Not rated by CMS — ratings are suppressed for new or low-volume facilities.
A standard survey is most likely before 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 Campbell Healthcare & Senior Living during CMS and state inspections, most recent first.
The facility failed to maintain sanitary conditions in food storage and distribution, affecting all 72 residents. Observations showed missing temperature checks for refrigerators, undated or expired food items, and unsanitary kitchen conditions, including trash cans without lids and a buildup of grease. Interviews confirmed these practices violated facility policies.
The facility failed to maintain resident dignity and privacy by exposing two residents during care. One resident with severe cognitive impairment was left exposed to a parking lot view during incontinent care, while another resident with dementia was exposed during wound care. Staff interviews confirmed that window curtains should have been closed to ensure privacy.
The facility failed to maintain a safe, clean, and homelike environment, with issues such as peeled paint, exposed sheetrock, and unclean shower areas. Observations included damaged trim, unsecured electrical conduits, and unsanitary conditions in the shower room. Housekeeping staff were unaware of these issues, and the Maintenance Supervisor emphasized the need for written documentation of repairs.
The facility failed to provide written transfer or discharge notifications to residents, their responsible parties, and the LTC Ombudsman for three residents. The facility's policy did not include sending a monthly transfer log to the Ombudsman. Interviews revealed that the Regional LTC Ombudsman had not received any transfer logs this year, and the Administrator was unaware of the notification requirements.
A facility failed to complete a significant change MDS assessment within 14 days for a resident admitted to hospice care. The policy requires a Significant Change in Status Assessment when a resident's condition changes, but lacks a specific timeframe. Interviews with staff confirmed the assessment should have been completed within 14 days. The facility uses a virtual MDS Coordinator, which may have contributed to the oversight.
The facility failed to accurately document MDS assessments for two residents. One resident with cerebral infarction and dysphagia had a fall that was not recorded in their MDS, while another resident with chronic atrial fibrillation and Type 2 diabetes had discrepancies in their MDS regarding insulin injections. Staff interviews confirmed the inaccuracies, and the administration acknowledged the expectation for accurate MDS coding.
The facility did not document a Level I PASARR for two residents, one with schizophrenia and anxiety disorder, and another with a psychotic disorder, TBI, and dementia. The Administrator confirmed the absence of these assessments and was unable to retrieve them from previous facilities.
A facility failed to provide a baseline care plan to a resident within 48 hours of admission, as required by policy. The resident, with multiple health conditions, did not receive a written summary of the care plan. The MDS coordinator worked offsite, and the Director of Nursing was unaware of the requirement to provide the care plan to the resident, indicating a gap in the facility's process.
A resident with epilepsy and muscle spasms had a physician's order for fall mats on both sides of their bed. Observations showed a mat only on the left side, contrary to the order. Interviews with the DON and Administrator confirmed the expectation for mats on both sides, highlighting a failure to follow the physician's directive.
A facility failed to identify and assess a resident with PTSD, resulting in a lack of supportive interventions. The resident's care plan did not address PTSD or document past trauma or triggers, despite having related diagnoses and medication orders. Interviews with the DON and Administrator revealed a lack of awareness and implementation of PTSD assessments.
The facility failed to provide sufficient nursing staff to answer call lights promptly, affecting residents' well-being. The call system report showed delays from over an hour to more than seven hours. Residents reported long wait times, especially at night, with some not receiving timely care. Staff practices contributed to the issue, as some CNAs cleared call light notifications without providing care, contrary to facility policy.
The facility failed to maintain proper infection control practices during incontinent and wound care, as well as in the kitchen. CNAs did not wear gowns or change gloves during resident care, and dietary staff did not perform hand hygiene between serving residents. Additionally, the facility lacked a risk management process for Legionella disease, as there was no water flow diagram identifying areas at risk for Legionella growth.
The facility did not document the provision of education on the benefits and side effects of influenza and pneumococcal vaccines for five residents. Despite policy requirements, there was no record of education being provided before vaccine administration or refusal. The DON confirmed the need for documentation, and the Administrator noted the absence of a Social Services Designee responsible for this task.
The facility did not provide the required twelve hours of annual in-service education for two CNAs, as mandated by their policy. Despite the policy's requirement for staff to participate in training to enhance residents' quality of life, records showed no documentation of such training for the CNAs hired in April and July 2023. The Administrator acknowledged the oversight and committed to ensuring proper documentation in the future.
Sanitation and Food Storage Deficiencies
Penalty
Summary
The facility failed to maintain sanitary conditions in its food storage and distribution processes, which could potentially affect all 72 residents. Observations revealed that temperature checks for two standup refrigerators were not conducted over several days, and various food items in the freezers were either undated or past their expiration dates. Additionally, the kitchen was found to have unsanitary conditions, including trash cans without lids, a buildup of grease and grime on kitchen equipment, and broken floor tiles. Further observations in the canned goods area showed expired food items, and the dish machine area had a buildup of dirt and debris, with a bristle brush and a panel unattached from the wall lying on the floor. Interviews with the Dietary Manager and the Administrator confirmed that these practices were not in line with the facility's policies, which require daily cleaning and monitoring of kitchen equipment and food storage areas.
Failure to Maintain Resident Dignity and Privacy
Penalty
Summary
The facility failed to ensure that staff treated residents with dignity and respect by exposing two residents during care. Resident #9, who has severe cognitive impairment and is always incontinent of bowel, was observed on 09/11/24 during incontinent care performed by two CNAs. The CNAs did not close the window curtains, leaving the resident's breast and genitalia exposed to the view of the parking lot and yard outside. This lack of privacy was contrary to the facility's expected practice as described by staff interviews. Similarly, Resident #11, who has diagnoses including dementia and metabolic encephalopathy, was observed on 09/12/24 during wound care. The CNAs and an LPN assisting with the care closed the door to the hallway but left the window curtains open, exposing the resident's genitalia and buttocks to the outside. Interviews with staff, including a CNA and the DON, confirmed that the standard procedure should have included closing the window curtains to maintain resident privacy during such care activities.
Facility Fails to Maintain Safe and Homelike Environment
Penalty
Summary
The facility failed to provide a safe, clean, and comfortable homelike environment for its residents, as evidenced by several observations made during a survey. On the 500 hall unit, issues included a three-foot piece of base trim peeled off the bottom wall of a closet, a piece of wood trim hanging off the bottom of another closet, and several areas of exposed sheetrock and peeled paint on a wall above a bed. In the courtyard, two electrical conduits with broken zip ties were observed hanging low from a wooden awning. Additionally, in one room, five stuffed animals were placed on top of an overbed light fixture. Further deficiencies were noted in the shower room on the 400 hall, where a four-foot cove base trim was missing, and the floor of the shower stall had a buildup of brown grime near the drain. The toilet had dried fecal matter on the lid, and a large shower chair had a dried brown substance on its seat and surrounding surfaces. Interviews with housekeeping staff revealed that they had not yet cleaned the showers and bathrooms on the morning of the survey, and they were unaware of any environmental issues to report to maintenance. The Maintenance Supervisor indicated that repairs should be documented in writing to ensure timely addressing of issues.
Failure to Provide Transfer/Discharge Notifications
Penalty
Summary
The facility failed to provide a written copy of the notice of transfer or discharge to the residents and/or their responsible parties, as well as to the representative of the Office of Long-Term Care (LTC) Ombudsman, for three residents out of four sampled. This deficiency was identified during a review of the facility's policy and resident records. The facility's policy, revised in March 2021, mandates that residents and/or their representatives be notified in writing, in a language and format they understand, prior to transfer or discharge. However, the policy did not address the requirement to send a monthly transfer log to the Office of the State LTC Ombudsman. For Resident #9, there was no documentation of written notification with the reason for the hospital transfer provided to the resident and/or the responsible party, nor was there documentation of the written transfer/discharge notification provided to the representative of the Office of the LTC Ombudsman. Similarly, for Resident #21, there was no documentation of written notification for two hospital transfers. Interviews revealed that the Regional LTC Ombudsman had not received any transfer logs from the facility this year, and the Administrator was unaware of the requirement to provide written notices and send transfer logs to the Ombudsman.
Failure to Complete Timely Significant Change MDS Assessment for Hospice Resident
Penalty
Summary
The facility failed to complete a significant change Minimum Data Set (MDS) assessment within 14 days for a resident who was admitted to hospice care. This deficiency was identified for one resident out of three sampled closed resident records, with the facility's census being 72. The facility's policy on comprehensive assessments, revised in October 2023, mandates that a Significant Change in Status Assessment (SCSA) should be conducted when the Interdisciplinary Team determines a resident meets the significant change guidelines. However, the policy did not specify a timeframe for submitting a significant change assessment. The medical record review for the resident showed that they were admitted to hospice care on June 7, 2024, but the facility did not complete the significant change MDS within the required 14 days. Interviews with the RN, Director of Nursing (DON), and the Administrator confirmed that a significant change assessment should have been completed within 14 days upon the resident receiving hospice services. The facility does not have an in-house MDS Coordinator and relies on a virtual coordinator from the corporate office, which may have contributed to the oversight.
Inaccurate MDS Documentation for Two Residents
Penalty
Summary
The facility failed to document accurate Minimum Data Set (MDS) assessments for two residents, leading to deficiencies in the accuracy of resident records. Resident #9, who was admitted with diagnoses including cerebral infarction and dysphagia, experienced a fall and was sent to the hospital on July 18, 2024. However, the resident's admission and quarterly MDS did not reflect any prior falls, indicating a failure to accurately code the resident's MDS. Interviews with facility staff confirmed that the fall occurred and should have been documented in the MDS. Similarly, Resident #15, admitted with chronic atrial fibrillation, insomnia, and Type 2 diabetes, had discrepancies in their MDS regarding insulin injections. The resident's annual MDS inaccurately showed that they received one insulin injection weekly, while the quarterly MDS indicated zero injections. A review of the Physician's Order Sheet from April to September 2024 showed no insulin injections prescribed, further highlighting the inaccuracy in the MDS documentation. Interviews with the facility's LPN and RN confirmed that changes in a resident's condition should be accurately reflected in the MDS, and the facility's administration acknowledged the expectation for accurate MDS coding.
Failure to Document PASARR for Two Residents
Penalty
Summary
The facility failed to provide documentation of a Level I Preadmission Screening and Resident Review (PASARR) for two residents out of 18 sampled. Resident #21, who was admitted on an unspecified date, had diagnoses of schizophrenia, violent behavior, and generalized anxiety disorder, yet lacked a Level I PASARR in their medical record. Similarly, Resident #43, admitted on another unspecified date, had diagnoses of a psychotic disorder, traumatic brain injury, and dementia, but also did not have a Level I PASARR documented. During an interview, the Administrator acknowledged the absence of the PASARR documentation for these residents and mentioned efforts to obtain them from previous facilities, with plans to initiate new assessments.
Failure to Provide Baseline Care Plan to Resident
Penalty
Summary
The facility failed to ensure that a baseline care plan was developed and provided to a resident within 48 hours of admission, as required by their policy. The baseline care plan is intended to meet the resident's immediate health and safety needs and should include specific interventions and a written summary for the resident or their representative. In this case, the facility did not document a written summary of the baseline care plan for a resident who was admitted with diagnoses of coronary artery disease, renal insufficiency, diabetes mellitus, and depression. The resident reported not receiving any paperwork, and the Director of Nursing was unaware that the baseline care plan needed to be given to the resident or their representative. The facility's process for creating and distributing baseline care plans was inadequate, as the MDS coordinator and care plan coordinator worked offsite, and a part-time nurse was not responsible for completing MDS and care plans. The Director of Nursing stated that the MDS coordinator always generates a computer-based care plan upon admission, but there was no evidence that this plan was shared with the resident. The Administrator confirmed that the MDS coordinator worked offsite but had access to the facility's computer system, indicating a potential gap in communication and execution of the baseline care plan process.
Failure to Follow Physician's Order for Fall Mats
Penalty
Summary
The facility failed to adhere to a physician's order for the placement of fall mats for a resident. The resident, who was admitted with diagnoses including abnormal involuntary movements, epilepsy, and muscle spasms, had a physician's order dated January 29, 2024, for fall mats to be placed on both sides of their bed. However, observations on multiple occasions in September 2024 revealed that a fall mat was only placed on the left side of the resident's bed, with no mat on the right side as ordered. Interviews with the Director of Nursing and the Administrator confirmed that they expected fall mats to be placed on both sides of the bed when ordered by a physician. This oversight indicates a failure to follow the physician's directive, potentially compromising the resident's safety.
Failure to Provide Trauma-Informed Care for Resident with PTSD
Penalty
Summary
The facility failed to identify, assess, and provide supportive interventions for a resident diagnosed with post-traumatic stress disorder (PTSD). The resident, who was admitted with diagnoses of PTSD, major depressive disorder, and anxiety disorder, did not have a documented PTSD assessment in their medical record. Despite having physician orders for medications related to PTSD and anxiety, the resident's care plan did not address PTSD or include any documentation of past trauma or triggers that could lead to behaviors. Interviews with the Director of Nursing (DON) and the Administrator revealed a lack of awareness and implementation of PTSD assessments for residents with such diagnoses. The DON acknowledged the absence of a PTSD assessment and stated that it should be part of the resident's care plan, including triggers and interventions. The Administrator also expressed an expectation for residents with PTSD to have care plans addressing their condition, including triggers and interventions.
Delayed Response to Call Lights
Penalty
Summary
The facility failed to provide sufficient nursing staff to answer call lights in a timely manner, impacting the residents' rights and their physical, mental, and psychosocial well-being. The facility's policy on answering call lights was not adhered to, as evidenced by the wireless nurse call system report log, which showed numerous instances of delayed response times ranging from over an hour to more than seven hours. Interviews with residents revealed consistent complaints about the long wait times for call lights to be answered, particularly during the night shift. Several residents reported that their call lights were not answered promptly, with some waiting for hours without receiving assistance. One resident mentioned having a bowel movement and not being changed all night, while another resident stated that they had to wait until their lunch tray was brought to them before their call light was addressed. The issue was further compounded by staff practices, where some CNAs admitted to clearing call light notifications on their facility-issued iPhones without providing the necessary care to the residents. The facility's call light system involves a two-step process, which requires staff to acknowledge the alert on their iPhones and then turn off the call light in the resident's room after providing care. However, interviews with CNAs revealed that this process was not consistently followed, as some staff members turned off call lights without attending to the residents' needs. The facility administrator expressed that staff should not turn off call lights without providing care, indicating a disconnect between policy expectations and actual practice.
Infection Control Deficiencies in Resident Care and Kitchen Practices
Penalty
Summary
The facility failed to maintain proper infection control practices during incontinent care and wound care for several residents. Observations revealed that Certified Nurse Aides (CNAs) did not wear gowns while performing incontinent care for residents with gastrostomy tubes and Foley catheters, despite Enhanced Barrier Precautions (EBP) signage on the doors. Additionally, during incontinent care, CNAs did not change gloves or perform hand hygiene after cleaning the peri-area before placing a clean brief on a resident. Similarly, during wound care, a Licensed Practical Nurse (LPN) did not change gloves or perform hand hygiene between removing a soiled dressing and applying a clean dressing. The facility also failed to implement a risk management process specific to Legionella disease, as evidenced by the absence of a water flow diagram identifying areas at risk for Legionella growth. The Maintenance Supervisor confirmed the lack of such a diagram, although water temperatures were monitored weekly. This deficiency had the potential to affect all residents, staff, and the public. In the kitchen, dietary staff did not perform hand hygiene between serving residents' meal plates. Observations showed that dietary staff re-entered the kitchen and served meals without washing hands between residents, even after touching tables and residents. Interviews with dietary staff and management revealed a lack of awareness regarding the necessity of hand hygiene between serving each resident, contributing to the deficiency in infection control practices.
Failure to Document Vaccine Education
Penalty
Summary
The facility failed to document the provision of education regarding the benefits, side effects, or warnings of the influenza and pneumococcal vaccines for five residents. The facility's policy requires that residents or their legal representatives receive this information prior to vaccination, and that the education provided is documented in the resident's medical record. However, for Residents #2, #6, #21, #24, and #31, there was no documentation of such education being provided, despite some of these residents receiving or refusing the vaccines. The Director of Nursing confirmed that education should be provided and documented before any vaccine administration. The Administrator indicated that the Social Services Designee was responsible for obtaining consents and providing education, but there was no Social Services Designee present during the annual survey. This lack of documentation and absence of a designated staff member to handle the education process contributed to the deficiency identified by the surveyors.
Failure to Provide Required In-Service Training for CNAs
Penalty
Summary
The facility failed to conduct at least twelve hours of annual in-service education for two Certified Nurse Aides (CNAs) out of a sample of two, despite having a policy in place that mandates such training. The policy, revised in August 2022, requires all staff to participate in initial orientation and annual in-service training to ensure they can enhance residents' quality of life and demonstrate competency in training topics. However, a review of the in-service records for CNA N, hired in April 2023, and CNA O, hired in July 2023, showed no documentation of the required annual in-service trainings. During an interview, the Administrator acknowledged the requirement for CNAs to have at least 12 hours of training annually and noted that she believed the trainings had been documented, but committed to ensuring this would be done moving forward.
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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 Campbell
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Aspire Senior Living Malden | 8.6 mi | — | 0 | 0 |
| Gideon Care Center | 9.2 mi | — | 7 | 0 |
| Piggott Healthcare & Senior Living, Llc | 9.7 mi | — | 12 | 0 |
| Winchester Nursing Center, Inc | 13.8 mi | — | 0 | 0 |
| Heritage Nursing Center - Skilled Nursing By Ameri | 17.3 mi | — | 7 | 0 |
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