All citations for Lutheran Home

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 Lutheran Home

Last standard health inspection on record

June 10, 2025

Showing 1 to 25 of 31 citations

  1. Harm to a resident

    Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

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

    Health citation F-0689, Quality of Life and Care Deficiencies. Inspection of October 19, 2023. Found during a complaint inspection.

    The home gave a date the problem would be corrected (November 17, 2023).

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

    Have properly located and lighted "Exit" signs.

    Widespread (many residents). CMS level F.

    Fire safety citation K-0293, Egress Deficiencies. Inspection of June 10, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (July 10, 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.

    Widespread (many residents). CMS level F.

    Health citation F-0812, Nutrition and Dietary Deficiencies. Inspection of March 14, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (April 14, 2024).

  4. 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.

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

    Health citation F-0628, Resident Rights Deficiencies. Inspection of June 10, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (July 10, 2025).

  5. 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 June 10, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (July 10, 2025).

  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 June 10, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (July 10, 2025).

  7. 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 June 10, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (July 10, 2025).

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

    Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.

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

    Fire safety citation K-0321, Smoke Deficiencies. Inspection of June 10, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (July 10, 2025).

  9. 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 March 14, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (April 14, 2024).

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

    Install smoke barrier doors that can resist smoke for at least 20 minutes.

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

    Fire safety citation K-0374, Smoke Deficiencies. Inspection of March 14, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (March 27, 2024).

  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 June 10, 2025. Found during a standard inspection and a complaint inspection.

    The home gave a date the problem would be corrected (July 10, 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 June 10, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (July 10, 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 June 10, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (July 10, 2025).

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

    Provide safe, appropriate pain management for a resident who requires such services.

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

    Health citation F-0697, Quality of Life and Care Deficiencies. Inspection of June 10, 2025. Found during a standard inspection and a complaint inspection.

    The home gave a date the problem would be corrected (July 10, 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 June 10, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (July 10, 2025).

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

    Install resident room doors of proper design and width.

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

    Fire safety citation K-0233, Egress Deficiencies. Inspection of June 10, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (July 10, 2025).

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

    Inspect, test, and maintain automatic sprinkler systems.

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

    Fire safety citation K-0353, Smoke Deficiencies. Inspection of June 10, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (July 10, 2025).

  18. 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.

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

    Health citation F-0689, Quality of Life and Care Deficiencies. Inspection of February 4, 2025. Found during a complaint inspection.

    The home gave a date the problem would be corrected (March 4, 2025).

  19. 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 March 14, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (April 14, 2024).

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

    Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

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

    Health citation F-0755, Pharmacy Service Deficiencies. Inspection of March 14, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (April 14, 2024).

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

    Ensure each resident’s drug regimen must be free from unnecessary drugs.

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

    Health citation F-0757, Pharmacy Service Deficiencies. Inspection of March 14, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (April 14, 2024).

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

    Ensure medication error rates are not 5 percent or greater.

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

    Health citation F-0759, Pharmacy Service Deficiencies. Inspection of March 14, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (April 14, 2024).

  23. 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 March 14, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (April 14, 2024).

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

    Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.

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

    Fire safety citation K-0321, Smoke Deficiencies. Inspection of March 14, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (March 27, 2024).

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

    Inspect, test, and maintain automatic sprinkler systems.

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

    Fire safety citation K-0353, Smoke Deficiencies. Inspection of March 14, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (March 27, 2024).

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.