Silver Spring, MD

Regency Care Of Silver Spring, LLC

5-star overall rating with 4-star inspections with 21 recent health deficiencies with 11 fire-safety deficiencies in the latest cycle

9101 Second Avenue, Silver Spring, MD

(301) 588-5544

Compare this facility

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

92

Certified beds

Average residents

72

Average occupied residents

Ownership

For-Profit

Publicly displayed owner type

Chain

Regency Care

Operator or chain grouping

Approved since

1968-10-01

CMS approved date

Coverage

Medicare + Medicaid

Participation flags

Chain footprint

4 facilities

Chain averages 3 overall / 2 health / 3 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

1.01

Registered nurse staffing · state 0.81 · national 0.68

LPN hours / resident day

0.80

Licensed practical nurse staffing · state 0.91 · national 0.87

Aide hours / resident day

1.85

Nurse aide staffing · state 2.15 · national 2.35

Total nurse hours

3.65

All reported nurse hours · state 3.87 · national 3.89

Licensed hours

1.81

RN + LPN hours · state 1.72 · national 1.54

Weekend hours

3.27

Weekend nurse staffing · state 3.46 · national 3.43

Weekend RN hours

0.70

Weekend registered nurse coverage · state 0.61 · national 0.47

Physical therapist

0.07

Reported PT staffing · state 0.09 · national 0.07

Adjusted RN hours

1.04

CMS adjusted RN staffing hours

Adjusted total hours

3.76

CMS adjusted total nurse staffing hours

Case-mix index

1.33

Higher values indicate more complex resident acuity

RN turnover

38%

Annual RN turnover · state 40% · national 45%

Total nurse turnover

48%

Annual nurse turnover · state 41% · national 46%

SNF VBP

Value-based purchasing

Program rank

4,648

Lower is better among SNFs in the FY 2026 VBP program.

Performance score

39.12

Composite VBP score used to determine payment impact.

Payment multiplier

0.9921

Above 1.000 increases Medicare payment; below 1.000 reduces it.

Program components

How the VBP score is built

Readmission

6.33

Baseline 17.77% · Performance 18.50% · Measure score 6.33 · Achievement 6.33 · Improvement 0

Healthcare-associated infections

0

Baseline 5.44% · Performance 9.20% · Measure score 0 · Achievement 0 · Improvement 0

Total nurse turnover

6.32

Baseline 37.93% · Performance 37.84% · Measure score 6.32 · Achievement 6.32 · Improvement 0

Adjusted total nurse staffing

2.99

Baseline 3.61 hours · Performance 3.93 hours · Measure score 2.99 · Achievement 2.99 · Improvement 0.98

SNF QRP

Medicare quality reporting measures

Measure Facility National Note
Potentially preventable 30-day readmission 11.13%
10.72%
0.4 pts worse
No Different than the National Rate · Eligible stays 140 · Observed rate 12.14% · Lower 95% interval 8.26%
Discharge to community 50.74%
50.57%
0.2 pts better
No Different than the National Rate · Eligible stays 177 · Observed rate 41.81% · Lower 95% interval 44.2%
Medicare spending per beneficiary 1.05
1.02
About the same
Drug regimen review with follow-up 98.85%
95.27%
3.6 pts better
Numerator 86 · Denominator 87
Falls with major injury 2.3%
0.77%
1.5 pts worse
Numerator 2 · Denominator 87
Discharge self-care score 55.56%
53.69%
1.9 pts better
Numerator 30 · Denominator 54
Discharge mobility score 46.3%
50.94%
4.6 pts worse
Numerator 25 · Denominator 54
Pressure ulcers or injuries, new or worsened 0%
2.29%
2.3 pts better
Numerator 0 · Denominator 86 · Adjusted rate 0%
Healthcare-associated infections requiring hospitalization 9.2%
7.12%
2.1 pts worse
No Different than the National Rate · Eligible stays 96 · Observed rate 13.54% · Lower 95% interval 5.75%
Staff COVID-19 vaccination coverage 7.79%
8.2%
0.4 pts worse
Numerator 6 · Denominator 77
Staff flu vaccination coverage 39.56%
42%
2.4 pts worse
Numerator 36 · Denominator 91
Discharge function score 51.85%
56.45%
4.6 pts worse
Numerator 28 · Denominator 54
Transfer of health information to provider 100%
95.95%
4 pts better
Numerator 44 · Denominator 44
Transfer of health information to patient 92.59%
96.28%
3.7 pts worse
Numerator 25 · Denominator 27
Resident COVID-19 vaccinations up to date 46.51%
25.2%
21.3 pts better
Numerator 20 · Denominator 43

Quality measures

Resident outcomes and process scores

Measure Facility State National Note
Number of hospitalizations per 1000 long-stay resident days 2.1
1.3
0.8 pts worse
1.9
0.2 pts worse
Long Stay · 20240701-20250630 · Adjusted 2.1 · Observed 2.3 · Expected 2.1 · Used in QM five-star
Number of outpatient emergency department visits per 1000 long-stay resident days 0.7
1.2
0.5 pts better
1.8
1.1 pts better
Long Stay · 20240701-20250630 · Adjusted 0.7 · Observed 0.7 · Expected 1.7 · Used in QM five-star
Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine 97.7%
91.9%
5.8 pts better
93.4%
4.3 pts better
Long Stay · 2024Q4-2025Q3 · Q1 98.1% · Q2 100.0% · Q3 96.2% · Q4 96.6% · 4Q avg 97.7%
Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine 96.5%
96.6%
0.1 pts worse
95.5%
1 pts better
Long Stay · 2024Q3-2025Q2 · 4Q avg 96.5%
Percentage of long-stay residents experiencing one or more falls with major injury 1.4%
2.3%
0.9 pts better
3.3%
1.9 pts better
Long Stay · 2024Q4-2025Q3 · Q1 1.9% · Q2 2.0% · Q3 1.9% · Q4 0.0% · 4Q avg 1.4% · Used in QM five-star
Percentage of long-stay residents who have depressive symptoms 1.0%
21.4%
20.4 pts better
11.4%
10.4 pts better
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 3.6% · 4Q avg 1.0%
Percentage of long-stay residents who lose too much weight 4.8%
5.7%
0.9 pts better
5.4%
0.6 pts better
Long Stay · 2024Q4-2025Q3 · Q1 2.0% · Q2 6.2% · Q3 7.7% · Q4 3.5% · 4Q avg 4.8%
Percentage of long-stay residents who received an antianxiety or hypnotic medication 9.6%
16.1%
6.5 pts better
19.6%
10 pts better
Long Stay · 2024Q4-2025Q3 · Q1 11.8% · Q2 8.3% · Q3 7.7% · Q4 10.5% · 4Q avg 9.6%
Percentage of long-stay residents who received an antipsychotic medication 10.3%
15.3%
5 pts better
16.7%
6.4 pts better
Long Stay · 2024Q4-2025Q3 · Q1 13.5% · Q2 12.1% · Q3 8.6% · Q4 7.3% · 4Q avg 10.3% · 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 14.7%
26.6%
11.9 pts better
16.3%
1.6 pts better
Long Stay · 2024Q4-2025Q3 · 4Q avg 14.7% · Used in QM five-star
Percentage of long-stay residents whose need for help with daily activities has increased 17.9%
22.9%
5 pts better
14.9%
3 pts worse
Long Stay · 2024Q4-2025Q3 · Q1 2.6% · Q2 35.7% · Q3 12.2% · Q4 19.6% · 4Q avg 17.9% · Used in QM five-star
Percentage of long-stay residents with a catheter inserted and left in their bladder 0.0%
0.7%
0.7 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 0.9%
1.5%
0.6 pts better
1.7%
0.8 pts better
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 2.0% · Q3 0.0% · Q4 1.7% · 4Q avg 0.9% · Used in QM five-star
Percentage of long-stay residents with new or worsened bowel or bladder incontinence 18.5%
25.4%
6.9 pts better
19.8%
1.3 pts better
Long Stay · 2024Q4-2025Q3 · Q1 19.7% · Q2 16.0% · Q3 12.4% · Q4 24.9% · 4Q avg 18.5%
Percentage of long-stay residents with pressure ulcers 3.4%
6.3%
2.9 pts better
5.1%
1.7 pts better
Long Stay · 2024Q4-2025Q3 · Q1 5.0% · Q2 1.7% · Q3 1.8% · Q4 5.0% · 4Q avg 3.4% · Used in QM five-star
Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine 89.1%
78.4%
10.7 pts better
81.7%
7.4 pts better
Short Stay · 2024Q4-2025Q3 · Q1 82.6% · Q2 87.9% · Q3 93.7% · Q4 92.5% · 4Q avg 89.1%
Percentage of short-stay residents who had an outpatient emergency department visit 5.3%
9.9%
4.6 pts better
12.0%
6.7 pts better
Short Stay · 20240701-20250630 · Adjusted 5.3% · Observed 5.3% · Expected 11.1% · 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 0.0% · Q2 1.6% · Q3 1.6% · 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 89.2%
80.6%
8.6 pts better
79.7%
9.5 pts better
Short Stay · 2024Q3-2025Q2 · 4Q avg 89.2%
Percentage of short-stay residents who were rehospitalized after a nursing home admission 28.8%
21.2%
7.6 pts worse
23.9%
4.9 pts worse
Short Stay · 20240701-20250630 · Adjusted 28.8% · Observed 32.0% · Expected 26.5% · Used in QM five-star

Survey summary

Recent inspection cycles

Cycle 1 Health 2025-04-17 · Fire 2025-04-17

21 health deficiencies

Top issue: Resident Assessment and Care Planning (5 deficiencies)

11 fire-safety deficiencies

Top issue: Smoke (3 deficiencies)

Cycle 2 Health 2021-02-26 · Fire 2021-02-26

2 health deficiencies

Top issue: Infection Control (1 deficiency)

5 fire-safety deficiencies

Top issue: Gas and Vacuum and Electrical Systems (2 deficiencies)

Cycle 3 Health 2019-06-18 · Fire 2019-06-18

15 health deficiencies

Top issue: Resident Assessment and Care Planning (5 deficiencies)

6 fire-safety deficiencies

Top issue: Emergency Preparedness (2 deficiencies)

Fire safety

Fire-safety citations

F · Potential for more than minimal harm 2025-04-17

E39 · Emergency Preparedness Deficiencies

Fire Safety

Conduct testing and exercise requirements.

Corrected 2025-06-20

F · Potential for more than minimal harm 2025-04-17

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 2025-06-20

F · Potential for more than minimal harm 2025-04-17

K324 · Smoke Deficiencies

Fire Safety

Provide properly protected cooking facilities.

Corrected 2025-06-20

F · Potential for more than minimal harm 2025-04-17

K345 · Smoke Deficiencies

Fire Safety

Have approved installation, maintenance and testing program for fire alarm systems.

Corrected 2025-06-20

F · Potential for more than minimal harm 2025-04-17

K353 · Smoke Deficiencies

Fire Safety

Inspect, test, and maintain automatic sprinkler systems.

Corrected 2025-06-20

F · Potential for more than minimal harm 2025-04-17

K712 · Miscellaneous Deficiencies

Fire Safety

Have simulated fire drills held at unexpected times.

Corrected 2025-06-20

F · Potential for more than minimal harm 2025-04-17

K761 · Miscellaneous Deficiencies

Fire Safety

To conduct inspection, testing and maintenance of fire doors by qualified individuals.

Corrected 2025-06-20

F · Potential for more than minimal harm 2025-04-17

K914 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.

Corrected 2025-06-20

F · Potential for more than minimal harm 2025-04-17

K918 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Have generator or other power source capable of supplying service within 10 seconds.

Corrected 2025-06-20

E · Potential for more than minimal harm 2025-04-17

K531 · Services Deficiencies

Fire Safety

Have elevators that firefighters can control in the event of a fire.

Corrected 2025-06-20

D · Potential for more than minimal harm 2025-04-17

E4 · Emergency Preparedness Deficiencies

Fire Safety

Develop and maintain an Emergency Preparedness Program (EP).

Corrected 2025-06-20

F · Potential for more than minimal harm 2021-02-26

K353 · Smoke Deficiencies

Fire Safety

Inspect, test, and maintain automatic sprinkler systems.

Corrected 2021-03-15

D · Potential for more than minimal harm 2021-02-26

K225 · Egress Deficiencies

Fire Safety

Have stairways and smokeproof enclosures used as exits that meet safety requirements.

Corrected 2021-03-15

D · Potential for more than minimal harm 2021-02-26

K918 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Have generator or other power source capable of supplying service within 10 seconds.

Corrected 2021-03-15

C · Minimal harm 2021-02-26

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 2021-03-15

C · Minimal harm 2021-02-26

K923 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Have proper medical gas storage and administration areas.

Corrected 2021-03-15

E · Potential for more than minimal harm 2019-06-18

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 2019-07-31

D · Potential for more than minimal harm 2019-06-18

K374 · Smoke Deficiencies

Fire Safety

Install smoke barrier doors that can resist smoke for at least 20 minutes.

Corrected 2019-07-31

C · Minimal harm 2019-06-18

E36 · Emergency Preparedness Deficiencies

Fire Safety

Establish emergency prep training and testing.

Corrected 2019-07-31

C · Minimal harm 2019-06-18

E37 · Emergency Preparedness Deficiencies

Fire Safety

Establish staff and initial training requirements.

Corrected 2019-07-31

C · Minimal harm 2019-06-18

K921 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Ensure that testing and maintenance of electrical equipment is performed.

Corrected 2019-07-31

B · Minimal harm 2019-06-18

K923 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Have proper medical gas storage and administration areas.

Corrected 2019-07-31

Inspection history

Recent health citations

E · Potential for more than minimal harm 2025-04-17

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 2025-05-14

D · Potential for more than minimal harm 2025-04-17

F578 · Resident Rights Deficiencies

Health

Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.

Corrected 2025-05-14

D · Potential for more than minimal harm 2025-04-17

F580 · Resident Rights Deficiencies

Health

Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

Corrected 2025-05-14

D · Potential for more than minimal harm 2025-04-17

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 2025-05-14

D · Potential for more than minimal harm 2025-04-17

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 2025-05-14

D · Potential for more than minimal harm 2025-04-17

F641 · Resident Assessment and Care Planning Deficiencies

Health

Ensure each resident receives an accurate assessment.

Corrected 2025-05-14

D · Potential for more than minimal harm 2025-04-17

F645 · Resident Assessment and Care Planning Deficiencies

Health

PASARR screening for Mental disorders or Intellectual Disabilities

Corrected 2025-05-14

D · Potential for more than minimal harm 2025-04-17

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 2025-05-14

D · Potential for more than minimal harm 2025-04-17

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 2025-05-14

D · Potential for more than minimal harm 2025-04-17

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 2025-05-14

D · Potential for more than minimal harm 2025-04-17

F695 · Quality of Life and Care Deficiencies

Health

Provide safe and appropriate respiratory care for a resident when needed.

Corrected 2025-05-14

D · Potential for more than minimal harm 2025-04-17

F697 · Quality of Life and Care Deficiencies

Health

Provide safe, appropriate pain management for a resident who requires such services.

Corrected 2025-05-14

D · Potential for more than minimal harm 2025-04-17

F711 · Nursing and Physician Services Deficiencies

Health

Ensure the resident's doctor reviews the resident's care, writes, signs and dates progress notes and orders, at each required visit.

Corrected 2025-05-14

D · Potential for more than minimal harm 2025-04-17

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 2025-05-14

D · Potential for more than minimal harm 2025-04-17

F757 · Pharmacy Service Deficiencies

Health

Ensure each resident’s drug regimen must be free from unnecessary drugs.

Corrected 2025-05-14

D · Potential for more than minimal harm 2025-04-17

F839 · Administration Deficiencies

Health

Employ staff that are licensed, certified, or registered in accordance with state laws.

Corrected 2025-05-14

D · Potential for more than minimal harm 2025-04-17

F840 · Administration Deficiencies

Health

Employ or obtain outside professional resources to provide services in the nursing home when the facility does not employ a qualified professional to furnish a required service.

Corrected 2025-05-14

D · Potential for more than minimal harm 2025-04-17

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 2025-05-14

D · Potential for more than minimal harm 2025-04-17

F849 · Administration Deficiencies

Health

Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.

Corrected 2025-05-14

D · Potential for more than minimal harm 2025-04-17

F868 · Administration Deficiencies

Health

Have the Quality Assessment and Assurance group have the required members and meet at least quarterly

Corrected 2025-05-14

C · Minimal harm 2025-04-17

F732 · Nursing and Physician Services Deficiencies

Health

Post nurse staffing information every day.

Corrected 2025-05-14

D · Potential for more than minimal harm 2021-02-26

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 2021-03-26

D · Potential for more than minimal harm 2021-02-26

F880 · Infection Control Deficiencies

Health

Provide and implement an infection prevention and control program.

Corrected 2021-03-26

F · Potential for more than minimal harm 2019-06-18

F725 · Nursing and Physician Services Deficiencies

Health

Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.

Corrected 2019-07-12

E · Potential for more than minimal harm 2019-06-18

F561 · Resident Rights Deficiencies

Health

Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.

Corrected 2019-07-12

D · Potential for more than minimal harm 2019-06-18

F608 · Freedom from Abuse, Neglect, and Exploitation Deficiencies

Health

Develop and implement policies and procedures to ensure (1) employees report any suspicion of a crime against any resident, according to timelines; (2) post the notice of employee rights; and (3) prohibit and prevent retaliation for reporting.

Corrected 2019-07-12

D · Potential for more than minimal harm 2019-06-18

F610 · Freedom from Abuse, Neglect, and Exploitation Deficiencies

Health

Respond appropriately to all alleged violations.

Corrected 2019-07-12

D · Potential for more than minimal harm 2019-06-18

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 2019-07-12

D · Potential for more than minimal harm 2019-06-18

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 2019-07-12

D · Potential for more than minimal harm 2019-06-18

F658 · Resident Assessment and Care Planning Deficiencies

Health

Ensure services provided by the nursing facility meet professional standards of quality.

Corrected 2019-07-12

D · Potential for more than minimal harm 2019-06-18

F684 · Quality of Life and Care Deficiencies

Health

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Corrected 2019-07-12

D · Potential for more than minimal harm 2019-06-18

F694 · Quality of Life and Care Deficiencies

Health

Provide for the safe, appropriate administration of IV fluids for a resident when needed.

Corrected 2019-07-12

D · Potential for more than minimal harm 2019-06-18

F726 · Nursing and Physician Services Deficiencies

Health

Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.

Corrected 2019-07-12

D · Potential for more than minimal harm 2019-06-18

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 2019-07-12

D · Potential for more than minimal harm 2019-06-18

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 2019-07-12

C · Minimal harm 2019-06-18

F730 · Nursing and Physician Services Deficiencies

Health

Observe each nurse aide's job performance and give regular training.

Corrected 2019-07-12

B · Minimal harm 2019-06-18

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 2019-07-12

B · Minimal harm 2019-06-18

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 2019-07-12

Penalties and ownership

What sits behind the stars

Ownership

Womack, Steven

5% Or Greater Direct Ownership Interest · Individual

70% 3 facilities 2016-11-01
Woodward, Melvin

5% Or Greater Direct Ownership Interest · Individual

30% 6 facilities 2016-11-01
Womack, Steven

Operational/Managerial Control · Individual

0% 3 facilities 2016-11-01
Woodward, Melvin

Operational/Managerial Control · Individual

0% 6 facilities 2016-11-01
Ww Healthcare Consultants, LLC

Operational/Managerial Control · Organization

0% 3 facilities 2016-11-01

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Staffing
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3-star overall rating with 3-star inspections with 27 recent health deficiencies with 17 fire-safety deficiencies in the latest cycle

Overall
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#3

Autumn Lake Healthcare At Oakview

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3-star overall rating with 3-star inspections with 13 recent health deficiencies with 12 fire-safety deficiencies in the latest cycle

Overall
3 / 5
Health
3 / 5
Staffing
4 / 5
Fines
$0

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