Independent · Federal inspection records, searchable
Not a law firm · Not a government agency
Nursing Home Violations Public inspection data, searchable
Facility profile · CCN 056194

Windsor Gardens Convalescent Hospital

100 federal citations on record , and 2 federal enforcement actions totaling $37,882.

Record summary

Federal record · Q1 2026
100
Total citations
70
Last 3 years
4
Actual harm+
2
Federal penalties
$37,882
Total fines
2
Overall ★ rating

Most common violation categories here

Quality of Care26 Resident Rights20 Care Planning16 Medication & Pharmacy13 Nutrition & Dietary11

Most common F-tags at this facility

F6565 F5584 F6904 F8804 F6844

Citation history

100 on record
SurveyF-TagViolationSeveritySource
Aug 14, 2025F658Ensure services provided by the nursing facility meet professional standards of quality.DComplaint
Aug 14, 2025F558Reasonably accommodate the needs and preferences of each resident.EComplaint
Jul 29, 2025F689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.DComplaint
Mar 2, 2025F880Provide and implement an infection prevention and control program.DStandard
Mar 2, 2025F812Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.EStandard
Mar 2, 2025F805Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.EStandard
Mar 2, 2025F803Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.EStandard
Mar 2, 2025F760Ensure that residents are free from significant medication errors.DStandard
Mar 2, 2025F759Ensure medication error rates are not 5 percent or greater.DStandard
Mar 2, 2025F758Implement 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
Mar 2, 2025F757Ensure each resident’s drug regimen must be free from unnecessary drugs.DStandard
Mar 2, 2025F693Ensure 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
Mar 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.DStandard
Mar 2, 2025F686Provide appropriate pressure ulcer care and prevent new ulcers from developing.DStandard
Mar 2, 2025F685Assist a resident in gaining access to vision and hearing services.DStandard
Mar 2, 2025F677Provide care and assistance to perform activities of daily living for any resident who is unable.DStandard
Mar 2, 2025F657Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.DStandard
Mar 2, 2025F641Ensure each resident receives an accurate assessment.DStandard
Mar 2, 2025F636Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.DStandard
Mar 2, 2025F558Reasonably accommodate the needs and preferences of each resident.DStandard
Mar 2, 2025F552Ensure that residents are fully informed and understand their health status, care and treatments.DStandard
Feb 12, 2025F573Let each resident or the resident's legal representative access or purchase copies of all the resident's records.DComplaint
Jan 24, 2025F760Ensure that residents are free from significant medication errors.DComplaint
Nov 5, 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.DComplaint
Oct 30, 2024F626Permit a resident to return to the nursing home after hospitalization or therapeutic leave that exceeds bed-hold policy.DComplaint
Aug 15, 2024F695Provide safe and appropriate respiratory care for a resident when needed.DComplaint
Aug 1, 2024F880Provide and implement an infection prevention and control program.DComplaint
Jul 18, 2024F755Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.DComplaint
Jul 18, 2024F727Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.FComplaint
Jul 18, 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
Jul 18, 2024F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.DComplaint
Jul 18, 2024F656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.DComplaint
Jul 2, 2024F744Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia.DComplaint
Jul 2, 2024F609Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.DComplaint
Jun 7, 2024F835Administer the facility in a manner that enables it to use its resources effectively and efficiently.DComplaint
Jun 7, 2024F658Ensure services provided by the nursing facility meet professional standards of quality.DComplaint
Apr 22, 2024F755Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.DComplaint
Apr 22, 2024F656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.DComplaint
Apr 22, 2024F585Honor 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
Apr 22, 2024F580Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.EComplaint
Mar 8, 2024F758Implement 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.EComplaint
Mar 8, 2024F755Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.EComplaint
Mar 8, 2024F558Reasonably accommodate the needs and preferences of each resident.DComplaint
Mar 6, 2024F760Ensure that residents are free from significant medication errors.DComplaint
Mar 6, 2024F689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.GComplaint
Feb 23, 2024F609Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.DComplaint
Feb 8, 2024F732Post nurse staffing information every day.EComplaint
Feb 8, 2024F686Provide appropriate pressure ulcer care and prevent new ulcers from developing.DComplaint
Feb 8, 2024F676Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.DComplaint
Feb 8, 2024F656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.EComplaint
Feb 8, 2024F644Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.DComplaint
Feb 8, 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.EComplaint
Feb 8, 2024F552Ensure that residents are fully informed and understand their health status, care and treatments.DComplaint
Feb 8, 2024F550Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.DComplaint
Feb 8, 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
Feb 8, 2024F695Provide safe and appropriate respiratory care for a resident when needed.DStandard
Jan 23, 2024F919Make sure that a working call system is available in each resident's bathroom and bathing area.DComplaint
Jan 23, 2024F806Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.DComplaint
Jan 23, 2024F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.DComplaint
Jan 23, 2024F658Ensure services provided by the nursing facility meet professional standards of quality.DComplaint
Jan 5, 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.DComplaint
Jan 5, 2024F755Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.DComplaint
Dec 4, 2023F610Respond appropriately to all alleged violations.DComplaint
Nov 4, 2023F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.GComplaint
Nov 4, 2023F600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.GComplaint
Aug 25, 2023F842Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.DComplaint
Jun 9, 2023F880Provide and implement an infection prevention and control program.EComplaint
Jun 9, 2023F804Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.DComplaint
Jun 9, 2023F677Provide care and assistance to perform activities of daily living for any resident who is unable.DComplaint
Jun 5, 2023F550Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.DComplaint
Apr 17, 2023F690Provide 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 11, 2023F580Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.DComplaint
Mar 28, 2023F770Provide timely, quality laboratory services/tests to meet the needs of residents.DComplaint
Mar 28, 2023F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.GComplaint
Mar 28, 2023F656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.DComplaint
May 7, 2021F880Provide and implement an infection prevention and control program.DStandard
May 7, 2021F842Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.DStandard
May 7, 2021F812Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.FStandard
May 7, 2021F810Provide special eating equipment and utensils for residents who need them and appropriate assistance.DStandard
May 7, 2021F806Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.EStandard
May 7, 2021F805Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.DStandard
May 7, 2021F803Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.EStandard
May 7, 2021F802Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service.FStandard
May 7, 2021F732Post nurse staffing information every day.DStandard
May 7, 2021F694Provide for the safe, appropriate administration of IV fluids for a resident when needed.DStandard
May 7, 2021F693Ensure 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 7, 2021F692Provide enough food/fluids to maintain a resident's health.DStandard
May 7, 2021F690Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.DStandard
May 7, 2021F689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.EStandard
May 7, 2021F688Provide 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
May 7, 2021F677Provide care and assistance to perform activities of daily living for any resident who is unable.DStandard
May 7, 2021F656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.EStandard
May 7, 2021F655Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admittedDStandard
May 7, 2021F641Ensure each resident receives an accurate assessment.DStandard
May 7, 2021F584Honor 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
May 7, 2021F583Keep residents' personal and medical records private and confidential.DStandard
May 7, 2021F577Allow residents to easily view the nursing home's survey results and communicate with advocate agencies.DStandard
May 7, 2021F574The resident has the right to receive notices in a format and a language he or she understands.DStandard
May 7, 2021F572Give residents a notice of rights, rules, services and charges.DStandard
May 7, 2021F558Reasonably accommodate the needs and preferences of each resident.DStandard

Federal enforcement history

Federal regulators have imposed 2 enforcement actions against this facility, including 1 civil money penalties totaling $37,882 and 1 payment-denial actions spanning 18 days.

DateTypeFinePayment denial
Jan 23, 2024Fine$37,882—
Nov 4, 2023Payment Denial—Dec 15, 2023 · 18 days
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.

Concerned about care at Windsor Gardens Convalescent Hospital?

An attorney who focuses on nursing-home abuse and neglect can review the facility's record with you — citation patterns, scope/severity levels, complaint-driven findings — and tell you whether the law recognizes what happened.

  • Consultation is free and confidential
  • You pay nothing unless there is a recovery
  • Your note is shared only with vetted plaintiff attorneys
Free · Confidential · Nationwide network
Free Consultation Request
Tell us about your family's situation
A plaintiff attorney will review your note and respond within one business day.