Cycle 1
Health 2025-09-10 · Fire 2025-09-10
6 health deficiencies
Top issue: Quality of Life and Care (2 deficiencies)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Livonia, MI
Marywood Nursing Care Center
5-star overall rating with 4-star inspections with 6 recent health deficiencies
36975 W. Five Mile Road, Livonia, MI
(734) 464-0600
Overall
5 / 5
CMS overall stars
Health inspections
4 / 5
Survey and complaint cycles
Staffing
4 / 5
RN + nurse staffing
Quality measures
5 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
103
Certified beds
Average residents
93
Average occupied residents
Ownership
Non-Profit
Publicly displayed owner type
Chain
Felician Services
Operator or chain grouping
Approved since
1992-12-09
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Chain footprint
3 facilities
Chain averages 3 overall / 3 health / 4 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
0.69
Registered nurse staffing · state 0.77 · national 0.68
LPN hours / resident day
1.71
Licensed practical nurse staffing · state 0.88 · national 0.87
Aide hours / resident day
2.69
Nurse aide staffing · state 2.38 · national 2.35
Total nurse hours
5.09
All reported nurse hours · state 4.03 · national 3.89
Licensed hours
2.40
RN + LPN hours · state 1.65 · national 1.54
Weekend hours
4.43
Weekend nurse staffing · state 3.52 · national 3.43
Weekend RN hours
0.31
Weekend registered nurse coverage · state 0.49 · national 0.47
Physical therapist
0.22
Reported PT staffing · state 0.07 · national 0.07
Adjusted RN hours
0.62
CMS adjusted RN staffing hours
Adjusted total hours
4.58
CMS adjusted total nurse staffing hours
Case-mix index
1.52
Higher values indicate more complex resident acuity
RN turnover
35%
Annual RN turnover · state 41% · national 45%
Total nurse turnover
23%
Annual nurse turnover · state 44% · national 46%
SNF VBP
Value-based purchasing
Program rank
703
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
65.13
Composite VBP score used to determine payment impact.
Payment multiplier
1.0194
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
6.52
Baseline 20.73% · Performance 18.41% · Measure score 6.52 · Achievement 6.52 · Improvement 5.76
Healthcare-associated infections
5.34
Baseline 4.45% · Performance 6.24% · Measure score 5.34 · Achievement 5.34 · Improvement 0
Total nurse turnover
10
Baseline 32.50% · Performance 24.03% · Measure score 10 · Achievement 10 · Improvement 9
Adjusted total nurse staffing
4.20
Baseline 4.74 hours · Performance 4.27 hours · Measure score 4.20 · Achievement 4.20 · Improvement 0
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 12.13% |
10.72%
1.4 pts worse
|
No Different than the National Rate · Eligible stays 1099 · Observed rate 10.19% · Lower 95% interval 10% |
| Discharge to community | 71.91% |
50.57%
21.3 pts better
|
Better than the National Rate · Eligible stays 1116 · Observed rate 70.43% · Lower 95% interval 70.05% |
| Medicare spending per beneficiary | 0.8 |
1.02
0.2 pts better
|
|
| Drug regimen review with follow-up | 97.76% |
95.27%
2.5 pts better
|
Numerator 610 · Denominator 624 |
| Falls with major injury | 0.48% |
0.77%
0.3 pts better
|
Numerator 3 · Denominator 624 |
| Discharge self-care score | 39.33% |
53.69%
14.4 pts worse
|
Numerator 201 · Denominator 511 |
| Discharge mobility score | 33.86% |
50.94%
17.1 pts worse
|
Numerator 173 · Denominator 511 |
| Pressure ulcers or injuries, new or worsened | 0.16% |
2.29%
2.1 pts better
|
Numerator 1 · Denominator 623 · Adjusted rate 0.15% |
| Healthcare-associated infections requiring hospitalization | 6.24% |
7.12%
0.9 pts better
|
No Different than the National Rate · Eligible stays 583 · Observed rate 4.63% · Lower 95% interval 4.61% |
| Staff COVID-19 vaccination coverage | 8.26% |
8.2%
0.1 pts better
|
Numerator 20 · Denominator 242 |
| Staff flu vaccination coverage | 46.78% |
42%
4.8 pts better
|
Numerator 138 · Denominator 295 |
| Discharge function score | 32.49% |
56.45%
24 pts worse
|
Numerator 166 · Denominator 511 |
| Transfer of health information to provider | 99.5% |
95.95%
3.5 pts better
|
Numerator 395 · Denominator 397 |
| Transfer of health information to patient | 97.69% |
96.28%
1.4 pts better
|
Numerator 211 · Denominator 216 |
| Resident COVID-19 vaccinations up to date | 86.34% |
25.2%
61.1 pts better
|
Numerator 278 · Denominator 322 |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 99.8% |
82.8%
17 pts better
|
81.7%
18.1 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 99.8% · Q2 99.9% · Q3 99.7% · Q4 99.7% · 4Q avg 99.8% |
| 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 5.7% · Expected 9.5% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 0.4% |
1.3%
0.9 pts better
|
1.6%
1.2 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 0.3% · Q2 0.6% · Q3 0.5% · Q4 0.2% · 4Q avg 0.4% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 99.1% |
79.5%
19.6 pts better
|
79.7%
19.4 pts better
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 99.1% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 19.3% |
24.2%
4.9 pts better
|
23.9%
4.6 pts better
|
Short Stay · 20240701-20250630 · Adjusted 19.3% · Observed 16.1% · Expected 19.9% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2024-08-29 · Fire 2024-08-29
7 health deficiencies
Top issue: Freedom from Abuse and Neglect and Exploitation (2 deficiencies)
8 fire-safety deficiencies
Top issue: Egress (2 deficiencies)
Cycle 3
Health 2023-09-20 · Fire 2023-09-20
8 health deficiencies
Top issue: Quality of Life and Care (3 deficiencies)
9 fire-safety deficiencies
Top issue: Egress (3 deficiencies)
Fire safety
Fire-safety citations
F · Potential for more than minimal harm
2024-08-29
E15 · Emergency Preparedness Deficiencies
Fire Safety
Address subsistence needs for staff and patients.
Corrected 2024-10-03
F · Potential for more than minimal harm
2024-08-29
K291 · Egress Deficiencies
Fire Safety
Install emergency lighting that can last at least 1 1/2 hours.
Corrected 2024-10-03
F · Potential for more than minimal harm
2024-08-29
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 2024-10-03
F · Potential for more than minimal harm
2024-08-29
K353 · Smoke Deficiencies
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2024-10-03
F · Potential for more than minimal harm
2024-08-29
K761 · Miscellaneous Deficiencies
Fire Safety
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
Corrected 2024-10-03
F · Potential for more than minimal harm
2024-08-29
K918 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have generator or other power source capable of supplying service within 10 seconds.
Corrected 2024-10-03
E · Potential for more than minimal harm
2024-08-29
K211 · Egress Deficiencies
Fire Safety
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Corrected 2024-10-03
D · Potential for more than minimal harm
2024-08-29
K920 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Ensure proper usage of power strips and extension cords.
Corrected 2024-10-03
F · Potential for more than minimal harm
2023-09-20
K345 · Smoke Deficiencies
Fire Safety
Have approved installation, maintenance and testing program for fire alarm systems.
Corrected 2023-10-10
F · Potential for more than minimal harm
2023-09-20
K353 · Smoke Deficiencies
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2023-10-10
F · Potential for more than minimal harm
2023-09-20
K355 · Smoke Deficiencies
Fire Safety
Properly select, install, inspect, or maintain portable fire extinguishes.
Corrected 2023-10-10
F · Potential for more than minimal harm
2023-09-20
K918 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have generator or other power source capable of supplying service within 10 seconds.
Corrected 2023-10-10
E · Potential for more than minimal harm
2023-09-20
K211 · Egress Deficiencies
Fire Safety
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Corrected 2023-10-10
E · Potential for more than minimal harm
2023-09-20
K223 · Egress Deficiencies
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 2023-10-10
E · Potential for more than minimal harm
2023-09-20
K293 · Egress Deficiencies
Fire Safety
Have properly located and lighted "Exit" signs.
Corrected 2023-10-10
E · Potential for more than minimal harm
2023-09-20
K920 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Ensure proper usage of power strips and extension cords.
Corrected 2023-10-10
D · Potential for more than minimal harm
2023-09-20
K912 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have power receptacles that are properly grounded.
Corrected 2023-10-10
Inspection history
Recent health citations
G · Actual harm
2026-01-08
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 2026-01-21
D · Potential for more than minimal harm
2025-12-02
F684 · Quality of Life and Care Deficiencies
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2025-12-23
D · Potential for more than minimal harm
2025-09-10
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 2025-10-01
D · Potential for more than minimal harm
2025-09-10
F583 · Resident Rights Deficiencies
Health
Keep residents' personal and medical records private and confidential.
Corrected 2025-10-01
D · Potential for more than minimal harm
2025-09-10
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2025-10-01
D · Potential for more than minimal harm
2025-06-04
F842 · Resident Assessment and Care Planning Deficiencies
Health
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Corrected 2025-06-16
D · Potential for more than minimal harm
2024-10-16
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 2024-11-13
D · Potential for more than minimal harm
2024-10-16
F610 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Respond appropriately to all alleged violations.
Corrected 2024-11-13
D · Potential for more than minimal harm
2024-08-29
F558 · Resident Rights Deficiencies
Health
Reasonably accommodate the needs and preferences of each resident.
Corrected 2024-09-18
D · Potential for more than minimal harm
2024-08-29
F692 · Quality of Life and Care Deficiencies
Health
Provide enough food/fluids to maintain a resident's health.
Corrected 2024-09-18
D · Potential for more than minimal harm
2024-08-29
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 2024-09-18
D · Potential for more than minimal harm
2024-08-29
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2024-09-18
D · Potential for more than minimal harm
2024-03-07
F770 · Administration Deficiencies
Health
Provide timely, quality laboratory services/tests to meet the needs of residents.
Corrected 2024-03-25
F · Potential for more than minimal harm
2023-09-20
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 2023-10-09
F · Potential for more than minimal harm
2023-09-20
F925 · Environmental Deficiencies
Health
Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
Corrected 2023-10-09
E · Potential for more than minimal harm
2023-09-20
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 2023-10-09
D · Potential for more than minimal harm
2023-09-20
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 2023-10-09
D · Potential for more than minimal harm
2023-09-20
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 2023-10-09
D · Potential for more than minimal harm
2023-09-20
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 2023-10-09
D · Potential for more than minimal harm
2023-09-20
F688 · Quality of Life and Care Deficiencies
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 2023-10-09
D · Potential for more than minimal harm
2023-09-20
F690 · Quality of Life and Care Deficiencies
Health
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Corrected 2023-10-09
Penalties and ownership
What sits behind the stars
Ownership
Felician Services Inc
5% Or Greater Direct Ownership Interest · Organization
Dunn, Deborah
Corporate Director · Individual
Francone, Vincent
Corporate Director · Individual
Fuller, James
Corporate Director · Individual
Glynn, John
Corporate Director · Individual
Hiltz, John
Corporate Director · Individual
Jamroz, Nancy
Corporate Director · Individual
Kern, Michael
Corporate Director · Individual
Kohn-Parrot, Kathryn
Corporate Director · Individual
Masters, Shirley
Corporate Officer · Individual
Mikkilineni, Prasad
Corporate Officer · Individual
Mimnaugh, John
Corporate Officer · Individual
Mohan, Tilak
Corporate Director · Individual
Riordan, Michael
Corporate Director · Individual
Rushlow, Judy
Operational/Managerial Control · Individual
Soltys, Frank
Corporate Director · Individual
Talty, Martin
Corporate Director · Individual
Nearby options
Other facilities in reach
#1
Majestic Care of Livonia
Livonia, MI
2-star overall rating with 1-star inspections with abuse icon flag with $139,006 in total fines with 14 recent health deficiencies with 13 fire-safety deficiencies in the latest cycle
#2
Four Seasons Nursing Center of Westland
Westland, MI
3-star overall rating with 2-star inspections with abuse icon flag with $15,593 in total fines with 14 recent health deficiencies with 5 fire-safety deficiencies in the latest cycle
#3
Medilodge of Plymouth
Plymouth, MI
5-star overall rating with 5-star inspections with 1 recent health deficiencies with 2 fire-safety deficiencies in the latest cycle
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