire safety

    • Not serious Scope/severity E

      K0923 Gas, Vacuum, and Electrical Systems Deficiencies

      Have proper medical gas storage and administration areas.

      Corrected Oct 25, 2024 · CMS fire safety

11. Jul 11, 2024 Health · 1 finding
    • Not serious Scope/severity D Complaint

      F0755 Pharmacy Service Deficiencies

      Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

      Corrected Jul 27, 2024 · CMS health inspection

12. May 18, 2024 Health · 5 findings
    • Not serious Scope/severity D Complaint

      F0550 Resident Rights Deficiencies

      Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

      Corrected Jun 8, 2024 · CMS health inspection

    • Not serious Scope/severity D Complaint

      F0684 Quality of Life and Care Deficiencies

      Provide appropriate treatment and care according to orders, resident’s preferences and goals.

      Corrected Jun 8, 2024 · CMS health inspection

    • Not serious Scope/severity E Complaint

      F0692 Quality of Life and Care Deficiencies

      Provide enough food/fluids to maintain a resident's health.

      Corrected Jun 8, 2024 · CMS health inspection

    • Not serious Scope/severity D Complaint

      F0755 Pharmacy Service Deficiencies

      Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

      Corrected Jun 8, 2024 · CMS health inspection

    • Not serious Scope/severity D Complaint

      F0825 Quality of Life and Care Deficiencies

      Provide or get specialized rehabilitative services as required for a resident.

      Corrected Jun 8, 2024 · CMS health inspection

13. Apr 24, 2024 Health · 1 finding
    • Not serious Scope/severity E Complaint

      F0759 Pharmacy Service Deficiencies

      Ensure medication error rates are not 5 percent or greater.

      Corrected May 10, 2024 · CMS health inspection

14. Mar 21, 2024 Health · 4 findings
    • Serious Scope/severity G Complaint

      F0686 Quality of Life and Care Deficiencies

      Provide appropriate pressure ulcer care and prevent new ulcers from developing.

      Corrected Apr 10, 2024 · CMS health inspection

    • Not serious Scope/severity E Complaint

      F0690 Quality of Life and Care Deficiencies

      Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

      Corrected Apr 10, 2024 · CMS health inspection

    • Not serious Scope/severity F Complaint

      F0725 Nursing and Physician Services Deficiencies

      Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.

      Corrected Apr 11, 2024 · CMS health inspection

    • Not serious Scope/severity F Complaint

      F0838 Administration Deficiencies

      Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies.

      Corrected Apr 10, 2024 · CMS health inspection

15. Feb 27, 2024 Health · 5 findings
    • Serious Scope/severity G Complaint

      F0580 Resident Rights Deficiencies

      Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

      Corrected Apr 12, 2024 · CMS health inspection

    • Not serious Scope/severity E Complaint

      F0755 Pharmacy Service Deficiencies

      Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

      Corrected Apr 12, 2024 · CMS health inspection

    • Not serious Scope/severity F Complaint

      F0756 Pharmacy Service Deficiencies

      Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.

      Corrected Apr 12, 2024 · CMS health inspection

    • Not serious Scope/severity D Complaint

      F0759 Pharmacy Service Deficiencies

      Ensure medication error rates are not 5 percent or greater.

      Corrected Apr 12, 2024 · CMS health inspection

    • Serious Scope/severity J Complaint

      F0760 Pharmacy Service Deficiencies

      Ensure that residents are free from significant medication errors.

      Corrected May 3, 2024 · CMS health inspection

16. Jan 6, 2024 Health · 2 findings
    • Not serious Scope/severity D Complaint

      F0600 Freedom from Abuse, Neglect, and Exploitation Deficiencies

      Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

      Corrected Jan 19, 2024 · CMS health inspection

    • Not serious Scope/severity D Complaint

      F0690 Quality of Life and Care Deficiencies

      Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

      Corrected Jan 19, 2024 · CMS health inspection

17. Dec 21, 2023 Health · 9 findings
    • Not serious Scope/severity D Complaint

      F0558 Resident Rights Deficiencies

      Reasonably accommodate the needs and preferences of each resident.

      Corrected Feb 13, 2024 · CMS health inspection

    • Not serious Scope/severity D Complaint

      F0657 Resident Assessment and Care Planning Deficiencies

      Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

      Corrected Feb 13, 2024 · CMS health inspection

    • Not serious Scope/severity D Complaint

      F0677 Quality of Life and Care Deficiencies

      Provide care and assistance to perform activities of daily living for any resident who is unable.

      Corrected Feb 13, 2024 · CMS health inspection

    • Serious Scope/severity J Complaint

      F0686 Quality of Life and Care Deficiencies

      Provide appropriate pressure ulcer care and prevent new ulcers from developing.

      Corrected Feb 13, 2024 · CMS health inspection

    • Serious Scope/severity J Complaint

      F0689 Quality of Life and Care Deficiencies

      Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

      Corrected Feb 22, 2024 · CMS health inspection

    • Not serious Scope/severity F Complaint

      F0725 Nursing and Physician Services Deficiencies

      Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.

      Corrected Feb 13, 2024 · CMS health inspection

    • Not serious Scope/severity F Complaint

      F0835 Administration Deficiencies

      Administer the facility in a manner that enables it to use its resources effectively and efficiently.

      Corrected Feb 13, 2024 · CMS health inspection

    • Serious Scope/severity A

      Type A Illinois Nursing Home Care Act violation

      Type A: substantial probability of death or serious harm, or actual harm (1-129). Sections of the Illinois Administrative Code cited: 300.610a), 300.696a), 300.1210a), 300.1210b), 300.1210c), 300.1210d)2)5), and 300.1220b)3). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high-risk designation: 300.1210b) and 300.1210d)5).

      Statement of deficiencies (PDF)

    • Serious Scope/severity A

      Type A Illinois Nursing Home Care Act violation

      Type A: substantial probability of death or serious harm, or actual harm (1-129). Sections of the Illinois Administrative Code cited: 300.610a), 300.1210b), 300.1210c), and 300.1210d)6). The fine was doubled in this instance in accordance with 300.282i) and j) of the Code due to the violation of the sections of the Code with a high-risk designation: 300.1210b) and 300.1210d)6).

      Statement of deficiencies (PDF)

18. Nov 30, 2023 Health · 4 findings
    • Not serious Scope/severity F Complaint

      F0727 Nursing and Physician Services Deficiencies

      Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.

      Corrected Dec 17, 2023 · CMS health inspection

    • Not serious Scope/severity D Complaint

      F0759 Pharmacy Service Deficiencies

      Ensure medication error rates are not 5 percent or greater.

      Corrected Dec 17, 2023 · CMS health inspection

    • Not serious Scope/severity E Complaint

      F0761 Pharmacy Service Deficiencies

      Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

      Corrected Dec 17, 2023 · CMS health inspection

    • Not serious Scope/severity F Complaint

      F0880 Infection Control Deficiencies

      Provide and implement an infection prevention and control program.

      Corrected Dec 17, 2023 · CMS health inspection

19. Oct 31, 2023 Health · 4 findings
    • Not serious Scope/severity D Complaint

      F0657 Resident Assessment and Care Planning Deficiencies

      Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

      Corrected Nov 22, 2023 · CMS health inspection

    • Not serious Scope/severity D Complaint

      F0689 Quality of Life and Care Deficiencies

      Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

      Corrected Nov 22, 2023 · CMS health inspection

    • Not serious Scope/severity F Complaint

      F0725 Nursing and Physician Services Deficiencies

      Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.

      Corrected Nov 22, 2023 · CMS health inspection

    • Not serious Scope/severity F Complaint

      F0880 Infection Control Deficiencies

      Provide and implement an infection prevention and control program.

      Corrected Nov 22, 2023 · CMS health inspection

20. Jul 24, 2023 Health · 38 findings
    • Not serious Scope/severity D

      F0558 Resident Rights Deficiencies

      Reasonably accommodate the needs and preferences of each resident.

      Corrected Sep 14, 2023 · CMS health inspection

    • Not serious Scope/severity E

      F0584 Resident Rights Deficiencies

      Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.

      Corrected Sep 14, 2023 · CMS health inspection

    • Not serious Scope/severity D

      F0636 Resident Assessment and Care Planning Deficiencies

      Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.

      Corrected Sep 14, 2023 · CMS health inspection

    • Not serious Scope/severity D

      F0637 Resident Assessment and Care Planning Deficiencies

      Assess the resident when there is a significant change in condition

      Corrected Aug 30, 2023 · CMS health inspection

    • Not serious Scope/severity D

      F0638 Resident Assessment and Care Planning Deficiencies

      Assure that each resident’s assessment is updated at least once every 3 months.

      Corrected Aug 30, 2023 · CMS health inspection

    • Not serious Scope/severity D

      F0655 Resident Assessment and Care Planning Deficiencies

      Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted

      Corrected Sep 14, 2023 · CMS health inspection

    • Not serious Scope/severity E

      F0656 Resident Assessment and Care Planning Deficiencies

      Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

      Corrected Sep 14, 2023 · CMS health inspection

    • Not serious Scope/severity D

      F0657 Resident Assessment and Care Planning Deficiencies

      Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

      Corrected Aug 30, 2023 · CMS health inspection

    • Not serious Scope/severity F

      F0679 Quality of Life and Care Deficiencies

      Provide activities to meet all resident's needs.

      Corrected Aug 30, 2023 · CMS health inspection

    • Not serious Scope/severity F

      F0680 Quality of Life and Care Deficiencies

      Ensure the activities program is directed by a qualified professional.

      Corrected Aug 30, 2023 · CMS health inspection

    • Not serious Scope/severity D

      F0686 Quality of Life and Care Deficiencies

      Provide appropriate pressure ulcer care and prevent new ulcers from developing.

      Corrected Aug 30, 2023 · CMS health inspection

    • Not serious Scope/severity D

      F0689 Quality of Life and Care Deficiencies

      Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

      Corrected Sep 14, 2023 · CMS health inspection

    • Not serious Scope/severity D

      F0690 Quality of Life and Care Deficiencies

      Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

      Corrected Aug 30, 2023 · CMS health inspection

    • Not serious Scope/severity D

      F0692 Quality of Life and Care Deficiencies

      Provide enough food/fluids to maintain a resident's health.

      Corrected Aug 30, 2023 · CMS health inspection

    • Not serious Scope/severity D

      F0695 Quality of Life and Care Deficiencies

      Provide safe and appropriate respiratory care for a resident when needed.

      Corrected Aug 30, 2023 · CMS health inspection

    • Not serious Scope/severity F

      F0727 Nursing and Physician Services Deficiencies

      Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.

      Corrected Aug 30, 2023 · CMS health inspection

    • Not serious Scope/severity C

      F0732 Nursing and Physician Services Deficiencies

      Post nurse staffing information every day.

      Corrected Aug 30, 2023 · CMS health inspection

    • Not serious Scope/severity D

      F0758 Pharmacy Service Deficiencies

      Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.

      Corrected Aug 30, 2023 · CMS health inspection

    • Not serious Scope/severity D

      F0760 Pharmacy Service Deficiencies

      Ensure that residents are free from significant medication errors.

      Corrected Aug 30, 2023 · CMS health inspection

    • Not serious Scope/severity E

      F0761 Pharmacy Service Deficiencies

      Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

      Corrected Sep 14, 2023 · CMS health inspection

    • Not serious Scope/severity F

      F0806 Nutrition and Dietary Deficiencies

      Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.

      Corrected Aug 30, 2023 · CMS health inspection

    • Not serious Scope/severity F

      F0812 Nutrition and Dietary Deficiencies

      Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

      Corrected Aug 30, 2023 · CMS health inspection

    • Not serious Scope/severity F

      F0835 Administration Deficiencies

      Administer the facility in a manner that enables it to use its resources effectively and efficiently.

      Corrected Aug 30, 2023 · CMS health inspection

    • Not serious Scope/severity F

      F0837 Administration Deficiencies

      Establish a governing body that is legally responsible for establishing and implementing policies for managing and operating the facility and appoints a properly licensed administrator responsible for managing the facility.

      Corrected Aug 30, 2023 · CMS health inspection

    • Not serious Scope/severity D

      F0847 Administration Deficiencies

      Inform resident or representatives choice to enter into binding arbitration agreement and right to refuse.

      Corrected Sep 14, 2023 · CMS health inspection

    • Not serious Scope/severity F

      F0867 Administration Deficiencies

      Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.

      Corrected Aug 30, 2023 · CMS health inspection

    • Not serious Scope/severity F

      F0868 Administration Deficiencies

      Have the Quality Assessment and Assurance group have the required members and meet at least quarterly

      Corrected Aug 30, 2023 · CMS health inspection

    • Not serious Scope/severity F

      F0880 Infection Control Deficiencies

      Provide and implement an infection prevention and control program.

      Corrected Aug 30, 2023 · CMS health inspection

    • Not serious Scope/severity E

      K0225 Egress Deficiencies

      Have stairways and smokeproof enclosures used as exits that meet safety requirements.

      Corrected Aug 17, 2023 · CMS fire safety

    • Not serious Scope/severity E

      K0271 Egress Deficiencies

      Have exits that are accessible at all times.

      Corrected Aug 17, 2023 · CMS fire safety

    • Not serious Scope/severity E

      K0293 Egress Deficiencies

      Have properly located and lighted "Exit" signs.

      Corrected Aug 17, 2023 · CMS fire safety

    • Not serious Scope/severity E

      K0321 Smoke Deficiencies

      Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.

      Corrected Aug 17, 2023 · CMS fire safety

    • Not serious Scope/severity E

      K0351 Smoke Deficiencies

      Install an approved automatic sprinkler system.

      Corrected Aug 17, 2023 · CMS fire safety

    • Not serious Scope/severity E

      K0353 Smoke Deficiencies

      Inspect, test, and maintain automatic sprinkler systems.

      Corrected Aug 17, 2023 · CMS fire safety

    • Not serious Scope/severity E

      K0363 Smoke Deficiencies

      Install corridor and hallway doors that block smoke.

      Corrected Aug 17, 2023 · CMS fire safety

    • Not serious Scope/severity E

      K0374 Smoke Deficiencies

      Install smoke barrier doors that can resist smoke for at least 20 minutes.

      Corrected Aug 17, 2023 · CMS fire safety

    • Not serious Scope/severity F

      K0712 Miscellaneous Deficiencies

      Have simulated fire drills held at unexpected times.

      Corrected Aug 17, 2023 · CMS fire safety

    • Not serious Scope/severity E

      K0923 Gas, Vacuum, and Electrical Systems Deficiencies

      Have proper medical gas storage and administration areas.

      Corrected Aug 17, 2023 · CMS fire safety

21. Aug 12, 2022 Health · 23 findings
    • Not serious Scope/severity E

      F0553 Resident Rights Deficiencies

      Allow resident to participate in the development and implementation of his or her person-centered plan of care.

      Corrected Aug 26, 2022 · CMS health inspection

    • Not serious Scope/severity D

      F0557 Resident Rights Deficiencies

      Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions.

      Corrected Aug 26, 2022 · CMS health inspection

    • Not serious Scope/severity D

      F0656 Resident Assessment and Care Planning Deficiencies

      Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

      Corrected Aug 26, 2022 · CMS health inspection

    • Not serious Scope/severity D

      F0677 Quality of Life and Care Deficiencies

      Provide care and assistance to perform activities of daily living for any resident who is unable.

      Corrected Aug 26, 2022 · CMS health inspection

    • Not serious Scope/severity D

      F0684 Quality of Life and Care Deficiencies

      Provide appropriate treatment and care according to orders, resident’s preferences and goals.

      Corrected Aug 26, 2022 · CMS health inspection

    • Not serious Scope/severity E

      F0688 Quality of Life and Care Deficiencies

      Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.

      Corrected Aug 26, 2022 · CMS health inspection

    • Not serious Scope/severity D

      F0689 Quality of Life and Care Deficiencies

      Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

      Corrected Aug 26, 2022 · CMS health inspection

    • Not serious Scope/severity D

      F0698 Quality of Life and Care Deficiencies

      Provide safe, appropriate dialysis care/services for a resident who requires such services.

      Corrected Aug 26, 2022 · CMS health inspection

    • Not serious Scope/severity D

      F0791 Quality of Life and Care Deficiencies

      Provide or obtain dental services for each resident.

      Corrected Aug 26, 2022 · CMS health inspection

    • Not serious Scope/severity D

      F0921 Environmental Deficiencies

      Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.

      Corrected Aug 26, 2022 · CMS health inspection

    • Not serious Scope/severity E

      K0271 Egress Deficiencies

      Have exits that are accessible at all times.

      Corrected Sep 16, 2022 · CMS fire safety

    • Not serious Scope/severity E

      K0291 Egress Deficiencies

      Install emergency lighting that can last at least 1 1/2 hours.

      Corrected Sep 16, 2022 · CMS fire safety

    • Not serious Scope/severity E

      K0311 Smoke Deficiencies

      Have an enclosure around a vertical opening shaft.

      Corrected Sep 16, 2022 · CMS fire safety

    • Not serious Scope/severity E

      K0321 Smoke Deficiencies

      Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.

      Corrected Sep 16, 2022 · CMS fire safety

    • Not serious Scope/severity F

      K0353 Smoke Deficiencies

      Inspect, test, and maintain automatic sprinkler systems.

      Corrected Sep 16, 2022 · CMS fire safety

    • Not serious Scope/severity E

      K0374 Smoke Deficiencies

      Install smoke barrier doors that can resist smoke for at least 20 minutes.

      Corrected Sep 16, 2022 · CMS fire safety

    • Not serious Scope/severity F

      K0711 Miscellaneous Deficiencies

      Provide a written emergency evacuation plan.

      Corrected Sep 16, 2022 · CMS fire safety

    • Not serious Scope/severity F

      K0712 Miscellaneous Deficiencies

      Have simulated fire drills held at unexpected times.

      Corrected Sep 16, 2022 · CMS fire safety

    • Not serious Scope/severity F

      K0741 Miscellaneous Deficiencies

      Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.

      Corrected Sep 16, 2022 · CMS fire safety

    • Not serious Scope/severity F

      K0761 Miscellaneous Deficiencies

      To conduct inspection, testing and maintenance of fire doors by qualified individuals.

      Corrected Sep 16, 2022 · CMS fire safety

    • Not serious Scope/severity E

      K0913 Gas, Vacuum, and Electrical Systems Deficiencies

      Ensure operating rooms are properly protected and written records are maintained and available for inspection.

      Corrected Sep 16, 2022 · CMS fire safety

    • Not serious Scope/severity F

      K0918 Gas, Vacuum, and Electrical Systems Deficiencies

      Have generator or other power source capable of supplying service within 10 seconds.

      Corrected Sep 16, 2022 · CMS fire safety

    • Not serious Scope/severity E

      K0920 Gas, Vacuum, and Electrical Systems Deficiencies

      Ensure proper usage of power strips and extension cords.

      Corrected Sep 16, 2022 · CMS fire safety

Owners and managers (as published by CMS)

• AHEARN, MICHAEL — adp of the snf, NOT APPLICABLE, since 12/01/2024
• AHEARN, MICHAEL — operational/managerial control, NOT APPLICABLE, since 12/01/2024
• BERKOWITZ, DAVID — trustee of the snf, NOT APPLICABLE, since 12/01/2024
• BERKOWITZ, DAVID — individual is an owner, partner or trustee of any adp of the snf, NOT APPLICABLE, since 05/29/2025
• MEYSTEL, YOSEF — individual is an owner, partner or trustee of any adp of the snf, NOT APPLICABLE, since 03/19/2025
• SPECTOR, JENNIFER — operational/managerial control, NOT APPLICABLE, since 12/01/2024
• SPECTOR, JENNIFER — adp of the snf, NOT APPLICABLE, since 12/01/2024
• SPECTOR, JENNIFER — corporate director, NOT APPLICABLE, since 12/01/2024
• STACHOWIAK, MELISSA — managing control - governing body, NOT APPLICABLE, since 12/01/2024
• STACHOWIAK, MELISSA — adp of the snf, NOT APPLICABLE, since 12/01/2024
• STEWART, JASON — operational/managerial control, NOT APPLICABLE, since 12/01/2024
• STEWART, JASON — adp of the snf, NOT APPLICABLE, since 12/01/2024
• STEWART, JASON — managing control - governing body, NOT APPLICABLE, since 12/01/2024
• TUROFSKY, STEVEN — adp of the snf, NOT APPLICABLE, since 12/01/2024
• TUROFSKY, STEVEN — operational/managerial control, NOT APPLICABLE, since 12/01/2024
• TVERSKY, AARON — operational/managerial control, NOT APPLICABLE, since 12/01/2024
• TVERSKY, AARON — managing control - governing body, NOT APPLICABLE, since 12/01/2024
• TVERSKY, AARON — adp of the snf, NOT APPLICABLE, since 12/01/2024
• WILHELM, NAFTALI — operational/managerial control, NOT APPLICABLE, since 12/01/2024
• WILHELM, NAFTALI — adp of the snf, NOT APPLICABLE, since 12/01/2024
• CURIS SERVICES LLC — adp of the snf, NOT APPLICABLE, since 12/01/2024
• GOLDWATER CARE MANAGEMENT LLC — adp of the snf, NOT APPLICABLE, since 03/19/2025
• GOLDWATER CARE MANAGEMENT LLC — operational/managerial control, NOT APPLICABLE, since 12/01/2024
• PETERSEN SNF HOLDINGS LLC — adp of the snf, NOT APPLICABLE, since 03/19/2025