All citations for Neilson Place

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 Neilson Place

Last standard health inspection on record

March 5, 2026

Showing 26 to 50 of 65 citations

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

    Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.

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

    Health citation F-0605, Freedom from Abuse, Neglect, and Exploitation Deficiencies. Inspection of March 5, 2026. Found during a standard inspection.

    The home gave a date the problem would be corrected (April 17, 2026).

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

    Assess the resident when there is a significant change in condition

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

    Health citation F-0637, Resident Assessment and Care Planning Deficiencies. Inspection of March 5, 2026. Found during a standard inspection and a complaint inspection.

    The home gave a date the problem would be corrected (April 17, 2026).

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

    Ensure services provided by the nursing facility meet professional standards of quality.

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

    Health citation F-0658, Resident Assessment and Care Planning Deficiencies. Inspection of March 5, 2026. Found during a standard inspection.

    The home gave a date the problem would be corrected (April 17, 2026).

  4. 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 March 5, 2026. Found during a standard inspection.

    The home gave a date the problem would be corrected (April 17, 2026).

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

    Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.

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

    Health citation F-0688, Quality of Life and Care Deficiencies. Inspection of March 5, 2026. Found during a standard inspection.

    The home gave a date the problem would be corrected (April 17, 2026).

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

    Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.

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

    Health citation F-0700, Quality of Life and Care Deficiencies. Inspection of March 5, 2026. Found during a standard inspection.

    The home gave a date the problem would be corrected (April 17, 2026).

  7. 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 5, 2026. Found during a standard inspection.

    The home gave a date the problem would be corrected (April 17, 2026).

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

    Follow proper procedures when the fire alarm was out of service for more than 4 hours.

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

    Fire safety citation K-0346, Smoke Deficiencies. Inspection of March 5, 2026. Found during a standard inspection.

    The home gave a date the problem would be corrected (April 17, 2026).

  9. 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.

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

    Fire safety citation K-0354, Smoke Deficiencies. Inspection of March 5, 2026. Found during a standard inspection.

    The home gave a date the problem would be corrected (April 17, 2026).

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

    Properly select, install, inspect, or maintain portable fire extinguishes.

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

    Fire safety citation K-0355, Smoke Deficiencies. Inspection of March 5, 2026. Found during a standard inspection.

    The home gave a date the problem would be corrected (April 17, 2026).

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

    Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions.

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

    Health citation F-0557, Resident Rights Deficiencies. Inspection of July 2, 2025. Found during a complaint inspection.

    The home gave a date the problem would be corrected (July 28, 2025).

  12. 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 April 4, 2025. Found during a complaint inspection.

    The home gave a date the problem would be corrected (April 25, 2025).

  13. 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 February 25, 2025. Found during a complaint inspection.

    The home gave a date the problem would be corrected (February 28, 2025).

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

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

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

    Health citation F-0684, Quality of Life and Care Deficiencies. Inspection of February 25, 2025. Found during a complaint inspection.

    The home gave a date the problem would be corrected (February 28, 2025).

  15. 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 December 5, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 17, 2025).

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

    Provide enough food/fluids to maintain a resident's health.

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

    Health citation F-0692, Quality of Life and Care Deficiencies. Inspection of December 5, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 17, 2025).

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

    Post nurse staffing information every day.

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

    Health citation F-0732, Nursing and Physician Services Deficiencies. Inspection of December 5, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 17, 2025).

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

    Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.

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

    Health citation F-0756, Pharmacy Service Deficiencies. Inspection of December 5, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 17, 2025).

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

    Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.

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

    Health citation F-0758, Pharmacy Service Deficiencies. Inspection of December 5, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 17, 2025).

  20. 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 December 5, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 17, 2025).

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

    Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.

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

    Health citation F-0803, Nutrition and Dietary Deficiencies. Inspection of December 5, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 17, 2025).

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

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

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

    Health citation F-0883, Infection Control Deficiencies. Inspection of December 5, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 17, 2025).

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

    Ensure proper usage of power strips and extension cords.

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

    Fire safety citation K-0920, Gas, Vacuum, and Electrical Systems Deficiencies. Inspection of December 5, 2024. Found during a standard inspection.

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

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

    Ensure each resident must receive and the facility must provide necessary behavioral health care and services.

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

    Health citation F-0740, Quality of Life and Care Deficiencies. Inspection of July 2, 2024. Found during a complaint inspection.

    The home gave a date the problem would be corrected (August 2, 2024).

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

    Ensure that residents are free from significant medication errors.

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

    Health citation F-0760, Pharmacy Service Deficiencies. Inspection of July 2, 2024. Found during a complaint inspection.

    The home gave a date the problem would be corrected (August 2, 2024).

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.