Independent · Federal inspection records, searchable
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Nursing Home Violations Public inspection data, searchable
Facility profile · CCN 075017

Montowese Center For Health & Rehabilitation

80 federal citations on record , including 1 at the Immediate Jeopardy level, and 2 federal enforcement actions totaling $19,344.

1 Immediate Jeopardy

Record summary

Federal record · Q1 2026
80
Total citations
52
Last 3 years
4
Actual harm+
2
Federal penalties
$19,344
Total fines
1
Overall ★ rating

Most common violation categories here

Quality of Care22 Care Planning14 Resident Rights12 Medication & Pharmacy7 Abuse & Neglect7

Most common F-tags at this facility

F6847 F6585 F5805 F7604 F6893

Citation history

80 on record
SurveyF-TagViolationSeveritySource
Jan 27, 2026F658Ensure services provided by the nursing facility meet professional standards of quality.DComplaint
May 22, 2025F658Ensure services provided by the nursing facility meet professional standards of quality.EComplaint
May 5, 2025F658Ensure services provided by the nursing facility meet professional standards of quality.DComplaint
Jan 15, 2025F600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.GComplaint
Dec 23, 2024F655Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admittedDComplaint
Oct 24, 2024F882Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.EComplaint
Oct 24, 2024F880Provide and implement an infection prevention and control program.EComplaint
Oct 24, 2024F919Make sure that a working call system is available in each resident's bathroom and bathing area.EStandard
Oct 24, 2024F756Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.EStandard
Oct 24, 2024F711Ensure the resident's doctor reviews the resident's care, writes, signs and dates progress notes and orders, at each required visit.EStandard
Oct 24, 2024F689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.DStandard
Oct 24, 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.EStandard
Oct 24, 2024F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.EStandard
Oct 24, 2024F657Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.DStandard
Oct 24, 2024F580Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.EStandard
Sep 30, 2024F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.DComplaint
Sep 30, 2024F550Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.DComplaint
Jul 17, 2024F600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.DComplaint
Jun 26, 2024F842Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.DComplaint
May 23, 2024F921Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.DComplaint
May 23, 2024F842Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.DComplaint
May 23, 2024F806Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.DComplaint
May 23, 2024F776Provide timely, approved x-ray services, or have an agreement with an approved provider to obtain them.DComplaint
May 23, 2024F775Keep complete, dated laboratory records in the resident's record.DComplaint
May 23, 2024F770Provide timely, quality laboratory services/tests to meet the needs of residents.DComplaint
May 23, 2024F760Ensure that residents are free from significant medication errors.EComplaint
May 23, 2024F726Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.DComplaint
May 23, 2024F725Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.DComplaint
May 23, 2024F697Provide safe, appropriate pain management for a resident who requires such services.DComplaint
May 23, 2024F692Provide enough food/fluids to maintain a resident's health.DComplaint
May 23, 2024F686Provide appropriate pressure ulcer care and prevent new ulcers from developing.DComplaint
May 23, 2024F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.DComplaint
May 23, 2024F636Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.DComplaint
May 23, 2024F635Provide doctor's orders for the resident's immediate care at the time the resident was admitted.DComplaint
May 23, 2024F624Prepare residents for a safe transfer or discharge from the nursing home.DComplaint
May 23, 2024F610Respond appropriately to all alleged violations.EComplaint
May 23, 2024F580Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.DComplaint
May 23, 2024F577Allow residents to easily view the nursing home's survey results and communicate with advocate agencies.DComplaint
May 23, 2024F554Allow residents to self-administer drugs if determined clinically appropriate.DComplaint
Mar 14, 2024F726Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.DComplaint
Mar 14, 2024F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.DComplaint
Mar 14, 2024F656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.DComplaint
Mar 14, 2024F610Respond appropriately to all alleged violations.DComplaint
Mar 14, 2024F609Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.DComplaint
Dec 7, 2023F760Ensure that residents are free from significant medication errors.DComplaint
Dec 7, 2023F658Ensure services provided by the nursing facility meet professional standards of quality.DComplaint
Nov 13, 2023F694Provide for the safe, appropriate administration of IV fluids for a resident when needed.DComplaint
Nov 13, 2023F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.DComplaint
Oct 24, 2023F658Ensure services provided by the nursing facility meet professional standards of quality.DComplaint
Jun 7, 2023F760Ensure that residents are free from significant medication errors.GComplaint
Jun 7, 2023F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.DComplaint
Jun 7, 2023F580Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.DComplaint
Aug 16, 2022F880Provide and implement an infection prevention and control program.EStandard
Aug 16, 2022F836Ensure the facility is licensed under applicable State and local law and operates and provides services in compliance with all applicable Federal, State, and local laws, regulations, and codes, and with accepted professional standards.DStandard
Aug 16, 2022F772Have an agreement with an approved laboratory to obtain services, if on-site laboratory services aren't provided.EStandard
Aug 16, 2022F761Ensure 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.DStandard
Aug 16, 2022F760Ensure that residents are free from significant medication errors.JStandard
Aug 16, 2022F758Implement 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.DStandard
Aug 16, 2022F690Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.EStandard
Aug 16, 2022F689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.DStandard
Aug 16, 2022F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.GStandard
Aug 16, 2022F657Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.DStandard
Aug 16, 2022F656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.DStandard
Aug 16, 2022F580Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.DStandard
Aug 16, 2022F578Honor 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
Mar 6, 2020F880Provide and implement an infection prevention and control program.DStandard
Mar 6, 2020F814Dispose of garbage and refuse properly.DStandard
Mar 6, 2020F812Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.EStandard
Mar 6, 2020F791Provide or obtain dental services for each resident.DStandard
Mar 6, 2020F694Provide for the safe, appropriate administration of IV fluids for a resident when needed.DStandard
Mar 6, 2020F692Provide enough food/fluids to maintain a resident's health.DStandard
Mar 6, 2020F689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.DStandard
Mar 6, 2020F687Provide appropriate foot care.DStandard
Mar 6, 2020F686Provide appropriate pressure ulcer care and prevent new ulcers from developing.DStandard
Mar 6, 2020F677Provide care and assistance to perform activities of daily living for any resident who is unable.DStandard
Mar 6, 2020F609Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.DStandard
Mar 6, 2020F600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.DStandard
Mar 6, 2020F585Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.DStandard
Mar 6, 2020F580Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.DStandard
Mar 6, 2020F558Reasonably accommodate the needs and preferences of each resident.DStandard

Federal enforcement history

Federal regulators have imposed 2 enforcement actions against this facility, including 2 civil money penalties totaling $19,344 .

DateTypeFinePayment denial
Dec 23, 2024Fine$10,033—
Jun 7, 2023Fine$9,311—
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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