Not rated by CMS — ratings are suppressed for new or low-volume facilities.
A standard survey is most likely before around December 2026
Estimate from public CMS data, current as of June 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at South Cove Manor Nursing & Rehabilitation Center during CMS and state inspections, most recent first.
The facility lacked a specific policy for monthly drug regimen reviews (MRR) by a licensed pharmacist. The DON admitted there was no structured process or timeline for MRRs, relying instead on a general policy that did not address these requirements. Despite requests, the facility failed to provide an appropriate MRR policy, resulting in a deficiency noted under F758.
A facility failed to monitor a resident's visual hallucinations despite being prescribed Seroquel for this behavior. Staff interviews revealed a lack of awareness and documentation, and the care plan intervention to track behaviors was not followed. The resident's family reported the hallucinations as positive and non-distressing, but the facility did not comply with its policy on behavioral assessment and monitoring.
A resident with fragile skin and a diagnosis of type 2 diabetes mellitus did not consistently receive Geri-sleeves as per physician's orders, leading to a deficiency in care. Despite the resident's skin being prone to bruising and tears, the sleeves were not always applied, and there was no documentation of the resident's refusal to wear them. Interviews with staff confirmed the lack of a care plan for the resident's refusal, contributing to the deficiency.
A resident with severe cognitive impairment and daily wandering behaviors did not receive a required quarterly wander risk assessment. Despite having a wanderguard and documented wandering episodes, the last assessment was completed months ago, contrary to the facility's policy. Interviews confirmed the lapse in assessment, highlighting a deficiency in adhering to the facility's safety protocols.
A facility failed to maintain sanitary conditions for a resident's oxygen concentrator, which was observed to be dusty with a clogged filter. The resident, with COPD and other conditions, used the concentrator continuously. Staff interviews revealed a lack of documentation and a clear process for cleaning the equipment, with the Director of Nursing admitting that the unit lacked a cleaning schedule.
A facility failed to monitor a resident's targeted behavior for Seroquel, prescribed for visual hallucinations, and did not attempt two gradual dose reductions (GDR) within the first year as required. Staff were unaware of the need to track hallucinations, and the consultant pharmacist did not recommend a GDR until nearly a year later. The physician declined the GDR recommendation without reviewing the resident's record, relying on staff reports of unrelated behaviors. This highlights a systemic issue in medication management and monitoring processes.
A resident eligible for the PCV-20 pneumococcal vaccine was not offered the vaccination or educated on its benefits and side effects, despite facility policy and CDC guidelines. The resident had previously received the PPSV23 vaccine and declined the PCV13 vaccine, but was not offered the PCV20 vaccine, which was an oversight acknowledged by the Infection Preventionist.
Lack of Policy for Monthly Drug Regimen Reviews
Penalty
Summary
The facility failed to develop and maintain a policy and procedure for conducting monthly drug regimen reviews (MRR) by a licensed pharmacist. During the survey, the Director of Nurses (DON) admitted that the facility did not have a specific MRR policy. Instead, they relied on a general policy titled 'Follow Up on Recommendations of Consulting Physicians or Other Practitioners,' which did not outline the steps or timeline for pharmacists to complete MRRs. This lack of a dedicated policy meant there was no structured process for pharmacists to follow when conducting these reviews, nor was there a timeline for when recommendations should be reviewed. The survey team requested a copy of the MRR policy, but the facility was unable to provide one. The DON acknowledged the absence of a policy and expressed the need to contact the pharmacy consultant to create one. Even after the survey exit, the facility failed to provide a suitable MRR policy. An emailed policy titled 'Medication Monitoring and Management' was reviewed but did not address the required process for monthly drug regimen reviews or the timeline for reviewing recommendations. This deficiency was noted under F758.
Failure to Monitor Visual Hallucinations in Resident
Penalty
Summary
The facility failed to implement a person-centered care plan intervention for monitoring the behavior of visual hallucinations in a resident with severe dementia and mood disturbances. Despite the resident being prescribed Seroquel for visual hallucinations, the facility did not track or monitor these behaviors as required by their care plan policy. Interviews with various staff members, including a nurse, consultant, and the Assistant Director of Nurses, revealed a lack of awareness and documentation regarding the resident's visual hallucinations. The care plan intervention to track target behaviors was not being followed, and the behavior monitoring sheets did not include any records of visual hallucinations. The resident's family reported that the visual hallucinations were frequent but not distressing, as they were positive memories from the resident's past. However, the facility's failure to monitor these hallucinations was noted during a review of the care plan by the Unit Manager. The deficiency was identified as a failure to comply with the facility's policy on behavioral assessment, intervention, and monitoring, which requires individualized interventions and documentation of behaviors when medications are prescribed.
Inconsistent Application of Geri-sleeves for Resident
Penalty
Summary
The facility failed to ensure that a resident received care in accordance with professional standards of practice, specifically regarding the consistent application of Geri-sleeves as per physician's orders. The resident, who was admitted in April 2023 and had a diagnosis of type 2 diabetes mellitus, was cognitively intact and required assistance with upper body dressing, showering, and bathing. Despite physician's orders for Geri-sleeves to be applied on the resident's bilateral upper extremities every shift for skin protection, observations revealed inconsistencies in their application. The resident's skin was described as thin, paper-like, and prone to bruising and skin tears, yet the sleeves were not consistently applied, and there was no documented evidence of the resident's refusal to wear them. During multiple observations, the resident was found without the Geri-sleeves, and the sleeves were observed resting out of reach. Interviews with the resident and nursing staff indicated that the resident's skin was fragile and that the sleeves were recommended to prevent skin tears. However, there was no care plan in place for the resident's refusal to wear the sleeves, and the Director of Nursing confirmed that physician's orders should have been consistently followed unless there was a documented rationale for not doing so. The lack of documentation and care planning for the resident's refusal to wear the sleeves contributed to the deficiency in care.
Failure to Complete Quarterly Wander Risk Assessment
Penalty
Summary
The facility failed to complete a quarterly assessment for wander risk for a resident with severe cognitive impairment and daily wandering behaviors. The resident, admitted in May 2022 with a diagnosis of dementia, was observed wandering throughout the unit with a wanderguard on their left ankle. The facility's policy requires that residents with potential for wandering be assessed quarterly, annually, and with significant changes, and that their care plan reflects this behavior with all disciplines aware of the need for monitoring. Despite the policy, the last documented Wander Risk Assessment for the resident was completed in February 2024, and no current quarterly assessment was found. Interviews with the Unit Manager and the Director of Nurses confirmed that the quarterly elopement assessment was not completed for the resident this quarter, which is against the facility's expectations for residents at risk for elopement.
Failure to Maintain Sanitary Conditions for Respiratory Equipment
Penalty
Summary
The facility failed to provide necessary respiratory care and services for a resident with chronic obstructive pulmonary disease (COPD), pulmonary hypertension, and chronic congestive heart failure. The deficiency was identified when the surveyor observed the resident using an oxygen concentrator with a nasal cannula, where the exterior of the concentrator was covered in dust, and the external filter was completely laden with dusty gray matter. The facility's policy required thorough cleaning of all exterior surfaces of equipment and regular maintenance of oxygen concentrators, including rinsing and drying the external filter weekly or as needed when visibly dusty. Interviews with facility staff revealed a lack of documentation and a clear process for cleaning the oxygen concentrator and filter. Nurse #4 acknowledged the absence of documentation regarding the cleaning of the equipment and the necessity for the filter to be clean for air purity. The Assistant Director of Nursing and the Director of Nursing (DON) were unsure about specific orders or policies for maintaining respiratory equipment. The DON admitted that the first-floor unit, where the resident resided, did not have a written schedule for cleaning respiratory equipment, unlike other units in the facility.
Failure to Monitor Antipsychotic Medication and Attempt GDR
Penalty
Summary
The facility failed to monitor the targeted behavior of an antipsychotic medication and attempt two gradual dose reductions (GDR) for a resident who had a new antipsychotic medication initiated within the last year. The resident, admitted in August 2023, was prescribed Seroquel for visual hallucinations. However, the facility did not track or monitor these hallucinations, which were the targeted behavior for the medication. The resident's care plan and medication administration records (MAR) did not reflect monitoring of visual hallucinations, and the staff, including the regular nurse and unit manager, were unaware of the need to track this behavior. The facility's policies on behavioral assessment and psychoactive drug monitoring require documentation of the rationale, dosage, duration, and monitoring for efficacy and adverse consequences of medications prescribed for behavioral symptoms. Despite these policies, the interdisciplinary team did not monitor the resident's indication for Seroquel or implement a GDR. The consultant pharmacist also failed to recommend a GDR until July 2024, despite the requirement for two attempts within the first year of antipsychotic initiation unless clinically contraindicated. Interviews with staff revealed a lack of awareness and communication regarding the resident's targeted behavior and the necessity of a GDR. The physician, who disagreed with the pharmacist's GDR recommendation, did not review the resident's record and relied on staff reports of continued behaviors unrelated to the medication's indication. The director of nurses acknowledged the failure to monitor the targeted behavior and attempt a GDR as required, highlighting a systemic issue in the facility's medication management and monitoring processes.
Failure to Offer Pneumococcal Vaccine
Penalty
Summary
The facility failed to ensure that a resident, who was eligible for the recommended pneumococcal vaccine (PCV-20), was offered the vaccination and educated on its benefits and potential side effects in a timely manner. The resident, who was readmitted to the facility in January 2021 and is currently of an age that requires pneumococcal vaccination according to CDC guidelines, had previously received the PPSV23 vaccine in 2010 and declined the PCV13 vaccine in 2019. Despite this, the resident was not offered the PCV20 vaccine, which should have been administered as per CDC recommendations. The facility's policy, revised in January 2024, mandates that each resident be offered the pneumococcal vaccine unless medically contraindicated or already immunized according to CDC guidelines. However, the immunization history and medical records for the resident did not indicate that the PCV20 vaccine was offered. The Infection Preventionist confirmed that the resident had not been offered the PCV20 vaccine, acknowledging it as an error, despite the resident's consent for vaccinations being documented in October 2023 without a decision on pneumococcal vaccinations.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Quincy
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Hancock Park Rehabiliation And Nursing Center | 0.7 mi | — | 10 | 0 |
| Regalcare At Quincy | 1 mi | — | 0 | 0 |
| John Scott House Nursing & Rehabilitation Center | 2.2 mi | — | 2 | 0 |
| Royal Braintree Nursing And Rehabilitation Center | 2.2 mi | — | 18 | 0 |
| Pope Nursing Home | 2.4 mi | — | 0 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release August 2026) and official state health department websites.