Independent · Federal inspection records, searchable
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Nursing Home Violations Public inspection data, searchable
Facility profile · CCN 455429

Rose Trail Nursing And Rehabilitation Center

63 federal citations on record , including 9 at the Immediate Jeopardy level, and 7 federal enforcement actions totaling $539,122.

Special Focus Status 9 Immediate Jeopardy

Record summary

Federal record · Q1 2026
63
Total citations
59
Last 3 years
12
Actual harm+
7
Federal penalties
$539,122
Total fines
1
Overall ★ rating

Most common violation categories here

Quality of Care15 Care Planning14 Abuse & Neglect10 Resident Rights8 Infection Control5

Most common F-tags at this facility

F6565 F8805 F6903 F6953 F6893

Citation history

63 on record
SurveyF-TagViolationSeveritySource
Jan 2, 2026F583Keep residents' personal and medical records private and confidential.EComplaint
Dec 4, 2025F880Provide and implement an infection prevention and control program.EStandard
Dec 4, 2025F812Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.EStandard
Dec 4, 2025F760Ensure that residents are free from significant medication errors.DStandard
Dec 4, 2025F759Ensure medication error rates are not 5 percent or greater.DStandard
Dec 4, 2025F755Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.DStandard
Dec 4, 2025F695Provide safe and appropriate respiratory care for a resident when needed.DStandard
Dec 4, 2025F656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.DStandard
Dec 4, 2025F655Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admittedDStandard
Dec 4, 2025F644Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.DStandard
Dec 4, 2025F550Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.DStandard
Nov 18, 2025F656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.EComplaint
Nov 18, 2025F655Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admittedEComplaint
Oct 2, 2025F880Provide and implement an infection prevention and control program.KComplaint
Oct 2, 2025F695Provide safe and appropriate respiratory care for a resident when needed.KComplaint
Oct 2, 2025F690Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.DComplaint
Oct 2, 2025F656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.DComplaint
Oct 2, 2025F609Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.DComplaint
Aug 15, 2025F695Provide safe and appropriate respiratory care for a resident when needed.DComplaint
Aug 15, 2025F689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.JComplaint
Mar 25, 2025F880Provide and implement an infection prevention and control program.DComplaint
Mar 25, 2025F686Provide appropriate pressure ulcer care and prevent new ulcers from developing.DComplaint
Mar 25, 2025F656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.DComplaint
Sep 25, 2024F880Provide and implement an infection prevention and control program.DStandard
Sep 25, 2024F759Ensure medication error rates are not 5 percent or greater.DStandard
Sep 25, 2024F755Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.EStandard
Sep 25, 2024F644Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.DStandard
Sep 25, 2024F641Ensure each resident receives an accurate assessment.EStandard
Aug 25, 2024F770Provide timely, quality laboratory services/tests to meet the needs of residents.DComplaint
Jul 10, 2024F850Hire a qualified full-time social worker in a facility with more than 120 beds.DComplaint
May 17, 2024F610Respond appropriately to all alleged violations.DComplaint
May 17, 2024F600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.GComplaint
Apr 3, 2024F690Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.DComplaint
Apr 3, 2024F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.KComplaint
Mar 18, 2024F626Permit a resident to return to the nursing home after hospitalization or therapeutic leave that exceeds bed-hold policy.DComplaint
Mar 18, 2024F623Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.DComplaint
Mar 18, 2024F622Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged.DComplaint
Jan 9, 2024F880Provide and implement an infection prevention and control program.FComplaint
Dec 18, 2023F689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.GComplaint
Dec 18, 2023F600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.GComplaint
Dec 18, 2023F585Honor 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.DComplaint
Nov 2, 2023F791Provide or obtain dental services for each resident.EComplaint
Nov 2, 2023F656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.DComplaint
Nov 2, 2023F641Ensure each resident receives an accurate assessment.DComplaint
Sep 22, 2023F693Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.EComplaint
Sep 22, 2023F690Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.EComplaint
Sep 22, 2023F550Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.EComplaint
Aug 18, 2023F610Respond appropriately to all alleged violations.JComplaint
Aug 18, 2023F609Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.DComplaint
Aug 18, 2023F607Develop and implement policies and procedures to prevent abuse, neglect, and theft.JComplaint
Aug 18, 2023F600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.JComplaint
Aug 18, 2023F732Post nurse staffing information every day.CStandard
Aug 18, 2023F677Provide care and assistance to perform activities of daily living for any resident who is unable.EStandard
Aug 18, 2023F641Ensure each resident receives an accurate assessment.EStandard
Aug 18, 2023F640Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment.DStandard
Aug 18, 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.EStandard
Aug 4, 2023F607Develop and implement policies and procedures to prevent abuse, neglect, and theft.DComplaint
Aug 4, 2023F606Not hire anyone with a finding of abuse, neglect, exploitation, or theft.EComplaint
Jun 29, 2023F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.JComplaint
Apr 3, 2023F926Have policies on smoking.DComplaint
Apr 3, 2023F921Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.DComplaint
Apr 3, 2023F689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.JComplaint
Apr 3, 2023F636Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.DComplaint

Federal enforcement history

Federal regulators have imposed 7 enforcement actions against this facility, including 7 civil money penalties totaling $539,122 .

DateTypeFinePayment denial
Aug 15, 2025Fine$161,475—
Aug 15, 2025Fine$18,520—
Mar 18, 2024Fine$230,484—
Dec 18, 2023Fine$44,590—
Aug 4, 2023Fine$49,470—
Jun 29, 2023Fine$14,518—
Apr 3, 2023Fine$20,065—
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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