ElderGrade

Inspection citations at Burgh Care Center

120 citations on record, 5 of which inspectors scored at actual harm or immediate jeopardy. Each one is the state surveyor's own finding, not our summary.

Reading the scope & severity code

A–C

No harm, minimal potential

D–F

No harm, potential for harm

G–I

Actual harm to a resident

J–L

Immediate jeopardy

The letter also encodes how many residents were affected — isolated, a pattern, or widespread. Full explainer.

Citations by survey year

Year Citations Involving harm or jeopardy
2026 36 0
2025 48 4
2024 33 1
2023 3 0
C April 10, 2026 Tag F0579 Corrected May 2026

Resident Rights Deficiencies

Provide information about how to apply for and use Medicare and Medicaid benefits.

No actual harm, minimal potential

C April 10, 2026 Tag F0577 Corrected May 2026

Resident Rights Deficiencies

Allow residents to easily view the nursing home's survey results and communicate with advocate agencies.

No actual harm, minimal potential

C April 10, 2026 Tag F0575 Corrected May 2026

Resident Rights Deficiencies

Post a list of names, addresses, and telephone numbers of all pertinent State agencies and advocacy groups and a statement that the resident may file a complaint with the State Survey Agency.

No actual harm, minimal potential

D April 10, 2026 Tag F0908 Corrected May 2026

Environmental Deficiencies

Keep all essential equipment working safely.

No actual harm, potential for more than minimal harm

D April 10, 2026 Tag F0887 Corrected May 2026

Infection Control Deficiencies

Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status.

No actual harm, potential for more than minimal harm

D April 10, 2026 Tag F0883 Corrected May 2026

Infection Control Deficiencies

Develop and implement policies and procedures for flu and pneumonia vaccinations.

No actual harm, potential for more than minimal harm

D April 10, 2026 Tag F0847 Corrected May 2026

Administration Deficiencies

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

No actual harm, potential for more than minimal harm

D April 10, 2026 Tag F0761 Corrected May 2026

Pharmacy Service Deficiencies

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.

No actual harm, potential for more than minimal harm

D April 10, 2026 Tag F0698 Corrected May 2026

Quality of Life and Care Deficiencies

Provide safe, appropriate dialysis care/services for a resident who requires such services.

No actual harm, potential for more than minimal harm

D April 10, 2026 Tag F0691 Corrected May 2026

Quality of Life and Care Deficiencies

Provide appropriate colostomy, urostomy, or ileostomy care/services for a resident who requires such services.

No actual harm, potential for more than minimal harm

D April 10, 2026 Tag F0690 Corrected May 2026

Quality of Life and Care Deficiencies

Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

No actual harm, potential for more than minimal harm

D April 10, 2026 Tag F0686 Corrected May 2026

Quality of Life and Care Deficiencies

Provide appropriate pressure ulcer care and prevent new ulcers from developing.

No actual harm, potential for more than minimal harm

D April 10, 2026 Tag F0657 Corrected May 2026

Resident Assessment and Care Planning Deficiencies

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

No actual harm, potential for more than minimal harm

D April 10, 2026 Tag F0620 Corrected May 2026

Resident Rights Deficiencies

Not require residents to give up Medicare or Medicaid benefits, or pay privately as a condition of admission; and must tell residents what care they do not provide.

No actual harm, potential for more than minimal harm

D April 10, 2026 Tag F0610 Complaint investigation Corrected May 2026

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Respond appropriately to all alleged violations.

No actual harm, potential for more than minimal harm

D April 10, 2026 Tag F0607 Corrected May 2026

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Develop and implement policies and procedures to prevent abuse, neglect, and theft.

No actual harm, potential for more than minimal harm

E April 10, 2026 Tag F0949 Corrected May 2026

Administration Deficiencies

Provide behavior health training consistent with the requirements and as determined by a facility assessment.

No actual harm, potential for more than minimal harm

E April 10, 2026 Tag F0947 Corrected May 2026

Nursing and Physician Services Deficiencies

Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.

No actual harm, potential for more than minimal harm

E April 10, 2026 Tag F0946 Corrected May 2026

Administration Deficiencies

Provide training in compliance and ethics.

No actual harm, potential for more than minimal harm

E April 10, 2026 Tag F0945 Corrected May 2026

Infection Control Deficiencies

Include as part of its infection prevention and control program, mandatory training that includes written standards, policies, and procedures for the program.

No actual harm, potential for more than minimal harm

E April 10, 2026 Tag F0944 Corrected May 2026

Administration Deficiencies

Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program.

No actual harm, potential for more than minimal harm

E April 10, 2026 Tag F0943 Corrected May 2026

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation.

No actual harm, potential for more than minimal harm

E April 10, 2026 Tag F0942 Corrected May 2026

Resident Rights Deficiencies

Ensure that staff members are educated on resident rights and facility responsibilities to properly care for its residents.

No actual harm, potential for more than minimal harm

E April 10, 2026 Tag F0941 Corrected May 2026

Administration Deficiencies

Develop, implement, and/or maintain an effective training program that includes effective communications for direct care staff members.

No actual harm, potential for more than minimal harm

E April 10, 2026 Tag F0881 Corrected May 2026

Infection Control Deficiencies

Implement a program that monitors antibiotic use.

No actual harm, potential for more than minimal harm

E April 10, 2026 Tag F0880 Corrected May 2026

Infection Control Deficiencies

Provide and implement an infection prevention and control program.

No actual harm, potential for more than minimal harm

E April 10, 2026 Tag F0803 Corrected May 2026

Nutrition and Dietary Deficiencies

Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.

No actual harm, potential for more than minimal harm

E April 10, 2026 Tag F0756 Corrected May 2026

Pharmacy Service Deficiencies

Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.

No actual harm, potential for more than minimal harm

E April 10, 2026 Tag F0730 Corrected May 2026

Nursing and Physician Services Deficiencies

Observe each nurse aide's job performance and give regular training.

No actual harm, potential for more than minimal harm

E April 10, 2026 Tag F0695 Corrected May 2026

Quality of Life and Care Deficiencies

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

No actual harm, potential for more than minimal harm

E April 10, 2026 Tag F0684 Corrected May 2026

Quality of Life and Care Deficiencies

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

No actual harm, potential for more than minimal harm

E April 10, 2026 Tag F0628 Corrected May 2026

Resident Rights Deficiencies

Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.

No actual harm, potential for more than minimal harm

E April 10, 2026 Tag F0605 Corrected May 2026

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.

No actual harm, potential for more than minimal harm

F April 10, 2026 Tag F0812 Corrected May 2026

Nutrition and Dietary Deficiencies

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

No actual harm, potential for more than minimal harm

F April 10, 2026 Tag F0801 Corrected May 2026

Nutrition and Dietary Deficiencies

Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician.

No actual harm, potential for more than minimal harm

D January 29, 2026 Tag F0584 Complaint investigation Corrected Feb 2026

Resident Rights Deficiencies

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.

No actual harm, potential for more than minimal harm

D December 4, 2025 Tag F0844 Complaint investigation Corrected Dec 2025

Administration Deficiencies

Follow rules about disclosure of ownership requirements and tell the state agency about changes in ownership and/or administrative personnel.

No actual harm, potential for more than minimal harm

D December 4, 2025 Tag F0840 Complaint investigation Corrected Dec 2025

Administration Deficiencies

Employ or obtain outside professional resources to provide services in the nursing home when the facility does not employ a qualified professional to furnish a required service.

No actual harm, potential for more than minimal harm

D December 4, 2025 Tag F0698 Complaint investigation Corrected Dec 2025

Quality of Life and Care Deficiencies

Provide safe, appropriate dialysis care/services for a resident who requires such services.

No actual harm, potential for more than minimal harm

D May 22, 2025 Tag F0917 Complaint investigation Corrected Jun 2025

Environmental Deficiencies

Make sure each resident has 1) at least one window to the outside in a room; 2) a room at or above ground level; 3) adequate bedding; 4) furniture that meets the resident's needs; or 5) adequate closet space.

No actual harm, potential for more than minimal harm

Citations are published by CMS from state survey agency findings. A citation describes what an inspector observed on a specific date; homes are required to submit a correction plan, and many findings are resolved long before you read them. Ask the administrator what happened and what changed.