Cycle 1
Health 2025-03-25 · Fire 2025-03-25
7 health deficiencies
Top issue: Pharmacy Service (2 deficiencies)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Summerville, SC
Hallmark Healthcare Center
2-star overall rating with 2-star inspections with 7 recent health deficiencies
255 Midland Parkway, Summerville, SC
(843) 821-5005
Overall
2 / 5
CMS overall stars
Health inspections
2 / 5
Survey and complaint cycles
Staffing
2 / 5
RN + nurse staffing
Quality measures
3 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
88
Certified beds
Average residents
81
Average occupied residents
Ownership
For-Profit
Publicly displayed owner type
Chain
Fundamental Healthcare
Operator or chain grouping
Approved since
1992-11-13
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Chain footprint
69 facilities
Chain averages 2 overall / 2 health / 2 staffing / 4 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
0.41
Registered nurse staffing · state 0.63 · national 0.68
LPN hours / resident day
0.99
Licensed practical nurse staffing · state 1.01 · national 0.87
Aide hours / resident day
1.77
Nurse aide staffing · state 2.22 · national 2.35
Total nurse hours
3.17
All reported nurse hours · state 3.86 · national 3.89
Licensed hours
1.40
RN + LPN hours · state 1.65 · national 1.54
Weekend hours
2.72
Weekend nurse staffing · state 3.34 · national 3.43
Weekend RN hours
0.19
Weekend registered nurse coverage · state 0.40 · national 0.47
Physical therapist
0.04
Reported PT staffing · state 0.09 · national 0.07
Adjusted RN hours
0.39
CMS adjusted RN staffing hours
Adjusted total hours
2.97
CMS adjusted total nurse staffing hours
Case-mix index
1.46
Higher values indicate more complex resident acuity
RN turnover
33%
Annual RN turnover · state 44% · national 45%
Total nurse turnover
31%
Annual nurse turnover · state 47% · national 46%
SNF VBP
Value-based purchasing
Program rank
9,436
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
23.66
Composite VBP score used to determine payment impact.
Payment multiplier
0.9832
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
4.28
Baseline 23.67% · Performance 20.50% · Measure score 4.28 · Achievement 2.02 · Improvement 4.28
Healthcare-associated infections
0
Baseline 7.94% · Performance 8.93% · Measure score 0 · Achievement 0 · Improvement 0
Total nurse turnover
5.18
Baseline 63.95% · Performance 42.50% · Measure score 5.18 · Achievement 5.18 · Improvement 4.99
Adjusted total nurse staffing
0
Baseline 3.29 hours · Performance 3.03 hours · Measure score 0 · Achievement 0 · Improvement 0
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 14.23% |
10.72%
3.5 pts worse
|
Worse than the National Rate · Eligible stays 150 · Observed rate 21.33% · Lower 95% interval 10.93% |
| Discharge to community | 47.38% |
50.57%
3.2 pts worse
|
No Different than the National Rate · Eligible stays 109 · Observed rate 35.78% · Lower 95% interval 37.83% |
| Medicare spending per beneficiary | 1.25 |
1.02
0.2 pts worse
|
|
| Drug regimen review with follow-up | 86.9% |
95.27%
8.4 pts worse
|
Numerator 73 · Denominator 84 |
| Falls with major injury | 1.19% |
0.77%
0.4 pts worse
|
Numerator 1 · Denominator 84 |
| Discharge self-care score | 40% |
53.69%
13.7 pts worse
|
Numerator 24 · Denominator 60 |
| Discharge mobility score | 35% |
50.94%
15.9 pts worse
|
Numerator 21 · Denominator 60 |
| Pressure ulcers or injuries, new or worsened | 5.95% |
2.29%
3.7 pts worse
|
Numerator 5 · Denominator 84 · Adjusted rate 4.21% |
| Healthcare-associated infections requiring hospitalization | 8.93% |
7.12%
1.8 pts worse
|
No Different than the National Rate · Eligible stays 72 · Observed rate 13.89% · Lower 95% interval 5.44% |
| Staff COVID-19 vaccination coverage | 0% |
8.2%
8.2 pts worse
|
Numerator 0 · Denominator 70 |
| Staff flu vaccination coverage | 22.88% |
42%
19.1 pts worse
|
Numerator 27 · Denominator 118 |
| Discharge function score | 41.67% |
56.45%
14.8 pts worse
|
Numerator 25 · Denominator 60 |
| Transfer of health information to provider | 95% |
95.95%
1 pts worse
|
Numerator 19 · Denominator 20 |
| Transfer of health information to patient | 91.67% |
96.28%
4.6 pts worse
|
Numerator 33 · Denominator 36 |
| Resident COVID-19 vaccinations up to date | 29.27% |
25.2%
4.1 pts better
|
Numerator 12 · Denominator 41 |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 1.5 |
2.0
0.5 pts better
|
1.9
0.4 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.5 · Observed 1.4 · Expected 1.8 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 0.9 |
1.9
1 pts better
|
1.8
0.9 pts better
|
Long Stay · 20240701-20250630 · Adjusted 0.9 · Observed 0.9 · Expected 1.6 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 67.9% |
90.5%
22.6 pts worse
|
93.4%
25.5 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 50.0% · Q2 77.0% · Q3 72.0% · Q4 73.1% · 4Q avg 67.9% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 93.5% |
90.6%
2.9 pts better
|
95.5%
2 pts worse
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 93.5% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 2.1% |
3.0%
0.9 pts better
|
3.3%
1.2 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 2.7% · Q2 2.7% · Q3 1.3% · Q4 1.5% · 4Q avg 2.1% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 2.3% |
2.9%
0.6 pts better
|
11.4%
9.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 1.5% · Q2 1.5% · Q3 3.0% · Q4 3.2% · 4Q avg 2.3% |
| Percentage of long-stay residents who lose too much weight | 2.0% |
6.2%
4.2 pts better
|
5.4%
3.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 4.8% · Q2 1.5% · Q3 1.5% · Q4 0.0% · 4Q avg 2.0% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 22.1% |
20.4%
1.7 pts worse
|
19.6%
2.5 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 26.1% · Q2 23.5% · Q3 21.7% · Q4 16.4% · 4Q avg 22.1% |
| Percentage of long-stay residents who received an antipsychotic medication | 24.4% |
16.3%
8.1 pts worse
|
16.7%
7.7 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 29.4% · Q2 23.2% · Q3 22.2% · Q4 22.9% · 4Q avg 24.4% · 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 | 21.4% |
14.9%
6.5 pts worse
|
16.3%
5.1 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 44.8% · Q3 13.3% · 4Q avg 21.4% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 17.5% |
12.4%
5.1 pts worse
|
14.9%
2.6 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 32.8% · Q2 14.0% · Q3 11.7% · Q4 11.3% · 4Q avg 17.5% · 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 1.1% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.3% · 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 · 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 | 14.6% |
17.2%
2.6 pts better
|
19.8%
5.2 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 23.2% · Q2 7.9% · Q3 14.3% · Q4 13.6% · 4Q avg 14.6% |
| Percentage of long-stay residents with pressure ulcers | 5.7% |
5.8%
0.1 pts better
|
5.1%
0.6 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 6.4% · Q2 7.2% · Q3 5.0% · Q4 4.1% · 4Q avg 5.7% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 75.8% |
79.8%
4 pts worse
|
81.7%
5.9 pts worse
|
Short Stay · 2024Q4-2025Q3 · Q1 67.6% · Q2 70.7% · Q3 80.5% · Q4 82.6% · 4Q avg 75.8% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 16.3% |
14.1%
2.2 pts worse
|
12.0%
4.3 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 16.3% · Observed 21.1% · Expected 14.5% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 1.1% |
1.6%
0.5 pts better
|
1.6%
0.5 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 2.2% · Q4 2.0% · 4Q avg 1.1% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 77.2% |
78.0%
0.8 pts worse
|
79.7%
2.5 pts worse
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 77.2% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 15.9% |
24.7%
8.8 pts better
|
23.9%
8 pts better
|
Short Stay · 20240701-20250630 · Adjusted 15.9% · Observed 22.8% · Expected 34.1% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2023-06-23 · Fire 2023-06-23
9 health deficiencies
Top issue: Resident Rights (3 deficiencies)
1 fire-safety deficiencies
Top issue: Emergency Preparedness (1 deficiency)
Cycle 3
Health 2021-12-03 · Fire 2021-12-03
0 health deficiencies
No concentrated health issue counts in this cycle.
1 fire-safety deficiencies
Top issue: Egress (1 deficiency)
Fire safety
Fire-safety citations
D · Potential for more than minimal harm
2023-06-23
E1 · Emergency Preparedness Deficiencies
Fire Safety
Establish an Emergency Preparedness Program (EP).
Corrected 2023-08-18
D · Potential for more than minimal harm
2021-12-03
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 2021-12-16
Inspection history
Recent health citations
F · Potential for more than minimal harm
2025-03-25
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2025-04-14
F · Potential for more than minimal harm
2025-03-25
F908 · Environmental Deficiencies
Health
Keep all essential equipment working safely.
Corrected 2025-04-14
E · Potential for more than minimal harm
2025-03-25
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 2025-04-14
D · Potential for more than minimal harm
2025-03-25
F557 · Resident Rights Deficiencies
Health
Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions.
Corrected 2025-04-14
D · Potential for more than minimal harm
2025-03-25
F644 · Resident Assessment and Care Planning Deficiencies
Health
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
Corrected 2025-04-14
D · Potential for more than minimal harm
2025-03-25
F693 · Quality of Life and Care Deficiencies
Health
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 2025-04-14
D · Potential for more than minimal harm
2025-03-25
F756 · Pharmacy Service Deficiencies
Health
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Corrected 2025-04-14
E · Potential for more than minimal harm
2024-06-12
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 2024-06-30
F · Potential for more than minimal harm
2023-06-23
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 2023-07-31
F · Potential for more than minimal harm
2023-06-23
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2023-07-31
D · Potential for more than minimal harm
2023-06-23
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 2023-07-31
D · Potential for more than minimal harm
2023-06-23
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 2023-07-31
D · Potential for more than minimal harm
2023-06-23
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 2023-07-31
D · Potential for more than minimal harm
2023-06-23
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 2023-07-31
D · Potential for more than minimal harm
2023-06-23
F679 · Quality of Life and Care Deficiencies
Health
Provide activities to meet all resident's needs.
Corrected 2023-07-31
D · Potential for more than minimal harm
2023-06-23
F760 · Pharmacy Service Deficiencies
Health
Ensure that residents are free from significant medication errors.
Corrected 2023-07-31
Penalties and ownership
What sits behind the stars
Ownership
Thi Of South Carolina, LLC
5% Or Greater Direct Ownership Interest · Organization
Flathmann, Rusty
Corporate Officer · Individual
Forman, Murray
5% Or Greater Indirect Ownership Interest · Individual
Hunt Valley Holdings LLC
5% Or Greater Indirect Ownership Interest · Organization
Robinson, Gwendolyn
Corporate Officer · Individual
Robinson, Gwendolyn
W-2 Managing Employee · Individual
Thi Of Baltimore, Inc.
5% Or Greater Indirect Ownership Interest · Organization
Nearby options
Other facilities in reach
#1
Oakbrook Health And Rehabilitation Center
Summerville, SC
1-star overall rating with 2-star inspections with $22,564 in total fines with 7 recent health deficiencies
#2
Presbyterian Communities Of South Carolina-Summerv
Summerville, SC
5-star overall rating with 4-star inspections with 2 recent health deficiencies
#3
White Oak Manor - Charleston
Charleston, SC
4-star overall rating with 4-star inspections with $8,788 in total fines with 2 recent health deficiencies
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