Facility profile · CCN 675998
Legacy At Town Creek
38 federal citations on record , including 3 at the Immediate Jeopardy level, and 2 federal enforcement actions totaling $300,185.
Record summary
Federal record · Q1 202638
Total citations
38
Last 3 years
5
Actual harm+
2
Federal penalties
$300,185
Total fines
2
Overall ★ rating
Most common violation categories here
Most common F-tags at this facility
Citation history
38 on record| Survey | F-Tag | Violation | Severity | Source |
|---|---|---|---|---|
| Jan 7, 2026 | F580 | Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | D | Complaint |
| Oct 8, 2025 | F695 | Provide safe and appropriate respiratory care for a resident when needed. | G | Complaint |
| Aug 6, 2025 | F880 | Provide and implement an infection prevention and control program. | D | Standard |
| Aug 6, 2025 | F813 | Have a policy regarding use and storage of foods brought to residents by family and other visitors. | D | Standard |
| Aug 6, 2025 | F812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | E | Standard |
| Aug 6, 2025 | F755 | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | D | Standard |
| Jul 31, 2024 | F925 | Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. | D | Complaint |
| Jul 31, 2024 | F880 | Provide and implement an infection prevention and control program. | D | Standard |
| Jul 31, 2024 | F812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | F | Standard |
| Jul 31, 2024 | 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. | D | Standard |
| Jul 31, 2024 | F755 | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | D | Standard |
| Jul 31, 2024 | F689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D | Standard |
| Jul 31, 2024 | F640 | Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment. | B | Standard |
| Jun 6, 2024 | F880 | Provide and implement an infection prevention and control program. | D | Complaint |
| Jun 6, 2024 | F689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | G | Complaint |
| Jun 6, 2024 | F610 | Respond appropriately to all alleged violations. | K | Complaint |
| Jun 6, 2024 | F609 | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | E | Complaint |
| Jun 6, 2024 | F607 | Develop and implement policies and procedures to prevent abuse, neglect, and theft. | K | Complaint |
| Jun 6, 2024 | F600 | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | K | Complaint |
| Jan 22, 2024 | 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 |
| Jan 22, 2024 | F695 | Provide safe and appropriate respiratory care for a resident when needed. | D | Complaint |
| Aug 8, 2023 | F607 | Develop and implement policies and procedures to prevent abuse, neglect, and theft. | D | Complaint |
| Apr 26, 2023 | F926 | Have policies on smoking. | D | Standard |
| Apr 26, 2023 | F921 | Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. | E | Standard |
| Apr 26, 2023 | F880 | Provide and implement an infection prevention and control program. | D | Standard |
| Apr 26, 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. | E | Standard |
| Apr 26, 2023 | F755 | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | D | Standard |
| Apr 26, 2023 | F698 | Provide safe, appropriate dialysis care/services for a resident who requires such services. | D | Standard |
| Apr 26, 2023 | F695 | Provide safe and appropriate respiratory care for a resident when needed. | E | Standard |
| Apr 26, 2023 | F692 | Provide enough food/fluids to maintain a resident's health. | D | Standard |
| Apr 26, 2023 | 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 |
| Apr 26, 2023 | F677 | Provide care and assistance to perform activities of daily living for any resident who is unable. | E | Standard |
| Apr 26, 2023 | 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 | Standard |
| Apr 26, 2023 | F656 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | E | Standard |
| Apr 26, 2023 | F655 | Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | E | Standard |
| Apr 26, 2023 | 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 | Standard |
| Apr 26, 2023 | F552 | Ensure that residents are fully informed and understand their health status, care and treatments. | E | Standard |
| Apr 26, 2023 | F550 | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | D | Standard |
Federal enforcement history
Federal regulators have imposed 2 enforcement actions against this facility, including 2 civil money penalties totaling $300,185 .
| Date | Type | Fine | Payment denial |
|---|---|---|---|
| Oct 8, 2025 | Fine | $15,935 | — |
| Jun 6, 2024 | Fine | $284,250 | — |
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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