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 17 of 17 citations

  1. Immediate jeopardy to resident health or safety

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

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

    Health citation F-0607, Freedom from Abuse, Neglect, and Exploitation Deficiencies. Inspection of December 28, 2023. Found during a complaint inspection.

    The home gave a date the problem would be corrected (February 22, 2024).

  2. Immediate jeopardy to resident health or safety

    Respond appropriately to all alleged violations.

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

    Health citation F-0610, Freedom from Abuse, Neglect, and Exploitation Deficiencies. Inspection of December 28, 2023. Found during a complaint inspection.

    The home gave a date the problem would be corrected (February 22, 2024).

  3. Immediate jeopardy to resident health or safety

    Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

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

    Health citation F-0600, Freedom from Abuse, Neglect, and Exploitation Deficiencies. Inspection of December 28, 2023. Found during a complaint inspection.

    The home gave a date the problem would be corrected (February 22, 2024).

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

    Install an approved automatic sprinkler system.

    Widespread (many residents). CMS level F.

    Fire safety citation K-0351, Smoke Deficiencies. Inspection of April 6, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 10, 2022).

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

    Ensure that testing and maintenance of electrical equipment is performed.

    Widespread (many residents). CMS level F.

    Fire safety citation K-0921, Gas, Vacuum, and Electrical Systems Deficiencies. Inspection of April 6, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 10, 2022).

  6. 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 October 10, 2023. Found during a complaint inspection.

    The home gave a date the problem would be corrected (October 24, 2023).

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

    Honor 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.

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

    Health citation F-0578, Resident Rights Deficiencies. Inspection of April 6, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 3, 2022).

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

    Provide and implement an infection prevention and control program.

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

    Health citation F-0880, Infection Control Deficiencies. Inspection of April 6, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 3, 2022).

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

    Have generator or other power source capable of supplying service within 10 seconds.

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

    Fire safety citation K-0918, Gas, Vacuum, and Electrical Systems Deficiencies. Inspection of April 6, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 10, 2022).

  10. 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 December 28, 2023. Found during a complaint inspection.

    The home gave a date the problem would be corrected (February 22, 2024).

  11. 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.

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

    Health citation F-0690, Quality of Life and Care Deficiencies. Inspection of December 28, 2023. Found during a complaint inspection.

    The home gave a date the problem would be corrected (March 5, 2024).

  12. 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 December 28, 2023. Found during a complaint inspection.

    The home gave a date the problem would be corrected (March 5, 2024).

  13. 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 6, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 3, 2022).

  14. 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 6, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 3, 2022).

    The home is disputing this citation.

  15. 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 6, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 3, 2022).

    The home is disputing this citation.

  16. 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 April 6, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 3, 2022).

  17. No harm, with potential for minimal harm

    Ensure that personnel concerned with handling of medical gases and cylinders are trained on the risk.

    Widespread (many residents). CMS level C.

    Fire safety citation K-0926, Gas, Vacuum, and Electrical Systems Deficiencies. Inspection of April 6, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 10, 2022).

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.