Cycle 1
Health 2025-12-10 · Fire 2025-12-10
1 health deficiencies
Top issue: Nutrition and Dietary (1 deficiency)
14 fire-safety deficiencies
Top issue: Emergency Preparedness (7 deficiencies)
Daytona Beach, FL
Gardens Healthcare & Rehabilitation Center
5-star overall rating with 4-star inspections with $8,512 in total fines with 1 recent health deficiencies with 14 fire-safety deficiencies in the latest cycle
1704 Huntington Village Circle, Daytona Beach, FL
(386) 255-6571
Overall
5 / 5
CMS overall stars
Health inspections
4 / 5
Survey and complaint cycles
Staffing
2 / 5
RN + nurse staffing
Quality measures
5 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
108
Certified beds
Average residents
102
Average occupied residents
Ownership
For-Profit
Publicly displayed owner type
Chain
Gold Fl Trust Ii
Operator or chain grouping
Approved since
1993-07-14
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Chain footprint
46 facilities
Chain averages 3 overall / 3 health / 3 staffing / 5 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
0.40
Registered nurse staffing · state 0.73 · national 0.68
LPN hours / resident day
1.01
Licensed practical nurse staffing · state 0.79 · national 0.87
Aide hours / resident day
2.32
Nurse aide staffing · state 2.34 · national 2.35
Total nurse hours
3.73
All reported nurse hours · state 3.86 · national 3.89
Licensed hours
1.41
RN + LPN hours · state 1.52 · national 1.54
Weekend hours
3.38
Weekend nurse staffing · state 3.51 · national 3.43
Weekend RN hours
0.32
Weekend registered nurse coverage · state 0.53 · national 0.47
Physical therapist
0.13
Reported PT staffing · state 0.10 · national 0.07
Adjusted RN hours
0.37
CMS adjusted RN staffing hours
Adjusted total hours
3.48
CMS adjusted total nurse staffing hours
Case-mix index
1.47
Higher values indicate more complex resident acuity
RN turnover
53%
Annual RN turnover · state 46% · national 45%
Total nurse turnover
52%
Annual nurse turnover · state 42% · national 46%
SNF VBP
Value-based purchasing
Program rank
12,464
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
12.13
Composite VBP score used to determine payment impact.
Payment multiplier
0.9811
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
1.13
Baseline 21.88% · Performance 21.09% · Measure score 1.13 · Achievement 0.74 · Improvement 1.13
Healthcare-associated infections
0
Baseline 6.83% · Performance 8.56% · Measure score 0 · Achievement 0 · Improvement 0
Total nurse turnover
2.54
Baseline 66.39% · Performance 53.78% · Measure score 2.54 · Achievement 2.42 · Improvement 2.54
Adjusted total nurse staffing
1.19
Baseline 3.74 hours · Performance 3.42 hours · Measure score 1.19 · Achievement 1.19 · Improvement 0
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 11.42% |
10.72%
0.7 pts worse
|
No Different than the National Rate · Eligible stays 388 · Observed rate 12.37% · Lower 95% interval 9.13% |
| Discharge to community | 57.78% |
50.57%
7.2 pts better
|
Better than the National Rate · Eligible stays 348 · Observed rate 50.57% · Lower 95% interval 52.74% |
| Medicare spending per beneficiary | 1.04 |
1.02
About the same
|
|
| Drug regimen review with follow-up | 100% |
95.27%
4.7 pts better
|
Numerator 362 · Denominator 362 |
| Falls with major injury | 0.28% |
0.77%
0.5 pts better
|
Numerator 1 · Denominator 362 |
| Discharge self-care score | 53.49% |
53.69%
0.2 pts worse
|
Numerator 115 · Denominator 215 |
| Discharge mobility score | 29.3% |
50.94%
21.6 pts worse
|
Numerator 63 · Denominator 215 |
| Pressure ulcers or injuries, new or worsened | 1.1% |
2.29%
1.2 pts better
|
Numerator 4 · Denominator 362 · Adjusted rate 0.99% |
| Healthcare-associated infections requiring hospitalization | 8.56% |
7.12%
1.4 pts worse
|
No Different than the National Rate · Eligible stays 253 · Observed rate 9.88% · Lower 95% interval 6.12% |
| Staff COVID-19 vaccination coverage | 0% |
8.2%
8.2 pts worse
|
Numerator 0 · Denominator 162 |
| Staff flu vaccination coverage | 34.81% |
42%
7.2 pts worse
|
Numerator 63 · Denominator 181 |
| Discharge function score | 38.14% |
56.45%
18.3 pts worse
|
Numerator 82 · Denominator 215 |
| Transfer of health information to provider | 99.65% |
95.95%
3.7 pts better
|
Numerator 286 · Denominator 287 |
| 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 | 5.43% |
25.2%
19.8 pts worse
|
Numerator 10 · Denominator 184 |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 1.4 |
2.1
0.7 pts better
|
1.9
0.5 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.4 · Observed 1.5 · Expected 2.1 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 0.9 |
1.2
0.3 pts better
|
1.8
0.9 pts better
|
Long Stay · 20240701-20250630 · Adjusted 0.9 · Observed 0.8 · Expected 1.6 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 100.0% |
97.8%
2.2 pts better
|
93.4%
6.6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 100.0% · Q2 100.0% · Q3 100.0% · Q4 100.0% · 4Q avg 100.0% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 100.0% |
99.2%
0.8 pts better
|
95.5%
4.5 pts better
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 100.0% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 0.7% |
2.6%
1.9 pts better
|
3.3%
2.6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 1.5% · Q2 1.5% · Q3 0.0% · Q4 0.0% · 4Q avg 0.7% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 14.0% |
3.7%
10.3 pts worse
|
11.4%
2.6 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 8.3% · Q2 44.3% · Q3 4.5% · Q4 0.0% · 4Q avg 14.0% |
| Percentage of long-stay residents who lose too much weight | 1.4% |
5.9%
4.5 pts better
|
5.4%
4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 2.0% · Q2 3.8% · Q3 0.0% · Q4 0.0% · 4Q avg 1.4% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 21.3% |
15.7%
5.6 pts worse
|
19.6%
1.7 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 26.4% · Q2 26.4% · Q3 19.0% · Q4 14.3% · 4Q avg 21.3% |
| Percentage of long-stay residents who received an antipsychotic medication | 7.8% |
9.8%
2 pts better
|
16.7%
8.9 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 8.5% · Q2 6.7% · Q3 7.8% · Q4 8.2% · 4Q avg 7.8% · Used in QM five-star |
| Percentage of long-stay residents who were physically restrained | 0.0% |
0.0%
About the same
|
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 | 9.0% |
11.7%
2.7 pts better
|
16.3%
7.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 12.9% · Q2 13.4% · Q3 3.3% · Q4 5.5% · 4Q avg 9.0% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 7.0% |
9.8%
2.8 pts better
|
14.9%
7.9 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 7.8% · Q2 6.0% · Q3 6.6% · Q4 7.5% · 4Q avg 7.0% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 0.0% |
0.4%
0.4 pts better
|
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% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 0.0% |
0.8%
0.8 pts better
|
1.7%
1.7 pts better
|
Long 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 long-stay residents with new or worsened bowel or bladder incontinence | 4.3% |
12.5%
8.2 pts better
|
19.8%
15.5 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 7.0% · Q2 1.7% · Q3 3.2% · Q4 5.5% · 4Q avg 4.3% |
| Percentage of long-stay residents with pressure ulcers | 2.6% |
5.1%
2.5 pts better
|
5.1%
2.5 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 2.9% · Q2 2.7% · Q3 3.6% · Q4 1.2% · 4Q avg 2.6% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 99.5% |
94.3%
5.2 pts better
|
81.7%
17.8 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 99.0% · Q2 99.3% · Q3 99.6% · Q4 100.0% · 4Q avg 99.5% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 6.9% |
9.3%
2.4 pts better
|
12.0%
5.1 pts better
|
Short Stay · 20240701-20250630 · Adjusted 6.9% · Observed 6.6% · Expected 10.7% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 0.6% |
1.5%
0.9 pts better
|
1.6%
1 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 0.4% · Q2 0.0% · Q3 0.5% · Q4 1.6% · 4Q avg 0.6% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 99.7% |
94.7%
5 pts better
|
79.7%
20 pts better
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 99.7% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 21.5% |
26.2%
4.7 pts better
|
23.9%
2.4 pts better
|
Short Stay · 20240701-20250630 · Adjusted 21.5% · Observed 22.0% · Expected 24.5% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2024-01-25 · Fire 2024-01-25
5 health deficiencies
Top issue: Nutrition and Dietary (2 deficiencies)
2 fire-safety deficiencies
Top issue: Gas and Vacuum and Electrical Systems (1 deficiency)
Cycle 3
Health 2022-02-24 · Fire 2022-02-24
2 health deficiencies
Top issue: Pharmacy Service (1 deficiency)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Fire safety
Fire-safety citations
D · Potential for more than minimal harm
2025-12-10
E25 · Emergency Preparedness Deficiencies
Fire Safety
Create arrangements with other facilities to receive patients.
Corrected 2026-01-10
D · Potential for more than minimal harm
2025-12-10
E30 · Emergency Preparedness Deficiencies
Fire Safety
List the names and contact information of those in the facility.
Corrected 2026-01-10
D · Potential for more than minimal harm
2025-12-10
E36 · Emergency Preparedness Deficiencies
Fire Safety
Establish emergency prep training and testing.
Corrected 2026-01-10
D · Potential for more than minimal harm
2025-12-10
E37 · Emergency Preparedness Deficiencies
Fire Safety
Establish staff and initial training requirements.
Corrected 2026-01-10
D · Potential for more than minimal harm
2025-12-10
E4 · Emergency Preparedness Deficiencies
Fire Safety
Develop and maintain an Emergency Preparedness Program (EP).
Corrected 2026-01-10
D · Potential for more than minimal harm
2025-12-10
E42 · Emergency Preparedness Deficiencies
Fire Safety
Meet the requirements of an integrated health system.
Corrected 2026-01-10
D · Potential for more than minimal harm
2025-12-10
E6 · Emergency Preparedness Deficiencies
Fire Safety
Conduct risk assessment and an All-Hazards approach.
Corrected 2026-01-10
D · Potential for more than minimal harm
2025-12-10
K271 · Egress Deficiencies
Fire Safety
Have exits that are accessible at all times.
Corrected 2026-01-10
D · Potential for more than minimal harm
2025-12-10
K345 · Smoke Deficiencies
Fire Safety
Have approved installation, maintenance and testing program for fire alarm systems.
Corrected 2026-01-10
D · Potential for more than minimal harm
2025-12-10
K353 · Smoke Deficiencies
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2026-01-10
D · Potential for more than minimal harm
2025-12-10
K372 · Smoke Deficiencies
Fire Safety
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Corrected 2026-01-10
D · Potential for more than minimal harm
2025-12-10
K521 · Services Deficiencies
Fire Safety
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
Corrected 2026-01-10
D · Potential for more than minimal harm
2025-12-10
K761 · Miscellaneous Deficiencies
Fire Safety
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
Corrected 2026-01-10
D · Potential for more than minimal harm
2025-12-10
K914 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.
Corrected 2026-01-10
D · Potential for more than minimal harm
2024-01-25
K345 · Smoke Deficiencies
Fire Safety
Have approved installation, maintenance and testing program for fire alarm systems.
Corrected 2024-02-25
D · Potential for more than minimal harm
2024-01-25
K914 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.
Corrected 2024-02-25
Inspection history
Recent health citations
D · Potential for more than minimal harm
2025-12-10
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 2026-01-10
G · Actual harm
2024-12-10
F623 · Resident Rights Deficiencies
Health
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Corrected 2025-01-09
G · Actual harm
2024-12-10
F626 · Resident Rights Deficiencies
Health
Permit a resident to return to the nursing home after hospitalization or therapeutic leave that exceeds bed-hold policy.
Corrected 2025-01-09
F · Potential for more than minimal harm
2024-01-25
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 2024-02-25
D · Potential for more than minimal harm
2024-01-25
F677 · Quality of Life and Care Deficiencies
Health
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected 2024-02-25
D · Potential for more than minimal harm
2024-01-25
F814 · Nutrition and Dietary Deficiencies
Health
Dispose of garbage and refuse properly.
Corrected 2024-02-25
D · Potential for more than minimal harm
2022-02-24
F583 · Resident Rights Deficiencies
Health
Keep residents' personal and medical records private and confidential.
Corrected 2022-03-20
D · Potential for more than minimal harm
2022-02-24
F759 · Pharmacy Service Deficiencies
Health
Ensure medication error rates are not 5 percent or greater.
Corrected 2022-03-20
Penalties and ownership
What sits behind the stars
$4,256
2024-12-10
Fine
Fine · fine $4,256
Fine
$4,256
2024-12-10
Fine
Fine · fine $4,256
Fine
Ownership
Gardens SNF Holdco LLC
5% Or Greater Direct Ownership Interest · Organization
Copper Fl Trust Ii
5% Or Greater Indirect Ownership Interest · Organization
Fl Master Opco Holdco LLC
5% Or Greater Indirect Ownership Interest · Organization
Gold Fl Trust Ii
5% Or Greater Indirect Ownership Interest · Organization
Hager, Joe
W-2 Managing Employee · Individual
Shelby, Jack
Corporate Officer · Individual
Silver Fl Trust Ii
5% Or Greater Indirect Ownership Interest · Organization
Nearby options
Other facilities in reach
#1
Solaris Healthcare Daytona
Daytona Beach, FL
5-star overall rating with 5-star inspections with 2 recent health deficiencies
#2
Coastal Health And Rehabilitation Center
Daytona Beach, FL
3-star overall rating with 4-star inspections with 1 recent health deficiencies with 3 fire-safety deficiencies in the latest cycle
#3
Emory L Bennett Memorial Veterans Nursing Home
Daytona Beach, FL
3-star overall rating with 3-star inspections with $9,503 in total fines with 5 recent health deficiencies with 1 fire-safety deficiencies in the latest cycle
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