Cycle 1
Health 2025-04-10 · Fire 2025-04-10
4 health deficiencies
Top issue: Nutrition and Dietary (1 deficiency)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Hilton Head Island, SC
Fraser Health Center
5-star overall rating with 3-star inspections with 4 recent health deficiencies
300 Wood Haven Drive, Hilton Head Island, SC
(843) 842-3747
Overall
5 / 5
CMS overall stars
Health inspections
3 / 5
Survey and complaint cycles
Staffing
5 / 5
RN + nurse staffing
Quality measures
5 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
33
Certified beds
Average residents
26
Average occupied residents
Ownership
Non-Profit
Publicly displayed owner type
Chain
No chain reported
Operator or chain grouping
Approved since
1983-11-23
CMS approved date
Coverage
Medicare
Participation flags
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
1.19
Registered nurse staffing · state 0.63 · national 0.68
LPN hours / resident day
1.04
Licensed practical nurse staffing · state 1.01 · national 0.87
Aide hours / resident day
2.95
Nurse aide staffing · state 2.22 · national 2.35
Total nurse hours
5.17
All reported nurse hours · state 3.86 · national 3.89
Licensed hours
2.22
RN + LPN hours · state 1.65 · national 1.54
Weekend hours
4.48
Weekend nurse staffing · state 3.34 · national 3.43
Weekend RN hours
0.78
Weekend registered nurse coverage · state 0.40 · national 0.47
Physical therapist
0.17
Reported PT staffing · state 0.09 · national 0.07
Adjusted RN hours
1.35
CMS adjusted RN staffing hours
Adjusted total hours
5.90
CMS adjusted total nurse staffing hours
Case-mix index
1.20
Higher values indicate more complex resident acuity
RN turnover
36%
Annual RN turnover · state 44% · national 45%
Total nurse turnover
17%
Annual nurse turnover · state 47% · national 46%
SNF VBP
Value-based purchasing
Program rank
1,254
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
58.36
Composite VBP score used to determine payment impact.
Payment multiplier
1.0136
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
3.17
Baseline 21.60% · Performance 19.96% · Measure score 3.17 · Achievement 3.17 · Improvement 3.09
Healthcare-associated infections
6.34
Baseline 7.33% · Performance 5.94% · Measure score 6.34 · Achievement 6.34 · Improvement 5.45
Total nurse turnover
Not reported
This facility did not meet this measure's case minimum policy requirement and therefore no measure data is publicly reported.
Adjusted total nurse staffing
7.99
Performance 5.35 hours · Measure score 7.99 · Achievement 7.99 · This facility did not have sufficient data to calculate a baseline period measure result.
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 10.13% |
10.72%
0.6 pts better
|
No Different than the National Rate · Eligible stays 120 · Observed rate 7.5% · Lower 95% interval 6.72% |
| Discharge to community | 64.97% |
50.57%
14.4 pts better
|
Better than the National Rate · Eligible stays 113 · Observed rate 63.72% · Lower 95% interval 57.28% |
| Medicare spending per beneficiary | 0.89 |
1.02
0.1 pts better
|
|
| Drug regimen review with follow-up | 98.33% |
95.27%
3.1 pts better
|
Numerator 59 · Denominator 60 |
| Falls with major injury | 1.67% |
0.77%
0.9 pts worse
|
Numerator 1 · Denominator 60 |
| Discharge self-care score | 86.79% |
53.69%
33.1 pts better
|
Numerator 46 · Denominator 53 |
| Discharge mobility score | 83.02% |
50.94%
32.1 pts better
|
Numerator 44 · Denominator 53 |
| Pressure ulcers or injuries, new or worsened | 1.67% |
2.29%
0.6 pts better
|
Numerator 1 · Denominator 60 · Adjusted rate 2.14% |
| Healthcare-associated infections requiring hospitalization | 5.94% |
7.12%
1.2 pts better
|
No Different than the National Rate · Eligible stays 62 · Observed rate 1.61% · Lower 95% interval 2.94% |
| Staff COVID-19 vaccination coverage | 11.86% |
8.2%
3.7 pts better
|
Numerator 7 · Denominator 59 |
| Staff flu vaccination coverage | 28.33% |
42%
13.7 pts worse
|
Numerator 17 · Denominator 60 |
| Discharge function score | 84.91% |
56.45%
28.5 pts better
|
Numerator 45 · Denominator 53 |
| Transfer of health information to provider | Not Available |
95.95%
|
Numerator Not Available · Denominator 6 · Too few residents or stays to report publicly. |
| Transfer of health information to patient | 100% |
96.28%
3.7 pts better
|
Numerator 41 · Denominator 41 |
| Resident COVID-19 vaccinations up to date | 34.38% |
25.2%
9.2 pts better
|
Numerator 11 · Denominator 32 |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 1.6 |
2.0
0.4 pts better
|
1.9
0.3 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.6 · Observed 0.9 · Expected 1.1 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 2.5 |
1.9
0.6 pts worse
|
1.8
0.7 pts worse
|
Long Stay · 20240701-20250630 · Adjusted 2.5 · Observed 1.6 · Expected 1.1 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 100.0% |
90.5%
9.5 pts better
|
93.4%
6.6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q3 100.0% · 4Q avg 100.0% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 0.0% |
3.0%
3 pts better
|
3.3%
3.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q3 0.0% · 4Q avg 0.0% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 0.0% |
2.9%
2.9 pts better
|
11.4%
11.4 pts better
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 0.0% |
| Percentage of long-stay residents who lose too much weight | 2.8% |
6.2%
3.4 pts better
|
5.4%
2.6 pts better
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 2.8% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 13.2% |
20.4%
7.2 pts better
|
19.6%
6.4 pts better
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 13.2% |
| Percentage of long-stay residents who received an antipsychotic medication | 0.0% |
16.3%
16.3 pts better
|
16.7%
16.7 pts better
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 0.0% · 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 · Q3 0.0% · 4Q avg 0.0% |
| Percentage of long-stay residents whose need for help with daily activities has increased | 2.7% |
12.4%
9.7 pts better
|
14.9%
12.2 pts better
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 2.7% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 0.0% |
0.7%
0.7 pts better
|
1.0%
1 pts better
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 0.0% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 0.0% |
1.6%
1.6 pts better
|
1.7%
1.7 pts better
|
Long Stay · 2024Q4-2025Q3 · Q3 0.0% · 4Q avg 0.0% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 33.0% |
17.2%
15.8 pts worse
|
19.8%
13.2 pts worse
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 33.0% |
| Percentage of long-stay residents with pressure ulcers | 4.6% |
5.8%
1.2 pts better
|
5.1%
0.5 pts better
|
Long Stay · 2024Q4-2025Q3 · Q3 10.9% · 4Q avg 4.6% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 92.0% |
79.8%
12.2 pts better
|
81.7%
10.3 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 93.2% · Q2 94.2% · Q3 88.6% · Q4 91.7% · 4Q avg 92.0% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 11.8% |
14.1%
2.3 pts better
|
12.0%
0.2 pts better
|
Short Stay · 20240701-20250630 · Adjusted 11.8% · Observed 9.8% · Expected 9.3% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 0.9% |
1.6%
0.7 pts better
|
1.6%
0.7 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 3.2% · 4Q avg 0.9% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 92.2% |
78.0%
14.2 pts better
|
79.7%
12.5 pts better
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 92.2% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 20.3% |
24.7%
4.4 pts better
|
23.9%
3.6 pts better
|
Short Stay · 20240701-20250630 · Adjusted 20.3% · Observed 13.7% · Expected 16.1% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2023-07-27 · Fire 2023-07-27
2 health deficiencies
Top issue: Nutrition and Dietary (1 deficiency)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Cycle 3
Health 2021-10-13 · Fire 2021-10-13
0 health deficiencies
No concentrated health issue counts in this cycle.
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Inspection history
Recent health citations
F · Potential for more than minimal harm
2025-04-10
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 2025-05-09
D · Potential for more than minimal harm
2025-04-10
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 2025-05-09
D · Potential for more than minimal harm
2025-04-10
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 2025-05-09
D · Potential for more than minimal harm
2025-04-10
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 2025-05-09
F · Potential for more than minimal harm
2023-07-27
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 2023-08-17
D · Potential for more than minimal harm
2023-07-27
F760 · Pharmacy Service Deficiencies
Health
Ensure that residents are free from significant medication errors.
Corrected 2023-08-17
Penalties and ownership
What sits behind the stars
Ownership
Charlot, Francois
Operational/Managerial Control · Individual
Charlot, Francois
Corporate Officer · Individual
Seabrook Of Hilton Head, Inc
Operational/Managerial Control · Organization
Nearby options
Other facilities in reach
#1
Broad Creek Care Center
Hilton Head Island, SC
5-star overall rating with 5-star inspections
#2
Life Care Center of Hilton Head
Hilton Head Island, SC
2-star overall rating with 1-star inspections with abuse icon flag with $8,281 in total fines with 5 recent health deficiencies
#3
The Preston Health Center
Hilton Head Island, SC
5-star overall rating with 5-star inspections with $8,018 in total fines
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