Cycle 1
Health 2025-04-24 · Fire 2025-04-24
5 health deficiencies
Top issue: Quality of Life and Care (2 deficiencies)
2 fire-safety deficiencies
Top issue: Gas and Vacuum and Electrical Systems (1 deficiency)
Norwalk, OH
Twilight Gardens Nursing And Rehabilitation
4-star overall rating with 4-star inspections with 5 recent health deficiencies with 2 fire-safety deficiencies in the latest cycle
196 W Main St, Norwalk, OH
(419) 668-2086
Overall
4 / 5
CMS overall stars
Health inspections
4 / 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
94
Certified beds
Average residents
72
Average occupied residents
Ownership
For-Profit
Publicly displayed owner type
Chain
Cch Healthcare
Operator or chain grouping
Approved since
1980-07-03
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Chain footprint
32 facilities
Chain averages 3 overall / 2 health / 2 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
1.50
Registered nurse staffing · state 0.63 · national 0.68
LPN hours / resident day
0.55
Licensed practical nurse staffing · state 0.96 · national 0.87
Aide hours / resident day
2.36
Nurse aide staffing · state 2.14 · national 2.35
Total nurse hours
4.41
All reported nurse hours · state 3.72 · national 3.89
Licensed hours
2.05
RN + LPN hours · state 1.59 · national 1.54
Weekend hours
3.88
Weekend nurse staffing · state 3.29 · national 3.43
Weekend RN hours
1.26
Weekend registered nurse coverage · state 0.41 · national 0.47
Physical therapist
0.02
Reported PT staffing · state 0.05 · national 0.07
Adjusted RN hours
1.18
CMS adjusted RN staffing hours
Adjusted total hours
3.48
CMS adjusted total nurse staffing hours
Case-mix index
1.73
Higher values indicate more complex resident acuity
RN turnover
62%
Annual RN turnover · state 47% · national 45%
Total nurse turnover
53%
Annual nurse turnover · state 50% · national 46%
SNF VBP
Value-based purchasing
Program rank
10,374
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
20.61
Composite VBP score used to determine payment impact.
Payment multiplier
0.9824
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
1.24
Baseline 19.19% · Performance 20.86% · Measure score 1.24 · Achievement 1.24 · Improvement 0
Healthcare-associated infections
2.63
Baseline 6.97% · Performance 7.05% · Measure score 2.63 · Achievement 2.63 · Improvement 0
Total nurse turnover
4.35
Baseline 64.89% · Performance 45.88% · Measure score 4.35 · Achievement 4.35 · Improvement 4.25
Adjusted total nurse staffing
0.01
Baseline 3.04 hours · Performance 3.18 hours · Measure score 0.01 · Achievement 0 · Improvement 0.01
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 10.89% |
10.72%
0.2 pts worse
|
No Different than the National Rate · Eligible stays 78 · Observed rate 16.67% · Lower 95% interval 7.96% |
| Discharge to community | 48.79% |
50.57%
1.8 pts worse
|
No Different than the National Rate · Eligible stays 31 · Observed rate 35.48% · Lower 95% interval 34.01% |
| Medicare spending per beneficiary | 0.94 |
1.02
0.1 pts better
|
|
| Drug regimen review with follow-up | 100% |
95.27%
4.7 pts better
|
Numerator 77 · Denominator 77 |
| Falls with major injury | 0% |
0.77%
0.8 pts better
|
Numerator 0 · Denominator 77 |
| Discharge self-care score | 48.98% |
53.69%
4.7 pts worse
|
Numerator 24 · Denominator 49 |
| Discharge mobility score | 36.73% |
50.94%
14.2 pts worse
|
Numerator 18 · Denominator 49 |
| Pressure ulcers or injuries, new or worsened | 2.6% |
2.29%
0.3 pts worse
|
Numerator 2 · Denominator 77 · Adjusted rate 1.85% |
| Healthcare-associated infections requiring hospitalization | 7.05% |
7.12%
0.1 pts better
|
No Different than the National Rate · Eligible stays 38 · Observed rate 7.89% · Lower 95% interval 3.83% |
| Staff COVID-19 vaccination coverage | 0% |
8.2%
8.2 pts worse
|
Numerator 0 · Denominator 96 |
| Staff flu vaccination coverage | 0% |
42%
42 pts worse
|
Numerator 0 · Denominator 133 |
| Discharge function score | 44.9% |
56.45%
11.6 pts worse
|
Numerator 22 · Denominator 49 |
| Transfer of health information to provider | 100% |
95.95%
4 pts better
|
Numerator 27 · Denominator 27 |
| Transfer of health information to patient | Not Available |
96.28%
|
Numerator Not Available · Denominator 10 · Too few residents or stays to report publicly. |
| Resident COVID-19 vaccinations up to date | 13.95% |
25.2%
11.2 pts worse
|
Numerator 6 · Denominator 43 |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 1.5 |
1.8
0.3 pts better
|
1.9
0.4 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.5 · Observed 2.3 · Expected 2.9 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 5.9 |
1.8
4.1 pts worse
|
1.8
4.1 pts worse
|
Long Stay · 20240701-20250630 · Adjusted 5.9 · Observed 7.2 · Expected 2.0 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 97.4% |
92.4%
5 pts better
|
93.4%
4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 95.5% · Q2 98.4% · Q3 98.5% · Q4 97.1% · 4Q avg 97.4% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 89.0% |
94.5%
5.5 pts worse
|
95.5%
6.5 pts worse
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 89.0% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 1.9% |
3.3%
1.4 pts better
|
3.3%
1.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 4.5% · Q2 0.0% · Q3 0.0% · Q4 2.9% · 4Q avg 1.9% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 11.8% |
26.1%
14.3 pts better
|
11.4%
0.4 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 10.7% · Q2 11.8% · Q3 13.2% · Q4 11.5% · 4Q avg 11.8% |
| Percentage of long-stay residents who lose too much weight | 2.9% |
6.2%
3.3 pts better
|
5.4%
2.5 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 3.5% · Q3 3.1% · Q4 4.7% · 4Q avg 2.9% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 43.1% |
25.4%
17.7 pts worse
|
19.6%
23.5 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 43.1% · Q2 44.8% · Q3 41.5% · Q4 43.1% · 4Q avg 43.1% |
| Percentage of long-stay residents who received an antipsychotic medication | 7.8% |
11.5%
3.7 pts better
|
16.7%
8.9 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 8.9% · Q2 7.1% · Q3 6.5% · Q4 8.5% · 4Q avg 7.8% · Used in QM five-star |
| Percentage of long-stay residents who were physically restrained | 0.0% |
0.1%
0.1 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 | 4.4% |
7.7%
3.3 pts better
|
16.3%
11.9 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 5.7% · Q2 11.5% · Q3 0.0% · 4Q avg 4.4% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 3.2% |
6.2%
3 pts better
|
14.9%
11.7 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 1.9% · Q2 3.8% · Q3 5.1% · Q4 1.8% · 4Q avg 3.2% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 0.0% |
0.2%
0.2 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 | 1.5% |
0.5%
1 pts worse
|
1.7%
0.2 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 6.0% · 4Q avg 1.5% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 24.8% |
21.7%
3.1 pts worse
|
19.8%
5 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 31.9% · Q2 29.6% · Q3 18.9% · Q4 19.7% · 4Q avg 24.8% |
| Percentage of long-stay residents with pressure ulcers | 3.5% |
3.7%
0.2 pts better
|
5.1%
1.6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 5.0% · Q2 2.9% · Q3 2.6% · Q4 3.6% · 4Q avg 3.5% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 74.1% |
78.1%
4 pts worse
|
81.7%
7.6 pts worse
|
Short Stay · 2024Q4-2025Q3 · Q1 79.6% · Q2 75.4% · Q3 71.9% · Q4 69.4% · 4Q avg 74.1% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 19.8% |
12.5%
7.3 pts worse
|
12.0%
7.8 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 19.8% · Observed 26.5% · Expected 15.0% · 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 | 44.6% |
75.6%
31 pts worse
|
79.7%
35.1 pts worse
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 44.6% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 29.5% |
25.1%
4.4 pts worse
|
23.9%
5.6 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 29.5% · Observed 46.9% · Expected 37.9% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2023-10-19 · Fire 2023-10-19
6 health deficiencies
Top issue: Pharmacy Service (3 deficiencies)
5 fire-safety deficiencies
Top issue: Smoke (2 deficiencies)
Cycle 3
Health 2021-06-22 · Fire 2021-06-22
4 health deficiencies
Top issue: Infection Control (1 deficiency)
8 fire-safety deficiencies
Top issue: Egress (2 deficiencies)
Fire safety
Fire-safety citations
F · Potential for more than minimal harm
2025-04-24
K741 · Miscellaneous Deficiencies
Fire Safety
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
Corrected 2025-05-29
F · Potential for more than minimal harm
2025-04-24
K918 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have generator or other power source capable of supplying service within 10 seconds.
Corrected 2025-05-29
F · Potential for more than minimal harm
2023-10-19
K222 · Egress Deficiencies
Fire Safety
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
Corrected 2023-12-07
F · Potential for more than minimal harm
2023-10-19
K353 · Smoke Deficiencies
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2023-12-07
F · Potential for more than minimal harm
2023-10-19
K372 · Smoke Deficiencies
Fire Safety
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Corrected 2023-12-07
F · Potential for more than minimal harm
2023-10-19
K511 · Services Deficiencies
Fire Safety
Have properly installed electrical wiring and gas equipment.
Corrected 2023-12-07
F · Potential for more than minimal harm
2023-10-19
K915 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have proper power supply for life support equipment.
Corrected 2023-12-07
F · Potential for more than minimal harm
2021-06-22
K222 · Egress Deficiencies
Fire Safety
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
Corrected 2021-07-21
F · Potential for more than minimal harm
2021-06-22
K291 · Egress Deficiencies
Fire Safety
Install emergency lighting that can last at least 1 1/2 hours.
Corrected 2021-07-21
F · Potential for more than minimal harm
2021-06-22
K761 · Miscellaneous Deficiencies
Fire Safety
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
Corrected 2021-07-21
F · Potential for more than minimal harm
2021-06-22
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 2021-07-21
F · Potential for more than minimal harm
2021-06-22
K923 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have proper medical gas storage and administration areas.
Corrected 2021-07-21
E · Potential for more than minimal harm
2021-06-22
K353 · Smoke Deficiencies
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2021-07-21
E · Potential for more than minimal harm
2021-06-22
K511 · Services Deficiencies
Fire Safety
Have properly installed electrical wiring and gas equipment.
Corrected 2021-07-21
E · Potential for more than minimal harm
2021-06-22
K741 · Miscellaneous Deficiencies
Fire Safety
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
Corrected 2021-07-21
Inspection history
Recent health citations
D · Potential for more than minimal harm
2026-01-22
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 2026-02-09
F · Potential for more than minimal harm
2025-04-24
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 2025-05-29
D · Potential for more than minimal harm
2025-04-24
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 2025-05-29
D · Potential for more than minimal harm
2025-04-24
F686 · Quality of Life and Care Deficiencies
Health
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected 2025-05-29
D · Potential for more than minimal harm
2025-04-24
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 2025-05-29
E · Potential for more than minimal harm
2023-10-19
F803 · Nutrition and Dietary Deficiencies
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 2023-12-07
D · Potential for more than minimal harm
2023-10-19
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 2023-12-07
D · Potential for more than minimal harm
2023-10-19
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 2023-12-07
D · Potential for more than minimal harm
2023-10-19
F759 · Pharmacy Service Deficiencies
Health
Ensure medication error rates are not 5 percent or greater.
Corrected 2023-12-07
D · Potential for more than minimal harm
2023-10-19
F760 · Pharmacy Service Deficiencies
Health
Ensure that residents are free from significant medication errors.
Corrected 2023-12-07
D · Potential for more than minimal harm
2023-10-19
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2023-12-07
D · Potential for more than minimal harm
2023-06-14
F552 · Resident Rights Deficiencies
Health
Ensure that residents are fully informed and understand their health status, care and treatments.
Corrected 2023-06-27
F · Potential for more than minimal harm
2021-06-22
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2021-07-21
E · Potential for more than minimal harm
2021-06-22
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 2021-07-21
D · Potential for more than minimal harm
2021-06-22
F698 · Quality of Life and Care Deficiencies
Health
Provide safe, appropriate dialysis care/services for a resident who requires such services.
Corrected 2021-07-21
Penalties and ownership
What sits behind the stars
Ownership
Twilight Nursing Holdings, LLC
5% Or Greater Direct Ownership Interest · Organization
Capital Holdings Trust
5% Or Greater Indirect Ownership Interest · Organization
Chomesh 2 LLC
5% Or Greater Indirect Ownership Interest · Organization
Czh Investments LLC
5% Or Greater Indirect Ownership Interest · Organization
Starlight Healthcare LLC
5% Or Greater Indirect Ownership Interest · Organization
Stern, Jacob
Corporate Director · Individual
Stern, Jacob
Corporate Officer · Individual
Wolmark, Rachel
5% Or Greater Indirect Ownership Interest · Individual
Wolmark, Yehuda
5% Or Greater Indirect Ownership Interest · Individual
Woodward, Curtis
W-2 Managing Employee · Individual
Nearby options
Other facilities in reach
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Gaymont Care And Rehabilitation
Norwalk, OH
3-star overall rating with 3-star inspections with 8 recent health deficiencies with 11 fire-safety deficiencies in the latest cycle
#2
Norwalk Memorial Home
Norwalk, OH
4-star overall rating with 4-star inspections with 8 recent health deficiencies with 5 fire-safety deficiencies in the latest cycle
#3
Vista Care Center Of Milan
Milan, OH
2-star overall rating with 1-star inspections with abuse icon flag with $12,834 in total fines with 22 recent health deficiencies with 6 fire-safety deficiencies in the latest cycle
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