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Facility profile · CCN 375174

Brentwood Extended Care & Rehab

47 federal citations on record , including 1 at the Immediate Jeopardy level, and 9 federal enforcement actions totaling $97,625.

1 Immediate Jeopardy

Record summary

Federal record · Q1 2026
47
Total citations
34
Last 3 years
1
Actual harm+
9
Federal penalties
$97,625
Total fines
1
Overall ★ rating

Most common violation categories here

Most common F-tags at this facility

Citation history

47 on record
SurveyF-TagViolationSeveritySource
Jul 31, 2025F851Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data.FComplaint
Jul 31, 2025F610Respond appropriately to all alleged violations.DComplaint
Jul 31, 2025F609Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.DComplaint
Jul 31, 2025F607Develop and implement policies and procedures to prevent abuse, neglect, and theft.DComplaint
Jul 31, 2025F677Provide care and assistance to perform activities of daily living for any resident who is unable.DStandard
Dec 27, 2024F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.DComplaint
Dec 27, 2024F609Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.DComplaint
Dec 27, 2024F600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.DComplaint
Dec 27, 2024F580Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.DComplaint
May 21, 2024F689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.KComplaint
Mar 25, 2024F919Make sure that a working call system is available in each resident's bathroom and bathing area.DStandard
Mar 25, 2024F908Keep all essential equipment working safely.DStandard
Mar 25, 2024F881Implement a program that monitors antibiotic use.EStandard
Mar 25, 2024F880Provide and implement an infection prevention and control program.EStandard
Mar 25, 2024F760Ensure that residents are free from significant medication errors.EStandard
Mar 25, 2024F757Ensure each resident’s drug regimen must be free from unnecessary drugs.DStandard
Mar 25, 2024F732Post nurse staffing information every day.DStandard
Mar 25, 2024F697Provide safe, appropriate pain management for a resident who requires such services.EStandard
Mar 25, 2024F695Provide safe and appropriate respiratory care for a resident when needed.DStandard
Mar 25, 2024F690Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.DStandard
Mar 25, 2024F688Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.DStandard
Mar 25, 2024F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.EStandard
Mar 25, 2024F677Provide care and assistance to perform activities of daily living for any resident who is unable.EStandard
Mar 25, 2024F655Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admittedDStandard
Mar 25, 2024F645PASARR screening for Mental disorders or Intellectual DisabilitiesEStandard
Mar 25, 2024F644Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.DStandard
Mar 25, 2024F641Ensure each resident receives an accurate assessment.DStandard
Mar 25, 2024F638Assure that each resident’s assessment is updated at least once every 3 months.EStandard
Mar 25, 2024F637Assess the resident when there is a significant change in conditionDStandard
Mar 25, 2024F584Honor 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.EStandard
Mar 25, 2024F582Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.DStandard
Nov 21, 2023F921Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.EComplaint
Aug 1, 2023F689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.DComplaint
Aug 1, 2023F584Honor 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.DComplaint
Feb 22, 2023F888Ensure staff are vaccinated for COVID-19DStandard
Feb 22, 2023F851Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data.EStandard
Feb 22, 2023F848Provide a neutral and fair arbitration process and agree to arbitrator and venue.EStandard
Feb 22, 2023F847Inform resident or representatives choice to enter into binding arbitration agreement and right to refuse.EStandard
Feb 22, 2023F812Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.EStandard
Feb 22, 2023F770Provide timely, quality laboratory services/tests to meet the needs of residents.EStandard
Feb 22, 2023F758Implement 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.EStandard
Feb 22, 2023F657Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.EStandard
Feb 22, 2023F656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.EStandard
Feb 22, 2023F645PASARR screening for Mental disorders or Intellectual DisabilitiesDStandard
Feb 22, 2023F641Ensure each resident receives an accurate assessment.EStandard
Feb 22, 2023F637Assess the resident when there is a significant change in conditionDStandard
Feb 22, 2023F578Honor 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.DStandard

Federal enforcement history

Federal regulators have imposed 9 enforcement actions against this facility, including 9 civil money penalties totaling $97,625 .

DateTypeFinePayment denial
Mar 25, 2024Fine$32,709
Feb 12, 2024Fine$4,938
Jan 22, 2024Fine$14,814
Jan 8, 2024Fine$4,938
Jan 2, 2024Fine$4,587
Dec 11, 2023Fine$13,762
Nov 20, 2023Fine$4,587
Nov 13, 2023Fine$4,587
Oct 23, 2023Fine$12,703
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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