Not rated by CMS — ratings are suppressed for new or low-volume facilities.
The next survey window likely opens around November 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 Lakewood A Continuing Care Center during CMS and state inspections, most recent first.
Surveyors found that care plans for several residents were incomplete or not updated to reflect current physical needs, including fall risk, mobility limitations, and toileting requirements. The plans lacked specific, person-centered interventions and did not accurately address changes in condition following hospitalizations or surgeries, as confirmed by facility staff.
Two residents were not properly assessed or documented for pneumococcal vaccination status as required by CDC guidelines and facility policy. One resident's consent form was incomplete and lacked evidence of vaccine administration or refusal, while another resident's record showed no documentation of being offered the vaccine.
The facility failed to maintain a sanitary and comfortable environment across all units, with issues such as exposed sheetrock, chipped paint, and uncleanable surfaces on equipment and wheelchairs. Multiple resident rooms had unpainted walls and ceilings with holes, and common areas had dirty equipment. The Facilities Director confirmed these findings during an environmental tour.
The facility did not follow physician orders for a resident's oxygen therapy, consistently setting the concentrator at 3 liters instead of the prescribed 4 liters. Additionally, PT recommendations for another resident's ambulation were not implemented due to communication issues and staffing constraints.
The facility failed to maintain a sanitary environment for respiratory care, affecting five residents. Observations revealed unlabeled and improperly stored nebulizer masks and nasal cannula tubing, confirmed by the DON. Additionally, an oxygen concentrator had dusty filters, and a nebulizer machine was found with uncovered tubing.
The facility failed to properly store and secure medications across three units. Inappropriate storage in a dorm-style refrigerator led to temperature fluctuations affecting medications, including a vaccination. Temperature records showed a year-long failure to maintain recommended ranges. Additionally, medication and treatment carts were found unlocked and unattended in various units, with residents and staff nearby.
The facility failed to maintain cleanliness in the kitchen, with dusty fans, vents, and lights observed. Additionally, the kitchen and skilled unit ice machines were not plumbed according to code, risking contamination. These deficiencies were confirmed by the Food Service Director.
The facility failed to notify the State Agency of potential neglect concerns and did not investigate an unwitnessed fall with a major injury. A complaint was received about a CNA not providing adequate care, but the DON and Administrator were unaware of the incident reports. Additionally, the facility could not provide evidence of a completed investigation or a 5-day report for a resident's unwitnessed fall with a fracture.
The facility failed to secure a container of Clorox Healthcare Hydrogen Peroxide disinfectant wipes, which was found open with a wipe sticking out in a resident's bathroom. This was observed on two separate days, and the DON confirmed the wipes were not locked away, posing a potential hazard.
The facility failed to provide sufficient staffing, resulting in delayed call bell responses for residents. A resident reported waiting up to an hour for assistance, leading to incontinent episodes. Interviews with CNAs confirmed staffing issues, and the DON acknowledged the problem. The residents involved were cognitively intact, highlighting the impact on their care.
A resident's call bell was found non-functional despite previous reports of it being fixed. The issue was confirmed by a surveyor, RN, and CNA, with a temporary hand bell provided. The call bell briefly worked when the box was wiggled, indicating a potential battery issue.
A resident with a right-hand splint did not receive scheduled whirlpool baths for several weeks, impacting their self-determination and hygiene. The resident, unable to shave due to the injury, reported that staff were too busy to assist. Records lacked documentation of the baths on scheduled dates, and the issue was discussed with the DON.
A resident with dementia, anxiety, depression, PTSD, and agoraphobia was forcibly dressed and transferred by a CNA, leading to physical and emotional distress. Despite being asked to stop by another CNA, the abusive behavior continued, resulting in the resident experiencing pain and yelling for help. The incident was corroborated by witness statements and led to the dismissal of the CNA involved.
A nurse failed to follow infection control procedures during a medication pass, neglecting to perform hand hygiene before and after glove use. Despite receiving education on the facility's hand hygiene policy, the nurse admitted to forgetting to sanitize and expressed difficulty with glove application after using sanitizer. The Director of Nursing confirmed the nurse's training and expectations for compliance.
The facility did not ensure the Medical Director's attendance at three required quarterly Quality Assurance Committee meetings, as confirmed by attendance sheets and an interview with the Administrator.
Failure to Develop and Revise Comprehensive, Person-Centered Care Plans
Penalty
Summary
The facility failed to develop and revise comprehensive care plans that accurately addressed the physical needs of four sampled residents. For one resident with chronic pain and bilateral hand and knee contractures, the care plan did not specify the current fall risk status and included interventions for conditions not present in the resident's clinical record. The care plan was not updated to reflect the resident's actual diagnoses and needs, as confirmed by the DON and MDS Coordinator during review. Another resident with a recent left femur fracture and an indwelling urinary catheter had a care plan that did not reflect current ADL and toileting needs, despite changes in condition following hospitalizations and surgical interventions. Additional residents with recent fractures and mobility limitations had care plans that lacked person-centered details, such as specific assistance requirements, frequency, and interventions tailored to their post-operative and rehabilitative needs. In each case, the care plans were not revised or completed to address the residents' current physical conditions and care requirements, as confirmed by facility staff during surveyor interviews.
Failure to Offer and Document Pneumococcal Vaccinations per CDC Guidelines
Penalty
Summary
The facility failed to ensure that residents were offered pneumococcal vaccinations in accordance with CDC recommendations, as required by facility policy. Record review and interviews revealed that two residents were not properly assessed or documented for pneumococcal vaccination status within the required timeframe. For one resident, a consent form for the Prevnar20 vaccine was present in the paper chart and signed, but the form was left blank regarding whether the vaccine was accepted or declined, and there was no evidence in the clinical record that the vaccine was offered, administered, or refused. For another resident, the clinical record lacked any documentation indicating that the pneumococcal vaccine was offered, administered, or refused. These findings were confirmed during an interview with the Infection Preventionist.
Deficiencies in Housekeeping and Maintenance Services
Penalty
Summary
The facility failed to provide adequate housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable environment across all units, including the Skilled Unit, Long-Term Care Unit, and Memory Care Unit. During an environmental tour, surveyors observed several deficiencies, such as a ceiling in the activity room with exposed sheetrock and floor seams held down with black tape. In the skilled unit common area, sit-to-stand lifts were found with dirt and debris in the foot base areas, and one lift had ripped non-skid tape and chipped paint, creating uncleanable surfaces. Multiple resident rooms had unpainted ceilings and walls with holes, dusty bathroom ceiling vents, and dirty bathroom floors. Additionally, a hallway ceiling tile had a brown stain, and several rooms had large unpainted areas and chipped paint. In the Memory Care Unit, a resident's wheelchair had ripped armrests, and hallway walls had chipped paint and exposed metal corners. A sit-to-stand lift and baseboard heater register also had chipped paint. The Personal Care Room had cabinets with chipped laminate and missing pieces, and a linen warmer was improperly used to store a doll and blanket. In the Long-Term Care Unit, residents' wheelchairs had ripped armrests, creating uncleanable surfaces, and an electric wheelchair had tape on the armrest. The Facilities Director confirmed these findings during an interview with the surveyors.
Failure to Follow Physician Orders and PT Recommendations
Penalty
Summary
The facility failed to adhere to physician orders for oxygen therapy for Resident #3. The resident had a physician order for continuous oxygen therapy at 4 liters per minute via nasal cannula, documented since August 26, 2024. However, observations by surveyors on multiple occasions from November 12 to November 14, 2024, revealed that the oxygen concentrator was consistently set at 3 liters instead of the prescribed 4 liters. The Director of Nursing confirmed that staff were not following the physician's orders, and an LPN admitted to setting the concentrator at 3 liters, stating that the resident did not need 4 liters, despite the physician's directive. Additionally, the facility did not implement the recommendations provided by Physical Therapy for Resident #87's restorative care. The PT note from October 8, 2024, outlined a Functional Maintenance Program for ambulation, which included specific instructions for the resident to be out of bed for meals and to receive consistent verbal cues during walks. However, the resident reported that staff frequently cited insufficient staffing as a reason for not assisting with walks. The Administrator acknowledged a lack of communication, resulting in the failure to follow up on the PT recommendations.
Failure to Maintain Sanitary Respiratory Care Environment
Penalty
Summary
The facility failed to maintain a sanitary environment for respiratory care, affecting five residents. Observations revealed that a resident's nebulizer mask was unlabeled and stored on their bedside table, while another resident's nasal cannula tubing was similarly unlabeled and stored on their bedside table. Additionally, a resident's nasal cannula tubing was found unlabeled and stored on a wheelchair in the hallway. The Director of Nursing confirmed these findings. Furthermore, an oxygen concentrator in a resident's bathroom had tubing taped to the floor and filters heavily built up with dust. Another resident's nebulizer machine was found with a mask and oxygen tubing resting uncovered on a chest of drawers, which was also confirmed by the Director of Nursing.
Medication Storage and Security Deficiencies
Penalty
Summary
The facility failed to properly store medications and biologicals across three units, as observed by surveyors. In the long-term care unit, a dorm-style refrigerator with a freezer compartment was used inappropriately for medication storage, leading to significant temperature fluctuations. The refrigerator showed a 10-degree Fahrenheit difference in temperatures, with ice buildup and pooled water affecting medications, including a Spice Vax vaccination. The temperature records for this refrigerator indicated a year-long failure to maintain the recommended range of 36-46 degrees Fahrenheit, with no follow-up actions taken. Similarly, in the Skilled Nursing unit, influenza vaccinations were stored without documented temperature checks for the past year, confirmed by the Unit Manager. Additionally, the facility failed to secure medication and treatment carts. An unlocked and unattended medication cart was observed in the Skilled Unit hallway for approximately five minutes, with residents and staff nearby. This was brought to the attention of an LPN by a surveyor. Similarly, two treatment carts containing insulin and ointments were found unlocked and unattended in the Long Term Care Unit hallway, with residents nearby. This was confirmed with an LPN. Another incident involved an unlocked and unattended medication cart in the Memory Care Unit nurses station, observed for about three minutes with residents and a Hospice CNA nearby. This was confirmed with a Certified Medication Technician.
Sanitation and Plumbing Deficiencies in Kitchen and Ice Machines
Penalty
Summary
The facility failed to maintain the kitchen in a clean and sanitary manner, as observed during a survey conducted by a surveyor and the Food Service Director (FSD). The surveyor noted that the dish room contained two wall-mounted fans that were dusty and dirty. Additionally, there were two ceiling vents over food preparation areas that were also dusty and dirty. Furthermore, five ceiling lights in the kitchen were heavily soiled with dust and debris. These observations indicate a lack of adherence to professional standards for cleanliness in food preparation areas. Moreover, the facility did not ensure that the kitchen ice machine and the skilled unit ice machine were plumbed in accordance with code requirements, specifically regarding the air-gap separation needed to prevent food contamination. The direct connection of wastewater and potable water was in violation of the State of Maine Rules Chapter 226 and the Code of Federal Regulation, Title 21, Part 1250, Section 1250, 30 (d). This deficiency was confirmed by the FSD during an interview, highlighting a significant oversight in maintaining sanitary conditions and preventing potential contamination in the facility's water supply and food handling processes.
Failure to Report and Investigate Incidents
Penalty
Summary
The facility failed to notify the State Agency after identifying potential neglect concerns and did not investigate an unwitnessed fall resulting in a major injury. In the first incident, a complaint was received by the Division of Licensing and Certification alleging that a CNA did not provide adequate care during a night shift, resulting in residents being soaked with urine. An email from the facility confirmed the complaint, but the Director of Nursing (DON) was unaware of the incident reports due to her recent start at the facility. The Administrator was also not informed of the complaint and confirmed that the State Agency was not notified of the concerns. In the second incident, the facility reported an unwitnessed fall with a fracture involving a resident to the State Agency. However, the facility could not provide evidence of a completed investigation or a 5-day report sent to the State Agency. The DON confirmed the absence of the investigation and report during an interview. These failures were identified during an annual survey, highlighting deficiencies in the facility's reporting and investigation processes.
Improper Storage of Disinfectant Wipes
Penalty
Summary
The facility failed to ensure that the resident's environment was free of accident hazards due to improper storage of chemicals. During the survey, it was observed that a container of Clorox Healthcare Hydrogen Peroxide disinfectant wipes was left open with a wipe sticking out in the bathroom of a resident's room. This occurred on two separate days of the survey. The Director of Nursing confirmed that the wipes were not secured in a locked cabinet, making them accessible and posing a potential hazard.
Staffing Deficiency Leads to Delayed Call Bell Responses
Penalty
Summary
The facility failed to ensure sufficient direct care staff were scheduled and on duty to meet the needs of residents on the Long Term Care Unit. This deficiency was identified through interviews and record reviews, revealing that residents experienced significant delays in response times to their call bells. Resident #4 reported waiting between 30 minutes to 1 hour for staff to respond, with records showing waits of 25 minutes to 1 hour and 18 minutes on multiple occasions. Resident #45 also experienced delays, leading to incontinent episodes, with waits ranging from 27 minutes to 1 hour and 26 minutes. Resident #87 reported similar issues, with waits of 25 minutes to 1 hour and 18 minutes. Interviews with Certified Nursing Assistants (CNAs) confirmed the staffing issues, with CNA #1 and CNA #2 acknowledging difficulties in responding to call bells promptly due to limited staff. The Director of Nursing confirmed the information provided by the CNAs. The residents involved were cognitively intact, as indicated by their Brief Interview for Mental Status (BIMS) scores, which further emphasizes the impact of the staffing deficiency on their care and daily living activities.
Non-Functional Call Bell for Resident
Penalty
Summary
The facility failed to ensure that a call bell was functional for one of the sampled residents. During an interview, the resident reported that their call bell had not been working despite being told it was fixed. When the surveyor tested the call bell, the light above the door did not illuminate, and the call bell screen at the nurse's station did not show an active call. A Certified Nurses Aid confirmed the call bell was not working. The Minimum Data Set project manager provided a hand bell for the resident to use temporarily. RN #3 attempted to fix the call bell, which briefly illuminated when the call bell box was wiggled, suggesting a possible battery issue. The resident mentioned that the call bell had been reported as fixed recently.
Failure to Provide Scheduled Whirlpool Baths
Penalty
Summary
The facility failed to honor a resident's right to self-determination by not adhering to the resident's preferred bathing schedule. Resident #37, who had a splint on his/her right hand, expressed that he/she had not received the scheduled whirlpool baths on Tuesdays for several weeks. The resident, who was unable to shave him/herself due to the injury, also reported that staff were too busy to assist with shaving. Observations confirmed that the resident was unshaven and had not received the whirlpool bath as scheduled. Further review of the resident's Activities of Daily Living records revealed a lack of documentation for whirlpool baths on the scheduled dates, as well as missing records of bathing on several occasions. The issue was discussed with the Director of Nursing, and it was noted that the resident did not receive the whirlpool bath on the day of the survey but was scheduled to have one the following day.
Resident Abuse by CNA
Penalty
Summary
The facility failed to protect a resident's right to be free from physical and emotional abuse by staff when a Certified Nursing Assistant (CNA) forcibly dressed and transferred a resident. The incident involved a resident with a medical history of dementia, anxiety, depression, PTSD, and agoraphobia, who requires a gentle and patient approach due to their condition. On the day of the incident, the resident was subjected to forceful handling by CNA #1, who dressed the resident with an abrasive attitude and forced them into a sit/stand position without proper securement, causing the resident to yell for help. Witnesses, including another CNA and an RN, reported that CNA #1 continued to manhandle the resident despite being asked to stop. The resident expressed pain in their back following the incident, which was noted to be reddened. CNA #1 admitted to forcing the resident's arm into a shirt and acknowledged that it was a mistake. The facility's internal investigation and witness statements corroborated the occurrence of abuse, leading to the dismissal of CNA #1.
Infection Control Deficiency During Medication Pass
Penalty
Summary
The facility failed to adhere to its infection control procedures during a medication pass observation on the Memory Lane unit. Registered Nurse (RN) #2 was observed checking a resident's blood sugar with gloved hands and then exiting the room without performing hand hygiene. RN #2 removed her gloves and, without using hand sanitizer, handled a pen and a set of keys, and accessed the medication cart. She then donned a new pair of gloves without sanitizing her hands, prepared insulin, and administered it to the resident. After discarding the gloves, RN #2 again failed to perform hand hygiene before donning another pair of gloves to attend to another resident. During an interview, the Director of Nursing confirmed that RN #2 had received education on the facility's hand hygiene policy, which requires sanitizing hands before and after glove use. Despite this, RN #2 admitted to forgetting to sanitize and expressed difficulty in donning gloves after using sanitizer due to stickiness. The surveyor intervened to ensure compliance with the hand hygiene policy, highlighting the deficiency in infection control practices.
Medical Director's Absence from QA Meetings
Penalty
Summary
The facility failed to ensure that the Medical Director attended the required quarterly Quality Assurance Committee meetings. A review of the attendance sheets for these meetings revealed that the Medical Director was absent from all three meetings held on January 17, April 17, and July 24, 2024. This deficiency was confirmed during an interview with the Administrator on November 14, 2024.
What surveyors are citing around you — mapped
All 10 risk areas, ranked with evidence
Repeat citations, what's rising near you, and quality measures — ranked so department heads know exactly where to look first.
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What surveyors actually found near you
We read the 53 citations issued within 25 miles in the last 12 months — and tell you exactly what happened, in plain English, matched to your record.
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.
Illustrative
A prioritized, do-first checklist
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Risk indicators are statistical estimates from public CMS data — not predictions, findings, or compliance advice.
Nursing homes near Waterville
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Oak Grove Center | 1 mi | — | 1 | 0 |
| Waterville Center For Health And Rehab | 2.7 mi | — | 1 | 0 |
| Maine Veterans Home - Augusta | 13.5 mi | — | 12 | 0 |
| Woodlawn Rehabilitation & Nursing Center | 15.3 mi | — | 6 | 0 |
| Cedar Ridge Center | 16.7 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.