Cycle 1
Health 2025-08-14 · Fire 2025-08-14
7 health deficiencies
Top issue: Quality of Life and Care (2 deficiencies)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Ocala, FL
Ocala Oaks Rehabilitation Center
3-star overall rating with 3-star inspections with 7 recent health deficiencies
3930 E Silver Springs Blvd, Ocala, FL
(352) 236-2626
Overall
3 / 5
CMS overall stars
Health inspections
3 / 5
Survey and complaint cycles
Staffing
3 / 5
RN + nurse staffing
Quality measures
4 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
120
Certified beds
Average residents
108
Average occupied residents
Ownership
For-Profit
Publicly displayed owner type
Chain
Sovereign Healthcare Holdings
Operator or chain grouping
Approved since
1991-04-18
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Chain footprint
43 facilities
Chain averages 4 overall / 3 health / 3 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
0.39
Registered nurse staffing · state 0.73 · national 0.68
LPN hours / resident day
0.90
Licensed practical nurse staffing · state 0.79 · national 0.87
Aide hours / resident day
2.19
Nurse aide staffing · state 2.34 · national 2.35
Total nurse hours
3.48
All reported nurse hours · state 3.86 · national 3.89
Licensed hours
1.28
RN + LPN hours · state 1.52 · national 1.54
Weekend hours
3.22
Weekend nurse staffing · state 3.51 · national 3.43
Weekend RN hours
0.27
Weekend registered nurse coverage · state 0.53 · national 0.47
Physical therapist
0.11
Reported PT staffing · state 0.10 · national 0.07
Adjusted RN hours
0.44
CMS adjusted RN staffing hours
Adjusted total hours
3.92
CMS adjusted total nurse staffing hours
Case-mix index
1.21
Higher values indicate more complex resident acuity
RN turnover
46%
Annual RN turnover · state 46% · national 45%
Total nurse turnover
40%
Annual nurse turnover · state 42% · national 46%
SNF VBP
Value-based purchasing
Program rank
11,561
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
16.29
Composite VBP score used to determine payment impact.
Payment multiplier
0.9816
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
0
Baseline 22.88% · Performance 24.06% · Measure score 0 · Achievement 0 · Improvement 0
Healthcare-associated infections
4.16
Baseline 7.02% · Performance 6.59% · Measure score 4.16 · Achievement 4.16 · Improvement 1.62
Total nurse turnover
1.43
Baseline 62.39% · Performance 57.85% · Measure score 1.43 · Achievement 1.43 · Improvement 0.71
Adjusted total nurse staffing
0.93
Baseline 4.12 hours · Performance 3.34 hours · Measure score 0.93 · Achievement 0.93 · Improvement 0
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 11.79% |
10.72%
1.1 pts worse
|
No Different than the National Rate · Eligible stays 173 · Observed rate 12.72% · Lower 95% interval 9.09% |
| Discharge to community | 40.77% |
50.57%
9.8 pts worse
|
Worse than the National Rate · Eligible stays 148 · Observed rate 34.46% · Lower 95% interval 34.08% |
| Medicare spending per beneficiary | 1.05 |
1.02
About the same
|
|
| Drug regimen review with follow-up | 100% |
95.27%
4.7 pts better
|
Numerator 136 · Denominator 136 |
| Falls with major injury | 2.21% |
0.77%
1.4 pts worse
|
Numerator 3 · Denominator 136 |
| Discharge self-care score | 54.12% |
53.69%
0.4 pts better
|
Numerator 46 · Denominator 85 |
| Discharge mobility score | 34.12% |
50.94%
16.8 pts worse
|
Numerator 29 · Denominator 85 |
| Pressure ulcers or injuries, new or worsened | 2.94% |
2.29%
0.6 pts worse
|
Numerator 4 · Denominator 136 · Adjusted rate 2.61% |
| Healthcare-associated infections requiring hospitalization | 6.59% |
7.12%
0.5 pts better
|
No Different than the National Rate · Eligible stays 84 · Observed rate 4.76% · Lower 95% interval 3.96% |
| Staff COVID-19 vaccination coverage | 8.45% |
8.2%
0.2 pts better
|
Numerator 12 · Denominator 142 |
| Staff flu vaccination coverage | 16.18% |
42%
25.8 pts worse
|
Numerator 28 · Denominator 173 |
| Discharge function score | 43.53% |
56.45%
12.9 pts worse
|
Numerator 37 · Denominator 85 |
| Transfer of health information to provider | 92.94% |
95.95%
3 pts worse
|
Numerator 79 · Denominator 85 |
| Transfer of health information to patient | Not Available |
96.28%
|
Numerator Not Available · Denominator 5 · Too few residents or stays to report publicly. |
| Resident COVID-19 vaccinations up to date | 13.89% |
25.2%
11.3 pts worse
|
Numerator 10 · Denominator 72 |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 2.4 |
2.1
0.3 pts worse
|
1.9
0.5 pts worse
|
Long Stay · 20240701-20250630 · Adjusted 2.4 · Observed 2.2 · Expected 1.7 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 1.3 |
1.2
0.1 pts worse
|
1.8
0.5 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.3 · Observed 1.2 · Expected 1.5 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 99.2% |
97.8%
1.4 pts better
|
93.4%
5.8 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 100.0% · Q2 98.9% · Q3 99.0% · Q4 98.9% · 4Q avg 99.2% |
| 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 | 3.5% |
2.6%
0.9 pts worse
|
3.3%
0.2 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 3.4% · Q2 3.2% · Q3 4.2% · Q4 3.3% · 4Q avg 3.5% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 5.2% |
3.7%
1.5 pts worse
|
11.4%
6.2 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 10.1% · Q2 0.0% · Q3 3.3% · Q4 8.0% · 4Q avg 5.2% |
| Percentage of long-stay residents who lose too much weight | 4.7% |
5.9%
1.2 pts better
|
5.4%
0.7 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 13.0% · Q2 0.0% · Q3 1.7% · Q4 3.4% · 4Q avg 4.7% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 11.3% |
15.7%
4.4 pts better
|
19.6%
8.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 12.7% · Q2 10.1% · Q3 10.9% · Q4 11.3% · 4Q avg 11.3% |
| Percentage of long-stay residents who received an antipsychotic medication | 12.2% |
9.8%
2.4 pts worse
|
16.7%
4.5 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 10.3% · Q2 11.1% · Q3 15.1% · Q4 12.0% · 4Q avg 12.2% · 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 | 6.3% |
11.7%
5.4 pts better
|
16.3%
10 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 19.4% · Q2 8.4% · Q3 0.0% · Q4 0.0% · 4Q avg 6.3% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 8.6% |
9.8%
1.2 pts better
|
14.9%
6.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 11.8% · Q2 12.3% · Q3 4.8% · Q4 4.9% · 4Q avg 8.6% · 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 | 0.3% |
0.8%
0.5 pts better
|
1.7%
1.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 1.1% · Q3 0.0% · Q4 0.0% · 4Q avg 0.3% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 5.8% |
12.5%
6.7 pts better
|
19.8%
14 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 12.7% · Q2 5.2% · Q3 4.4% · Q4 1.1% · 4Q avg 5.8% |
| Percentage of long-stay residents with pressure ulcers | 2.2% |
5.1%
2.9 pts better
|
5.1%
2.9 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 3.2% · Q2 3.7% · Q3 0.9% · Q4 1.0% · 4Q avg 2.2% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 95.5% |
94.3%
1.2 pts better
|
81.7%
13.8 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 94.5% · Q2 100.0% · Q3 97.2% · Q4 89.6% · 4Q avg 95.5% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 9.7% |
9.3%
0.4 pts worse
|
12.0%
2.3 pts better
|
Short Stay · 20240701-20250630 · Adjusted 9.7% · Observed 10.3% · Expected 11.8% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 1.1% |
1.5%
0.4 pts better
|
1.6%
0.5 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 3.8% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 1.1% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 100.0% |
94.7%
5.3 pts better
|
79.7%
20.3 pts better
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 100.0% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 20.9% |
26.2%
5.3 pts better
|
23.9%
3 pts better
|
Short Stay · 20240701-20250630 · Adjusted 20.9% · Observed 21.8% · Expected 24.9% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2024-05-16 · Fire 2024-05-16
8 health deficiencies
Top issue: Quality of Life and Care (2 deficiencies)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Cycle 3
Health 2023-01-12 · Fire 2023-01-12
4 health deficiencies
Top issue: Infection Control (1 deficiency)
1 fire-safety deficiencies
Top issue: Smoke (1 deficiency)
Fire safety
Fire-safety citations
E · Potential for more than minimal harm
2023-01-12
K363 · Smoke Deficiencies
Fire Safety
Install corridor and hallway doors that block smoke.
Corrected 2023-02-20
Inspection history
Recent health citations
D · Potential for more than minimal harm
2025-08-14
F582 · Resident Rights Deficiencies
Health
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
Corrected 2025-09-20
D · Potential for more than minimal harm
2025-08-14
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 2025-09-20
D · Potential for more than minimal harm
2025-08-14
F684 · Quality of Life and Care Deficiencies
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2025-09-20
D · Potential for more than minimal harm
2025-08-14
F695 · Quality of Life and Care Deficiencies
Health
Provide safe and appropriate respiratory care for a resident when needed.
Corrected 2025-09-20
D · Potential for more than minimal harm
2025-08-14
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 2025-09-20
D · Potential for more than minimal harm
2025-08-14
F865 · Administration Deficiencies
Health
Have a plan that describes the process for conducting QAPI and QAA activities.
Corrected 2025-09-20
D · Potential for more than minimal harm
2025-08-14
F925 · Environmental Deficiencies
Health
Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
Corrected 2025-09-20
E · Potential for more than minimal harm
2024-05-16
F582 · Resident Rights Deficiencies
Health
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
Corrected 2024-06-19
E · Potential for more than minimal harm
2024-05-16
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 2024-06-19
E · Potential for more than minimal harm
2024-05-16
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 2024-06-19
D · Potential for more than minimal harm
2024-05-16
F640 · Resident Assessment and Care Planning Deficiencies
Health
Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment.
Corrected 2024-06-19
D · Potential for more than minimal harm
2024-05-16
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 2024-06-19
D · Potential for more than minimal harm
2024-05-16
F695 · Quality of Life and Care Deficiencies
Health
Provide safe and appropriate respiratory care for a resident when needed.
Corrected 2024-06-19
D · Potential for more than minimal harm
2024-05-16
F732 · Nursing and Physician Services Deficiencies
Health
Post nurse staffing information every day.
Corrected 2024-06-19
D · Potential for more than minimal harm
2024-05-16
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2024-06-19
E · Potential for more than minimal harm
2023-01-12
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 2023-02-20
E · Potential for more than minimal harm
2023-01-12
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 2023-02-20
D · Potential for more than minimal harm
2023-01-12
F684 · Quality of Life and Care Deficiencies
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2023-02-20
D · Potential for more than minimal harm
2023-01-12
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2023-02-22
Penalties and ownership
What sits behind the stars
Ownership
3930, LLC
5% Or Greater Security Interest · Organization
Clevinger, Sidney
Operational/Managerial Control · Individual
Cronquist, Royce
Operational/Managerial Control · Individual
Foster, Patricia
Operational/Managerial Control · Individual
Health Services Properties LLC
5% Or Greater Security Interest · Organization
Mangine, John
Operational/Managerial Control · Individual
Melton, Donald
Operational/Managerial Control · Individual
Notermann, William
Operational/Managerial Control · Individual
Orix Real Estate Capital LLC
5% Or Greater Security Interest · Organization
Southern Healthcare Management LLC
Operational/Managerial Control · Organization
Nearby options
Other facilities in reach
#1
The Lodge Healthcare And Rehabilitation Center
Ocala, FL
3-star overall rating with 2-star inspections with $17,737 in total fines with 10 recent health deficiencies with 2 fire-safety deficiencies in the latest cycle
#2
Aviata At Arbor Springs
Ocala, FL
1-star overall rating with 2-star inspections with 15 recent health deficiencies
#3
Ocala Health And Rehabilitation Center
Ocala, FL
4-star overall rating with 3-star inspections with 9 recent health deficiencies with 1 fire-safety deficiencies in the latest cycle
Jump out