All citations for Sandgate Gardens Rehab and Nursing 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 Sandgate Gardens Rehab and Nursing Center

Last standard health inspection on record

April 18, 2025

Showing 26 to 50 of 53 citations

  1. 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 April 18, 2025. Found during a standard inspection.

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

  2. 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 April 18, 2025. Found during a standard inspection.

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

  3. 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 18, 2025. Found during a standard inspection.

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

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

    Implement a program that monitors antibiotic use.

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

    Health citation F-0881, Infection Control Deficiencies. Inspection of April 18, 2025. Found during a standard inspection.

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

  5. 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 April 18, 2025. Found during a standard inspection.

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

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

    Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.

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

    Fire safety citation K-0222, Egress Deficiencies. Inspection of April 18, 2025. Found during a standard inspection.

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

  7. 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 December 21, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 21, 2024).

  8. 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 21, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 21, 2024).

  9. 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 December 21, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 21, 2024).

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

    Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.

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

    Health citation F-0693, Quality of Life and Care Deficiencies. Inspection of December 21, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 21, 2024).

  11. 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 December 21, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 21, 2024).

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

    Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.

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

    Health citation F-0726, Nursing and Physician Services Deficiencies. Inspection of December 21, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 21, 2024).

  13. 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 December 21, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 21, 2024).

  14. 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 December 21, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 21, 2024).

  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 December 21, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 21, 2024).

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

    Provide timely, quality laboratory services/tests to meet the needs of residents.

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

    Health citation F-0770, Administration Deficiencies. Inspection of December 21, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 21, 2024).

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

    Regularly inspect all bed frames, mattresses, and bed rails (if any) for safety; and all bed rails and mattresses must attach safely to the bed frame.

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

    Health citation F-0909, Environmental Deficiencies. Inspection of December 21, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 21, 2024).

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

    Reasonably accommodate the needs and preferences of each resident.

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

    Health citation F-0558, Resident Rights Deficiencies. Inspection of August 25, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (September 24, 2022).

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

    Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.

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

    Health citation F-0584, Resident Rights Deficiencies. Inspection of August 25, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (September 24, 2022).

  20. 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 August 25, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (September 24, 2022).

  21. 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 August 25, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (September 24, 2022).

  22. 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 August 25, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (September 24, 2022).

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

    Provide safe and appropriate respiratory care for a resident when needed.

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

    Health citation F-0695, Quality of Life and Care Deficiencies. Inspection of August 25, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (September 24, 2022).

  24. 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 August 25, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (September 24, 2022).

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

    Provide timely, quality laboratory services/tests to meet the needs of residents.

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

    Health citation F-0770, Administration Deficiencies. Inspection of August 25, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (September 24, 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.