All citations for Holbrook 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 Holbrook Healthcare Center

Last standard health inspection on record

July 29, 2025

Showing 1 to 21 of 21 citations

  1. Immediate jeopardy to resident health or safety

    Ensure each resident receives and the facility provides drinks consistent with resident needs and preferences and sufficient to maintain resident hydration.

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

    Health citation F-0807, Nutrition and Dietary Deficiencies. Inspection of July 29, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (September 3, 2025).

  2. 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 29, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (September 3, 2025).

  3. 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 29, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (September 3, 2025).

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

    Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

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

    Health citation F-0842, Resident Assessment and Care Planning Deficiencies. Inspection of July 29, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (September 3, 2025).

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

    Inspect, test, and maintain automatic sprinkler systems.

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

    Fire safety citation K-0353, Smoke Deficiencies. Inspection of July 29, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (August 11, 2025).

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

    Ensure smoke barriers are constructed to a 1 hour fire resistance rating.

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

    Fire safety citation K-0372, Smoke Deficiencies. Inspection of July 29, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (August 11, 2025).

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

    Ensure that residents are fully informed and understand their health status, care and treatments.

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

    Health citation F-0552, Resident Rights Deficiencies. Inspection of July 29, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (September 3, 2025).

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

    Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

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

    Health citation F-0580, Resident Rights Deficiencies. Inspection of July 29, 2025. Found during a standard inspection and a complaint inspection.

    The home gave a date the problem would be corrected (September 3, 2025).

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

    Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.

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

    Health citation F-0628, Resident Rights Deficiencies. Inspection of July 29, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (September 3, 2025).

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

    Ensure each resident receives an accurate assessment.

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

    Health citation F-0641, Resident Assessment and Care Planning Deficiencies. Inspection of July 29, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (September 3, 2025).

  11. 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.

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

    Health citation F-0656, Resident Assessment and Care Planning Deficiencies. Inspection of July 29, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (September 3, 2025).

  12. 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 July 29, 2025. Found during a standard inspection and a complaint inspection.

    The home gave a date the problem would be corrected (September 3, 2025).

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

    Provide appropriate pressure ulcer care and prevent new ulcers from developing.

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

    Health citation F-0686, Quality of Life and Care Deficiencies. Inspection of July 29, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (September 3, 2025).

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

    Ensure 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.

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

    Health citation F-0693, Quality of Life and Care Deficiencies. Inspection of July 29, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (September 3, 2025).

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

    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.

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

    Health citation F-0761, Pharmacy Service Deficiencies. Inspection of July 29, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (September 3, 2025).

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

    Provide timely, quality laboratory services/tests to meet the needs of residents.

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

    Health citation F-0770, Administration Deficiencies. Inspection of July 29, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (September 3, 2025).

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

    Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.

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

    Health citation F-0806, Nutrition and Dietary Deficiencies. Inspection of July 29, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (September 3, 2025).

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

    Provide special eating equipment and utensils for residents who need them and appropriate assistance.

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

    Health citation F-0810, Nutrition and Dietary Deficiencies. Inspection of July 29, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (September 3, 2025).

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

    Provide and implement an infection prevention and control program.

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

    Health citation F-0880, Infection Control Deficiencies. Inspection of July 29, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (September 3, 2025).

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

    Implement a program that monitors antibiotic use.

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

    Health citation F-0881, Infection Control Deficiencies. Inspection of July 29, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (September 3, 2025).

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

    Have properly installed electrical wiring and gas equipment.

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

    Fire safety citation K-0511, Services Deficiencies. Inspection of July 29, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (August 11, 2025).

Source: CMS Provider Information, Fire Safety Deficiencies, Health Deficiencies, Citation Code Look-up, data as of September 30, 2026. Inspection results describe the home at the time of each inspection.