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 25 of 42 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 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 January 2, 2026. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 21, 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.

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

    Health citation F-0677, Quality of Life and Care Deficiencies. Inspection of January 2, 2026. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 7, 2026).

  5. 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.

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

    Health citation F-0755, Pharmacy Service Deficiencies. Inspection of January 2, 2026. Found during a standard inspection.

    The home gave a date the problem would be corrected (February 19, 2026).

  6. 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 January 2, 2026. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 8, 2026).

  7. 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 December 1, 2025. Found during a complaint inspection.

    The home gave a date the problem would be corrected (December 5, 2025).

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

    Make sure that a working call system is available in each resident's bathroom and bathing area.

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

    Health citation F-0919, Environmental Deficiencies. Inspection of December 1, 2025. Found during a complaint inspection.

    The home gave a date the problem would be corrected (December 5, 2025).

  9. 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 15, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (December 15, 2024).

  10. 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.

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

    Health citation F-0700, Quality of Life and Care Deficiencies. Inspection of November 15, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (December 15, 2024).

  11. 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 November 15, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (December 15, 2024).

  12. 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 15, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (December 15, 2024).

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

    Make sure that a working call system is available in each resident's bathroom and bathing area.

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

    Health citation F-0919, Environmental Deficiencies. Inspection of November 15, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (December 15, 2024).

  14. 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).

  15. 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).

  16. 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).

  17. 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).

  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.

    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).

  19. 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).

  20. 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).

  21. 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).

  22. 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 January 2, 2026. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 22, 2026).

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

    Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.

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

    Health citation F-0644, Resident Assessment and Care Planning Deficiencies. Inspection of January 2, 2026. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 15, 2026).

  24. 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 January 2, 2026. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 16, 2026).

  25. 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 January 2, 2026. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 15, 2026).

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.