Monument Healthcare South Salt Lake
2472 South 300 East · Salt Lake City, UT · 84115 · 8014662211
140 certified beds Government - Hospital district Chain: Monument Health Group Hospital-based
Why this verdict
- Inspectors found immediate jeopardy — danger of serious harm or death — in the most recent cycle (2 citations).
- Inspection record is far worse than the national median (deficiency count and severity).
- Inspection results are getting worse cycle over cycle, not better.
- 7 citations involved actual harm to residents.
The complete Safety Report — $19
Everything on this page plus the full citation-by-citation history with inspector findings, the complete penalty record, staffing vs benchmarks, side-by-side nearby comparisons, and the printable tour checklist. One PDF, emailed in minutes, yours to keep and share with family.
Red flags
Special Focus Facility candidate
CMS lists this facility as a candidate for its Special Focus program for persistently poor inspection performance.
2 immediate-jeopardy citations in the most recent inspection cycle
Immediate jeopardy is the most serious finding an inspector can make: a situation likely to cause serious injury, harm, or death.
1 abuse-related citation at the actual-harm level
Inspectors cited failures in the abuse-prevention rules (F600–F610) that resulted in actual harm to a resident.
If someone you love was harmed at a facility with findings like these, you have options — read this.
Score breakdown
Quality-measure stars are deliberately excluded — they're largely self-reported by facilities. Full method.
CMS ratings & staffing
Overall: 2 of 5 Inspections: 1 of 5 Staffing: 2 of 5 Quality measures: 5 of 5
| Total nurse hours / resident-day | 3.58 | 3.48 min · 4.1 strong |
|---|---|---|
| RN hours / resident-day | 1.19 | 0.55–0.75 |
| Weekend hours / resident-day | 3.19 | ≈ weekday level |
| Nursing turnover / year | 54% | median 45% |
| Fines (3-yr window) | 2 · $31,391 |
Inspection citations (57 in the current record)
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Immediate jeopardy · K June 19, 2025
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
Corrected June 30, 2025 · Environmental
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Immediate jeopardy · L June 19, 2025 · found via complaint
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected June 30, 2025 · Quality of Life and Care
-
Actual harm · G June 19, 2025
Provide the appropriate treatment and services to a resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder.
Corrected June 30, 2025 · Quality of Life and Care
-
Potential for harm · E June 19, 2025
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Corrected June 30, 2025 · Resident Rights
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Potential for harm · D June 19, 2025
Ensure that residents are fully informed and understand their health status, care and treatments.
Corrected June 30, 2025 · Resident Rights
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Potential for harm · E June 19, 2025
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected June 30, 2025 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · D June 19, 2025
Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
Corrected June 30, 2025 · Resident Rights
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Potential for harm · D June 19, 2025
Ensure each resident receives an accurate assessment.
Corrected June 30, 2025 · Resident Assessment and Care Planning
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Potential for harm · D June 19, 2025
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.
Corrected June 30, 2025 · Quality of Life and Care
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Potential for harm · D June 19, 2025
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected June 30, 2025 · Quality of Life and Care
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Potential for harm · D June 19, 2025
Provide enough food/fluids to maintain a resident's health.
Corrected June 30, 2025 · Quality of Life and Care
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Potential for harm · D June 19, 2025
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Corrected June 30, 2025 · Pharmacy Service
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Potential for harm · E June 19, 2025
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.
Corrected June 30, 2025 · Pharmacy Service
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Potential for harm · F June 19, 2025
Provide timely, quality laboratory services/tests to meet the needs of residents.
Corrected June 30, 2025 · Administration
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Potential for harm · E June 19, 2025
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected June 30, 2025 · Nutrition and Dietary
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Potential for harm · D June 19, 2025
Employ or obtain outside professional resources to provide services in the nursing home when the facility does not employ a qualified professional to furnish a required service.
Corrected June 30, 2025 · Administration
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Potential for harm · D June 19, 2025
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Corrected June 30, 2025 · Resident Assessment and Care Planning
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Potential for harm · E June 19, 2025
Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.
Corrected June 30, 2025 · Administration
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Potential for harm · D June 19, 2025
Provide and implement an infection prevention and control program.
Corrected June 30, 2025 · Infection Control
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Potential for harm · D June 19, 2025 · found via complaint
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected June 30, 2025 · Freedom from Abuse, Neglect, and Exploitation
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Actual harm · G January 25, 2024 · found via complaint
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected February 15, 2024 · Quality of Life and Care
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Potential for harm · D January 25, 2024
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected February 14, 2024 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · D January 25, 2024
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
Corrected January 31, 2024 · Resident Assessment and Care Planning
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Potential for harm · D January 25, 2024
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected January 31, 2024 · Resident Assessment and Care Planning
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Potential for harm · D January 25, 2024
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected January 31, 2024 · Quality of Life and Care
Showing the 25 most recent. The Safety Report includes every citation with full findings.
Federal penalties
| Date | Type | Amount / length |
|---|---|---|
| June 19, 2025 | Fine | $13,000 |
| January 25, 2024 | Fine | $18,391 |
Family & resident reviews — a separate signal, never mixed into the score
No approved reviews yet. If your family has experience with this facility, yours could be the review that helps the next family decide.
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Source: CMS Care Compare (public domain), data as of June 1, 2026 · CCN 465146 · certified since May 6, 1997. The score is a screen, not a verdict on any one resident's experience — read how it's computed, then visit in person.