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Public Record

Autumn Lake Healthcare at Loch Raven

Nursing HomeBaltimore, MDCMS 215090
111 citations on record

From CMS

Facility profile

CMS overall rating
1 / 5

*CMS Five-Star

Certified beds
113

*CMS

Avg. residents per day
97

*CMS

Inspection record

On record from CMS

Citations on record
111

*CMS

Inspections on file
7

*CMS

Last inspection
2025-09-11

*CMS

Citations

111 citations on record

Each deficiency cited on a CMS health inspection of this facility, sourced from the federal record. Open a report for the raw CMS Scope and Severity grade on each finding.

What do CMS severity letters mean?

Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.

General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.

Each letter combines severity with scope: how many residents the deficiency affected.

  • 0949Generalpotential for harm

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

  • 0946Generalpotential for harm

    Provide training in compliance and ethics.

  • 0945Generalpotential for harm

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

  • 0944Generalpotential for harm

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

  • 0550Generalpotential for harm

    Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

  • 0584Generalpotential for 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.

  • 0602Generalpotential for harm

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

  • 0641Generalpotential for harm

    Ensure each resident receives an accurate assessment.

  • 0655Generalpotential for harm

    Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted

  • 0657Generalpotential for harm

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

  • 0658Generalpotential for harm

    Ensure services provided by the nursing facility meet professional standards of quality.

  • 0684Generalpotential for harm

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

  • 0686Generalpotential for harm

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

  • 0689Generalpotential for harm

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

  • 0698Generalpotential for harm

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

  • 0730Generalpotential for harm

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

  • 0880Generalpotential for harm

    Provide and implement an infection prevention and control program.

  • 0842Generalpotential for harm

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

  • 0812Generalpotential for harm

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

  • 0803Generalpotential for harm

    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.

  • 0761Generalpotential for 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.

  • 0757Generalpotential for harm

    Ensure each resident’s drug regimen must be free from unnecessary drugs.

  • 0568Generalpotential for harm

    Properly hold, secure, and manage each resident's personal money which is deposited with the nursing home.

  • 0914Generalpotential for harm

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

  • 0712Generalpotential for harm

    Have simulated fire drills held at unexpected times.

  • 0345Generalpotential for harm

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

  • 0947Generalpotential for harm

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

  • 0584Generalpotential for 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.

  • 0880Generalpotential for harm

    Provide and implement an infection prevention and control program.

  • 0754Generalpotential for harm

    Provide properly sized and located linen or trash receptacles.

  • 0761Generalpotential for harm

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

  • 0781Generalpotential for harm

    Have restrictions on the use of portable space heaters.

  • 0914Generalpotential for harm

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

  • 0918Generalpotential for harm

    Have generator or other power source capable of supplying service within 10 seconds.

  • 0321Generalpotential for harm

    Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.

  • 0324Generalpotential for harm

    Provide properly protected cooking facilities.

  • 0341Generalpotential for harm

    Install a fire alarm system that can be heard throughout the facility.

  • 0345Generalpotential for harm

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

  • 0351Generalpotential for harm

    Install an approved automatic sprinkler system.

  • 0353Generalpotential for harm

    Inspect, test, and maintain automatic sprinkler systems.

  • 0355Generalpotential for harm

    Properly select, install, inspect, or maintain portable fire extinguishes.

  • 0363Generalpotential for harm

    Install corridor and hallway doors that block smoke.

  • 0374Generalpotential for harm

    Install smoke barrier doors that can resist smoke for at least 20 minutes.

  • 0712Generalpotential for harm

    Have simulated fire drills held at unexpected times.

  • 0685Generalpotential for harm

    Assist a resident in gaining access to vision and hearing services.

  • 0561Generalpotential for harm

    Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.

  • 0610Generalpotential for harm

    Respond appropriately to all alleged violations.

  • 0641Generalpotential for harm

    Ensure each resident receives an accurate assessment.

  • 0656Generalpotential for harm

    Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

  • 0657Generalpotential for harm

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

  • 0677Generalpotential for harm

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

  • 0684Generalpotential for harm

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

  • 0686Generalpotential for harm

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

  • 0689Generalpotential for harm

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

  • 0692Generalpotential for harm

    Provide enough food/fluids to maintain a resident's health.

  • 0693Generalpotential for 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.

  • 0698Generalpotential for harm

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

  • 0711Generalpotential for harm

    Ensure the resident's doctor reviews the resident's care, writes, signs and dates progress notes and orders, at each required visit.

  • 0806Generalpotential for harm

    Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.

  • 0842Generalpotential for harm

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

  • 0881Generalno actual harm

    Implement a program that monitors antibiotic use.

  • 0511Generalpotential for harm

    Have properly installed electrical wiring and gas equipment.

  • 0161Generalpotential for harm

    Use approved construction type or materials.

  • 0211Generalpotential for harm

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

  • 0222Generalpotential for 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.

  • 0225Generalpotential for harm

    Have stairways and smokeproof enclosures used as exits that meet safety requirements.

  • 0553Generalpotential for harm

    Allow resident to participate in the development and implementation of his or her person-centered plan of care.

  • 0550Generalpotential for harm

    Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

  • 0754Generalpotential for harm

    Provide properly sized and located linen or trash receptacles.

  • 0919Generalpotential for harm

    Meet requirements for the use of electrical equipment.

  • 0725Generalpotential for harm

    Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.

  • 0577Generalno actual harm

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

  • 0580Generalpotential for harm

    Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

  • 0584Generalpotential for 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.

  • 0623Generalno actual harm

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

  • 0624Generalpotential for harm

    Prepare residents for a safe transfer or discharge from the nursing home.

  • 0625Generalno actual harm

    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.

  • 0637Generalpotential for harm

    Assess the resident when there is a significant change in condition

  • 0641Generalpotential for harm

    Ensure each resident receives an accurate assessment.

  • 0655Generalpotential for harm

    Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted

  • 0656Generalpotential for harm

    Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

  • 0657Generalpotential for harm

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

  • 0658Generalpotential for harm

    Ensure services provided by the nursing facility meet professional standards of quality.

  • 0677Generalpotential for harm

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

  • 0679Generalpotential for harm

    Provide activities to meet all resident's needs.

  • 0684Generalpotential for harm

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

  • 0685Generalpotential for harm

    Assist a resident in gaining access to vision and hearing services.

  • 0686Generalpotential for harm

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

  • 0688Generalpotential for harm

    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.

  • 0689Generalpotential for harm

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

  • 0801Generalpotential for harm

    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.

  • 0770Generalpotential for harm

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

  • 0761Generalpotential for 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.

  • 0760Generalpotential for harm

    Ensure that residents are free from significant medication errors.

  • 0759Generalpotential for harm

    Ensure medication error rates are not 5 percent or greater.

  • 0758Generalpotential for 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.

  • 0757Generalpotential for harm

    Ensure each resident’s drug regimen must be free from unnecessary drugs.

  • 0756Generalpotential for harm

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

  • 0755Generalpotential for harm

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

  • 0744Generalpotential for harm

    Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia.

  • 0726Generalpotential for 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.

  • 0693Generalpotential for 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.

  • 0695Generalpotential for harm

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

  • 0698Generalpotential for harm

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

  • 0812Generalpotential for harm

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

  • 0838Generalpotential for harm

    Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies.

  • 0842Generalpotential for harm

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

  • 0867Generalpotential for harm

    Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.

  • 0880Generalpotential for harm

    Provide and implement an infection prevention and control program.

  • 0947Generalpotential for harm

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

  • 0558Generalpotential for harm

    Reasonably accommodate the needs and preferences of each resident.

Inspection history

Every health inspection on record

Each CMS health inspection of this facility, and the deficiencies the surveyors cited. Where the verbatim Form 2567 statement of deficiencies is on file, it links to the full report.

FAQ

Questions and answers

What is Autumn Lake Healthcare at Loch Raven?
Autumn Lake Healthcare at Loch Raven is a Medicare- and Medicaid-certified nursing home in Baltimore, MD, tracked by the Centers for Medicare & Medicaid Services (CMS). Its CMS Certification Number (CCN) is 215090.
What is the CMS rating for Autumn Lake Healthcare at Loch Raven?
Autumn Lake Healthcare at Loch Raven has a CMS overall rating of 1 out of 5 stars. CMS rates nursing homes on health inspections, staffing, and quality measures.
How many beds does Autumn Lake Healthcare at Loch Raven have?
Autumn Lake Healthcare at Loch Raven is certified for 113 beds. It serves an average of 97 residents per day.
How many citations does Autumn Lake Healthcare at Loch Raven have?
Autumn Lake Healthcare at Loch Raven has 111 citations on record from CMS health inspections, each tied to a federal deficiency tag.
When was Autumn Lake Healthcare at Loch Raven last inspected?
Autumn Lake Healthcare at Loch Raven was last inspected on September 11, 2025. CMS surveys nursing homes about once a year and after complaints.
What can I do if I have concerns about care at this facility?
Start by raising the concern with the facility administrator or director of nursing. Every state also runs a free long-term care ombudsman program that advocates for residents and families; the federal Eldercare Locator at eldercare.acl.gov can connect you with yours. Complaints about quality of care can also be filed with your state survey agency.

*Sourced from the Centers for Medicare & Medicaid Services (CMS). See the official record on CMS Care Compare. If you believe any information is inaccurate, report it here.

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