Facility profile · CCN 675183
Twin Oaks Health And Rehabilitation Center
34 federal citations on record , including 2 at the Immediate Jeopardy level, and 1 federal enforcement actions totaling $174,431.
Record summary
Federal record · Q1 202634
Total citations
34
Last 3 years
2
Actual harm+
1
Federal penalties
$174,431
Total fines
3
Overall ★ rating
Most common violation categories here
Most common F-tags at this facility
Citation history
34 on record| Survey | F-Tag | Violation | Severity | Source |
|---|---|---|---|---|
| Dec 31, 2025 | F812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | E | Standard |
| Dec 31, 2025 | F804 | Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | E | Standard |
| Dec 31, 2025 | F732 | Post nurse staffing information every day. | C | Standard |
| Dec 31, 2025 | F645 | PASARR screening for Mental disorders or Intellectual Disabilities | D | Standard |
| Dec 31, 2025 | F641 | Ensure each resident receives an accurate assessment. | D | Standard |
| Apr 15, 2025 | F622 | Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged. | D | Complaint |
| Sep 25, 2024 | F925 | Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. | D | Complaint |
| Sep 25, 2024 | F812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | F | Complaint |
| Sep 25, 2024 | F550 | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | D | Complaint |
| Sep 25, 2024 | F926 | Have policies on smoking. | F | Standard |
| Sep 25, 2024 | F924 | Put firmly secured handrails on each side of hallways. | D | Standard |
| Sep 25, 2024 | F919 | Make sure that a working call system is available in each resident's bathroom and bathing area. | D | Standard |
| Sep 25, 2024 | F887 | Educate 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. | E | Standard |
| Sep 25, 2024 | F883 | Develop and implement policies and procedures for flu and pneumonia vaccinations. | E | Standard |
| Sep 25, 2024 | F880 | Provide and implement an infection prevention and control program. | E | Standard |
| Sep 25, 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 |
| Sep 25, 2024 | F760 | Ensure that residents are free from significant medication errors. | D | Standard |
| Sep 25, 2024 | F689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | E | Standard |
| Sep 25, 2024 | F558 | Reasonably accommodate the needs and preferences of each resident. | E | Standard |
| Jan 18, 2024 | F697 | Provide safe, appropriate pain management for a resident who requires such services. | J | Complaint |
| Jan 18, 2024 | F609 | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | D | Complaint |
| Jan 18, 2024 | F580 | Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | J | Complaint |
| Oct 29, 2023 | F607 | Develop and implement policies and procedures to prevent abuse, neglect, and theft. | E | Complaint |
| Oct 29, 2023 | F600 | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | E | Complaint |
| Jul 26, 2023 | F607 | Develop and implement policies and procedures to prevent abuse, neglect, and theft. | E | Complaint |
| Jul 26, 2023 | F585 | Honor 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. | D | Complaint |
| Jul 26, 2023 | F925 | Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. | E | Standard |
| Jul 26, 2023 | F880 | Provide and implement an infection prevention and control program. | E | Standard |
| Jul 26, 2023 | F804 | Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | E | Standard |
| Jul 26, 2023 | 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 | Standard |
| Jul 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 |
| Jul 26, 2023 | F689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | E | Standard |
| Jul 26, 2023 | F677 | Provide care and assistance to perform activities of daily living for any resident who is unable. | D | Standard |
| Jul 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 |
Federal enforcement history
Federal regulators have imposed 1 enforcement actions against this facility, including 1 civil money penalties totaling $174,431 .
| Date | Type | Fine | Payment denial |
|---|---|---|---|
| Jan 18, 2024 | Fine | $174,431 | — |
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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