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 Majestic Care Of Kent during CMS and state inspections, most recent first.
A deficiency occurred when evening medications were not administered to multiple residents on two units after a nurse left her shift and took the med cart keys, and the on-duty nurse refused to use available backup keys because they were not formally signed out. Residents with conditions such as CHF, COPD, diabetes, dementia, schizophrenia, Alzheimer’s disease, seizure disorders, and acute respiratory failure missed ordered doses of anticoagulants, antipsychotics, antidepressants, antiepileptics, antihypertensives, antidiabetics, inhalers, sleep aids, supplements, and nutritional products. MAR reviews showed that no nighttime medications were given on those units during that shift, despite a nurse being present in the building.
The facility failed to provide advance, written, and signed notification of room changes for three residents who were moved to different rooms. Each resident had significant medical conditions and required extensive ADL assistance; two had intact cognition and one had moderate cognitive impairment. Staff documented verbal discussions and agreement about the moves for two residents, and reported verbal notification for the third, but the intra-facility room change forms for all three were left unsigned by the residents or their representatives, and no written notices were issued as required by facility policy. During interviews, leadership acknowledged that only verbal notice was given and that no written documentation of the room-change notifications existed.
Surveyors found that the facility did not follow its own food labeling and kitchen sanitation policies. In the walk-in freezer, large opened bags of beef patties, chicken breasts, breaded chicken tenderloins, and peppers and onions were left unsealed and undated, contrary to facility policy requiring all opened or stored food items to be clearly labeled and dated. In the dishwasher sanitization area, walls beneath the rinse shelf and an open wall section with exposed wiring were covered with a black mold-like substance and dirt and debris, and the wall opening created for a new dishwasher installation had never been closed, leaving interior drywall and wiring exposed to contamination.
A resident with multiple health conditions and a high fall risk was being transferred with a Hoyer lift by a CNA and an LPN when the lift's hook became unfastened, resulting in the resident falling and hitting her head. Both staff members reported not having recent or initial training on the lift, and facility policy requiring two trained staff and annual competency checks was not followed.
A resident with diabetes, hypertension, and heart failure did not receive prescribed doses of Insulin Lispro in the morning and Humalog sliding scale insulin at lunch, as required by physician orders. The DON confirmed these medications were not administered as documented in the medical record and care plan.
Missed Evening Medication Administration on Two Units Due to Key and Staffing Issues
Penalty
Summary
The deficiency involves the facility’s failure to administer ordered evening medications to multiple residents on specific units on 02/21/26. On that evening, residents with various diagnoses, including cellulitis, hypothyroidism, obesity, diabetes mellitus, congestive heart failure, lymphedema, COPD, emphysema, atrial fibrillation, necrotizing fasciitis, acute respiratory failure, dementia, schizophrenia, Alzheimer’s disease, seizure disorders, and insomnia, did not receive their prescribed nighttime medications. Medication Administration Record (MAR) reviews for 16 residents showed that a wide range of medications were not given, including antidiabetic agents, anticoagulants, antipsychotics, antidepressants, antiepileptics, antihypertensives, cholesterol-lowering agents, sleep aids, inhalers, supplements, nutritional products, and other routine medications. For example, one resident with cellulitis, hypothyroidism, and obesity did not receive a probiotic, desmopressin, levothyroxine, collagen supplement, protein supplement, and an antihistamine. Another resident with type 2 diabetes mellitus, morbid obesity, and depression did not receive colchicine. A resident with congestive heart failure, lymphedema, and diabetes insipidus missed doses of ezetimibe, metformin, collagen supplement, acetaminophen, gabapentin, and a protein supplement. Residents with COPD, emphysema, and atrial fibrillation did not receive multiple medications including melatonin, montelukast, Protonix, trazodone, apixaban, metoprolol, omega-3, Pulmicort, senna, Combivent, Haldol, and Tylenol. Additional residents with recent admissions and serious conditions such as necrotizing fasciitis and acute respiratory failure missed evening doses of atorvastatin. Other residents with dementia, Alzheimer’s disease, schizophrenia, vascular dementia, atrial fibrillation, senile brain degeneration, catatonic schizophrenia, intermittent explosive disorder, seizures, visual hallucinations, and overactive bladder also did not receive their ordered evening medications. These included donepezil, divalproex, melatonin, trazodone, Zyprexa, Seroquel, Ativan, Flomax, gabapentin, Keppra, magnesium oxide, memantine, metformin, Prilosec, Remeron, rivaroxaban, hydroxyzine, Symbicort, fluphenazine decanoate, aspirin, risperidone, benztropine, clonazepam, thiamine, Lantus, Eliquis, Humalog, and various nutritional supplements such as Ensure Plus, Magic Cup, Glucerna, and ProStat. The inaction that led to this deficiency was that no nighttime medications were administered to residents on the 300 and 400 halls during that shift, despite the presence of a nurse in the facility. Interviews with the Administrator and DON clarified the sequence of events leading to the missed medication administration. The Assistant Director of Nursing (ADON) had been called in to work the day shift and, when her shift ended at 7:00 P.M., her replacement did not arrive. The ADON then left the facility, quit her job, and dropped the medication cart keys at the Administrator’s home. Although there was still a nurse in the facility and extra medication cart keys were available in the Administrator’s office, the nurse on duty refused to take the keys because they had not been formally signed out to her. As a result, no residents on the 300 and 400 halls received their prescribed nighttime medications on that date. The facility’s self-reported investigation confirmed that the nurse left around 7:30 P.M. with the medication cart keys and that no nighttime medications were administered on those halls during that shift.
Failure to Provide Required Written Notice for Resident Room Changes
Penalty
Summary
The deficiency involves the facility’s failure to provide advance, written notification of room changes, signed by the resident or their representative, for three residents who experienced intra-facility room moves. Facility policy required that, prior to making a room or roommate change, residents and their representatives receive advance written notice in a language and manner they understand, including the reasons for the move. For one resident admitted with COPD, chronic respiratory failure, and obesity, with intact cognition and extensive ADL assistance needs, a progress note documented that staff discussed a room move with the resident and her daughter and that they agreed; however, the intra-facility room change form dated the following day was not signed by the resident or her representative. A second resident, admitted with hypertensive chronic kidney disease, GERD, and obesity, had moderate cognitive impairment and required extensive ADL assistance. A progress note documented that this resident was informed of a room move, agreed to it, and was observed telling others about the move, but the corresponding intra-facility room change form was not signed by the resident or a representative. A third resident, admitted with limb girdle muscular dystrophy, neuromuscular bladder, and osteoarthritis, had intact cognition and extensive ADL assistance needs. For this resident, there were no progress notes documenting a discussion of the room change, and the intra-facility room change form was also unsigned by the resident or representative. During interviews, the social worker and administrator confirmed that room changes occurred for all three residents, that no written notice of the transfer was given, and that they believed 24-hour verbal notice was appropriate, which did not meet the facility’s written-notice requirement.
Improper Frozen Food Storage and Unsanitary Dishwasher Area
Penalty
Summary
Surveyors identified that the facility failed to maintain safe food storage and sanitary kitchen conditions, affecting all 51 residents who received food prepared in the kitchen. During a kitchen tour, the walk-in freezer contained one large bag each of beef patties, chicken breasts, breaded chicken tenderloins, and peppers and onions that were opened and undated. A kitchen aide and a facility staff member confirmed that these items should have been sealed and dated to prevent freezer burn, and facility policy on labeling and dating required all food items prepared, opened, or stored in the kitchen to be clearly labeled and dated to maintain food safety and prevent spoilage. Surveyors also observed unsanitary conditions in the dishwasher sanitization area. There was a large amount of black mold-like substance covering the walls below the rinse shelf where the automatic dishwasher was placed, as well as an open wall area approximately six by six inches with exposed wires that were also covered in the black mold-like substance and accumulated dirt and debris. The maintenance director confirmed that the wall opening had been created for installation of the new automatic dishwasher but was never closed, leaving the interior drywall and wiring exposed to the mold-like substance and debris. These conditions were inconsistent with the facility’s kitchen sanitation policy, which required storage, preparation, and serving areas, as well as equipment, to be clean, organized, and free of spills, mold, or buildup.
Resident Fall During Mechanical Lift Transfer Due to Staff Training and Supervision Lapses
Penalty
Summary
A deficiency occurred when a resident, identified as high risk for falls and dependent on staff for transfers, was not safely transferred using a mechanical Hoyer lift. The resident, who had multiple diagnoses including dementia, catatonic disorder, and impaired mobility, had a documented history of recent falls. On the day of the incident, the resident was being transferred with the assistance of a CNA and an LPN. During the transfer, the front left hook of the Hoyer lift became unfastened, causing the resident to fall from the lift and hit her head on the floor. The resident was sent to the emergency room and returned with no noted injuries. Interviews revealed that the CNA believed the resident may have attempted to move the Hoyer strap and could not recall her last training on the lift. The LPN, who was assisting, did not witness the hook check as she was gathering supplies at the time. After the fall, the LPN checked the equipment and found all straps in working order. Both staff members indicated a lack of recent or initial training on the Hoyer lift. Facility policy required two staff for mechanical lift transfers and annual competency documentation, but this was not followed, contributing to the incident.
Failure to Administer Diabetes Medications as Ordered
Penalty
Summary
The facility failed to ensure that medications for diabetes management were administered as ordered by the physician for one resident. The resident, who had diagnoses including diabetes mellitus, hypertension, and heart failure, was admitted with physician orders for Insulin Lispro to be given in the morning and at night, as well as Humalog sliding scale insulin to be administered based on blood sugar readings at multiple times throughout the day. Review of the Medication Administration Record showed that Insulin Lispro was not given in the morning and Humalog sliding scale insulin was not administered at lunch on a specific date. The resident's care plan indicated that staff should administer medications as ordered, and facility policy required medications to be administered according to physician orders. The Director of Nursing Services confirmed that the insulin doses were missed as documented.
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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 Kent
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Arbors At Stow | 1.3 mi | — | 9 | 0 |
| Tamarack Ridge Health And Rehabilitation | 3.1 mi | — | 2 | 0 |
| The Pavilion At Stow For Nursing And Rehabilitatio | 3.4 mi | — | 0 | 0 |
| Hudson Springs Nursing And Rehab | 3.6 mi | — | 10 | 0 |
| Heather Knoll Retirement Village | 4 mi | — | 1 | 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.