All citations for Tri-State Village NRSG & RHB

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 Tri-State Village NRSG & RHB

Last standard health inspection on record

April 30, 2025

Showing 1 to 25 of 36 citations

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

    Develop and maintain an Emergency Preparedness Program (EP).

    Widespread (many residents). CMS level F.

    Emergency preparedness citation E-0004, Emergency Preparedness Deficiencies. Inspection of April 30, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 23, 2025).

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

    Conduct risk assessment and an All-Hazards approach.

    Widespread (many residents). CMS level F.

    Emergency preparedness citation E-0006, Emergency Preparedness Deficiencies. Inspection of April 30, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 23, 2025).

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

    Address patient/client population and determine types of services needed.

    Widespread (many residents). CMS level F.

    Emergency preparedness citation E-0007, Emergency Preparedness Deficiencies. Inspection of April 30, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 23, 2025).

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

    Develop Emergency Preparedness policies and procedures.

    Widespread (many residents). CMS level F.

    Emergency preparedness citation E-0013, Emergency Preparedness Deficiencies. Inspection of April 30, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 23, 2025).

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

    Establish roles under a Waiver declared by secretary.

    Widespread (many residents). CMS level F.

    Emergency preparedness citation E-0026, Emergency Preparedness Deficiencies. Inspection of April 30, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 23, 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.

    Widespread (many residents). CMS level F.

    Fire safety citation K-0222, Egress Deficiencies. Inspection of April 30, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 30, 2025).

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

    Ensure that personnel concerned with handling of medical gases and cylinders are trained on the risk.

    Widespread (many residents). CMS level F.

    Fire safety citation K-0926, Gas, Vacuum, and Electrical Systems Deficiencies. Inspection of April 30, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 23, 2025).

  8. 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.

    Widespread (many residents). CMS level F.

    Fire safety citation K-0222, Egress Deficiencies. Inspection of April 26, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 24, 2024).

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

    Inspect, test, and maintain automatic sprinkler systems.

    Widespread (many residents). CMS level F.

    Fire safety citation K-0353, Smoke Deficiencies. Inspection of April 26, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 24, 2024).

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

    Have simulated fire drills held at unexpected times.

    Widespread (many residents). CMS level F.

    Fire safety citation K-0712, Miscellaneous Deficiencies. Inspection of April 26, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 24, 2024).

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

    To conduct inspection, testing and maintenance of fire doors by qualified individuals.

    Widespread (many residents). CMS level F.

    Fire safety citation K-0761, Miscellaneous Deficiencies. Inspection of April 26, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 24, 2024).

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

    Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.

    Widespread (many residents). CMS level F.

    Fire safety citation K-0914, Gas, Vacuum, and Electrical Systems Deficiencies. Inspection of April 26, 2024. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 24, 2024).

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

    Develop and maintain an Emergency Preparedness Program (EP).

    Widespread (many residents). CMS level F.

    Emergency preparedness citation E-0004, Emergency Preparedness Deficiencies. Inspection of January 19, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (February 18, 2023).

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

    Develop Emergency Preparedness policies and procedures.

    Widespread (many residents). CMS level F.

    Emergency preparedness citation E-0013, Emergency Preparedness Deficiencies. Inspection of January 19, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (February 18, 2023).

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

    Develop a communication plan.

    Widespread (many residents). CMS level F.

    Emergency preparedness citation E-0029, Emergency Preparedness Deficiencies. Inspection of January 19, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (February 18, 2023).

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

    Establish emergency prep training and testing.

    Widespread (many residents). CMS level F.

    Emergency preparedness citation E-0036, Emergency Preparedness Deficiencies. Inspection of January 19, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (February 18, 2023).

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

    Conduct testing and exercise requirements.

    Widespread (many residents). CMS level F.

    Emergency preparedness citation E-0039, Emergency Preparedness Deficiencies. Inspection of January 19, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (February 18, 2023).

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

    Have approved installation, maintenance and testing program for fire alarm systems.

    Widespread (many residents). CMS level F.

    Fire safety citation K-0345, Smoke Deficiencies. Inspection of January 19, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (February 18, 2023).

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

    Inspect, test, and maintain automatic sprinkler systems.

    Widespread (many residents). CMS level F.

    Fire safety citation K-0353, Smoke Deficiencies. Inspection of January 19, 2023. Found during a standard inspection.

    The home gave a date the problem would be corrected (February 18, 2023).

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

    Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector.

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

    Fire safety citation K-0223, Egress Deficiencies. Inspection of April 30, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 23, 2025).

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

    Install an approved automatic sprinkler system.

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

    Fire safety citation K-0351, Smoke Deficiencies. Inspection of April 30, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 23, 2025).

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

    Install corridor and hallway doors that block smoke.

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

    Fire safety citation K-0363, Smoke Deficiencies. Inspection of April 30, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 23, 2025).

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

    Ensure proper usage of power strips and extension cords.

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

    Fire safety citation K-0920, Gas, Vacuum, and Electrical Systems Deficiencies. Inspection of April 30, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 23, 2025).

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

    Have proper medical gas storage and administration areas.

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

    Fire safety citation K-0923, Gas, Vacuum, and Electrical Systems Deficiencies. Inspection of April 30, 2025. Found during a standard inspection.

    The home gave a date the problem would be corrected (May 23, 2025).

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

    Keep aisles, corridors, and exits free of obstruction in case of emergency.

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

    Fire safety citation K-0211, Egress Deficiencies. Inspection of April 26, 2024. Found during a standard inspection.

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