Independent · Federal inspection records, searchable
Not a law firm · Not a government agency
Nursing Home Violations Public inspection data, searchable
Facility profile · CCN 225198

Twin Oaks Center

58 federal citations on record , and 2 federal enforcement actions totaling $141,733.

Record summary

Federal record · Q1 2026
58
Total citations
58
Last 3 years
4
Actual harm+
2
Federal penalties
$141,733
Total fines
1
Overall ★ rating

Most common violation categories here

Quality of Care15 Care Planning10 Administration8 Resident Rights5 Medication & Pharmacy5

Most common F-tags at this facility

F6583 F6092 F6562 F6842 F6922

Citation history

58 on record
SurveyF-TagViolationSeveritySource
Jun 18, 2025F887Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status.DStandard
Jun 18, 2025F883Develop and implement policies and procedures for flu and pneumonia vaccinations.DStandard
Jun 18, 2025F881Implement a program that monitors antibiotic use.FStandard
Jun 18, 2025F880Provide and implement an infection prevention and control program.FStandard
Jun 18, 2025F867Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.FStandard
Jun 18, 2025F865Have a plan that describes the process for conducting QAPI and QAA activities.FStandard
Jun 18, 2025F842Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.DStandard
Jun 18, 2025F837Establish a governing body that is legally responsible for establishing and implementing policies for managing and operating the facility and appoints a properly licensed administrator responsible for managing the facility.FStandard
Jun 18, 2025F835Administer the facility in a manner that enables it to use its resources effectively and efficiently.FStandard
Jun 18, 2025F761Ensure 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.EStandard
Jun 18, 2025F759Ensure medication error rates are not 5 percent or greater.DStandard
Jun 18, 2025F699Provide care or services that was trauma informed and/or culturally competent.DStandard
Jun 18, 2025F692Provide enough food/fluids to maintain a resident's health.DStandard
Jun 18, 2025F688Provide 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.DStandard
Jun 18, 2025F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.DStandard
Jun 18, 2025F658Ensure services provided by the nursing facility meet professional standards of quality.DStandard
Jun 18, 2025F656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.DStandard
Jun 18, 2025F609Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.DStandard
Jun 18, 2025F550Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.DStandard
Jul 11, 2024F773Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results.GStandard
Jul 11, 2024F692Provide enough food/fluids to maintain a resident's health.GStandard
Jul 11, 2024F658Ensure services provided by the nursing facility meet professional standards of quality.EStandard
Dec 12, 2023F568Properly hold, secure, and manage each resident's personal money which is deposited with the nursing home.DComplaint
May 3, 2023F947Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.DStandard
May 3, 2023F925Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.FStandard
May 3, 2023F881Implement a program that monitors antibiotic use.DStandard
May 3, 2023F867Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.FStandard
May 3, 2023F865Have a plan that describes the process for conducting QAPI and QAA activities.FStandard
May 3, 2023F842Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.EStandard
May 3, 2023F835Administer the facility in a manner that enables it to use its resources effectively and efficiently.FStandard
May 3, 2023F812Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.EStandard
May 3, 2023F804Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.EStandard
May 3, 2023F791Provide or obtain dental services for each resident.DStandard
May 3, 2023F761Ensure 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.FStandard
May 3, 2023F760Ensure that residents are free from significant medication errors.HStandard
May 3, 2023F759Ensure medication error rates are not 5 percent or greater.EStandard
May 3, 2023F730Observe each nurse aide's job performance and give regular training.FStandard
May 3, 2023F726Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.DStandard
May 3, 2023F725Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.DStandard
May 3, 2023F698Provide safe, appropriate dialysis care/services for a resident who requires such services.DStandard
May 3, 2023F695Provide safe and appropriate respiratory care for a resident when needed.DStandard
May 3, 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.DStandard
May 3, 2023F689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.GStandard
May 3, 2023F687Provide appropriate foot care.DStandard
May 3, 2023F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.DStandard
May 3, 2023F679Provide activities to meet all resident's needs.EStandard
May 3, 2023F677Provide care and assistance to perform activities of daily living for any resident who is unable.DStandard
May 3, 2023F676Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.DStandard
May 3, 2023F658Ensure services provided by the nursing facility meet professional standards of quality.DStandard
May 3, 2023F656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.EStandard
May 3, 2023F641Ensure each resident receives an accurate assessment.DStandard
May 3, 2023F638Assure that each resident’s assessment is updated at least once every 3 months.DStandard
May 3, 2023F636Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.FStandard
May 3, 2023F610Respond appropriately to all alleged violations.DStandard
May 3, 2023F609Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.DStandard
May 3, 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.DStandard
May 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.FStandard
May 3, 2023F552Ensure that residents are fully informed and understand their health status, care and treatments.DStandard

Federal enforcement history

Federal regulators have imposed 2 enforcement actions against this facility, including 2 civil money penalties totaling $141,733 .

DateTypeFinePayment denial
Jul 11, 2024Fine$2,186—
May 3, 2023Fine$139,547—
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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