Grayson, KY

Carter Nursing and Rehabilitation

1-star overall rating with 1-star inspections with abuse icon flag with $87,165 in total fines with 5 recent health deficiencies with 3 fire-safety deficiencies in the latest cycle

250 McDavid Boulevard, Grayson, KY

(606) 474-7835

Compare this facility

Overall

1 / 5

CMS overall stars

Health inspections

1 / 5

Survey and complaint cycles

Staffing

1 / 5

RN + nurse staffing

Quality measures

3 / 5

Resident outcomes and process measures

Quick facts

Facility snapshot

Beds

120

Certified beds

Average residents

111

Average occupied residents

Ownership

For-Profit

Publicly displayed owner type

Chain

David Marx

Operator or chain grouping

Approved since

1991-02-21

CMS approved date

Coverage

Medicare + Medicaid

Participation flags

Chain footprint

10 facilities

Chain averages 2 overall / 3 health / 2 staffing / 3 quality stars

Changed ownership

No

Within the last 12 months

Family council

Yes

Resident and family council reported

Sprinklers

Yes

Automatic sprinklers in all required areas

Staffing

Hours and turnover

RN hours / resident day

0.44

Registered nurse staffing · state 0.77 · national 0.68

LPN hours / resident day

0.42

Licensed practical nurse staffing · state 0.81 · national 0.87

Aide hours / resident day

1.73

Nurse aide staffing · state 2.43 · national 2.35

Total nurse hours

2.59

All reported nurse hours · state 4.01 · national 3.89

Licensed hours

0.86

RN + LPN hours · state 1.58 · national 1.54

Weekend hours

1.80

Weekend nurse staffing · state 3.50 · national 3.43

Weekend RN hours

0.12

Weekend registered nurse coverage · state 0.52 · national 0.47

Physical therapist

0.03

Reported PT staffing · state 0.06 · national 0.07

Adjusted RN hours

0.41

CMS adjusted RN staffing hours

Adjusted total hours

2.41

CMS adjusted total nurse staffing hours

Case-mix index

1.47

Higher values indicate more complex resident acuity

RN turnover

25%

Annual RN turnover · state 43% · national 45%

Total nurse turnover

61%

Annual nurse turnover · state 47% · national 46%

SNF VBP

Value-based purchasing

Program rank

10,823

Lower is better among SNFs in the FY 2026 VBP program.

Performance score

18.97

Composite VBP score used to determine payment impact.

Payment multiplier

0.9821

Above 1.000 increases Medicare payment; below 1.000 reduces it.

Program components

How the VBP score is built

Readmission

0

Baseline 21.35% · Performance 21.75% · Measure score 0 · Achievement 0 · Improvement 0

Healthcare-associated infections

3.36

Baseline 9.35% · Performance 7.67% · Measure score 3.36 · Achievement 0.54 · Improvement 3.36

Total nurse turnover

4.23

Baseline 63.27% · Performance 46.39% · Measure score 4.23 · Achievement 4.23 · Improvement 3.89

Adjusted total nurse staffing

0

Baseline 2.88 hours · Performance 2.86 hours · Measure score 0 · Achievement 0 · Improvement 0

SNF QRP

Medicare quality reporting measures

Measure	Facility	National	Note
Potentially preventable 30-day readmission	10.09%	10.72% 0.6 pts better	No Different than the National Rate · Eligible stays 72 · Observed rate 9.72% · Lower 95% interval 6.85%
Discharge to community	39.59%	50.57% 11 pts worse	Worse than the National Rate · Eligible stays 69 · Observed rate 30.43% · Lower 95% interval 28.04%
Medicare spending per beneficiary	1.27	1.02 0.2 pts worse
Drug regimen review with follow-up	100%	95.27% 4.7 pts better	Numerator 57 · Denominator 57
Falls with major injury	0%	0.77% 0.8 pts better	Numerator 0 · Denominator 57
Discharge self-care score	24.14%	53.69% 29.5 pts worse	Numerator 7 · Denominator 29
Discharge mobility score	31.03%	50.94% 19.9 pts worse	Numerator 9 · Denominator 29
Pressure ulcers or injuries, new or worsened	3.51%	2.29% 1.2 pts worse	Numerator 2 · Denominator 57 · Adjusted rate 2.2%
Healthcare-associated infections requiring hospitalization	7.67%	7.12% 0.5 pts worse	No Different than the National Rate · Eligible stays 55 · Observed rate 10.91% · Lower 95% interval 4.62%
Staff COVID-19 vaccination coverage	0%	8.2% 8.2 pts worse	Numerator 0 · Denominator 71
Staff flu vaccination coverage	16.92%	42% 25.1 pts worse	Numerator 22 · Denominator 130
Discharge function score	27.59%	56.45% 28.9 pts worse	Numerator 8 · Denominator 29
Transfer of health information to provider	95%	95.95% 1 pts worse	Numerator 19 · Denominator 20
Transfer of health information to patient	Not Available	96.28%	Numerator Not Available · Denominator 14 · Too few residents or stays to report publicly.
Resident COVID-19 vaccinations up to date	48.15%	25.2% 22.9 pts better	Numerator 13 · Denominator 27

Quality measures

Resident outcomes and process scores

Measure	Facility	State	National	Note
Number of hospitalizations per 1000 long-stay resident days	2.7	1.9 0.8 pts worse	1.9 0.8 pts worse	Long Stay · 20240701-20250630 · Adjusted 2.7 · Observed 2.2 · Expected 1.5 · Used in QM five-star
Number of outpatient emergency department visits per 1000 long-stay resident days	1.6	2.2 0.6 pts better	1.8 0.2 pts better	Long Stay · 20240701-20250630 · Adjusted 1.6 · Observed 1.5 · Expected 1.5 · Used in QM five-star
Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine	98.8%	94.3% 4.5 pts better	93.4% 5.4 pts better	Long Stay · 2024Q4-2025Q3 · Q1 100.0% · Q2 99.0% · Q3 98.1% · Q4 98.0% · 4Q avg 98.8%
Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine	95.5%	96.2% 0.7 pts worse	95.5% About the same	Long Stay · 2024Q3-2025Q2 · 4Q avg 95.5%
Percentage of long-stay residents experiencing one or more falls with major injury	4.4%	3.8% 0.6 pts worse	3.3% 1.1 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 5.8% · Q2 4.9% · Q3 3.9% · Q4 3.1% · 4Q avg 4.4% · Used in QM five-star
Percentage of long-stay residents who have depressive symptoms	21.4%	15.2% 6.2 pts worse	11.4% 10 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 35.1% · Q2 24.2% · Q3 12.5% · Q4 13.1% · 4Q avg 21.4%
Percentage of long-stay residents who lose too much weight	4.6%	6.7% 2.1 pts better	5.4% 0.8 pts better	Long Stay · 2024Q4-2025Q3 · Q1 1.1% · Q2 2.1% · Q3 2.2% · Q4 13.2% · 4Q avg 4.6%
Percentage of long-stay residents who received an antianxiety or hypnotic medication	44.0%	29.6% 14.4 pts worse	19.6% 24.4 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 46.9% · Q2 43.9% · Q3 44.2% · Q4 40.9% · 4Q avg 44.0%
Percentage of long-stay residents who received an antipsychotic medication	11.2%	17.6% 6.4 pts better	16.7% 5.5 pts better	Long Stay · 2024Q4-2025Q3 · Q1 19.4% · Q2 12.5% · Q3 6.9% · Q4 5.8% · 4Q avg 11.2% · Used in QM five-star
Percentage of long-stay residents who were physically restrained	0.0%	0.2% 0.2 pts better	0.1% 0.1 pts better	Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0%
Percentage of long-stay residents whose ability to walk independently worsened	9.7%	17.3% 7.6 pts better	16.3% 6.6 pts better	Long Stay · 2024Q4-2025Q3 · Q1 16.9% · Q2 8.5% · Q3 6.3% · Q4 6.1% · 4Q avg 9.7% · Used in QM five-star
Percentage of long-stay residents whose need for help with daily activities has increased	7.4%	15.6% 8.2 pts better	14.9% 7.5 pts better	Long Stay · 2024Q4-2025Q3 · Q1 9.5% · Q2 5.7% · Q3 4.8% · Q4 9.8% · 4Q avg 7.4% · Used in QM five-star
Percentage of long-stay residents with a catheter inserted and left in their bladder	0.3%	0.7% 0.4 pts better	1.0% 0.7 pts better	Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 1.0% · Q4 0.0% · 4Q avg 0.3% · Used in QM five-star
Percentage of long-stay residents with a urinary tract infection	0.5%	1.7% 1.2 pts better	1.7% 1.2 pts better	Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 2.0% · Q4 0.0% · 4Q avg 0.5% · Used in QM five-star
Percentage of long-stay residents with new or worsened bowel or bladder incontinence	18.0%	19.8% 1.8 pts better	19.8% 1.8 pts better	Long Stay · 2024Q4-2025Q3 · Q1 22.5% · Q2 15.9% · Q3 15.1% · Q4 18.2% · 4Q avg 18.0%
Percentage of long-stay residents with pressure ulcers	3.6%	5.5% 1.9 pts better	5.1% 1.5 pts better	Long Stay · 2024Q4-2025Q3 · Q1 3.8% · Q2 1.9% · Q3 3.5% · Q4 5.5% · 4Q avg 3.6% · Used in QM five-star
Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine	83.6%	83.8% 0.2 pts worse	81.7% 1.9 pts better	Short Stay · 2024Q4-2025Q3 · Q1 86.4% · Q2 83.3% · Q3 81.2% · Q4 84.1% · 4Q avg 83.6%
Percentage of short-stay residents who had an outpatient emergency department visit	15.9%	13.9% 2 pts worse	12.0% 3.9 pts worse	Short Stay · 20240701-20250630 · Adjusted 15.9% · Observed 18.3% · Expected 12.9% · Used in QM five-star
Percentage of short-stay residents who newly received an antipsychotic medication	0.0%	1.8% 1.8 pts better	1.6% 1.6 pts better	Short Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% · Used in QM five-star
Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine	80.4%	83.6% 3.2 pts worse	79.7% 0.7 pts better	Short Stay · 2024Q3-2025Q2 · 4Q avg 80.4%
Percentage of short-stay residents who were rehospitalized after a nursing home admission	17.2%	24.5% 7.3 pts better	23.9% 6.7 pts better	Short Stay · 20240701-20250630 · Adjusted 17.2% · Observed 20.0% · Expected 27.8% · Used in QM five-star

Survey summary

Recent inspection cycles

Cycle 1 Health 2025-08-29 · Fire 2025-08-29

5 health deficiencies

Top issue: Freedom from Abuse and Neglect and Exploitation (2 deficiencies)

3 fire-safety deficiencies

Top issue: Miscellaneous (2 deficiencies)

Cycle 2 Health 2023-07-17 · Fire 2023-07-17

10 health deficiencies

Top issue: Freedom from Abuse and Neglect and Exploitation (2 deficiencies)

8 fire-safety deficiencies

Top issue: Gas and Vacuum and Electrical Systems (3 deficiencies)

Cycle 3 Health 2019-11-07 · Fire 2019-11-07

3 health deficiencies

Top issue: Freedom from Abuse and Neglect and Exploitation (1 deficiency)

6 fire-safety deficiencies

Top issue: Egress (2 deficiencies)

Fire safety

Fire-safety citations

D · Potential for more than minimal harm 2025-08-29

K712 · Miscellaneous Deficiencies

Fire Safety

Have simulated fire drills held at unexpected times.

Corrected 2025-09-06

D · Potential for more than minimal harm 2025-08-29

K781 · Miscellaneous Deficiencies

Fire Safety

Have restrictions on the use of portable space heaters.

Corrected 2025-09-06

D · Potential for more than minimal harm 2025-08-29

K920 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Ensure proper usage of power strips and extension cords.

Corrected 2025-09-06

F · Potential for more than minimal harm 2023-07-17

K712 · Miscellaneous Deficiencies

Fire Safety

Have simulated fire drills held at unexpected times.

Corrected 2023-08-06

F · Potential for more than minimal harm 2023-07-17

K918 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

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

Corrected 2023-08-06

F · Potential for more than minimal harm 2023-07-17

K920 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Ensure proper usage of power strips and extension cords.

Corrected 2023-08-06

E · Potential for more than minimal harm 2023-07-17

K321 · Smoke Deficiencies

Fire Safety

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

Corrected 2023-08-06

E · Potential for more than minimal harm 2023-07-17

K363 · Smoke Deficiencies

Fire Safety

Install corridor and hallway doors that block smoke.

Corrected 2023-08-06

E · Potential for more than minimal harm 2023-07-17

K372 · Smoke Deficiencies

Fire Safety

Ensure smoke barriers are constructed to a 1 hour fire resistance rating.

Corrected 2023-08-06

E · Potential for more than minimal harm 2023-07-17

K923 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Have proper medical gas storage and administration areas.

Corrected 2023-08-06

D · Potential for more than minimal harm 2023-07-17

K222 · Egress Deficiencies

Fire Safety

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 2023-08-06

F · Potential for more than minimal harm 2019-11-07

K353 · Smoke Deficiencies

Fire Safety

Inspect, test, and maintain automatic sprinkler systems.

Corrected 2019-12-06

D · Potential for more than minimal harm 2019-11-07

K222 · Egress Deficiencies

Fire Safety

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 2019-12-06

D · Potential for more than minimal harm 2019-11-07

K232 · Egress Deficiencies

Fire Safety

Have corridors or aisles that are unobstructed and are at least 8 feet in width.

Corrected 2019-12-06

D · Potential for more than minimal harm 2019-11-07

K321 · Smoke Deficiencies

Fire Safety

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

Corrected 2019-12-06

D · Potential for more than minimal harm 2019-11-07

K741 · Miscellaneous Deficiencies

Fire Safety

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

Corrected 2019-12-06

D · Potential for more than minimal harm 2019-11-07

K781 · Miscellaneous Deficiencies

Fire Safety

Have restrictions on the use of portable space heaters.

Corrected 2019-12-06

Inspection history

Recent health citations

G · Actual harm 2025-08-29

F600 · Freedom from Abuse, Neglect, and Exploitation Deficiencies

Health

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

Corrected 2025-09-12

G · Actual harm 2025-08-29

F609 · Freedom from Abuse, Neglect, and Exploitation Deficiencies

Health

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

Corrected 2025-09-12

F · Potential for more than minimal harm 2025-08-29

F812 · Nutrition and Dietary Deficiencies

Health

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

Corrected 2025-09-12

D · Potential for more than minimal harm 2025-08-29

F658 · Resident Assessment and Care Planning Deficiencies

Health

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

Corrected 2025-09-12

D · Potential for more than minimal harm 2025-08-29

F880 · Infection Control Deficiencies

Health

Provide and implement an infection prevention and control program.

Corrected 2025-09-12

K · Immediate jeopardy 2023-07-17

F584 · Resident Rights Deficiencies

Health

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 2023-08-06

K · Immediate jeopardy 2023-07-17

F689 · Quality of Life and Care Deficiencies

Health

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

Corrected 2023-08-06

E · Potential for more than minimal harm 2023-07-17

F600 · Freedom from Abuse, Neglect, and Exploitation Deficiencies

Health

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

Corrected 2023-08-08

E · Potential for more than minimal harm 2023-07-17

F759 · Pharmacy Service Deficiencies

Health

Ensure medication error rates are not 5 percent or greater.

Corrected 2023-08-08

E · Potential for more than minimal harm 2023-07-17

F812 · Nutrition and Dietary Deficiencies

Health

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

Corrected 2023-08-06

D · Potential for more than minimal harm 2023-07-17

F602 · Freedom from Abuse, Neglect, and Exploitation Deficiencies

Health

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

Corrected 2023-08-08

D · Potential for more than minimal harm 2023-07-17

F606 · Freedom from Abuse, Neglect, and Exploitation Deficiencies

Health

Not hire anyone with a finding of abuse, neglect, exploitation, or theft.

Corrected 2023-08-06

D · Potential for more than minimal harm 2023-07-17

F656 · Resident Assessment and Care Planning Deficiencies

Health

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

Corrected 2023-08-10

D · Potential for more than minimal harm 2023-07-17

F657 · Resident Assessment and Care Planning Deficiencies

Health

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

Corrected 2023-08-06

D · Potential for more than minimal harm 2023-07-17

F761 · Pharmacy Service Deficiencies

Health

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 2023-08-06

D · Potential for more than minimal harm 2023-07-17

F806 · Nutrition and Dietary Deficiencies

Health

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

Corrected 2023-08-08

D · Potential for more than minimal harm 2023-07-17

F880 · Infection Control Deficiencies

Health

Provide and implement an infection prevention and control program.

Corrected 2023-08-10

D · Potential for more than minimal harm 2019-11-07

F761 · Pharmacy Service Deficiencies

Health

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 2019-12-14

Penalties and ownership

What sits behind the stars

$87,165 2023-07-17

Fine

Fine · fine $87,165

Fine

Ownership

Carter Nursing And Rehabilitation Holdings LLC

5% Or Greater Direct Ownership Interest · Organization

100% 1 facilities 2019-07-25

Marx, David

5% Or Greater Indirect Ownership Interest · Individual

100% 30 facilities 2019-07-25

250 Mcdavid Blvd SNF Realty LLC

Operational/Managerial Control · Organization

0% 1 facilities 2019-09-01

Alexander, James