All citations for Tierra Pines 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 Tierra Pines Center

Last standard health inspection on record

January 30, 2025

Showing 1 to 21 of 21 citations

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

    Keep all essential equipment working safely.

    Widespread (many residents). CMS level F.

    Health citation F-0908, Environmental Deficiencies. Inspection of August 5, 2026. Found during a complaint inspection.

    The home gave a date the problem would be corrected (September 5, 2026).

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

    Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.

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

    Health citation F-0585, Resident Rights Deficiencies. Inspection of August 5, 2026. Found during a complaint inspection.

    The home gave a date the problem would be corrected (September 5, 2026).

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

    PASARR screening for Mental disorders or Intellectual Disabilities

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

    Health citation F-0645, Resident Assessment and Care Planning Deficiencies. Inspection of January 30, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (February 21, 2025).

  4. 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 January 30, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (February 21, 2025).

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

    Keep all essential equipment working safely.

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

    Health citation F-0908, Environmental Deficiencies. Inspection of April 15, 2024. Found during a complaint inspection.

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

  6. 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.

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

    Health citation F-0584, Resident Rights Deficiencies. Inspection of October 31, 2023. Found during a complaint inspection.

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

  7. 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 December 8, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 7, 2023).

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

    Inform resident or representatives choice to enter into binding arbitration agreement and right to refuse.

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

    Health citation F-0847, Administration Deficiencies. Inspection of December 8, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 7, 2023).

  9. 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 December 8, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 7, 2023).

  10. 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 8, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 7, 2023).

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

    Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.

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

    Health citation F-0582, Resident Rights Deficiencies. Inspection of August 5, 2026. Found during a complaint inspection.

    The home gave a date the problem would be corrected (September 5, 2026).

  12. 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 30, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (February 21, 2025).

  13. 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 January 30, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (February 21, 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 January 30, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (February 21, 2025).

  15. 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 8, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 7, 2023).

  16. 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 December 8, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 7, 2023).

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

    Ensure that the facility has sufficient staff members who possess the competencies and skills to meet the behavioral health needs of residents.

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

    Health citation F-0741, Quality of Life and Care Deficiencies. Inspection of December 8, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 7, 2023).

  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 8, 2022. Found during a standard inspection.

    The home gave a date the problem would be corrected (January 7, 2023).

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

    PASARR screening for Mental disorders or Intellectual Disabilities

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

    Health citation F-0645, Resident Assessment and Care Planning Deficiencies. Inspection of April 9, 2021. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 9, 2021).

  20. 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 April 9, 2021. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 9, 2021).

  21. 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 9, 2021. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 9, 2021).

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.