Trinity Rehabilitation & Healthcare Center

Penalties

• Jan 28, 2026 — Fine ($19,115)
• Jan 28, 2026 — Fine ($19,115)
• Jan 28, 2026 — Payment Denial · payment denial 8 days
• Nov 12, 2025 — Payment Denial · payment denial 4 days
• Nov 12, 2025 — Fine ($68,640)
• Nov 5, 2023 — Fine ($168,714)

Inspection findings

1. Apr 15, 2026 Health · 16 findings
   • Not serious Scope/severity D

     F0552 Resident Rights Deficiencies

     Ensure that residents are fully informed and understand their health status, care and treatments.

     Corrected May 8, 2026 · CMS health inspection

   • Not serious Scope/severity D

     F0644 Resident Assessment and Care Planning Deficiencies

     Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.

     Corrected May 8, 2026 · 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 May 8, 2026 · 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 May 8, 2026 · CMS health inspection

   • Not serious Scope/severity D

     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 May 8, 2026 · CMS health inspection

   • Not serious Scope/severity D

     F0804 Nutrition and Dietary Deficiencies

     Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.

     Corrected May 6, 2026 · CMS health inspection

   • Not serious Scope/severity D

     F0839 Administration Deficiencies

     Employ staff that are licensed, certified, or registered in accordance with state laws.

     Corrected May 6, 2026 · CMS health inspection

   • Not serious Scope/severity D

     F0880 Infection Control Deficiencies

     Provide and implement an infection prevention and control program.

     Corrected May 8, 2026 · CMS health inspection

   • Not serious Scope/severity D

     F0940 Administration Deficiencies

     Develop, implement, and/or maintain an effective training program for all new and existing staff members.

     Corrected May 8, 2026 · CMS health inspection

   • Not serious Scope/severity E

     F0941 Administration Deficiencies

     Develop, implement, and/or maintain an effective training program that includes effective communications for direct care staff members.

     Corrected May 8, 2026 · CMS health inspection

   • Not serious Scope/severity D

     F0942 Resident Rights Deficiencies

     Ensure that staff members are educated on resident rights and facility responsibilities to properly care for its residents.

     Corrected May 8, 2026 · CMS health inspection

   • Not serious Scope/severity D

     F0943 Freedom from Abuse, Neglect, and Exploitation Deficiencies

     Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation.

     Corrected May 8, 2026 · CMS health inspection

   • Not serious Scope/severity E

     F0945 Infection Control Deficiencies

     Include as part of its infection prevention and control program, mandatory training that includes written standards, policies, and procedures for the program.

     Corrected May 8, 2026 · CMS health inspection

   • Not serious Scope/severity D

     F0947 Nursing and Physician Services Deficiencies

     Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.

     Corrected May 8, 2026 · CMS health inspection

   • Not serious Scope/severity E

     F0949 Administration Deficiencies

     Provide behavior health training consistent with the requirements and as determined by a facility assessment.

     Corrected May 8, 2026 · CMS health inspection

   • Not serious Scope/severity F

     K0324 Smoke Deficiencies

     Provide properly protected cooking facilities.

     Corrected Apr 29, 2026 · CMS fire safety

2. Mar 4, 2026 Health · 5 findings
   • Serious Scope/severity G 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 Apr 10, 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 Apr 10, 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 Apr 1, 2026 · CMS health inspection

   • Not serious Scope/severity D Complaint

     F0726 Nursing and Physician Services Deficiencies

     Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.

     Corrected Apr 1, 2026 · CMS health inspection

   • Not serious Scope/severity D Complaint

     F0880 Infection Control Deficiencies

     Provide and implement an infection prevention and control program.

     Corrected Apr 1, 2026 · CMS health inspection

3. Jan 28, 2026 Health · 5 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 Feb 27, 2026 · 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 Feb 27, 2026 · CMS health inspection

   • Not serious Scope/severity D Complaint

     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 Feb 27, 2026 · CMS health inspection

   • Not serious Scope/severity E 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 27, 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 27, 2026 · CMS health inspection

4. Dec 17, 2025 Health · 2 findings
   • Not serious Scope/severity D Complaint

     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 Dec 18, 2025 · CMS health inspection

   • Not serious Scope/severity D Complaint

     F0694 Quality of Life and Care Deficiencies

     Provide for the safe, appropriate administration of IV fluids for a resident when needed.

     Corrected Dec 18, 2025 · CMS health inspection

5. Nov 26, 2025 Health · 2 findings
   • 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 Dec 15, 2025 · CMS health inspection

   • Not serious Scope/severity E Complaint

     F0842 Resident Assessment and Care Planning Deficiencies

     Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

     Corrected Dec 15, 2025 · CMS health inspection

6. Nov 12, 2025 Health · 7 findings
   • Serious Scope/severity K 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 Nov 20, 2025 · 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 Dec 8, 2025 · CMS health inspection

   • Serious Scope/severity H Complaint

     F0684 Quality of Life and Care Deficiencies

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

     Corrected Dec 5, 2025 · CMS health inspection

   • Serious Scope/severity K Complaint

     F0686 Quality of Life and Care Deficiencies

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

     Corrected Nov 20, 2025 · 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 Dec 8, 2025 · CMS health inspection

   • Serious Scope/severity K Complaint

     F0760 Pharmacy Service Deficiencies

     Ensure that residents are free from significant medication errors.

     Corrected Nov 20, 2025 · CMS health inspection

   • Not serious Scope/severity E Complaint

     F0880 Infection Control Deficiencies

     Provide and implement an infection prevention and control program.

     Corrected Dec 8, 2025 · CMS health inspection

7. Jul 27, 2025 Health · 1 finding
   • Not serious Scope/severity E Complaint

     F0919 Environmental Deficiencies

     Make sure that a working call system is available in each resident's bathroom and bathing area.

     Corrected Aug 12, 2025 · CMS health inspection

8. Feb 27, 2025 Fire Safety · 21 findings
   • Not serious Scope/severity F

     E0037 Emergency Preparedness Deficiencies

     Establish staff and initial training requirements.

     Corrected Feb 28, 2025 · CMS fire safety

   • Not serious Scope/severity D

     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 Feb 28, 2025 · CMS health inspection

   • Not serious Scope/severity D Complaint

     F0602 Freedom from Abuse, Neglect, and Exploitation Deficiencies

     Protect each resident from the wrongful use of the resident's belongings or money.

     Corrected Feb 28, 2025 · CMS health inspection

   • Not serious Scope/severity D

     F0644 Resident Assessment and Care Planning Deficiencies

     Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.

     Corrected Mar 13, 2025 · CMS health inspection

   • Not serious Scope/severity E Complaint

     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 Feb 28, 2025 · 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 Mar 14, 2025 · 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 Mar 14, 2025 · CMS health inspection

   • Not serious Scope/severity D

     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 Feb 28, 2025 · CMS health inspection

   • Not serious Scope/severity D

     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 Feb 28, 2025 · 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 Feb 28, 2025 · CMS health inspection

   • Not serious Scope/severity E

     F0880 Infection Control Deficiencies

     Provide and implement an infection prevention and control program.

     Corrected Mar 14, 2025 · CMS health inspection

   • Not serious Scope/severity D

     F0908 Environmental Deficiencies

     Keep all essential equipment working safely.

     Corrected Mar 13, 2025 · CMS health inspection

   • Not serious Scope/severity F

     F0925 Environmental Deficiencies

     Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.

     Corrected Feb 28, 2025 · CMS health inspection

   • Not serious Scope/severity E

     F0941 Administration Deficiencies

     Develop, implement, and/or maintain an effective training program that includes effective communications for direct care staff members.

     Corrected Mar 24, 2025 · CMS health inspection

   • Not serious Scope/severity E

     F0945 Infection Control Deficiencies

     Include as part of its infection prevention and control program, mandatory training that includes written standards, policies, and procedures for the program.

     Corrected Mar 24, 2025 · CMS health inspection

   • Not serious Scope/severity E

     F0947 Nursing and Physician Services Deficiencies

     Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.

     Corrected Mar 24, 2025 · CMS health inspection

   • Not serious Scope/severity E

     F0949 Administration Deficiencies

     Provide behavior health training consistent with the requirements and as determined by a facility assessment.

     Corrected Mar 24, 2025 · CMS health inspection

   • Not serious Scope/severity F

     K0222 Egress Deficiencies

     Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.

     Corrected Feb 28, 2025 · CMS fire safety

   • Not serious Scope/severity E

     K0511 Services Deficiencies

     Have properly installed electrical wiring and gas equipment.

     Corrected Mar 17, 2025 · CMS fire safety

   • Not serious Scope/severity E

     K0781 Miscellaneous Deficiencies

     Have restrictions on the use of portable space heaters.

     Corrected Feb 28, 2025 · 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 Mar 14, 2025 · CMS fire safety

9. Aug 28, 2024 Health · 2 findings
   • Not serious Scope/severity F Complaint

     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 Sep 24, 2024 · CMS health inspection

   • Not serious Scope/severity D Complaint

     F0880 Infection Control Deficiencies

     Provide and implement an infection prevention and control program.

     Corrected Sep 24, 2024 · CMS health inspection

10. Jan 10, 2024 Health · 9 findings
    • Not serious Scope/severity D

      F0658 Resident Assessment and Care Planning Deficiencies

      Ensure services provided by the nursing facility meet professional standards of quality.

      Corrected Feb 1, 2024 · 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 Feb 1, 2024 · CMS health inspection

    • Not serious Scope/severity D

      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 1, 2024 · 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 Feb 1, 2024 · CMS health inspection

    • Not serious Scope/severity F

      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 1, 2024 · 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 Feb 1, 2024 · CMS health inspection

    • Not serious Scope/severity E

      F0757 Pharmacy Service Deficiencies

      Ensure each resident’s drug regimen must be free from unnecessary drugs.

      Corrected Feb 1, 2024 · CMS health inspection

    • Not serious Scope/severity E Complaint

      F0880 Infection Control Deficiencies

      Provide and implement an infection prevention and control program.

      Corrected Feb 1, 2024 · CMS health inspection

    • Not serious Scope/severity C

      K0324 Smoke Deficiencies

      Provide properly protected cooking facilities.

      Corrected Mar 1, 2024 · CMS fire safety

11. Nov 5, 2023 Health · 3 findings
    • Serious Scope/severity K Complaint

      F0604 Freedom from Abuse, Neglect, and Exploitation Deficiencies

      Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.

      Corrected Nov 6, 2023 · CMS health inspection

    • Serious Scope/severity K Complaint

      F0607 Freedom from Abuse, Neglect, and Exploitation Deficiencies

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

      Corrected Nov 6, 2023 · CMS health inspection

    • Serious Scope/severity K Complaint

      F0700 Quality of Life and Care Deficiencies

      Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.

      Corrected Nov 6, 2023 · CMS health inspection

Owners and managers (as published by CMS)

• COOPER, KIMBERLY — corporate director, NOT APPLICABLE, since 01/29/2024
• NEWTON, ELIZABETH — corporate director, NOT APPLICABLE, since 02/22/2024
• SCIARRINI, JOSEPH — adp of the snf, NOT APPLICABLE, since 05/01/2021
• SMITH, MICHAEL — adp of the snf, NOT APPLICABLE, since 05/01/2021
• SQUYRES, HULEN — adp of the snf, NOT APPLICABLE, since 05/01/2021
• WHATLEY, DARCY — operational/managerial control, NOT APPLICABLE, since 05/01/2021
• TRINITY RHC LLC — adp of the snf, NOT APPLICABLE, since 05/08/2025
• TRINITY RHC LLC — operational/managerial control, NOT APPLICABLE, since 05/01/2021