Cycle 1
Health 2025-06-06 · Fire 2025-06-06
3 health deficiencies
Top issue: Pharmacy Service (2 deficiencies)
3 fire-safety deficiencies
Top issue: Emergency Preparedness (1 deficiency)
Raleigh, NC
The Rosewood Health Center
5-star overall rating with 4-star inspections with 3 recent health deficiencies with 3 fire-safety deficiencies in the latest cycle
8710 Cypress Club Drive, Raleigh, NC
(919) 870-9007
Overall
5 / 5
CMS overall stars
Health inspections
4 / 5
Survey and complaint cycles
Staffing
5 / 5
RN + nurse staffing
Quality measures
4 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
57
Certified beds
Average residents
45
Average occupied residents
Ownership
Non-Profit
Publicly displayed owner type
Chain
No chain reported
Operator or chain grouping
Approved since
2009-01-06
CMS approved date
Coverage
Medicare
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
0.90
Registered nurse staffing · state 0.59 · national 0.68
LPN hours / resident day
1.79
Licensed practical nurse staffing · state 0.87 · national 0.87
Aide hours / resident day
3.42
Nurse aide staffing · state 2.33 · national 2.35
Total nurse hours
6.11
All reported nurse hours · state 3.78 · national 3.89
Licensed hours
2.70
RN + LPN hours · state 1.45 · national 1.54
Weekend hours
5.83
Weekend nurse staffing · state 3.34 · national 3.43
Weekend RN hours
0.60
Weekend registered nurse coverage · state 0.38 · national 0.47
Physical therapist
0.09
Reported PT staffing · state 0.09 · national 0.07
Adjusted RN hours
1.05
CMS adjusted RN staffing hours
Adjusted total hours
7.16
CMS adjusted total nurse staffing hours
Case-mix index
1.17
Higher values indicate more complex resident acuity
RN turnover
33%
Annual RN turnover · state 48% · national 45%
Total nurse turnover
28%
Annual nurse turnover · state 50% · national 46%
SNF VBP
Value-based purchasing
Program rank
242
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
76.09
Composite VBP score used to determine payment impact.
Payment multiplier
1.0248
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
7.42
Performance 17.99% · Measure score 7.42 · Achievement 7.42 · This facility did not have sufficient data to calculate a baseline period measure result.
Healthcare-associated infections
4.86
Performance 6.38% · Measure score 4.86 · Achievement 4.86 · This facility did not have sufficient data to calculate a baseline period measure result.
Total nurse turnover
8.15
Baseline 42.65% · Performance 30.38% · Measure score 8.15 · Achievement 8.15 · Improvement 6.39
Adjusted total nurse staffing
10
Baseline 6.55 hours · Performance 6.72 hours · Measure score 10 · Achievement 10 · Improvement 9
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 12.16% |
10.72%
1.4 pts worse
|
No Different than the National Rate · Eligible stays 68 · Observed rate 14.71% · Lower 95% interval 8.27% |
| Discharge to community | 45.75% |
50.57%
4.8 pts worse
|
No Different than the National Rate · Eligible stays 53 · Observed rate 39.62% · Lower 95% interval 34.57% |
| Medicare spending per beneficiary | 0.57 |
1.02
0.5 pts better
|
|
| Drug regimen review with follow-up | 100% |
95.27%
4.7 pts better
|
Numerator 39 · Denominator 39 |
| Falls with major injury | 5.13% |
0.77%
4.4 pts worse
|
Numerator 2 · Denominator 39 |
| Discharge self-care score | 55.17% |
53.69%
1.5 pts better
|
Numerator 16 · Denominator 29 |
| Discharge mobility score | 44.83% |
50.94%
6.1 pts worse
|
Numerator 13 · Denominator 29 |
| Pressure ulcers or injuries, new or worsened | 2.56% |
2.29%
0.3 pts worse
|
Numerator 1 · Denominator 39 · Adjusted rate 4.16% |
| Healthcare-associated infections requiring hospitalization | 6.38% |
7.12%
0.7 pts better
|
No Different than the National Rate · Eligible stays 42 · Observed rate 2.38% · Lower 95% interval 3.05% |
| Staff COVID-19 vaccination coverage | Not Available |
8.2%
|
Numerator Not Available · Denominator Not Available · No data were submitted for this measure. |
| Staff flu vaccination coverage | 4.67% |
42%
37.3 pts worse
|
Numerator 10 · Denominator 214 |
| Discharge function score | 58.62% |
56.45%
2.2 pts better
|
Numerator 17 · Denominator 29 |
| Transfer of health information to provider | Not Available |
95.95%
|
Numerator Not Available · Denominator 6 · Too few residents or stays to report publicly. |
| Transfer of health information to patient | Not Available |
96.28%
|
Numerator Not Available · Denominator 17 · Too few residents or stays to report publicly. |
| Resident COVID-19 vaccinations up to date | Not Available |
25.2%
|
Numerator Not Available · Denominator 18 · Too few residents or stays to report publicly. |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 1.7 |
1.8
0.1 pts better
|
1.9
0.2 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.7 · Observed 1.1 · Expected 1.3 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 1.0 |
1.8
0.8 pts better
|
1.8
0.8 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.0 · Observed 0.8 · Expected 1.3 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 99.4% |
91.5%
7.9 pts better
|
93.4%
6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 100.0% · Q2 100.0% · Q3 97.7% · Q4 100.0% · 4Q avg 99.4% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 100.0% |
94.1%
5.9 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 | 8.4% |
3.6%
4.8 pts worse
|
3.3%
5.1 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 8.3% · Q2 11.4% · Q3 6.8% · Q4 7.0% · 4Q avg 8.4% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 0.0% |
4.8%
4.8 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 | 0.8% |
7.2%
6.4 pts better
|
5.4%
4.6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 3.4% · 4Q avg 0.8% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 28.3% |
21.6%
6.7 pts worse
|
19.6%
8.7 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 30.6% · Q2 33.3% · Q3 28.6% · Q4 20.6% · 4Q avg 28.3% |
| Percentage of long-stay residents who received an antipsychotic medication | 34.3% |
15.0%
19.3 pts worse
|
16.7%
17.6 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 31.0% · Q2 37.5% · Q3 41.7% · Q4 28.0% · 4Q avg 34.3% · 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 | 10.4% |
21.5%
11.1 pts better
|
16.3%
5.9 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 7.1% · Q2 15.2% · Q3 10.8% · 4Q avg 10.4% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 13.4% |
16.8%
3.4 pts better
|
14.9%
1.5 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 3.1% · Q2 13.3% · Q3 12.1% · Q4 25.0% · 4Q avg 13.4% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 0.0% |
0.9%
0.9 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 | 0.6% |
2.6%
2 pts better
|
1.7%
1.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 2.5% · 4Q avg 0.6% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 23.2% |
21.2%
2 pts worse
|
19.8%
3.4 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 12.4% · Q2 31.3% · Q3 26.1% · Q4 24.0% · 4Q avg 23.2% |
| Percentage of long-stay residents with pressure ulcers | 1.7% |
6.0%
4.3 pts better
|
5.1%
3.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 2.5% · Q3 2.3% · Q4 2.3% · 4Q avg 1.7% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 99.1% |
79.9%
19.2 pts better
|
81.7%
17.4 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 100.0% · Q2 97.0% · Q3 100.0% · Q4 100.0% · 4Q avg 99.1% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 3.9% |
13.2%
9.3 pts better
|
12.0%
8.1 pts better
|
Short Stay · 20240701-20250630 · Adjusted 3.9% · Observed 3.3% · Expected 9.5% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 2.6% |
1.5%
1.1 pts worse
|
1.6%
1 pts worse
|
Short Stay · 2024Q4-2025Q3 · Q2 4.8% · Q3 5.0% · 4Q avg 2.6% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 100.0% |
78.1%
21.9 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 | 36.7% |
22.9%
13.8 pts worse
|
23.9%
12.8 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 36.7% · Observed 30.0% · Expected 19.5% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2024-03-08 · Fire 2024-03-08
0 health deficiencies
No concentrated health issue counts in this cycle.
2 fire-safety deficiencies
Top issue: Gas and Vacuum and Electrical Systems (2 deficiencies)
Cycle 3
Health 2023-02-10 · Fire 2023-02-10
1 health deficiencies
Top issue: Infection Control (1 deficiency)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Fire safety
Fire-safety citations
F · Potential for more than minimal harm
2025-06-06
E1 · Emergency Preparedness Deficiencies
Fire Safety
Establish an Emergency Preparedness Program (EP).
Corrected 2025-06-30
D · Potential for more than minimal harm
2025-06-06
K353 · Smoke Deficiencies
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2025-07-07
D · Potential for more than minimal harm
2025-06-06
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 2025-07-07
F · Potential for more than minimal harm
2024-03-08
K916 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have a battery powered remote alarm panel in a location accessible by operating personnel.
Corrected 2024-05-24
D · Potential for more than minimal harm
2024-03-08
K923 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have proper medical gas storage and administration areas.
Corrected 2024-05-24
Inspection history
Recent health citations
E · Potential for more than minimal harm
2025-06-06
F760 · Pharmacy Service Deficiencies
Health
Ensure that residents are free from significant medication errors.
Corrected 2025-06-30
D · Potential for more than minimal harm
2025-06-06
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 2025-06-30
D · Potential for more than minimal harm
2025-06-06
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 2025-06-30
F · Potential for more than minimal harm
2023-02-10
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2023-03-17
Penalties and ownership
What sits behind the stars
Ownership
The Cypress Of Raleigh Club, Inc.
5% Or Greater Direct Ownership Interest · Organization
Andrews, Mark
Corporate Director · Individual
Andrews, Mark
Corporate Officer · Individual
Cline, Joe
Corporate Director · Individual
Ford, Thomas
Operational/Managerial Control · Individual
Ford, Thomas
Corporate Officer · Individual
Gospodarek, Dave
Corporate Director · Individual
Life Care Services LLC
Operational/Managerial Control · Organization
Mitterling, John
Corporate Officer · Individual
Pramann, Wyatt
Operational/Managerial Control · Individual
Sandman, Michael
Corporate Director · Individual
Sandman, Michael
Corporate Officer · Individual
Singh, Jaskeerat
Operational/Managerial Control · Individual
The Cypress Of Raleigh LLC
Operational/Managerial Control · Organization
The Cypress Of Raleigh Owners Association, Inc.
Operational/Managerial Control · Organization
Nearby options
Other facilities in reach
#1
Litchford Falls Health and Rehabilitation Center
Raleigh, NC
1-star overall rating with 2-star inspections with $181,873 in total fines with 8 recent health deficiencies with 12 fire-safety deficiencies in the latest cycle
#2
The Cardinal at North Hills
Raleigh, NC
4-star overall rating with 4-star inspections with $7,901 in total fines with 2 recent health deficiencies with 2 fire-safety deficiencies in the latest cycle
#3
Hillcrest Raleigh at Crabtree Valley
Raleigh, NC
3-star overall rating with 4-star inspections with $17,202 in total fines with 1 recent health deficiencies with 1 fire-safety deficiencies in the latest cycle
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