Cycle 1
Health 2023-08-02 · Fire 2023-08-02
6 health deficiencies
Top issue: Quality of Life and Care (3 deficiencies)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Warrenton, VA
Poplar Hill Health And Rehab
3-star overall rating with 3-star inspections with 6 recent health deficiencies
360 Hospital Drive, Warrenton, VA
(540) 316-5500
Overall
3 / 5
CMS overall stars
Health inspections
3 / 5
Survey and complaint cycles
Staffing
2 / 5
RN + nurse staffing
Quality measures
4 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
113
Certified beds
Average residents
97
Average occupied residents
Ownership
For-Profit
Publicly displayed owner type
Chain
No chain reported
Operator or chain grouping
Approved since
1991-03-20
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
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
0.37
Registered nurse staffing · state 0.69 · national 0.68
LPN hours / resident day
1.11
Licensed practical nurse staffing · state 1.00 · national 0.87
Aide hours / resident day
2.01
Nurse aide staffing · state 2.12 · national 2.35
Total nurse hours
3.49
All reported nurse hours · state 3.81 · national 3.89
Licensed hours
1.48
RN + LPN hours · state 1.68 · national 1.54
Weekend hours
3.06
Weekend nurse staffing · state 3.31 · national 3.43
Weekend RN hours
0.20
Weekend registered nurse coverage · state 0.46 · national 0.47
Physical therapist
0.09
Reported PT staffing · state 0.09 · national 0.07
Adjusted RN hours
0.39
CMS adjusted RN staffing hours
Adjusted total hours
3.65
CMS adjusted total nurse staffing hours
Case-mix index
1.31
Higher values indicate more complex resident acuity
RN turnover
70%
Annual RN turnover · state 49% · national 45%
Total nurse turnover
58%
Annual nurse turnover · state 48% · national 46%
SNF VBP
Value-based purchasing
Program rank
11,012
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
18.33
Composite VBP score used to determine payment impact.
Payment multiplier
0.9819
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
1.66
Performance 20.66% · Measure score 1.66 · Achievement 1.66 · This facility did not have sufficient data to calculate a baseline period measure result.
Healthcare-associated infections
3.96
Performance 6.65% · Measure score 3.96 · Achievement 3.96 · This facility did not have sufficient data to calculate a baseline period measure result.
Total nurse turnover
0
Baseline 53.49% · Performance 84.13% · Measure score 0 · Achievement 0 · Improvement 0
Adjusted total nurse staffing
1.71
Baseline 3.02 hours · Performance 3.56 hours · Measure score 1.71 · Achievement 1.71 · Improvement 1.47
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 8.9% |
10.72%
1.8 pts better
|
No Different than the National Rate · Eligible stays 84 · Observed rate 4.76% · Lower 95% interval 5.91% |
| Discharge to community | 56.11% |
50.57%
5.5 pts better
|
No Different than the National Rate · Eligible stays 70 · Observed rate 50% · Lower 95% interval 45.13% |
| Medicare spending per beneficiary | 0.98 |
1.02
About the same
|
|
| Drug regimen review with follow-up | 97.3% |
95.27%
2 pts better
|
Numerator 72 · Denominator 74 |
| Falls with major injury | 0% |
0.77%
0.8 pts better
|
Numerator 0 · Denominator 74 |
| Discharge self-care score | 40% |
53.69%
13.7 pts worse
|
Numerator 20 · Denominator 50 |
| Discharge mobility score | 50% |
50.94%
0.9 pts worse
|
Numerator 25 · Denominator 50 |
| Pressure ulcers or injuries, new or worsened | 6.76% |
2.29%
4.5 pts worse
|
Numerator 5 · Denominator 74 · Adjusted rate 6.43% |
| Healthcare-associated infections requiring hospitalization | 6.65% |
7.12%
0.5 pts better
|
No Different than the National Rate · Eligible stays 74 · Observed rate 5.41% · Lower 95% interval 4.38% |
| Staff COVID-19 vaccination coverage | 6.19% |
8.2%
2 pts worse
|
Numerator 7 · Denominator 113 |
| Staff flu vaccination coverage | Not Available |
42%
|
Numerator Not Available · Denominator Not Available · No data were submitted for this measure. |
| Discharge function score | 46% |
56.45%
10.5 pts worse
|
Numerator 23 · Denominator 50 |
| Transfer of health information to provider | 100% |
95.95%
4 pts better
|
Numerator 30 · Denominator 30 |
| Transfer of health information to patient | 100% |
96.28%
3.7 pts better
|
Numerator 33 · Denominator 33 |
| Resident COVID-19 vaccinations up to date | 17.31% |
25.2%
7.9 pts worse
|
Numerator 9 · Denominator 52 |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 0.7 |
1.5
0.8 pts better
|
1.9
1.2 pts better
|
Long Stay · 20240701-20250630 · Adjusted 0.7 · Observed 1.0 · Expected 2.8 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 2.2 |
1.4
0.8 pts worse
|
1.8
0.4 pts worse
|
Long Stay · 20240701-20250630 · Adjusted 2.2 · Observed 2.6 · Expected 1.9 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 99.3% |
91.2%
8.1 pts better
|
93.4%
5.9 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 100.0% · Q2 100.0% · Q3 100.0% · Q4 97.6% · 4Q avg 99.3% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 100.0% |
94.0%
6 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 | 0.0% |
3.6%
3.6 pts better
|
3.3%
3.3 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 who have depressive symptoms | 9.3% |
15.7%
6.4 pts better
|
11.4%
2.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 4.1% · Q2 7.5% · Q3 5.9% · Q4 17.1% · 4Q avg 9.3% |
| Percentage of long-stay residents who lose too much weight | 2.8% |
5.7%
2.9 pts better
|
5.4%
2.6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 3.4% · Q3 6.3% · Q4 1.3% · 4Q avg 2.8% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 9.2% |
20.2%
11 pts better
|
19.6%
10.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 4.1% · Q2 5.1% · Q3 10.9% · Q4 13.9% · 4Q avg 9.2% |
| Percentage of long-stay residents who received an antipsychotic medication | 14.1% |
15.0%
0.9 pts better
|
16.7%
2.6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 18.9% · Q2 12.8% · Q3 13.7% · Q4 12.5% · 4Q avg 14.1% · 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 | 23.3% |
17.5%
5.8 pts worse
|
16.3%
7 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q2 17.1% · Q3 13.7% · Q4 28.4% · 4Q avg 23.3% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 21.1% |
15.7%
5.4 pts worse
|
14.9%
6.2 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 17.4% · Q2 16.4% · Q3 13.6% · Q4 33.3% · 4Q avg 21.1% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 0.3% |
0.5%
0.2 pts better
|
1.0%
0.7 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.8% · 4Q avg 0.3% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 0.4% |
1.6%
1.2 pts better
|
1.7%
1.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 1.5% · Q4 0.0% · 4Q avg 0.4% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 24.0% |
22.2%
1.8 pts worse
|
19.8%
4.2 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 4.5% · Q2 28.8% · Q3 26.4% · Q4 30.2% · 4Q avg 24.0% |
| Percentage of long-stay residents with pressure ulcers | 7.3% |
5.2%
2.1 pts worse
|
5.1%
2.2 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 11.5% · Q2 14.7% · Q3 5.1% · Q4 1.1% · 4Q avg 7.3% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 89.9% |
74.6%
15.3 pts better
|
81.7%
8.2 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 89.5% · Q2 93.8% · Q3 91.6% · Q4 83.8% · 4Q avg 89.9% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 18.9% |
11.7%
7.2 pts worse
|
12.0%
6.9 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 18.9% · Observed 17.9% · Expected 10.6% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 0.0% |
1.2%
1.2 pts better
|
1.6%
1.6 pts better
|
Short 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 short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 92.5% |
73.6%
18.9 pts better
|
79.7%
12.8 pts better
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 92.5% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 21.6% |
22.0%
0.4 pts better
|
23.9%
2.3 pts better
|
Short Stay · 20240701-20250630 · Adjusted 21.6% · Observed 20.9% · Expected 23.0% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2022-01-27 · Fire 2022-01-27
13 health deficiencies
Top issue: Resident Assessment and Care Planning (5 deficiencies)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Cycle 3
Health 2019-10-18 · Fire 2019-10-18
9 health deficiencies
Top issue: Pharmacy Service (3 deficiencies)
5 fire-safety deficiencies
Top issue: Smoke (3 deficiencies)
Fire safety
Fire-safety citations
E · Potential for more than minimal harm
2019-10-18
K920 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Ensure proper usage of power strips and extension cords.
Corrected 2020-01-14
D · Potential for more than minimal harm
2019-10-18
K353 · Smoke Deficiencies
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2020-01-14
D · Potential for more than minimal harm
2019-10-18
K372 · Smoke Deficiencies
Fire Safety
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Corrected 2020-01-14
D · Potential for more than minimal harm
2019-10-18
K374 · Smoke Deficiencies
Fire Safety
Install smoke barrier doors that can resist smoke for at least 20 minutes.
Corrected 2020-01-14
D · Potential for more than minimal harm
2019-10-18
K761 · Miscellaneous Deficiencies
Fire Safety
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
Corrected 2020-01-14
Inspection history
Recent health citations
E · Potential for more than minimal harm
2023-08-02
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 2023-08-25
E · Potential for more than minimal harm
2023-08-02
F698 · Quality of Life and Care Deficiencies
Health
Provide safe, appropriate dialysis care/services for a resident who requires such services.
Corrected 2023-08-25
D · Potential for more than minimal harm
2023-08-02
F658 · Resident Assessment and Care Planning Deficiencies
Health
Ensure services provided by the nursing facility meet professional standards of quality.
Corrected 2023-08-25
D · Potential for more than minimal harm
2023-08-02
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 2023-08-25
D · Potential for more than minimal harm
2023-08-02
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 2023-08-25
D · Potential for more than minimal harm
2023-08-02
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 2023-08-25
E · Potential for more than minimal harm
2022-01-27
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 2022-02-22
E · Potential for more than minimal harm
2022-01-27
F684 · Quality of Life and Care Deficiencies
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2022-02-22
E · Potential for more than minimal harm
2022-01-27
F758 · Pharmacy Service Deficiencies
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 2022-02-22
D · Potential for more than minimal harm
2022-01-27
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 2022-02-22
D · Potential for more than minimal harm
2022-01-27
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 2022-02-22
D · Potential for more than minimal harm
2022-01-27
F641 · Resident Assessment and Care Planning Deficiencies
Health
Ensure each resident receives an accurate assessment.
Corrected 2022-02-22
D · Potential for more than minimal harm
2022-01-27
F655 · Resident Assessment and Care Planning Deficiencies
Health
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
Corrected 2022-02-22
D · Potential for more than minimal harm
2022-01-27
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 2022-02-22
D · Potential for more than minimal harm
2022-01-27
F658 · Resident Assessment and Care Planning Deficiencies
Health
Ensure services provided by the nursing facility meet professional standards of quality.
Corrected 2022-02-22
D · Potential for more than minimal harm
2022-01-27
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 2022-02-22
D · Potential for more than minimal harm
2022-01-27
F692 · Quality of Life and Care Deficiencies
Health
Provide enough food/fluids to maintain a resident's health.
Corrected 2022-02-22
D · Potential for more than minimal harm
2022-01-27
F697 · Quality of Life and Care Deficiencies
Health
Provide safe, appropriate pain management for a resident who requires such services.
Corrected 2022-02-22
D · Potential for more than minimal harm
2022-01-27
F757 · Pharmacy Service Deficiencies
Health
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Corrected 2022-02-22
E · Potential for more than minimal harm
2019-10-18
F757 · Pharmacy Service Deficiencies
Health
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Corrected 2019-12-01
D · Potential for more than minimal harm
2019-10-18
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 2019-12-01
D · Potential for more than minimal harm
2019-10-18
F622 · Resident Rights Deficiencies
Health
Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged.
Corrected 2019-12-01
D · Potential for more than minimal harm
2019-10-18
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 2019-12-01
D · Potential for more than minimal harm
2019-10-18
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 2019-12-01
D · Potential for more than minimal harm
2019-10-18
F695 · Quality of Life and Care Deficiencies
Health
Provide safe and appropriate respiratory care for a resident when needed.
Corrected 2019-12-01
D · Potential for more than minimal harm
2019-10-18
F755 · Pharmacy Service Deficiencies
Health
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Corrected 2019-12-01
D · Potential for more than minimal harm
2019-10-18
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 2019-12-01
D · Potential for more than minimal harm
2019-10-18
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2019-12-01
Penalties and ownership
What sits behind the stars
Ownership
Pc8 Capital Group LLC
5% Or Greater Indirect Ownership Interest · Organization
Burton, Noah
5% Or Greater Mortgage Interest · Individual
Gannon, Amanda
Operational/Managerial Control · Individual
Greenwald, Brian
5% Or Greater Mortgage Interest · Individual
Stern, Aharon
Operational/Managerial Control · Individual
Weiss, Hillel
5% Or Greater Mortgage Interest · Individual
Nearby options
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1-star overall rating with 1-star inspections with abuse icon flag with $146,073 in total fines with 29 recent health deficiencies
#2
Lake Manassas Health & Rehabilitation Center
Gainesville, VA
4-star overall rating with 3-star inspections with 15 recent health deficiencies
#3
Gainesville Health And Rehab Center
Gainesville, VA
3-star overall rating with 2-star inspections with 14 recent health deficiencies
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