All citations for Birchwood Park Rehabilitation

State inspectors check nursing homes that take Medicare or Medicaid against federal rules, usually about once a year, and also look into complaints. Each rule a home did not meet is a citation.

Back to Birchwood Park Rehabilitation

Last standard health inspection on record

December 19, 2024

Showing 1 to 25 of 41 citations

  1. Immediate jeopardy to resident health or safety

    Provide and implement an infection prevention and control program.

    Widespread (many residents). CMS level L.

    Health citation F-0880, Infection Control Deficiencies. Inspection of September 30, 2021. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 5, 2021).

  2. Immediate jeopardy to resident health or safety

    Perform COVID19 testing on residents and staff.

    Widespread (many residents). CMS level L.

    Health citation F-0886, Infection Control Deficiencies. Inspection of September 30, 2021. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 5, 2021).

  3. Harm to a resident

    Provide appropriate treatment and care according to orders, resident’s preferences and goals.

    Isolated (one or a few residents). CMS level G.

    Health citation F-0684, Quality of Life and Care Deficiencies. Inspection of December 19, 2024. Found during a complaint inspection.

    The home gave a date the problem would be corrected (May 14, 2025).

  4. No harm, with potential for more than minimal harm

    Establish 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.

    Widespread (many residents). CMS level F.

    Health citation F-0837, Administration Deficiencies. Inspection of September 30, 2021. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 5, 2021).

  5. No harm, with potential for more than minimal harm

    Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies.

    Widespread (many residents). CMS level F.

    Health citation F-0838, Administration Deficiencies. Inspection of September 30, 2021. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 5, 2021).

  6. No harm, with potential for more than minimal harm

    Employ or obtain outside professional resources to provide services in the nursing home when the facility does not employ a qualified professional to furnish a required service.

    Widespread (many residents). CMS level F.

    Health citation F-0840, Administration Deficiencies. Inspection of September 30, 2021. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 5, 2021).

  7. No harm, with potential for more than minimal harm

    Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.

    Widespread (many residents). CMS level F.

    Health citation F-0867, Administration Deficiencies. Inspection of September 30, 2021. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 5, 2021).

  8. No harm, with potential for more than minimal harm

    Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.

    Widespread (many residents). CMS level F.

    Health citation F-0925, Environmental Deficiencies. Inspection of September 30, 2021. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 5, 2021).

  9. No harm, with potential for more than minimal harm

    Ensure each resident receives an accurate assessment.

    Pattern (more than a few residents). CMS level E.

    Health citation F-0641, Resident Assessment and Care Planning Deficiencies. Inspection of December 19, 2024. Found during a complaint inspection.

    The home gave a date the problem would be corrected (May 14, 2025).

  10. No harm, with potential for more than minimal harm

    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.

    Pattern (more than a few residents). CMS level E.

    Health citation F-0622, Resident Rights Deficiencies. Inspection of September 30, 2021. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 5, 2021).

  11. No harm, with potential for more than minimal harm

    Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.

    Pattern (more than a few residents). CMS level E.

    Health citation F-0625, Resident Rights Deficiencies. Inspection of September 30, 2021. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 5, 2021).

  12. No harm, with potential for more than minimal harm

    Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

    Pattern (more than a few residents). CMS level E.

    Health citation F-0657, Resident Assessment and Care Planning Deficiencies. Inspection of September 30, 2021. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 5, 2021).

  13. No harm, with potential for more than minimal harm

    Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

    Pattern (more than a few residents). CMS level E.

    Health citation F-0690, Quality of Life and Care Deficiencies. Inspection of September 30, 2021. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 5, 2021).

  14. No harm, with potential for more than minimal harm

    Have 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.

    Pattern (more than a few residents). CMS level E.

    Health citation F-0727, Nursing and Physician Services Deficiencies. Inspection of September 30, 2021. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 5, 2021).

  15. No harm, with potential for more than minimal harm

    Implement a program that monitors antibiotic use.

    Pattern (more than a few residents). CMS level E.

    Health citation F-0881, Infection Control Deficiencies. Inspection of September 30, 2021. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 5, 2021).

  16. No harm, with potential for more than minimal harm

    Develop and implement policies and procedures for flu and pneumonia vaccinations.

    Pattern (more than a few residents). CMS level E.

    Health citation F-0883, Infection Control Deficiencies. Inspection of September 30, 2021. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 5, 2021).

  17. No harm, with potential for more than minimal harm

    Report COVID19 data to residents and families.

    Pattern (more than a few residents). CMS level E.

    Health citation F-0885, Infection Control Deficiencies. Inspection of September 30, 2021. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 5, 2021).

  18. No harm, with potential for more than minimal harm

    Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.

    Pattern (more than a few residents). CMS level E.

    Health citation F-0921, Environmental Deficiencies. Inspection of September 30, 2021. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 5, 2021).

  19. No harm, with potential for more than minimal harm

    Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0550, Resident Rights Deficiencies. Inspection of April 4, 2025. Found during a complaint inspection.

    The home gave a date the problem would be corrected (May 14, 2025).

  20. No harm, with potential for more than minimal harm

    Develop and implement policies and procedures to prevent abuse, neglect, and theft.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0607, Freedom from Abuse, Neglect, and Exploitation Deficiencies. Inspection of April 4, 2025. Found during a complaint inspection.

    The home gave a date the problem would be corrected (May 14, 2025).

  21. No harm, with potential for more than minimal harm

    Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0609, Freedom from Abuse, Neglect, and Exploitation Deficiencies. Inspection of April 4, 2025. Found during a complaint inspection.

    The home gave a date the problem would be corrected (May 14, 2025).

  22. No harm, with potential for more than minimal harm

    Respond appropriately to all alleged violations.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0610, Freedom from Abuse, Neglect, and Exploitation Deficiencies. Inspection of April 4, 2025. Found during a complaint inspection.

    The home gave a date the problem would be corrected (May 14, 2025).

  23. No harm, with potential for more than minimal harm

    Provide care and assistance to perform activities of daily living for any resident who is unable.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0677, Quality of Life and Care Deficiencies. Inspection of April 4, 2025. Found during a complaint inspection.

    The home gave a date the problem would be corrected (May 14, 2025).

  24. No harm, with potential for more than minimal harm

    Provide safe, appropriate dialysis care/services for a resident who requires such services.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0698, Quality of Life and Care Deficiencies. Inspection of April 4, 2025. Found during a complaint inspection.

    The home gave a date the problem would be corrected (May 14, 2025).

  25. No harm, with potential for more than minimal harm

    Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

    Isolated (one or a few residents). CMS level D.

    Health citation F-0550, Resident Rights Deficiencies. Inspection of December 19, 2024. Found during a complaint inspection.

    The home gave a date the problem would be corrected (May 14, 2025).

Source: CMS Provider Information, Fire Safety Deficiencies, Health Deficiencies, Citation Code Look-up, data as of October 1, 2026. Inspection results describe the home at the time of each inspection.