ElderGrade

Inspection citations at Kentmere Rehabilitation And Healthcare Center

33 citations on record, 1 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
2025 5 1
2024 16 0
2023 12 0
D December 13, 2025 Tag F0925 Complaint investigation Corrected Feb 2026

Environmental Deficiencies

Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.

No actual harm, potential for more than minimal harm

D December 13, 2025 Tag F0610 Complaint investigation Corrected Feb 2026

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Respond appropriately to all alleged violations.

No actual harm, potential for more than minimal harm

E December 13, 2025 Tag F0609 Complaint investigation Corrected Feb 2026

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

No actual harm, potential for more than minimal harm

F December 13, 2025 Tag F0812 Corrected Feb 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

G December 13, 2025 Tag F0689 Complaint investigation Corrected Feb 2026

Quality of Life and Care Deficiencies

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Actual harm to a resident

D November 22, 2024 Tag F0908 Corrected Jan 2025

Environmental Deficiencies

Keep all essential equipment working safely.

No actual harm, potential for more than minimal harm

D November 22, 2024 Tag F0741 Complaint investigation Corrected Jan 2025

Quality of Life and Care Deficiencies

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

No actual harm, potential for more than minimal harm

D November 22, 2024 Tag F0688 Corrected Jan 2025

Quality of Life and Care Deficiencies

Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.

No actual harm, potential for more than minimal harm

D November 22, 2024 Tag F0687 Corrected Jan 2025

Quality of Life and Care Deficiencies

Provide appropriate foot care.

No actual harm, potential for more than minimal harm

D November 22, 2024 Tag F0684 Corrected Jan 2025

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

D November 22, 2024 Tag F0677 Corrected Jan 2025

Quality of Life and Care Deficiencies

Provide care and assistance to perform activities of daily living for any resident who is unable.

No actual harm, potential for more than minimal harm

D November 22, 2024 Tag F0641 Corrected Jan 2025

Resident Assessment and Care Planning Deficiencies

Ensure each resident receives an accurate assessment.

No actual harm, potential for more than minimal harm

D November 22, 2024 Tag F0609 Complaint investigation Corrected Jan 2025

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

No actual harm, potential for more than minimal harm

D November 22, 2024 Tag F0602 Complaint investigation Corrected Jan 2025

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Protect each resident from the wrongful use of the resident's belongings or money.

No actual harm, potential for more than minimal harm

D November 22, 2024 Tag F0600 Complaint investigation Corrected Jan 2025

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

No actual harm, potential for more than minimal harm

D November 22, 2024 Tag F0554 Corrected Jan 2025

Resident Rights Deficiencies

Allow residents to self-administer drugs if determined clinically appropriate.

No actual harm, potential for more than minimal harm

D November 22, 2024 Tag F0552 Corrected Jan 2025

Resident Rights Deficiencies

Ensure that residents are fully informed and understand their health status, care and treatments.

No actual harm, potential for more than minimal harm

E November 22, 2024 Tag F0803 Corrected Jan 2025

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 November 22, 2024 Tag F0689 Complaint investigation Corrected Jan 2025

Quality of Life and Care Deficiencies

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

No actual harm, potential for more than minimal harm

F November 22, 2024 Tag F0812 Corrected Jan 2025

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 November 22, 2024 Tag F0755 Corrected Jan 2025

Pharmacy Service Deficiencies

Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

No actual harm, potential for more than minimal harm

D October 12, 2023 Tag F0761 Corrected Dec 2023

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 October 12, 2023 Tag F0730 Corrected Dec 2023

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

D October 12, 2023 Tag F0700 Corrected Dec 2023

Quality of Life and Care Deficiencies

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.

No actual harm, potential for more than minimal harm

D October 12, 2023 Tag F0644 Corrected Dec 2023

Resident Assessment and Care Planning Deficiencies

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

No actual harm, potential for more than minimal harm

D October 12, 2023 Tag F0641 Corrected Dec 2023

Resident Assessment and Care Planning Deficiencies

Ensure each resident receives an accurate assessment.

No actual harm, potential for more than minimal harm

D October 12, 2023 Tag F0625 Corrected Dec 2023

Resident Rights Deficiencies

Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.

No actual harm, potential for more than minimal harm

D October 12, 2023 Tag F0623 Corrected Dec 2023

Resident Rights Deficiencies

Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.

No actual harm, potential for more than minimal harm

E October 12, 2023 Tag F0947 Corrected Dec 2023

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 October 12, 2023 Tag F0848 Corrected Dec 2023

Administration Deficiencies

Provide a neutral and fair arbitration process and agree to arbitrator and venue.

No actual harm, potential for more than minimal harm

E October 12, 2023 Tag F0847 Corrected Dec 2023

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

E October 12, 2023 Tag F0842 Corrected Dec 2023

Resident Assessment and Care Planning Deficiencies

Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

No actual harm, potential for more than minimal harm

F October 12, 2023 Tag F0812 Corrected Dec 2023

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

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.