Breakwater Commons

Certification

Medicare-certified.

Ratings

Inspection history (57)

Records from September 2023 to April 2026.

• April 9, 2026

  Tag F0842

  Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

  Severity E: pattern, no actual harm, potential for more than minimal harm. Corrected May 8, 2026.

• April 9, 2026

  Tag F0609

  Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

  Severity E: pattern, no actual harm, potential for more than minimal harm. Corrected May 8, 2026.

• April 9, 2026

  Tag F0584

  Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.

  Severity E: pattern, no actual harm, potential for more than minimal harm. Corrected May 8, 2026.

• April 9, 2026

  Tag F0755

  Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

  Severity E: pattern, no actual harm, potential for more than minimal harm. Corrected May 8, 2026.

• April 9, 2026

  Tag F0657

  Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

  Severity E: pattern, no actual harm, potential for more than minimal harm. Corrected May 8, 2026.

• April 9, 2026

  Tag F0636

  Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.

  Severity D: isolated, no actual harm, potential for more than minimal harm. Corrected May 8, 2026.

• April 9, 2026

  Tag F0655

  Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted.

  Severity E: pattern, no actual harm, potential for more than minimal harm. Corrected May 8, 2026.

• April 9, 2026

  Tag F0578

  Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.

  Severity D: isolated, no actual harm, potential for more than minimal harm. Corrected May 8, 2026.

• April 9, 2026

  Tag F0699

  Provide care or services that was trauma informed and/or culturally competent.

  Severity D: isolated, no actual harm, potential for more than minimal harm. Corrected May 8, 2026.

• April 9, 2026

  Tag F0812

  Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

  Severity E: pattern, no actual harm, potential for more than minimal harm. Corrected May 8, 2026.

• April 9, 2026

  Tag F0689

  Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

  Severity D: isolated, no actual harm, potential for more than minimal harm. Corrected May 8, 2026.

• April 9, 2026

  Tag F0761

  Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

  Severity D: isolated, no actual harm, potential for more than minimal harm. Corrected May 8, 2026.

• April 9, 2026

  Tag F0628

  Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.

  Severity E: pattern, no actual harm, potential for more than minimal harm. Corrected May 8, 2026.

• May 28, 2025

  Tag F0865

  Have a plan that describes the process for conducting QAPI and QAA activities.

  Severity D: isolated, no actual harm, potential for more than minimal harm. Corrected August 1, 2025.

• May 28, 2025

  Tag F0690

  Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

  Severity D: isolated, no actual harm, potential for more than minimal harm. Corrected July 10, 2025.

• May 28, 2025

  Tag F0880

  Provide and implement an infection prevention and control program.

  Severity E: pattern, no actual harm, potential for more than minimal harm. Corrected July 10, 2025.

• May 28, 2025

  Tag F0940

  Develop, implement, and/or maintain an effective training program for all new and existing staff members.

  Severity D: isolated, no actual harm, potential for more than minimal harm. Corrected July 10, 2025.

• May 28, 2025

  Tag F0842

  Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

  Severity D: isolated, no actual harm, potential for more than minimal harm. Corrected August 1, 2025.

• January 23, 2025

  Tag F0584

  Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.

  Severity E: pattern, no actual harm, potential for more than minimal harm. Corrected March 4, 2025.

• January 23, 2025

  Tag F0657

  Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

  Severity E: pattern, no actual harm, potential for more than minimal harm. Corrected March 4, 2025.

Penalties (2)

Total fines: $11,998

• August 28, 2023 · Fine

  CMS recorded a civil money penalty of $3,529 against this nursing home on August 28, 2023.

• August 7, 2023 · Fine

  CMS recorded a civil money penalty of $8,469 against this nursing home on August 7, 2023.

Staffing

4.88 nurse hours per resident per day in Q2 2026, up from 4.80 in Q4 2025.

From the payroll records nursing homes file with CMS.

Ownership

For profit - Limited Liability company

• Parent company: Breakwater Commons Operations, LLC