All citations for Royal Oaks Manor-Bradbury Oaks

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 Royal Oaks Manor-Bradbury Oaks

Last standard health inspection on record

January 2, 2026

Showing 1 to 21 of 21 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 May 10, 2024. Found during a complaint inspection.

    The home gave a date the problem would be corrected (May 29, 2024).

  2. Harm to a resident

    Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia.

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

    Health citation F-0744, Quality of Life and Care Deficiencies. Inspection of April 15, 2024. Found during a complaint inspection.

    The home gave a date the problem would be corrected (May 10, 2024).

  3. 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 November 2, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 6, 2023).

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

    Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted

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

    Health citation F-0655, Resident Assessment and Care Planning Deficiencies. Inspection of November 2, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 10, 2023).

  5. 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 November 2, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 10, 2023).

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

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

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

    Health citation F-0684, Quality of Life and Care Deficiencies. Inspection of November 2, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 22, 2023).

  7. 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 November 2, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 16, 2023).

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

    Ensure that residents are free from significant medication errors.

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

    Health citation F-0760, Pharmacy Service Deficiencies. Inspection of November 2, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 14, 2023).

  9. 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 November 2, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 14, 2023).

  10. 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 November 2, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 2, 2023).

  11. 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 November 28, 2023. Found during a complaint inspection.

    The home gave a date the problem would be corrected (December 11, 2023).

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

    Allow residents to self-administer drugs if determined clinically appropriate.

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

    Health citation F-0554, Resident Rights Deficiencies. Inspection of November 2, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 20, 2023).

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

    Let each resident or the resident's legal representative access or purchase copies of all the resident's records.

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

    Health citation F-0573, Resident Rights Deficiencies. Inspection of November 2, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 20, 2023).

  14. 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 November 2, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 10, 2023).

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

    Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

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

    Health citation F-0657, Resident Assessment and Care Planning Deficiencies. Inspection of November 2, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 9, 2023).

  16. 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 November 2, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 20, 2023).

  17. 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 November 2, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 20, 2023).

  18. 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 November 2, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (November 14, 2023).

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

    Construct fire resistant interior walls.

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

    Fire safety citation K-0331, Smoke Deficiencies. Inspection of November 2, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (December 2, 2023).

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

    Ensure that waiting areas, nurse’s stations, gift shops, and cooking facilities, open to the corridor are properly protected.

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

    Fire safety citation K-0361, Smoke Deficiencies. Inspection of November 2, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (December 2, 2023).

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

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

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

    Fire safety citation K-0372, Smoke Deficiencies. Inspection of November 2, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (December 2, 2023).

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.