Facility profile · CCN 115555
Bonterra Transitional Care & Rehabilitation
41 federal citations on record , including 3 at the Immediate Jeopardy level, and 6 federal enforcement actions totaling $57,064.
Record summary
Federal record · Q1 202641
Total citations
29
Last 3 years
7
Actual harm+
6
Federal penalties
$57,064
Total fines
1
Overall ★ rating
Most common violation categories here
Most common F-tags at this facility
Citation history
41 on record| Survey | F-Tag | Violation | Severity | Source |
|---|---|---|---|---|
| Mar 19, 2025 | F949 | Provide behavior health training consistent with the requirements and as determined by a facility assessment. | E | Complaint |
| Mar 19, 2025 | F919 | Make sure that a working call system is available in each resident's bathroom and bathing area. | D | Complaint |
| Mar 19, 2025 | F881 | Implement a program that monitors antibiotic use. | F | Complaint |
| Mar 19, 2025 | F880 | Provide and implement an infection prevention and control program. | E | Complaint |
| Mar 19, 2025 | F835 | Administer the facility in a manner that enables it to use its resources effectively and efficiently. | J | Complaint |
| Mar 19, 2025 | F812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | E | Complaint |
| Mar 19, 2025 | F800 | Provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs. | E | Complaint |
| Mar 19, 2025 | F791 | Provide or obtain dental services for each resident. | D | Complaint |
| Mar 19, 2025 | F774 | Help the resident with transportation to and from laboratory services outside of the facility. | G | Complaint |
| Mar 19, 2025 | F761 | 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. | E | Complaint |
| Mar 19, 2025 | F697 | Provide safe, appropriate pain management for a resident who requires such services. | G | Complaint |
| Mar 19, 2025 | F695 | Provide safe and appropriate respiratory care for a resident when needed. | D | Complaint |
| Mar 19, 2025 | F689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | E | Complaint |
| Mar 19, 2025 | F684 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | J | Complaint |
| Mar 19, 2025 | F677 | Provide care and assistance to perform activities of daily living for any resident who is unable. | D | Complaint |
| Mar 19, 2025 | F656 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | J | Complaint |
| Mar 19, 2025 | F645 | PASARR screening for Mental disorders or Intellectual Disabilities | D | Complaint |
| Mar 19, 2025 | F609 | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | D | Complaint |
| Mar 19, 2025 | F600 | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | D | Complaint |
| Mar 19, 2025 | F584 | Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. | D | Complaint |
| Mar 19, 2025 | F550 | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | D | Complaint |
| Feb 22, 2024 | F880 | Provide and implement an infection prevention and control program. | F | Complaint |
| Feb 22, 2024 | F689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D | Complaint |
| Feb 22, 2024 | F584 | Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. | E | Complaint |
| Feb 22, 2024 | F550 | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | E | Complaint |
| Aug 16, 2023 | F740 | Ensure each resident must receive and the facility must provide necessary behavioral health care and services. | D | Complaint |
| Aug 16, 2023 | F689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | G | Complaint |
| Aug 16, 2023 | F656 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | G | Complaint |
| Aug 16, 2023 | F609 | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | D | Complaint |
| Jan 5, 2023 | F921 | Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. | D | Standard |
| Jan 5, 2023 | F919 | Make sure that a working call system is available in each resident's bathroom and bathing area. | D | Standard |
| Jan 5, 2023 | F842 | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | D | Standard |
| Jan 5, 2023 | F758 | 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. | D | Standard |
| Jan 5, 2023 | F656 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | D | Standard |
| Jan 5, 2023 | F641 | Ensure each resident receives an accurate assessment. | D | Standard |
| Jan 5, 2023 | F623 | Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | D | Standard |
| May 27, 2021 | F867 | Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. | D | Standard |
| May 27, 2021 | F646 | Notify the appropriate authorities when residents with MD or ID services has a significant change in condition. | D | Standard |
| May 27, 2021 | F645 | PASARR screening for Mental disorders or Intellectual Disabilities | D | Standard |
| May 27, 2021 | F609 | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | D | Standard |
| May 27, 2021 | F600 | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | D | Standard |
Federal enforcement history
Federal regulators have imposed 6 enforcement actions against this facility, including 5 civil money penalties totaling $57,064 and 1 payment-denial actions spanning 16 days.
| Date | Type | Fine | Payment denial |
|---|---|---|---|
| Mar 19, 2025 | Fine | $26,685 | — |
| Mar 19, 2025 | Payment Denial | — | May 13, 2025 · 16 days |
| Nov 20, 2023 | Fine | $4,587 | — |
| Nov 13, 2023 | Fine | $4,587 | — |
| Oct 23, 2023 | Fine | $13,762 | — |
| Aug 16, 2023 | Fine | $7,443 | — |
About this record
A citation is a finding by a state survey team working under federal contract. It is not a court
judgment. The description above is drawn verbatim from federal public datasets. Facilities have
the right to appeal findings through an Informal Dispute Resolution (IDR/IIDR) process.
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