Oakwood SNF LLC

1300 Windlass Drive · Middle River, MD · 21220 · 4106871383

130 certified beds For profit - Limited Liability company Chain: Hill Valley Healthcare

Why this verdict

  • Inspection record is far worse than the national median (deficiency count and severity).
  • Staffing levels are well below research benchmarks for safe care.
  • Inspection results are getting worse cycle over cycle, not better.

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Red flags

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.

Score breakdown

Inspection record 30% of score 28
Serious harm & abuse 20% 78
Staffing 20% 20
Federal penalties 15% 75
Trend 10% 27
Context 5% 75

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: 1 of 5 Quality measures: 5 of 5

Total nurse hours / resident-day3.48 min · 4.1 strong
RN hours / resident-day0.55–0.75
Weekend hours / resident-day≈ weekday level
Nursing turnover / yearmedian 45%
Fines (3-yr window)1 · $13,270

Inspection citations (88 in the current record)

  • Potential for harm · D March 3, 2026

    Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.

    Corrected April 14, 2026 · Resident Rights

  • Potential for harm · E March 3, 2026

    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.

    Corrected April 14, 2026 · Resident Rights

  • Potential for harm · D March 3, 2026

    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.

    Corrected April 14, 2026 · Resident Rights

  • Potential for harm · D March 3, 2026

    Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.

    Corrected April 14, 2026 · Freedom from Abuse, Neglect, and Exploitation

  • Potential for harm · E March 3, 2026

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

    Corrected April 14, 2026 · Resident Rights

  • Potential for harm · D March 3, 2026

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

    Corrected April 14, 2026 · Resident Assessment and Care Planning

  • Potential for harm · D March 3, 2026

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

    Corrected April 14, 2026 · Resident Assessment and Care Planning

  • Potential for harm · D March 3, 2026

    Ensure services provided by the nursing facility meet professional standards of quality.

    Corrected April 14, 2026 · Resident Assessment and Care Planning

  • Potential for harm · D March 3, 2026

    Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.

    Corrected April 14, 2026 · Quality of Life and Care

  • Potential for harm · D March 3, 2026

    Provide care and assistance to perform activities of daily living for any resident who is unable.

    Corrected April 14, 2026 · Quality of Life and Care

  • Potential for harm · D March 3, 2026

    Provide appropriate treatment and care according to orders, resident’s preferences and goals.

    Corrected April 14, 2026 · Quality of Life and Care

  • Potential for harm · D March 3, 2026

    Assist a resident in gaining access to vision and hearing services.

    Corrected April 14, 2026 · Quality of Life and Care

  • Potential for harm · D March 3, 2026

    Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.

    Corrected April 14, 2026 · Quality of Life and Care

  • Potential for harm · D March 3, 2026

    Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.

    Corrected April 14, 2026 · Quality of Life and Care

  • Potential for harm · D March 3, 2026

    Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.

    Corrected April 14, 2026 · Nursing and Physician Services

  • Potential for harm · D March 3, 2026

    Post nurse staffing information every day.

    Corrected April 14, 2026 · Nursing and Physician Services

  • Potential for harm · D March 3, 2026

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

    Corrected April 14, 2026 · Pharmacy Service

  • Potential for harm · D March 3, 2026

    Ensure each resident’s drug regimen must be free from unnecessary drugs.

    Corrected April 14, 2026 · Pharmacy Service

  • Potential for harm · D March 3, 2026

    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 April 14, 2026 · Pharmacy Service

  • Potential for harm · D March 3, 2026

    Provide or obtain dental services for each resident.

    Corrected April 14, 2026 · Quality of Life and Care

  • Potential for harm · D March 3, 2026

    Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.

    Corrected April 14, 2026 · Nutrition and Dietary

  • Potential for harm · D March 3, 2026

    Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.

    Corrected April 14, 2026 · Nutrition and Dietary

  • Potential for harm · D March 3, 2026

    Provide special eating equipment and utensils for residents who need them and appropriate assistance.

    Corrected April 14, 2026 · Nutrition and Dietary

  • Potential for harm · D March 3, 2026

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

    Corrected April 14, 2026 · Nutrition and Dietary

  • Potential for harm · D March 3, 2026

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

    Corrected April 14, 2026 · Resident Assessment and Care Planning

Showing the 25 most recent. The Safety Report includes every citation with full findings.

Federal penalties

DateTypeAmount / length
October 21, 2024Fine$13,270

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Source: CMS Care Compare (public domain), data as of June 1, 2026 · CCN 215181 · certified since October 28, 1988. The score is a screen, not a verdict on any one resident's experience — read how it's computed, then visit in person.