Litchford Falls Health and Rehabilitation Center
8200 Litchford Road, Raleigh, NC 27615
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Follow this homeLitchford Falls Health and Rehabilitation Center is a nursing home in Raleigh, North Carolina. This page lists the citations, fines and star ratings that CMS publishes for it. Each one has a date and a link to CMS.
At a glance
- CMS overall star rating1 of 5
- Last standard health inspectionJuly 10, 2026 (4 months ago)
- Health citations since March 21, 202421 (North Carolina average 18)
- Fines in the past three years1, $177,911 in total
- CMS flagsNone listed by CMS
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CMS flags
CMS does not list this home as a Special Focus Facility or a candidate. CMS does not show an abuse icon for it. CMS lists no change of ownership in the past 12 months.
Inspections, fines and changes
This list shows every citation and fine in CMS's current data, which covers about the last three years. It also shows changes CMS made to this home's ratings and records.
CMS update of October 28, 2026
Star rating
The CMS staffing star rating changed from 2 of 5 to 1 of 5.
Star rating
The CMS quality measures star rating changed from 2 of 5 to 3 of 5.
CMS update of October 8, 2026
Star rating
The CMS overall star rating changed from 2 of 5 to 1 of 5.
Star rating
The CMS health inspection star rating changed from 2 of 5 to 1 of 5.
CMS update of July 29, 2026
Star rating
The CMS overall star rating changed from 1 of 5 to 2 of 5.
Star rating
The CMS staffing star rating changed from 1 of 5 to 2 of 5.
Name
CMS lists a new legal business name for this home.
Ownership
CMS ownership records list new owners for this home.
Health inspection on July 10, 2026
3 citationsCMS lists this as a standard inspection and a complaint inspection.
Show the 3 citations
Citation F0585. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.
CMS lists it as corrected on July 27, 2026.
Citation F0582. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
CMS lists it as corrected on July 27, 2026.
Citation F0732. Severity C: potential for minimal harm, widespread.
The rule CMS cited:
Post nurse staffing information every day.
CMS lists it as corrected on July 27, 2026.
CMS update of February 25, 2026
Star rating
The CMS health inspection star rating changed from 1 of 5 to 2 of 5.
Star rating
The CMS staffing star rating changed from 2 of 5 to 1 of 5.
Fine
CMS changed the fine from December 17, 2024 from $164,740 to $177,911.
CMS update of January 14, 2026
Name
CMS lists a new name for this home. It was Litchford Falls Healthcare & Rehabilitation Center.
Health inspection on January 8, 2026
3 citationsCMS lists this as a complaint inspection.
Show the 3 citations
Citation F0686. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
CMS lists it as corrected on February 5, 2026.
CMS has cited this home for F0686 2 times since 2025.
Citation F0692. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide enough food/fluids to maintain a resident's health.
CMS lists it as corrected on February 5, 2026.
Citation F0842. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
CMS lists it as corrected on February 5, 2026.
CMS has cited this home for F0842 2 times since 2025.
CMS update of July 30, 2025
Star rating
The CMS overall star rating changed from 2 of 5 to 1 of 5. CMS changed how it scores this rating for many homes at once.
Star rating
The CMS health inspection star rating changed from 2 of 5 to 1 of 5. CMS changed how it scores this rating for many homes at once.
Star rating
The CMS quality measures star rating changed from 3 of 5 to 2 of 5.
Ownership
CMS lists this home under a new chain.
CMS update of June 25, 2025
Ownership
CMS lists this home under a new chain.
CMS update of May 28, 2025
Ownership
CMS lists this home under a new chain.
Fine
CMS changed the fine from December 17, 2024 from $253,445 to $164,739.
Health inspection on May 8, 2025
5 citationsCMS lists this as a standard inspection and a complaint inspection.
Show the 5 citations
Citation F0584. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
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.
CMS lists it as corrected on June 5, 2025.
CMS has cited this home for F0584 2 times since 2024.
Citation F0641. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Ensure each resident receives an accurate assessment.
CMS lists it as corrected on June 5, 2025.
Citation F0657. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
CMS lists it as corrected on June 5, 2025.
Citation F0677. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide care and assistance to perform activities of daily living for any resident who is unable.
CMS lists it as corrected on June 5, 2025.
Citation F0761. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
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.
CMS lists it as corrected on June 5, 2025.
Fire safety inspection on May 8, 2025
12 citationsCMS lists this as a standard inspection.
Show the 12 citations
Citation K0345. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Have approved installation, maintenance and testing program for fire alarm systems.
CMS lists it as corrected on July 15, 2025.
Citation K0351. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Install an approved automatic sprinkler system.
CMS lists it as corrected on July 15, 2025.
CMS has cited this home for K0351 2 times since 2022.
Citation K0161. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Use approved construction type or materials.
CMS lists it as corrected on July 15, 2025.
Citation K0211. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Keep aisles, corridors, and exits free of obstruction in case of emergency.
CMS lists it as corrected on July 15, 2025.
CMS has cited this home for K0211 2 times since 2024.
Citation K0271. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Have exits that are accessible at all times.
CMS lists it as corrected on July 15, 2025.
CMS has cited this home for K0271 2 times since 2024.
Citation K0321. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
CMS lists it as corrected on July 15, 2025.
CMS has cited this home for K0321 2 times since 2022.
Citation K0341. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Install a fire alarm system that can be heard throughout the facility.
CMS lists it as corrected on July 15, 2025.
CMS has cited this home for K0341 2 times since 2022.
Citation K0372. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
CMS lists it as corrected on July 15, 2025.
Citation K0521. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
CMS lists it as corrected on July 15, 2025.
CMS has cited this home for K0521 2 times since 2024.
Citation K0741. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
CMS lists it as corrected on July 15, 2025.
Citation K0918. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Have generator or other power source capable of supplying service within 10 seconds.
CMS lists it as corrected on July 15, 2025.
CMS has cited this home for K0918 3 times since 2022.
Citation K0923. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Have proper medical gas storage and administration areas.
CMS lists it as corrected on July 15, 2025.
CMS update of February 26, 2025
Star rating
The CMS overall star rating changed from 4 of 5 to 2 of 5. CMS changed how it scores this rating for many homes at once.
Star rating
The CMS health inspection star rating changed from 5 of 5 to 2 of 5.
Star rating
The CMS staffing star rating changed from 1 of 5 to 2 of 5.
Health inspection on February 17, 2025
5 citationsCMS lists this as a complaint inspection.
Show the 5 citations
Citation F0578. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
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.
CMS lists it as corrected on March 6, 2025.
Citation F0580. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
CMS lists it as corrected on March 6, 2025.
CMS has cited this home for F0580 2 times since 2024.
Citation F0684. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
CMS lists it as corrected on March 6, 2025.
CMS has cited this home for F0684 2 times since 2024.
Citation F0686. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
CMS lists it as corrected on March 6, 2025.
Citation F0842. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
CMS lists it as corrected on March 6, 2025.
Health inspection on December 17, 2024
4 citationsCMS lists this as a complaint inspection.
Severity J is the highest of CMS's four levels. CMS uses it when residents' health or safety is at serious risk right away.
88 of 419 North Carolina homes (21%) got a citation at the immediate jeopardy level in 2024.
CMS fine of $177,911 on December 17, 2024.
Show the 4 citations
Citation F0580. Severity J: immediate jeopardy, isolated.
The rule CMS cited:
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
CMS lists it as corrected on January 17, 2025.
Citation F0756. Severity J: immediate jeopardy, isolated.
The rule CMS cited:
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
CMS lists it as corrected on January 16, 2025.
Citation F0760. Severity J: immediate jeopardy, isolated.
The rule CMS cited:
Ensure that residents are free from significant medication errors.
CMS lists it as corrected on January 16, 2025.
Citation F0684. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
CMS lists it as corrected on January 16, 2025.
CMS update of October 30, 2024
Star rating
The CMS overall star rating changed from 5 of 5 to 4 of 5.
Star rating
The CMS staffing star rating changed from 3 of 5 to 1 of 5.
Staffing
Total nurse staffing reported to CMS went from 3.9 to 1.3 hours per resident per day.
CMS update of July 31, 2024
Star rating
The CMS quality measures star rating changed from 2 of 5 to 3 of 5.
Name
CMS lists a new name for this home. It was LITCHFORD FALLS HEALTHCARE.
CMS update of June 26, 2024
Star rating
The CMS overall star rating changed from 4 of 5 to 5 of 5.
Star rating
The CMS health inspection star rating changed from 4 of 5 to 5 of 5.
Fine
CMS changed the fine from September 28, 2023 from $6,095 to $3,962.
CMS update of April 25, 2024
Star rating
The CMS staffing star rating changed from 2 of 5 to 3 of 5.
Health inspection on March 21, 2024
1 citationCMS lists this as a standard inspection and a complaint inspection.
Show the 1 citation
Citation F0584. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
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.
CMS lists it as corrected on April 18, 2024.
Fire safety inspection on March 21, 2024
8 citationsCMS lists this as a standard inspection.
Show the 8 citations
Citation K0111. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Satisfy building requirements after a repair, renovation, modification, or change of user/occupancy.
CMS lists it as corrected on May 31, 2024.
Citation K0211. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Keep aisles, corridors, and exits free of obstruction in case of emergency.
CMS lists it as corrected on May 31, 2024.
Citation K0271. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Have exits that are accessible at all times.
CMS lists it as corrected on May 31, 2024.
Citation K0293. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Have properly located and lighted "Exit" signs.
CMS lists it as corrected on May 31, 2024.
Citation K0355. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Properly select, install, inspect, or maintain portable fire extinguishes.
CMS lists it as corrected on May 31, 2024.
Citation K0521. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
CMS lists it as corrected on May 31, 2024.
Citation K0911. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Meet requirements for the installation and maintenance of electrical systems.
CMS lists it as corrected on May 31, 2024.
Citation K0918. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Have generator or other power source capable of supplying service within 10 seconds.
CMS lists it as corrected on May 31, 2024.
CMS update of December 21, 2023
Star rating
The CMS overall star rating changed from 5 of 5 to 4 of 5.
Star rating
The CMS health inspection star rating changed from 5 of 5 to 4 of 5.
Fire safety inspection on December 9, 2022
8 citationsCMS lists this as a standard inspection.
Show the 8 citations
Citation K0374. Severity F: potential for more than minimal harm, widespread.
The rule CMS cited:
Install smoke barrier doors that can resist smoke for at least 20 minutes.
CMS lists it as corrected on February 19, 2023.
Citation K0918. Severity F: potential for more than minimal harm, widespread.
The rule CMS cited:
Have generator or other power source capable of supplying service within 10 seconds.
CMS lists it as corrected on February 19, 2023.
Citation K0321. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
CMS lists it as corrected on February 19, 2023.
Citation K0341. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Install a fire alarm system that can be heard throughout the facility.
CMS lists it as corrected on February 19, 2023.
Citation K0351. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Install an approved automatic sprinkler system.
CMS lists it as corrected on February 19, 2023.
Citation K0353. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Inspect, test, and maintain automatic sprinkler systems.
CMS lists it as corrected on February 19, 2023.
Citation K0712. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Have simulated fire drills held at unexpected times.
CMS lists it as corrected on February 19, 2023.
Citation K0781. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Have restrictions on the use of portable space heaters.
CMS lists it as corrected on February 19, 2023.
CMS star ratings
- 1 of 5CMS overall star rating
- 1 of 5CMS health inspection star rating
- 1 of 5CMS staffing star rating
- 3 of 5CMS quality measures star rating
Facts from CMS
- Phone
- (919) 878-7772
- Last standard health inspection
- July 10, 2026 (4 months ago)
- Certified beds
- 90
- Residents per day, on average
- 85.2
- Ownership type
- For profit - Limited Liability company
- Legal business name
- Litchford Operator LLC
- Chain
- Lifeworks Rehab
- Takes part in
- Medicare and Medicaid
More health citations than the North Carolina average (21 vs 18).
Owners and managers
CMS lists these owners and managers for this home. Names are as CMS writes them.
- LITCHFORD HOLDINGS I LLCDirect ownership interest · not applicable · since 06/01/2024
- 8200 LITCHFIELD ROAD LLCIndirect ownership interest · not applicable · since 06/01/2024
- BRIDGEWATER NC HOLDINGS LLCIndirect ownership interest · not applicable · since 06/01/2024
- CZ FAMILY TRUSTIndirect ownership interest · not applicable · since 06/01/2024
- HL FAMILY TRUSTIndirect ownership interest · not applicable · since 06/01/2024
Show 16 more
- HSHC 2024 FAMILY TRUSTIndirect ownership interest · not applicable · since 06/01/2024
- IB MIMI 2022 FAMILY GRANTOR TRUSTIndirect ownership interest · not applicable · since 06/01/2024
- IB MIMI 2022 FAMILY TRUSTIndirect ownership interest · not applicable · since 06/01/2024
- JK 2022 GRANTOR FAMILY TRUSTIndirect ownership interest · not applicable · since 06/01/2024
- MEDICAL FACILITIES OF AMERICA ADMINISTRATIVE CONSULTING SERVICES LLCIndirect ownership interest · not applicable · since 06/01/2024
- MILANO FAMILY HOLDINGS LLCIndirect ownership interest · not applicable · since 06/01/2024
- ML MILANO 2022 FAMILY GRANTOR TRUSTIndirect ownership interest · not applicable · since 06/01/2024
- ML MILANO 2022 FAMILY TRUSTIndirect ownership interest · not applicable · since 06/01/2024
- TJ FAMILY TRUSTIndirect ownership interest · not applicable · since 06/01/2024
- TOL OPCO INVESTCO LLCIndirect ownership interest · not applicable · since 06/01/2025
- UH CAROLINA LF SNF OPERATIONS HOLDINGS LLCIndirect ownership interest · not applicable · since 06/01/2024
- UNIVERSAL OPERATIONS HOLDINGS LLCIndirect ownership interest · not applicable · since 06/01/2024
- WILL FAMILY 2016 TRUSTIndirect ownership interest · not applicable · since 06/01/2024
- BRYANT -LEVANT, KARENOperational/managerial control · not applicable · since 06/01/2024
- KONDURU, RAMESHOperational/managerial control · not applicable · since 02/01/2026
- SHAYO, JULIUSOperational/managerial control · not applicable · since 06/01/2024
Questions
When was Litchford Falls Health and Rehabilitation Center last inspected?
CMS lists July 10, 2026 as the date of its most recent standard health inspection.
How many citations (violations) does Litchford Falls Health and Rehabilitation Center have?
CMS lists 21 health citations since March 21, 2024. CMS also calls these deficiencies.
Has Litchford Falls Health and Rehabilitation Center been fined?
CMS lists 1 fine in the past three years, $177,911 in total.
What is the CMS star rating of Litchford Falls Health and Rehabilitation Center?
Its CMS overall star rating is 1 of 5.
Is Litchford Falls Health and Rehabilitation Center a Special Focus Facility?
No. CMS does not list it as a Special Focus Facility or a candidate.
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