14 health deficiencies
Top issue: Quality of Life and Care (5 deficiencies)
9 fire-safety deficiencies
Top issue: Smoke (3 deficiencies)
Dearborn Heights, MI
1-star overall rating with 1-star inspections with 14 recent health deficiencies with 9 fire-safety deficiencies in the latest cycle
26505 Powers Avenue, Dearborn Heights, MI
(313) 291-6200
Overall
1 / 5
CMS overall stars
Health inspections
1 / 5
Survey and complaint cycles
Staffing
3 / 5
RN + nurse staffing
Quality measures
4 / 5
Resident outcomes and process measures
Quick facts
Beds
265
Certified beds
Average residents
224
Average occupied residents
Ownership
For-Profit
Publicly displayed owner type
Chain
Villa Healthcare
Operator or chain grouping
Approved since
1992-03-13
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Chain footprint
18 facilities
Chain averages 3 overall / 2 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
RN hours / resident day
0.33
Registered nurse staffing · state 0.77 · national 0.68
LPN hours / resident day
1.10
Licensed practical nurse staffing · state 0.88 · national 0.87
Aide hours / resident day
2.10
Nurse aide staffing · state 2.38 · national 2.35
Total nurse hours
3.53
All reported nurse hours · state 4.03 · national 3.89
Licensed hours
1.43
RN + LPN hours · state 1.65 · national 1.54
Weekend hours
3.22
Weekend nurse staffing · state 3.52 · national 3.43
Weekend RN hours
0.21
Weekend registered nurse coverage · state 0.49 · national 0.47
Physical therapist
0.03
Reported PT staffing · state 0.07 · national 0.07
Adjusted RN hours
0.37
CMS adjusted RN staffing hours
Adjusted total hours
3.92
CMS adjusted total nurse staffing hours
Case-mix index
1.23
Higher values indicate more complex resident acuity
RN turnover
52%
Annual RN turnover · state 41% · national 45%
Total nurse turnover
52%
Annual nurse turnover · state 44% · national 46%
SNF VBP
Program rank
5,429
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
36.21
Composite VBP score used to determine payment impact.
Payment multiplier
0.9897
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
Readmission
6.11
Baseline 25.10% · Performance 19.76% · Measure score 6.11 · Achievement 3.60 · Improvement 6.11
Healthcare-associated infections
4.52
Baseline 7.82% · Performance 6.48% · Measure score 4.52 · Achievement 4.52 · Improvement 4.23
Total nurse turnover
0.82
Baseline 64.52% · Performance 60.32% · Measure score 0.82 · Achievement 0.82 · Improvement 0.56
Adjusted total nurse staffing
3.03
Baseline 3.45 hours · Performance 3.94 hours · Measure score 3.03 · Achievement 3.03 · Improvement 1.60
SNF QRP
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 10.52% |
10.72%
0.2 pts better
|
No Different than the National Rate · Eligible stays 118 · Observed rate 13.56% · Lower 95% interval 7.9% |
| Discharge to community | 42.24% |
50.57%
8.3 pts worse
|
No Different than the National Rate · Eligible stays 109 · Observed rate 28.44% · Lower 95% interval 31.93% |
| Medicare spending per beneficiary | 0.81 |
1.02
0.2 pts better
|
|
| Drug regimen review with follow-up | 88.76% |
95.27%
6.5 pts worse
|
Numerator 79 · Denominator 89 |
| Falls with major injury | 1.12% |
0.77%
0.4 pts worse
|
Numerator 1 · Denominator 89 |
| Discharge self-care score | 52.27% |
53.69%
1.4 pts worse
|
Numerator 23 · Denominator 44 |
| Discharge mobility score | 31.82% |
50.94%
19.1 pts worse
|
Numerator 14 · Denominator 44 |
| Pressure ulcers or injuries, new or worsened | 1.15% |
2.29%
1.1 pts better
|
Numerator 1 · Denominator 87 · Adjusted rate 0.8% |
| Healthcare-associated infections requiring hospitalization | 6.48% |
7.12%
0.6 pts better
|
No Different than the National Rate · Eligible stays 55 · Observed rate 5.45% · Lower 95% interval 3.5% |
| Staff COVID-19 vaccination coverage | 0.43% |
8.2%
7.8 pts worse
|
Numerator 1 · Denominator 230 |
| Staff flu vaccination coverage | 10.99% |
42%
31 pts worse
|
Numerator 39 · Denominator 355 |
| Discharge function score | 36.36% |
56.45%
20.1 pts worse
|
Numerator 16 · Denominator 44 |
| Transfer of health information to provider | 83.78% |
95.95%
12.2 pts worse
|
Numerator 31 · Denominator 37 |
| Transfer of health information to patient | 96.55% |
96.28%
0.3 pts better
|
Numerator 28 · Denominator 29 |
| Resident COVID-19 vaccinations up to date | 1.82% |
25.2%
23.4 pts worse
|
Numerator 1 · Denominator 55 |
Quality measures
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 1.8 |
1.7
0.1 pts worse
|
1.9
0.1 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.8 · Observed 2.2 · Expected 2.3 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 0.4 |
1.5
1.1 pts better
|
1.8
1.4 pts better
|
Long Stay · 20240701-20250630 · Adjusted 0.4 · Observed 0.4 · Expected 1.7 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 82.7% |
95.0%
12.3 pts worse
|
93.4%
10.7 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 84.8% · Q2 87.4% · Q3 83.2% · Q4 75.5% · 4Q avg 82.7% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 83.0% |
95.0%
12 pts worse
|
95.5%
12.5 pts worse
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 83.0% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 0.7% |
3.1%
2.4 pts better
|
3.3%
2.6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 1.4% · Q2 0.5% · Q3 0.0% · Q4 1.0% · 4Q avg 0.7% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 7.3% |
4.1%
3.2 pts worse
|
11.4%
4.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 7.6% · Q2 5.8% · Q3 9.7% · Q4 6.3% · 4Q avg 7.3% |
| Percentage of long-stay residents who lose too much weight | 7.2% |
5.5%
1.7 pts worse
|
5.4%
1.8 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 7.8% · Q2 7.0% · Q3 6.0% · Q4 7.7% · 4Q avg 7.2% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 27.8% |
19.6%
8.2 pts worse
|
19.6%
8.2 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 26.8% · Q2 25.4% · Q3 25.4% · Q4 33.7% · 4Q avg 27.8% |
| Percentage of long-stay residents who received an antipsychotic medication | 31.2% |
16.5%
14.7 pts worse
|
16.7%
14.5 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 31.7% · Q2 33.3% · Q3 30.5% · Q4 29.4% · 4Q avg 31.2% · Used in QM five-star |
| Percentage of long-stay residents who were physically restrained | 0.0% |
0.1%
0.1 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 | 9.2% |
13.9%
4.7 pts better
|
16.3%
7.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 3.3% · Q2 6.5% · Q3 8.4% · Q4 17.5% · 4Q avg 9.2% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 7.1% |
11.7%
4.6 pts better
|
14.9%
7.8 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 4.8% · Q2 6.2% · Q3 8.8% · Q4 8.6% · 4Q avg 7.1% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 0.3% |
0.9%
0.6 pts better
|
1.0%
0.7 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.5% · Q2 0.0% · Q3 0.0% · Q4 0.7% · 4Q avg 0.3% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 0.0% |
1.7%
1.7 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 | 26.1% |
20.4%
5.7 pts worse
|
19.8%
6.3 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 24.7% · Q2 30.3% · Q3 23.2% · Q4 26.0% · 4Q avg 26.1% |
| Percentage of long-stay residents with pressure ulcers | 5.1% |
5.6%
0.5 pts better
|
5.1%
About the same
|
Long Stay · 2024Q4-2025Q3 · Q1 3.9% · Q2 4.3% · Q3 5.5% · Q4 6.8% · 4Q avg 5.1% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 30.7% |
82.8%
52.1 pts worse
|
81.7%
51 pts worse
|
Short Stay · 2024Q4-2025Q3 · Q1 23.4% · Q2 33.5% · Q3 36.9% · Q4 27.5% · 4Q avg 30.7% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 6.8% |
11.5%
4.7 pts better
|
12.0%
5.2 pts better
|
Short Stay · 20240701-20250630 · Adjusted 6.8% · Observed 7.9% · Expected 13.0% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 0.9% |
1.3%
0.4 pts better
|
1.6%
0.7 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 1.7% · Q2 1.2% · Q3 1.0% · Q4 0.0% · 4Q avg 0.9% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 32.6% |
79.5%
46.9 pts worse
|
79.7%
47.1 pts worse
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 32.6% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 38.2% |
24.2%
14 pts worse
|
23.9%
14.3 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 38.2% · Observed 46.1% · Expected 28.7% · Used in QM five-star |
Survey summary
Top issue: Quality of Life and Care (5 deficiencies)
9 fire-safety deficiencies
Top issue: Smoke (3 deficiencies)
Top issue: Quality of Life and Care (5 deficiencies)
3 fire-safety deficiencies
Top issue: Egress (2 deficiencies)
Top issue: Quality of Life and Care (7 deficiencies)
10 fire-safety deficiencies
Top issue: Egress (4 deficiencies)
Fire safety
Fire Safety
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Corrected 2025-03-24
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2025-03-24
Fire Safety
Have simulated fire drills held at unexpected times.
Corrected 2025-03-24
Fire Safety
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
Corrected 2025-03-24
Fire Safety
Install emergency lighting that can last at least 1 1/2 hours.
Corrected 2025-03-24
Fire Safety
Have a complete alarm system manually initiated and initiated by fire sprinkler system connection.
Corrected 2025-03-24
Fire Safety
Install smoke barrier doors that can resist smoke for at least 20 minutes.
Corrected 2025-03-24
Fire Safety
Have properly installed electrical wiring and gas equipment.
Corrected 2025-03-24
Fire Safety
Have proper medical gas storage and administration areas.
Corrected 2025-03-24
Fire Safety
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Corrected 2024-01-14
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 2024-01-14
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2024-01-14
Fire Safety
Have simulated fire drills held at unexpected times.
Corrected 2022-10-31
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 2022-10-31
Fire Safety
Provide sliding doors free of hazards, operable without special knowledge or effort, and meet weight requirements to set door in motion.
Corrected 2022-10-31
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2022-10-31
Fire Safety
Install corridor and hallway doors that block smoke.
Corrected 2022-10-31
Fire Safety
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Corrected 2022-10-31
Fire Safety
Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector.
Corrected 2022-10-31
Fire Safety
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
Corrected 2022-10-31
Fire Safety
Have power receptacles that are properly grounded.
Corrected 2022-10-31
Fire Safety
Ensure proper usage of power strips and extension cords.
Corrected 2022-10-31
Inspection history
Health
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected 2026-01-09
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2025-10-29
Health
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected 2025-08-22
Health
Provide safe, appropriate dialysis care/services for a resident who requires such services.
Corrected 2025-08-22
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2025-05-28
Health
Reasonably accommodate the needs and preferences of each resident.
Corrected 2025-03-24
Health
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
Corrected 2025-03-24
Health
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Corrected 2025-03-24
Health
Allow residents to self-administer drugs if determined clinically appropriate.
Corrected 2025-03-24
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 2025-03-24
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2025-03-24
Health
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected 2025-03-24
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 2025-03-24
Health
Provide and implement an infection prevention and control program.
Corrected 2025-03-24
Health
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Corrected 2024-06-17
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2024-03-02
Health
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
Corrected 2024-01-14
Health
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected 2024-01-14
Health
Reasonably accommodate the needs and preferences of each resident.
Corrected 2024-01-14
Health
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
Corrected 2024-01-14
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 2024-01-14
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2024-01-14
Health
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected 2024-01-14
Health
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
Corrected 2024-01-14
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2024-01-14
Health
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
Corrected 2024-01-14
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 2024-01-14
Health
Provide and implement an infection prevention and control program.
Corrected 2024-01-14
Health
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Corrected 2023-09-22
Health
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected 2023-09-22
Health
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
Corrected 2023-09-22
Health
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected 2023-06-20
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 2022-11-08
Health
Reasonably accommodate the needs and preferences of each resident.
Corrected 2022-11-08
Health
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected 2022-11-08
Health
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected 2022-11-08
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2022-11-08
Health
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected 2022-11-08
Health
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
Corrected 2022-11-08
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2022-11-08
Health
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Corrected 2022-11-08
Health
Allow residents to easily view the nursing home's survey results and communicate with advocate agencies.
Corrected 2022-11-08
Health
Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.
Corrected 2022-11-08
Penalties and ownership
5% Or Greater Direct Ownership Interest · Organization
Operational/Managerial Control · Individual
Operational/Managerial Control · Individual
Operational/Managerial Control · Individual
Operational/Managerial Control · Individual
Operational/Managerial Control · Individual
Nearby options
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