Inspection visit
Inspection
Citations
19 citations recorded*CMS
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.
F684 - Quality of care
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
F686 - Skin Integrity
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
F553 - The right to participate in the development and implementation of his or her
Allow resident to participate in the development and implementation of his or her person-centered plan of care.
F637 - Within 14 days after the facility determines, or should have determined,
Assess the resident when there is a significant change in condition
F638 - Quarterly Review Assessment
Assure that each resident’s assessment is updated at least once every 3 months.
F656 - Comprehensive Care Plans
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
F657 - Comprehensive Care Plans
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
F677 - A resident who is unable to carry out activities of daily living receives
Provide care and assistance to perform activities of daily living for any resident who is unable.
F842 - Resident-identifiable information
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
F880 - Infection Control
Provide and implement an infection prevention and control program.
- 0006GeneralS&S Epotential for harm
Conduct risk assessment and an All-Hazards approach.
- 0013GeneralS&S Epotential for harm
Develop Emergency Preparedness policies and procedures.
- 0015GeneralS&S Dpotential for harm
Address subsistence needs for staff and patients.
- 0223GeneralS&S Dpotential for harm
Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector.
- 0341GeneralS&S Dpotential for harm
Install a fire alarm system that can be heard throughout the facility.
- 0351GeneralS&S Dpotential for harm
Install an approved automatic sprinkler system.
- 0374GeneralS&S Dpotential for harm
Install smoke barrier doors that can resist smoke for at least 20 minutes.
F711 - Physician Visits
Provide a written emergency evacuation plan.
F921 - Other Environmental Conditions
Ensure that testing and maintenance of electrical equipment is performed.
FAQ · About this visit
Common questions about this visit
What happened during the September 12, 2025 survey of SAINT JOSEPH TRANSITIONAL REHABILITATION CENTER?
This was a inspection survey of SAINT JOSEPH TRANSITIONAL REHABILITATION CENTER on September 12, 2025. The surveyor cited 19 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at SAINT JOSEPH TRANSITIONAL REHABILITATION CENTER on September 12, 2025?
Yes, 19 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Provide appropriate treatment and care according to orders, resident’s preferences and goals."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.
Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.
Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.