Facility profile · CCN 285164
Holmes Lake Rehabilitation & Care Center
32 federal citations on record , and 1 federal enforcement actions totaling $3,174.
Record summary
Federal record · Q1 202632
Total citations
22
Last 3 years
0
Actual harm+
1
Federal penalties
$3,174
Total fines
1
Overall ★ rating
Most common violation categories here
Most common F-tags at this facility
Citation history
32 on record| Survey | F-Tag | Violation | Severity | Source |
|---|---|---|---|---|
| Jun 10, 2025 | F844 | Follow rules about disclosure of ownership requirements and tell the state agency about changes in ownership and/or administrative personnel. | F | Complaint |
| Jun 10, 2025 | F675 | Honor each resident's preferences, choices, values and beliefs. | E | Complaint |
| Jun 10, 2025 | F610 | Respond appropriately to all alleged violations. | D | Complaint |
| Jan 13, 2025 | F880 | Provide and implement an infection prevention and control program. | D | Complaint |
| Jan 13, 2025 | F760 | Ensure that residents are free from significant medication errors. | D | Complaint |
| Jan 13, 2025 | F657 | Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. | D | Complaint |
| Oct 21, 2024 | F880 | Provide and implement an infection prevention and control program. | D | Complaint |
| Oct 8, 2024 | 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 | Complaint |
| Oct 8, 2024 | F684 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | E | Complaint |
| Oct 8, 2024 | F947 | Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention. | F | Standard |
| Oct 8, 2024 | F880 | Provide and implement an infection prevention and control program. | F | Standard |
| Oct 8, 2024 | F812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | F | Standard |
| Oct 8, 2024 | F689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D | Standard |
| Oct 8, 2024 | F580 | Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | D | Standard |
| Mar 13, 2024 | F689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D | Complaint |
| Nov 30, 2023 | F684 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | D | Complaint |
| Nov 30, 2023 | F947 | Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention. | F | Standard |
| Nov 30, 2023 | F880 | Provide and implement an infection prevention and control program. | F | Standard |
| Nov 30, 2023 | F732 | Post nurse staffing information every day. | F | Standard |
| Nov 30, 2023 | F695 | Provide safe and appropriate respiratory care for a resident when needed. | E | Standard |
| Nov 30, 2023 | F686 | Provide appropriate pressure ulcer care and prevent new ulcers from developing. | D | Standard |
| Sep 6, 2023 | F689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | E | Complaint |
| Nov 8, 2022 | F880 | Provide and implement an infection prevention and control program. | F | Standard |
| Nov 8, 2022 | F812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | F | Standard |
| Nov 8, 2022 | F803 | 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. | F | Standard |
| Nov 8, 2022 | F725 | Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. | E | Standard |
| Nov 8, 2022 | F690 | Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. | D | Standard |
| Nov 8, 2022 | F689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D | Standard |
| Nov 8, 2022 | F684 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | D | Standard |
| Nov 8, 2022 | F609 | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | D | Standard |
| Nov 8, 2022 | F580 | Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | D | Standard |
| Nov 8, 2022 | F554 | Allow residents to self-administer drugs if determined clinically appropriate. | D | Standard |
Federal enforcement history
Federal regulators have imposed 1 enforcement actions against this facility, including 1 civil money penalties totaling $3,174 .
| Date | Type | Fine | Payment denial |
|---|---|---|---|
| May 15, 2023 | Fine | $3,174 | — |
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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