Independent · Federal inspection records, searchable
Not a law firm · Not a government agency
Nursing Home Violations Public inspection data, searchable
Facility profile · CCN 395500

Twin Lakes Rehabilitation And Healthcare Center

77 federal citations on record , including 1 at the Immediate Jeopardy level, and 1 federal enforcement actions totaling $11,035.

1 Immediate Jeopardy

Record summary

Federal record · Q1 2026
77
Total citations
77
Last 3 years
1
Actual harm+
1
Federal penalties
$11,035
Total fines
1
Overall ★ rating

Most common violation categories here

Quality of Care21 Care Planning20 Resident Rights11 Medication & Pharmacy7 Administration6

Most common F-tags at this facility

F6845 F6565 F8424 F6893 F6573

Citation history

77 on record
SurveyF-TagViolationSeveritySource
Jan 2, 2026F835Administer the facility in a manner that enables it to use its resources effectively and efficiently.EComplaint
Jan 2, 2026F689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.KComplaint
Nov 20, 2025F867Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.DStandard
Nov 20, 2025F812Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.EStandard
Nov 20, 2025F804Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.EStandard
Nov 20, 2025F760Ensure that residents are free from significant medication errors.DStandard
Nov 20, 2025F755Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.DStandard
Nov 20, 2025F689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.DStandard
Nov 20, 2025F687Provide appropriate foot care.DStandard
Nov 20, 2025F658Ensure services provided by the nursing facility meet professional standards of quality.EStandard
Nov 20, 2025F657Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.DStandard
Nov 20, 2025F656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.DStandard
Nov 20, 2025F636Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.DStandard
Nov 20, 2025F558Reasonably accommodate the needs and preferences of each resident.DStandard
May 14, 2025F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.EComplaint
Apr 30, 2025F842Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.DComplaint
Dec 3, 2024F773Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results.DComplaint
Dec 3, 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
Oct 9, 2024F810Provide special eating equipment and utensils for residents who need them and appropriate assistance.DComplaint
Oct 9, 2024F690Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.EComplaint
Oct 9, 2024F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.DComplaint
Oct 9, 2024F677Provide care and assistance to perform activities of daily living for any resident who is unable.EComplaint
Oct 9, 2024F658Ensure services provided by the nursing facility meet professional standards of quality.DComplaint
Oct 9, 2024F558Reasonably accommodate the needs and preferences of each resident.DComplaint
Oct 9, 2024F554Allow residents to self-administer drugs if determined clinically appropriate.DComplaint
Oct 9, 2024F552Ensure that residents are fully informed and understand their health status, care and treatments.DComplaint
Oct 9, 2024F921Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.DStandard
Oct 9, 2024F867Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.DStandard
Oct 9, 2024F842Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.DStandard
Oct 9, 2024F761Ensure 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
Oct 9, 2024F756Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.DStandard
Oct 9, 2024F730Observe each nurse aide's job performance and give regular training.DStandard
Oct 9, 2024F712Ensure that the resident and his/her doctor meet face-to-face at all required visits.EStandard
Oct 9, 2024F699Provide care or services that was trauma informed and/or culturally competent.DStandard
Oct 9, 2024F694Provide for the safe, appropriate administration of IV fluids for a resident when needed.EStandard
Oct 9, 2024F693Ensure 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.EStandard
Oct 9, 2024F685Assist a resident in gaining access to vision and hearing services.DStandard
Oct 9, 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 9, 2024F656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.DStandard
Oct 9, 2024F641Ensure each resident receives an accurate assessment.DStandard
Oct 9, 2024F623Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.DStandard
Oct 9, 2024F607Develop and implement policies and procedures to prevent abuse, neglect, and theft.DStandard
Oct 9, 2024F578Honor 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
Sep 11, 2024F880Provide and implement an infection prevention and control program.DComplaint
Sep 11, 2024F686Provide appropriate pressure ulcer care and prevent new ulcers from developing.DComplaint
Sep 11, 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.DComplaint
Jul 3, 2024F880Provide and implement an infection prevention and control program.DComplaint
Jul 3, 2024F689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.DComplaint
Jul 3, 2024F553Allow resident to participate in the development and implementation of his or her person-centered plan of care.EComplaint
May 30, 2024F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.DComplaint
May 1, 2024F755Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.DComplaint
Mar 5, 2024F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.DComplaint
Nov 9, 2023F880Provide and implement an infection prevention and control program.EComplaint
Nov 9, 2023F867Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.EComplaint
Nov 9, 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.DComplaint
Nov 9, 2023F686Provide appropriate pressure ulcer care and prevent new ulcers from developing.DComplaint
Nov 9, 2023F842Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.DStandard
Nov 9, 2023F812Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.EStandard
Nov 9, 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
Nov 9, 2023F755Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.EStandard
Nov 9, 2023F692Provide enough food/fluids to maintain a resident's health.EStandard
Nov 9, 2023F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.EStandard
Nov 9, 2023F657Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.DStandard
Nov 9, 2023F656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.DStandard
Nov 9, 2023F641Ensure each resident receives an accurate assessment.DStandard
Nov 9, 2023F638Assure that each resident’s assessment is updated at least once every 3 months.DStandard
Nov 9, 2023F636Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.DStandard
Oct 3, 2023F677Provide care and assistance to perform activities of daily living for any resident who is unable.DComplaint
Oct 3, 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.EComplaint
Aug 29, 2023F656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.DComplaint
Jul 12, 2023F842Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.DComplaint
Jul 12, 2023F712Ensure that the resident and his/her doctor meet face-to-face at all required visits.DComplaint
Jul 12, 2023F677Provide care and assistance to perform activities of daily living for any resident who is unable.EComplaint
Jul 12, 2023F656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.DComplaint
Jul 12, 2023F655Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admittedDComplaint
May 22, 2023F773Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results.DComplaint
May 22, 2023F580Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.DComplaint

Federal enforcement history

Federal regulators have imposed 1 enforcement actions against this facility, including 1 civil money penalties totaling $11,035 .

DateTypeFinePayment denial
Nov 20, 2025Fine$11,035—
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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