All citations for Carriage Square Rehab and Healthcare Center

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 Carriage Square Rehab and Healthcare Center

Last standard health inspection on record

March 14, 2025

Showing 1 to 25 of 35 citations

No harm, with potential for more than minimal harm
Provide and implement an infection prevention and control program.
Widespread (many residents). CMS level F.
Health citation F-0880, Infection Control Deficiencies. Inspection of July 14, 2023. Found during a standard inspection.
The home gave a date the problem would be corrected (September 20, 2023).
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.
Widespread (many residents). CMS level F.
Health citation F-0921, Environmental Deficiencies. Inspection of July 14, 2023. Found during a standard inspection.
The home gave a date the problem would be corrected (September 20, 2023).
No harm, with potential for more than minimal harm
Have approved installation, maintenance and testing program for fire alarm systems.
Widespread (many residents). CMS level F.
Fire safety citation K-0345, Smoke Deficiencies. Inspection of July 14, 2023. Found during a standard inspection.
The home gave a date the problem would be corrected (September 6, 2023).
No harm, with potential for more than minimal harm
Inspect, test, and maintain automatic sprinkler systems.
Widespread (many residents). CMS level F.
Fire safety citation K-0353, Smoke Deficiencies. Inspection of July 14, 2023. Found during a standard inspection.
The home gave a date the problem would be corrected (September 6, 2023).
No harm, with potential for more than minimal harm
Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours.
Widespread (many residents). CMS level F.
Fire safety citation K-0354, Smoke Deficiencies. Inspection of July 14, 2023. Found during a standard inspection.
The home gave a date the problem would be corrected (September 6, 2023).
No harm, with potential for more than minimal harm
Have simulated fire drills held at unexpected times.
Widespread (many residents). CMS level F.
Fire safety citation K-0712, Miscellaneous Deficiencies. Inspection of July 14, 2023. Found during a standard inspection.
The home gave a date the problem would be corrected (September 6, 2023).
No harm, with potential for more than minimal harm
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
Widespread (many residents). CMS level F.
Fire safety citation K-0761, Miscellaneous Deficiencies. Inspection of July 14, 2023. Found during a standard inspection.
The home gave a date the problem would be corrected (September 6, 2023).
No harm, with potential for more than minimal harm
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.
Widespread (many residents). CMS level F.
Fire safety citation K-0914, Gas, Vacuum, and Electrical Systems Deficiencies. Inspection of July 14, 2023. Found during a standard inspection.
The home gave a date the problem would be corrected (September 6, 2023).
No harm, with potential for more than minimal harm
Have generator or other power source capable of supplying service within 10 seconds.
Widespread (many residents). CMS level F.
Fire safety citation K-0918, Gas, Vacuum, and Electrical Systems Deficiencies. Inspection of July 14, 2023. Found during a standard inspection.
The home gave a date the problem would be corrected (September 6, 2023).
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.
Pattern (more than a few residents). CMS level E.
Health citation F-0550, Resident Rights Deficiencies. Inspection of July 14, 2023. Found during a standard inspection.
The home gave a date the problem would be corrected (September 20, 2023).
No harm, with potential for more than minimal harm
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
Pattern (more than a few residents). CMS level E.
Health citation F-0561, Resident Rights Deficiencies. Inspection of July 14, 2023. Found during a standard inspection.
The home gave a date the problem would be corrected (September 20, 2023).
No harm, with potential for more than minimal harm
Honor 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.
Pattern (more than a few residents). CMS level E.
Health citation F-0584, Resident Rights Deficiencies. Inspection of July 14, 2023. Found during a standard inspection.
The home gave a date the problem would be corrected (September 20, 2023).
No harm, with potential for more than minimal harm
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Pattern (more than a few residents). CMS level E.
Health citation F-0623, Resident Rights Deficiencies. Inspection of July 14, 2023. Found during a standard inspection.
The home gave a date the problem would be corrected (September 20, 2023).
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 July 14, 2023. Found during a standard inspection.
The home gave a date the problem would be corrected (September 20, 2023).
No harm, with potential for more than minimal harm
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Pattern (more than a few residents). CMS level E.
Health citation F-0656, Resident Assessment and Care Planning Deficiencies. Inspection of July 14, 2023. Found during a standard inspection.
The home gave a date the problem would be corrected (September 20, 2023).
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.
Pattern (more than a few residents). CMS level E.
Health citation F-0677, Quality of Life and Care Deficiencies. Inspection of July 14, 2023. Found during a standard inspection.
The home gave a date the problem would be corrected (September 20, 2023).
No harm, with potential for more than minimal harm
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Pattern (more than a few residents). CMS level E.
Health citation F-0689, Quality of Life and Care Deficiencies. Inspection of July 14, 2023. Found during a standard inspection.
The home gave a date the problem would be corrected (September 20, 2023).
No harm, with potential for more than minimal harm
Provide care or services that was trauma informed and/or culturally competent.
Pattern (more than a few residents). CMS level E.
Health citation F-0699, Quality of Life and Care Deficiencies. Inspection of July 14, 2023. Found during a standard inspection.
The home gave a date the problem would be corrected (September 20, 2023).
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 July 14, 2023. Found during a standard inspection.
The home gave a date the problem would be corrected (September 20, 2023).
No harm, with potential for more than minimal harm
Ensure medication error rates are not 5 percent or greater.
Pattern (more than a few residents). CMS level E.
Health citation F-0759, Pharmacy Service Deficiencies. Inspection of July 14, 2023. Found during a standard inspection.
The home gave a date the problem would be corrected (September 20, 2023).
No harm, with potential for more than minimal harm
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Pattern (more than a few residents). CMS level E.
Health citation F-0804, Nutrition and Dietary Deficiencies. Inspection of July 14, 2023. Found during a standard inspection.
The home gave a date the problem would be corrected (September 20, 2023).
No harm, with potential for more than minimal harm
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Pattern (more than a few residents). CMS level E.
Health citation F-0812, Nutrition and Dietary Deficiencies. Inspection of July 14, 2023. Found during a standard inspection.
The home gave a date the problem would be corrected (September 20, 2023).
No harm, with potential for more than minimal harm
Use approved construction type or materials.
Pattern (more than a few residents). CMS level E.
Fire safety citation K-0161, Construction Deficiencies. Inspection of July 14, 2023. Found during a standard inspection.
The home gave a date the problem would be corrected (September 6, 2023).
No harm, with potential for more than minimal harm
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Pattern (more than a few residents). CMS level E.
Fire safety citation K-0211, Egress Deficiencies. Inspection of July 14, 2023. Found during a standard inspection.
The home gave a date the problem would be corrected (September 6, 2023).
No harm, with potential for more than minimal harm
Install emergency lighting that can last at least 1 1/2 hours.
Pattern (more than a few residents). CMS level E.
Fire safety citation K-0291, Egress Deficiencies. Inspection of July 14, 2023. Found during a standard inspection.
The home gave a date the problem would be corrected (September 6, 2023).

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.