Louisville, KY

Eastway Health & Rehabilitation

2-star overall rating with 1-star inspections with $13,762 in total fines with 2 recent health deficiencies with 9 fire-safety deficiencies in the latest cycle

1155 Eastern Parkway, Louisville, KY

(502) 636-5241

Compare this facility

Overall

2 / 5

CMS overall stars

Health inspections

1 / 5

Survey and complaint cycles

Staffing

1 / 5

RN + nurse staffing

Quality measures

5 / 5

Resident outcomes and process measures

Quick facts

Facility snapshot

Beds

252

Certified beds

Average residents

172

Average occupied residents

Ownership

For-Profit

Publicly displayed owner type

Chain

Lyon Healthcare

Operator or chain grouping

Approved since

1973-05-14

CMS approved date

Coverage

Medicare + Medicaid

Participation flags

Chain footprint

14 facilities

Chain averages 2 overall / 2 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

0.27

Registered nurse staffing · state 0.77 · national 0.68

LPN hours / resident day

1.01

Licensed practical nurse staffing · state 0.81 · national 0.87

Aide hours / resident day

2.14

Nurse aide staffing · state 2.43 · national 2.35

Total nurse hours

3.41

All reported nurse hours · state 4.01 · national 3.89

Licensed hours

1.27

RN + LPN hours · state 1.58 · national 1.54

Weekend hours

3.02

Weekend nurse staffing · state 3.50 · national 3.43

Weekend RN hours

0.15

Weekend registered nurse coverage · state 0.52 · national 0.47

Physical therapist

0.02

Reported PT staffing · state 0.06 · national 0.07

Adjusted RN hours

0.25

CMS adjusted RN staffing hours

Adjusted total hours

3.16

CMS adjusted total nurse staffing hours

Case-mix index

1.48

Higher values indicate more complex resident acuity

RN turnover

40%

Annual RN turnover · state 43% · national 45%

Total nurse turnover

49%

Annual nurse turnover · state 47% · national 46%

SNF VBP

Value-based purchasing

Program rank

4,583

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

Performance score

39.38

Composite VBP score used to determine payment impact.

Payment multiplier

0.9924

Above 1.000 increases Medicare payment; below 1.000 reduces it.

Program components

How the VBP score is built

Readmission

6.94

Baseline 24.30% · Performance 18.89% · Measure score 6.94 · Achievement 5.48 · Improvement 6.94

Healthcare-associated infections

4.16

Baseline 6.21% · Performance 6.59% · Measure score 4.16 · Achievement 4.16 · Improvement 0

Total nurse turnover

2.78

Baseline 63.68% · Performance 52.33% · Measure score 2.78 · Achievement 2.78 · Improvement 2.42

Adjusted total nurse staffing

1.88

Baseline 3.40 hours · Performance 3.61 hours · Measure score 1.88 · Achievement 1.88 · Improvement 0.39

SNF QRP

Medicare quality reporting measures

Measure Facility National Note
Potentially preventable 30-day readmission 11.41%
10.72%
0.7 pts worse
No Different than the National Rate · Eligible stays 54 · Observed rate 14.81% · Lower 95% interval 7.07%
Discharge to community 51.49%
50.57%
0.9 pts better
No Different than the National Rate · Eligible stays 39 · Observed rate 43.59% · Lower 95% interval 38.62%
Medicare spending per beneficiary 1
1.02
About the same
Drug regimen review with follow-up 100%
95.27%
4.7 pts better
Numerator 31 · Denominator 31
Falls with major injury 0%
0.77%
0.8 pts better
Numerator 0 · Denominator 31
Discharge self-care score 52.17%
53.69%
1.5 pts worse
Numerator 12 · Denominator 23
Discharge mobility score 60.87%
50.94%
9.9 pts better
Numerator 14 · Denominator 23
Pressure ulcers or injuries, new or worsened 6.45%
2.29%
4.2 pts worse
Numerator 2 · Denominator 31 · Adjusted rate 5.35%
Healthcare-associated infections requiring hospitalization 6.59%
7.12%
0.5 pts better
No Different than the National Rate · Eligible stays 28 · Observed rate 3.57% · Lower 95% interval 3.83%
Staff COVID-19 vaccination coverage 1.15%
8.2%
7 pts worse
Numerator 2 · Denominator 174
Staff flu vaccination coverage 12.02%
42%
30 pts worse
Numerator 28 · Denominator 233
Discharge function score 60.87%
56.45%
4.4 pts better
Numerator 14 · Denominator 23
Transfer of health information to provider Not Available
95.95%
Numerator Not Available · Denominator 8 · Too few residents or stays to report publicly.
Transfer of health information to patient Not Available
96.28%
Numerator Not Available · Denominator 17 · Too few residents or stays to report publicly.
Resident COVID-19 vaccinations up to date Not Available
25.2%
Numerator Not Available · Denominator 18 · Too few residents or stays to report publicly.

Quality measures

Resident outcomes and process scores

Measure Facility State National Note
Number of hospitalizations per 1000 long-stay resident days 1.1
1.9
0.8 pts better
1.9
0.8 pts better
Long Stay · 20240701-20250630 · Adjusted 1.1 · Observed 0.8 · Expected 1.4 · Used in QM five-star
Number of outpatient emergency department visits per 1000 long-stay resident days 1.1
2.2
1.1 pts better
1.8
0.7 pts better
Long Stay · 20240701-20250630 · Adjusted 1.1 · Observed 0.9 · Expected 1.3 · Used in QM five-star
Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine 67.7%
94.3%
26.6 pts worse
93.4%
25.7 pts worse
Long Stay · 2024Q4-2025Q3 · Q1 85.2% · Q2 65.4% · Q3 57.1% · Q4 62.6% · 4Q avg 67.7%
Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine 98.8%
96.2%
2.6 pts better
95.5%
3.3 pts better
Long Stay · 2024Q3-2025Q2 · 4Q avg 98.8%
Percentage of long-stay residents experiencing one or more falls with major injury 1.7%
3.8%
2.1 pts better
3.3%
1.6 pts better
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 1.9% · Q3 2.6% · Q4 2.6% · 4Q avg 1.7% · Used in QM five-star
Percentage of long-stay residents who have depressive symptoms 10.2%
15.2%
5 pts better
11.4%
1.2 pts better
Long Stay · 2024Q4-2025Q3 · Q1 17.9% · Q2 2.7% · Q3 7.7% · Q4 12.1% · 4Q avg 10.2%
Percentage of long-stay residents who lose too much weight 4.7%
6.7%
2 pts better
5.4%
0.7 pts better
Long Stay · 2024Q4-2025Q3 · Q1 5.2% · Q2 2.7% · Q3 6.7% · Q4 4.1% · 4Q avg 4.7%
Percentage of long-stay residents who received an antianxiety or hypnotic medication 25.9%
29.6%
3.7 pts better
19.6%
6.3 pts worse
Long Stay · 2024Q4-2025Q3 · Q1 25.8% · Q2 22.8% · Q3 28.0% · Q4 27.0% · 4Q avg 25.9%
Percentage of long-stay residents who received an antipsychotic medication 16.2%
17.6%
1.4 pts better
16.7%
0.5 pts better
Long Stay · 2024Q4-2025Q3 · Q1 15.8% · Q2 16.2% · Q3 17.3% · Q4 15.5% · 4Q avg 16.2% · 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 12.9%
17.3%
4.4 pts better
16.3%
3.4 pts better
Long Stay · 2024Q4-2025Q3 · Q1 4.9% · Q2 23.3% · Q3 14.5% · Q4 8.5% · 4Q avg 12.9% · Used in QM five-star
Percentage of long-stay residents whose need for help with daily activities has increased 6.9%
15.6%
8.7 pts better
14.9%
8 pts better
Long Stay · 2024Q4-2025Q3 · Q1 7.2% · Q2 8.2% · Q3 6.0% · Q4 6.1% · 4Q avg 6.9% · Used in QM five-star
Percentage of long-stay residents with a catheter inserted and left in their bladder 0.1%
0.7%
0.6 pts better
1.0%
0.9 pts better
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.4% · Q4 0.0% · 4Q avg 0.1% · Used in QM five-star
Percentage of long-stay residents with a urinary tract infection 1.0%
1.7%
0.7 pts better
1.7%
0.7 pts better
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 1.3% · Q3 1.3% · Q4 1.3% · 4Q avg 1.0% · Used in QM five-star
Percentage of long-stay residents with new or worsened bowel or bladder incontinence 14.2%
19.8%
5.6 pts better
19.8%
5.6 pts better
Long Stay · 2024Q4-2025Q3 · Q1 15.8% · Q2 14.7% · Q3 16.1% · Q4 9.9% · 4Q avg 14.2%
Percentage of long-stay residents with pressure ulcers 4.9%
5.5%
0.6 pts better
5.1%
0.2 pts better
Long Stay · 2024Q4-2025Q3 · Q1 3.8% · Q2 5.7% · Q3 5.0% · Q4 5.0% · 4Q avg 4.9% · Used in QM five-star
Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine 51.8%
83.8%
32 pts worse
81.7%
29.9 pts worse
Short Stay · 2024Q4-2025Q3 · Q1 67.9% · Q2 65.3% · Q3 42.0% · Q4 33.6% · 4Q avg 51.8%
Percentage of short-stay residents who had an outpatient emergency department visit 11.0%
13.9%
2.9 pts better
12.0%
1 pts better
Short Stay · 20240701-20250630 · Adjusted 11.0% · Observed 11.1% · Expected 11.2% · Used in QM five-star
Percentage of short-stay residents who newly received an antipsychotic medication 2.8%
1.8%
1 pts worse
1.6%
1.2 pts worse
Short Stay · 2024Q4-2025Q3 · Q1 1.3% · Q2 1.7% · Q3 2.7% · Q4 5.3% · 4Q avg 2.8% · Used in QM five-star
Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine 62.7%
83.6%
20.9 pts worse
79.7%
17 pts worse
Short Stay · 2024Q3-2025Q2 · 4Q avg 62.7%
Percentage of short-stay residents who were rehospitalized after a nursing home admission 18.1%
24.5%
6.4 pts better
23.9%
5.8 pts better
Short Stay · 20240701-20250630 · Adjusted 18.1% · Observed 18.5% · Expected 24.4% · Used in QM five-star

Survey summary

Recent inspection cycles

Cycle 1 Health 2024-07-12 · Fire 2024-07-12

2 health deficiencies

Top issue: Infection Control (1 deficiency)

9 fire-safety deficiencies

Top issue: Gas and Vacuum and Electrical Systems (4 deficiencies)

Cycle 2 Health 2021-07-03 · Fire 2021-07-03

29 health deficiencies

Top issue: Resident Rights (6 deficiencies)

0 fire-safety deficiencies

No concentrated fire-safety issue counts in this cycle.

Cycle 3 Health 2019-12-06 · Fire 2019-12-06

8 health deficiencies

Top issue: Resident Assessment and Care Planning (2 deficiencies)

7 fire-safety deficiencies

Top issue: Smoke (4 deficiencies)

Fire safety

Fire-safety citations

F · Potential for more than minimal harm 2024-07-12

K918 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

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

Corrected 2024-08-19

F · Potential for more than minimal harm 2024-07-12

K921 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Ensure that testing and maintenance of electrical equipment is performed.

Corrected 2024-08-19

E · Potential for more than minimal harm 2024-07-12

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 2024-08-19

E · Potential for more than minimal harm 2024-07-12

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 2024-08-19

E · Potential for more than minimal harm 2024-07-12

K351 · Smoke Deficiencies

Fire Safety

Install an approved automatic sprinkler system.

Corrected 2024-08-19

E · Potential for more than minimal harm 2024-07-12

K372 · Smoke Deficiencies

Fire Safety

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

Corrected 2024-08-19

E · Potential for more than minimal harm 2024-07-12

K374 · Smoke Deficiencies

Fire Safety

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

Corrected 2024-08-19

E · Potential for more than minimal harm 2024-07-12

K912 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Have power receptacles that are properly grounded.

Corrected 2024-08-19

E · Potential for more than minimal harm 2024-07-12

K923 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Have proper medical gas storage and administration areas.

Corrected 2024-08-19

F · Potential for more than minimal harm 2019-12-06

K353 · Smoke Deficiencies

Fire Safety

Inspect, test, and maintain automatic sprinkler systems.

Corrected 2020-02-06

D · Potential for more than minimal harm 2019-12-06

K225 · Egress Deficiencies

Fire Safety

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

Corrected 2020-02-06

D · Potential for more than minimal harm 2019-12-06

K232 · Egress Deficiencies

Fire Safety

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

Corrected 2020-02-06

D · Potential for more than minimal harm 2019-12-06

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 2020-02-06

D · Potential for more than minimal harm 2019-12-06

K363 · Smoke Deficiencies

Fire Safety

Install corridor and hallway doors that block smoke.

Corrected 2020-02-06

D · Potential for more than minimal harm 2019-12-06

K374 · Smoke Deficiencies

Fire Safety

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

Corrected 2020-02-06

D · Potential for more than minimal harm 2019-12-06

K921 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Ensure that testing and maintenance of electrical equipment is performed.

Corrected 2020-02-06

Inspection history

Recent health citations

F · Potential for more than minimal harm 2024-07-12

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 2024-08-19

F · Potential for more than minimal harm 2024-07-12

F880 · Infection Control Deficiencies

Health

Provide and implement an infection prevention and control program.

Corrected 2024-08-19

J · Immediate jeopardy 2021-07-03

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 2021-09-21

J · Immediate jeopardy 2021-07-03

F607 · Freedom from Abuse, Neglect, and Exploitation Deficiencies

Health

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

Corrected 2021-09-21

J · Immediate jeopardy 2021-07-03

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 2021-11-24

J · Immediate jeopardy 2021-07-03

F745 · Quality of Life and Care Deficiencies

Health

Provide medically-related social services to help each resident achieve the highest possible quality of life.

Corrected 2021-09-21

J · Immediate jeopardy 2021-07-03

F835 · Administration Deficiencies

Health

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

Corrected 2021-12-17

G · Actual harm 2021-07-03

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 2021-09-21

G · Actual harm 2021-07-03

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 2021-11-24

G · Actual harm 2021-07-03

F697 · Quality of Life and Care Deficiencies

Health

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

Corrected 2021-09-21

F · Potential for more than minimal harm 2021-07-03

F802 · Nutrition and Dietary Deficiencies

Health

Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service.

Corrected 2021-09-21

F · Potential for more than minimal harm 2021-07-03

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 2021-09-21

F · Potential for more than minimal harm 2021-07-03

F837 · Administration Deficiencies

Health

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 2021-09-21

F · Potential for more than minimal harm 2021-07-03

F867 · Administration Deficiencies

Health

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

Corrected 2021-12-17

E · Potential for more than minimal harm 2021-07-03

F561 · Resident Rights Deficiencies

Health

Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.

Corrected 2021-09-21

E · Potential for more than minimal harm 2021-07-03

F565 · Resident Rights Deficiencies

Health

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

Corrected 2021-09-21

E · Potential for more than minimal harm 2021-07-03

F583 · Resident Rights Deficiencies

Health

Keep residents' personal and medical records private and confidential.

Corrected 2021-09-21

E · Potential for more than minimal harm 2021-07-03

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 2021-09-21

E · Potential for more than minimal harm 2021-07-03

F755 · Pharmacy Service Deficiencies

Health

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

Corrected 2021-09-21

E · Potential for more than minimal harm 2021-07-03

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 2021-09-21

E · Potential for more than minimal harm 2021-07-03

F803 · Nutrition and Dietary Deficiencies

Health

Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.

Corrected 2021-09-21

E · Potential for more than minimal harm 2021-07-03

F880 · Infection Control Deficiencies

Health

Provide and implement an infection prevention and control program.

Corrected 2021-09-21

D · Potential for more than minimal harm 2021-07-03

F550 · Resident Rights Deficiencies

Health

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

Corrected 2021-09-21

D · Potential for more than minimal harm 2021-07-03

F580 · Resident Rights Deficiencies

Health

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

Corrected 2021-11-24

D · Potential for more than minimal harm 2021-07-03

F610 · Freedom from Abuse, Neglect, and Exploitation Deficiencies

Health

Respond appropriately to all alleged violations.

Corrected 2021-09-21

D · Potential for more than minimal harm 2021-07-03

F641 · Resident Assessment and Care Planning Deficiencies

Health

Ensure each resident receives an accurate assessment.

Corrected 2021-09-21

D · Potential for more than minimal harm 2021-07-03

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 2021-09-21

D · Potential for more than minimal harm 2021-07-03

F684 · Quality of Life and Care Deficiencies

Health

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

Corrected 2021-09-21

D · Potential for more than minimal harm 2021-07-03

F726 · Nursing and Physician Services Deficiencies

Health

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 2021-09-21

D · Potential for more than minimal harm 2021-07-03

F759 · Pharmacy Service Deficiencies

Health

Ensure medication error rates are not 5 percent or greater.

Corrected 2021-09-21

D · Potential for more than minimal harm 2021-07-03

F791 · Quality of Life and Care Deficiencies

Health

Provide or obtain dental services for each resident.

Corrected 2021-09-21

G · Actual harm 2019-12-06

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 2020-02-24

G · Actual harm 2019-12-06

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 2020-02-24

E · Potential for more than minimal harm 2019-12-06

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 2020-02-06

E · Potential for more than minimal harm 2019-12-06

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 2020-02-06

E · Potential for more than minimal harm 2019-12-06

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 2020-02-06

D · Potential for more than minimal harm 2019-12-06

F625 · Resident Rights Deficiencies

Health

Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.

Corrected 2020-02-06

D · Potential for more than minimal harm 2019-12-06

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 2020-02-06

D · Potential for more than minimal harm 2019-12-06

F880 · Infection Control Deficiencies

Health

Provide and implement an infection prevention and control program.

Corrected 2020-02-06

Penalties and ownership

What sits behind the stars

$13,762 2023-07-17

Fine

Fine · fine $13,762

Fine

Ownership

A&M Healthcare Investments LLC

5% Or Greater Direct Ownership Interest · Organization

100% 5 facilities 2017-09-01
Meisels, Joseph

5% Or Greater Indirect Ownership Interest · Individual

23% 10 facilities 2017-09-01
Monagham, Peter

W-2 Managing Employee · Individual

0% 1 facilities 2022-05-02

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#2

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2-star overall rating with 2-star inspections with $17,523 in total fines with 7 recent health deficiencies with 6 fire-safety deficiencies in the latest cycle

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Staffing
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Fines
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#3

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Overall
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Health
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Staffing
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Fines
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