Sun City Center, FL
1-star overall rating with 1-star inspections with abuse icon flag with $85,965 in total fines with 12 recent health deficiencies with 7 fire-safety deficiencies in the latest cycle
3850 Upper Creek Dr, Sun City Center, FL
(813) 633-2875
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
132
Certified beds
Average residents
122
Average occupied residents
Ownership
For-Profit
Publicly displayed owner type
Chain
Palm Garden Health And Rehabilitation
Operator or chain grouping
Approved since
1991-06-28
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Chain footprint
14 facilities
Chain averages 3 overall / 2 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
RN hours / resident day
0.49
Registered nurse staffing · state 0.73 · national 0.68
LPN hours / resident day
1.00
Licensed practical nurse staffing · state 0.79 · national 0.87
Aide hours / resident day
2.22
Nurse aide staffing · state 2.34 · national 2.35
Total nurse hours
3.71
All reported nurse hours · state 3.86 · national 3.89
Licensed hours
1.49
RN + LPN hours · state 1.52 · national 1.54
Weekend hours
3.26
Weekend nurse staffing · state 3.51 · national 3.43
Weekend RN hours
0.24
Weekend registered nurse coverage · state 0.53 · national 0.47
Physical therapist
0.06
Reported PT staffing · state 0.10 · national 0.07
Adjusted RN hours
0.53
CMS adjusted RN staffing hours
Adjusted total hours
4.00
CMS adjusted total nurse staffing hours
Case-mix index
1.27
Higher values indicate more complex resident acuity
RN turnover
41%
Annual RN turnover · state 46% · national 45%
Total nurse turnover
42%
Annual nurse turnover · state 42% · national 46%
SNF VBP
Program rank
4,510
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
39.65
Composite VBP score used to determine payment impact.
Payment multiplier
0.9926
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
Readmission
5.61
Baseline 26.04% · Performance 20.54% · Measure score 5.61 · Achievement 1.93 · Improvement 5.61
Healthcare-associated infections
2.95
Baseline 8.86% · Performance 7.52% · Measure score 2.95 · Achievement 1.05 · Improvement 2.95
Total nurse turnover
5.45
Baseline 41.44% · Performance 41.41% · Measure score 5.45 · Achievement 5.45 · Improvement 0
Adjusted total nurse staffing
1.85
Baseline 3.54 hours · Performance 3.60 hours · Measure score 1.85 · Achievement 1.85 · Improvement 0
SNF QRP
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 10.73% |
10.72%
About the same
|
No Different than the National Rate · Eligible stays 428 · Observed rate 10.51% · Lower 95% interval 8.34% |
| Discharge to community | 58.1% |
50.57%
7.5 pts better
|
Better than the National Rate · Eligible stays 436 · Observed rate 52.98% · Lower 95% interval 52.64% |
| Medicare spending per beneficiary | 0.99 |
1.02
About the same
|
|
| Drug regimen review with follow-up | 99.03% |
95.27%
3.8 pts better
|
Numerator 307 · Denominator 310 |
| Falls with major injury | 0% |
0.77%
0.8 pts better
|
Numerator 0 · Denominator 310 |
| Discharge self-care score | 67.5% |
53.69%
13.8 pts better
|
Numerator 135 · Denominator 200 |
| Discharge mobility score | 32% |
50.94%
18.9 pts worse
|
Numerator 64 · Denominator 200 |
| Pressure ulcers or injuries, new or worsened | 0% |
2.29%
2.3 pts better
|
Numerator 0 · Denominator 310 · Adjusted rate 0% |
| Healthcare-associated infections requiring hospitalization | 7.52% |
7.12%
0.4 pts worse
|
No Different than the National Rate · Eligible stays 288 · Observed rate 7.29% · Lower 95% interval 5.34% |
| Staff COVID-19 vaccination coverage | 11.84% |
8.2%
3.6 pts better
|
Numerator 18 · Denominator 152 |
| Staff flu vaccination coverage | 25.85% |
42%
16.1 pts worse
|
Numerator 38 · Denominator 147 |
| Discharge function score | 47% |
56.45%
9.5 pts worse
|
Numerator 94 · Denominator 200 |
| Transfer of health information to provider | 97.04% |
95.95%
1.1 pts better
|
Numerator 262 · Denominator 270 |
| Transfer of health information to patient | 74.19% |
96.28%
22.1 pts worse
|
Numerator 23 · Denominator 31 |
| Resident COVID-19 vaccinations up to date | 7.05% |
25.2%
18.1 pts worse
|
Numerator 11 · Denominator 156 |
Quality measures
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 1.7 |
2.1
0.4 pts better
|
1.9
0.2 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.7 · Observed 1.8 · Expected 2.0 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 0.8 |
1.2
0.4 pts better
|
1.8
1 pts better
|
Long Stay · 20240701-20250630 · Adjusted 0.8 · 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 | 98.8% |
99.2%
0.4 pts worse
|
95.5%
3.3 pts better
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 98.8% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 3.1% |
2.6%
0.5 pts worse
|
3.3%
0.2 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 1.3% · Q2 1.3% · Q3 4.9% · Q4 4.4% · 4Q avg 3.1% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 0.0% |
3.7%
3.7 pts better
|
11.4%
11.4 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 who lose too much weight | 1.3% |
5.9%
4.6 pts better
|
5.4%
4.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 1.4% · Q2 1.4% · Q3 1.3% · Q4 1.2% · 4Q avg 1.3% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 20.9% |
15.7%
5.2 pts worse
|
19.6%
1.3 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 17.1% · Q2 21.6% · Q3 21.2% · Q4 23.0% · 4Q avg 20.9% |
| Percentage of long-stay residents who received an antipsychotic medication | 10.5% |
9.8%
0.7 pts worse
|
16.7%
6.2 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 11.5% · Q2 9.7% · Q3 10.0% · Q4 10.8% · 4Q avg 10.5% · 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 | 34.2% |
11.7%
22.5 pts worse
|
16.3%
17.9 pts worse
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 34.2% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 18.7% |
9.8%
8.9 pts worse
|
14.9%
3.8 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 22.6% · Q2 18.2% · Q3 18.6% · Q4 16.2% · 4Q avg 18.7% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 1.1% |
0.4%
0.7 pts worse
|
1.0%
0.1 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 1.3% · Q2 2.4% · Q3 0.9% · Q4 0.0% · 4Q avg 1.1% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 1.2% |
0.8%
0.4 pts worse
|
1.7%
0.5 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 1.3% · Q3 2.5% · Q4 1.1% · 4Q avg 1.2% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 24.1% |
12.5%
11.6 pts worse
|
19.8%
4.3 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 28.7% · Q2 22.2% · Q3 21.1% · Q4 24.5% · 4Q avg 24.1% |
| Percentage of long-stay residents with pressure ulcers | 5.1% |
5.1%
About the same
|
5.1%
About the same
|
Long Stay · 2024Q4-2025Q3 · Q1 5.9% · Q2 7.0% · Q3 5.4% · Q4 2.7% · 4Q avg 5.1% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 99.8% |
94.3%
5.5 pts better
|
81.7%
18.1 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 99.7% · Q2 100.0% · Q3 99.7% · Q4 99.7% · 4Q avg 99.8% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 6.7% |
9.3%
2.6 pts better
|
12.0%
5.3 pts better
|
Short Stay · 20240701-20250630 · Adjusted 6.7% · Observed 7.0% · Expected 11.6% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 0.3% |
1.5%
1.2 pts better
|
1.6%
1.3 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 0.9% · Q2 0.4% · Q3 0.0% · Q4 0.0% · 4Q avg 0.3% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 94.8% |
94.7%
0.1 pts better
|
79.7%
15.1 pts better
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 94.8% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 27.4% |
26.2%
1.2 pts worse
|
23.9%
3.5 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 27.4% · Observed 27.9% · Expected 24.3% · Used in QM five-star |
Survey summary
Top issue: Freedom from Abuse and Neglect and Exploitation (2 deficiencies)
7 fire-safety deficiencies
Top issue: Gas and Vacuum and Electrical Systems (3 deficiencies)
Top issue: Infection Control (1 deficiency)
2 fire-safety deficiencies
Top issue: Egress (1 deficiency)
Top issue: Quality of Life and Care (2 deficiencies)
3 fire-safety deficiencies
Top issue: Gas and Vacuum and Electrical Systems (2 deficiencies)
Fire safety
Fire Safety
Provide properly protected cooking facilities.
Corrected 2024-10-10
Fire Safety
Have approved installation, maintenance and testing program for fire alarm systems.
Corrected 2024-10-10
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2024-10-10
Fire Safety
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
Corrected 2024-10-10
Fire Safety
Have power receptacles that are properly grounded.
Corrected 2024-10-10
Fire Safety
Ensure that testing and maintenance of electrical equipment is performed.
Corrected 2024-10-10
Fire Safety
Ensure precautions for handling oxygen cylinders and equipment are correctly followed.
Corrected 2024-10-10
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 2022-10-03
Fire Safety
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Corrected 2022-10-03
Fire Safety
Have approved installation, maintenance and testing program for fire alarm systems.
Corrected 2021-04-30
Fire Safety
Ensure proper usage of power strips and extension cords.
Corrected 2021-05-30
Fire Safety
Have proper medical gas storage and administration areas.
Corrected 2021-05-30
Inspection history
Health
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected 2025-06-09
Health
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected 2024-10-10
Health
Provide safe, appropriate pain management for a resident who requires such services.
Corrected 2024-10-10
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2024-10-10
Health
PASARR screening for Mental disorders or Intellectual Disabilities
Corrected 2024-10-10
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 2024-10-10
Health
Provide and implement an infection prevention and control program.
Corrected 2024-10-10
Health
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Corrected 2024-10-10
Health
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected 2024-10-10
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 2024-10-10
Health
Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.
Corrected 2024-10-10
Health
Have a Compliance and Ethics Program.
Corrected 2024-10-10
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2022-09-12
Health
Provide and implement an infection prevention and control program.
Corrected 2022-09-12
Health
Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.
Corrected 2022-09-12
Health
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected 2021-05-30
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2021-05-30
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2021-05-30
Penalties and ownership
Fine · fine $68,880
Fine
Fine · fine $4,085
Fine
Fine · fine $4,846
Fine
Fine · fine $8,154
Fine
5% Or Greater Direct Ownership Interest · Organization
Corporate Officer · Individual
Corporate Officer · Individual
Operational/Managerial Control · Individual
Corporate Officer · Individual
5% Or Greater Indirect Ownership Interest · Organization
5% Or Greater Indirect Ownership Interest · Organization
5% Or Greater Indirect Ownership Interest · Individual
5% Or Greater Indirect Ownership Interest · Organization
5% Or Greater Security Interest · Organization
5% Or Greater Security Interest · Organization
5% Or Greater Mortgage Interest · Organization
Operational/Managerial Control · Individual
Nearby options
Sun City Center, FL
3-star overall rating with 2-star inspections with 10 recent health deficiencies
Sun City Center, FL
4-star overall rating with 4-star inspections with 4 recent health deficiencies with 1 fire-safety deficiencies in the latest cycle
Tampa, FL
3-star overall rating with 2-star inspections with $23,560 in total fines with 12 recent health deficiencies with 3 fire-safety deficiencies in the latest cycle
Jump out