Windsor Health and Rehabilitation
820 Cottage Street Ne, Salem, OR 97301
Windsor Health and Rehabilitation is a nursing home in Salem, Oregon. 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 13, 2026 (3 months ago)
- Health citations since November 16, 202336 (Oregon average 34)
- Fines in the past three years1, $13,592 in total
- CMS flagsNone listed by CMS
Get an email when CMS publishes something new about this home
One email per CMS update, only when something changed: a new citation, a fine, a star rating change, a new owner. Early access follows one home per address.
Email alerts for this home open soon.
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
Fine
CMS changed the fine from July 13, 2026 from $20,910 to $13,592.
CMS update of October 8, 2026
Star rating
The CMS overall star rating changed from 3 of 5 to 1 of 5.
Star rating
The CMS health inspection star rating changed from 3 of 5 to 1 of 5.
Health inspection on July 13, 2026
19 citationsCMS lists this as a standard inspection and a complaint inspection.
Severity G is the second-highest of CMS's four levels. It means a resident was harmed.
14 of 128 Oregon homes (11%) got a citation at the actual harm level in 2026.
CMS fine of $13,592 on July 13, 2026.
Show the 19 citations
Citation F0740. Severity G: actual harm, isolated.
The rule CMS cited:
Ensure each resident must receive and the facility must provide necessary behavioral health care and services.
CMS lists it as corrected on July 31, 2026.
Citation F0727. Severity F: potential for more than minimal harm, widespread.
The rule CMS cited:
Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.
CMS lists it as corrected on July 31, 2026.
Citation F0679. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Provide activities to meet all resident's needs.
CMS lists it as corrected on July 31, 2026.
Citation F0725. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
CMS lists it as corrected on July 31, 2026.
Citation F0791. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Provide or obtain dental services for each resident.
CMS lists it as corrected on July 31, 2026.
Citation F0847. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Inform resident or representatives choice to enter into binding arbitration agreement and right to refuse.
CMS lists it as corrected on July 31, 2026.
Citation F0880. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Provide and implement an infection prevention and control program.
CMS lists it as corrected on July 31, 2026.
CMS has cited this home for F0880 3 times since 2023.
Citation F0554. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Allow residents to self-administer drugs if determined clinically appropriate.
CMS lists it as corrected on July 31, 2026.
Citation F0561. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
CMS lists it as corrected on July 31, 2026.
Citation F0565. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Honor the resident's right to organize and participate in resident/family groups in the facility.
CMS lists it as corrected on July 31, 2026.
Citation F0605. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.
CMS lists it as corrected on July 31, 2026.
Citation F0610. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Respond appropriately to all alleged violations.
CMS lists it as corrected on July 31, 2026.
CMS has cited this home for F0610 2 times since 2026.
Citation F0627. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge.
CMS lists it as corrected on July 31, 2026.
Citation F0637. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Assess the resident when there is a significant change in condition
CMS lists it as corrected on July 31, 2026.
Citation F0655. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
CMS lists it as corrected on July 31, 2026.
Citation F0688. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
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.
CMS lists it as corrected on July 31, 2026.
Citation F0689. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Citation F0695. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide safe and appropriate respiratory care for a resident when needed.
CMS lists it as corrected on July 31, 2026.
Citation F0698. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide safe, appropriate dialysis care/services for a resident who requires such services.
CMS lists it as corrected on July 31, 2026.
Fire safety inspection on July 13, 2026
2 citationsCMS lists this as a standard inspection.
Show the 2 citations
Citation K0712. Severity F: potential for more than minimal harm, widespread.
The rule CMS cited:
Have simulated fire drills held at unexpected times.
CMS lists it as corrected on August 11, 2026.
CMS has cited this home for K0712 2 times since 2025.
Citation E0024. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Establish policies and procedures for volunteers.
CMS lists it as corrected on August 11, 2026.
CMS update of April 29, 2026
Star rating
The CMS overall star rating changed from 4 of 5 to 3 of 5.
Star rating
The CMS health inspection star rating changed from 4 of 5 to 3 of 5.
Star rating
The CMS quality measures star rating changed from 3 of 5 to 2 of 5.
Name
CMS lists a new name for this home. It was WINDSOR HEALTH & REHABILITATION CENTER.
CMS update of March 25, 2026
Ownership
CMS lists this home under a new chain.
Health inspection on March 17, 2026
2 citationsCMS lists this as a complaint inspection.
Show the 2 citations
Citation F0558. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Reasonably accommodate the needs and preferences of each resident.
CMS lists it as corrected on April 15, 2026.
Citation F0697. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide safe, appropriate pain management for a resident who requires such services.
CMS lists it as corrected on April 15, 2026.
CMS update of February 25, 2026
Star rating
The CMS overall star rating changed from 1 of 5 to 4 of 5.
Star rating
The CMS health inspection star rating changed from 2 of 5 to 4 of 5.
Star rating
The CMS staffing star rating changed from 1 of 5 to 3 of 5.
Star rating
The CMS quality measures star rating changed from 4 of 5 to 3 of 5.
Health inspection on February 24, 2026
4 citationsCMS lists this as a complaint inspection.
Show the 4 citations
Citation F0600. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
CMS lists it as corrected on March 31, 2026.
Citation F0603. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Protect each resident from separation (from other residents, his/her room, or confinement to his/her room).
CMS lists it as corrected on March 31, 2026.
Citation F0609. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
CMS lists it as corrected on March 31, 2026.
Citation F0610. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Respond appropriately to all alleged violations.
CMS lists it as corrected on March 31, 2026.
CMS update of November 20, 2025
Star rating
The CMS overall star rating changed from 3 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 3 of 5 to 2 of 5. CMS changed how it scores this rating for many homes at once.
Star rating
The CMS staffing star rating changed from 3 of 5 to 1 of 5.
CMS update of July 30, 2025
Star rating
The CMS overall star rating changed from 4 of 5 to 3 of 5. CMS changed how it scores this rating for many homes at once.
Star rating
The CMS staffing star rating changed from 4 of 5 to 3 of 5.
Star rating
The CMS quality measures star rating changed from 5 of 5 to 4 of 5.
Health inspection on July 3, 2025
1 citationCMS lists this as a complaint inspection.
Show the 1 citation
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 August 1, 2025.
CMS update of June 25, 2025
Health citation
CMS removed citation F0758 from the health inspection on March 14, 2025.
CMS update of May 28, 2025
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 4 of 5 to 3 of 5.
Health inspection on March 14, 2025
9 citationsCMS lists this as a standard inspection.
Show the 9 citations
Citation F0812. Severity F: potential for more than minimal harm, widespread.
The rule CMS cited:
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
CMS lists it as corrected on May 3, 2025.
Citation F0730. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Observe each nurse aide's job performance and give regular training.
CMS lists it as corrected on May 3, 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 May 3, 2025.
Citation F0690. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
CMS lists it as corrected on May 3, 2025.
Citation F0694. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide for the safe, appropriate administration of IV fluids for a resident when needed.
CMS lists it as corrected on May 3, 2025.
Citation F0758. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
CMS lists it as corrected on May 3, 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 May 3, 2025.
Citation F0880. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide and implement an infection prevention and control program.
CMS lists it as corrected on May 3, 2025.
Citation F0883. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Develop and implement policies and procedures for flu and pneumonia vaccinations.
CMS lists it as corrected on May 3, 2025.
Fire safety inspection on March 14, 2025
6 citationsCMS lists this as a standard inspection.
Show the 6 citations
Citation E0013. Severity F: potential for more than minimal harm, widespread.
The rule CMS cited:
Develop Emergency Preparedness policies and procedures.
CMS lists it as corrected on April 11, 2025.
Citation E0020. Severity F: potential for more than minimal harm, widespread.
The rule CMS cited:
Establish policies and procedures including evacuation.
CMS lists it as corrected on April 11, 2025.
Citation K0345. Severity F: potential for more than minimal harm, widespread.
The rule CMS cited:
Have approved installation, maintenance and testing program for fire alarm systems.
CMS lists it as corrected on May 3, 2025.
Citation K0712. Severity F: potential for more than minimal harm, widespread.
The rule CMS cited:
Have simulated fire drills held at unexpected times.
CMS lists it as corrected on April 11, 2025.
Citation K0324. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide properly protected cooking facilities.
CMS lists it as corrected on April 11, 2025.
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 April 11, 2025.
CMS update of February 26, 2025
Star rating
The CMS overall star rating changed from 4 of 5 to 5 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 5 of 5. CMS changed how it scores this rating for many homes at once.
Staffing
Total nurse staffing reported to CMS went from 5.9 to 5.2 hours per resident per day.
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 5 of 5 to 4 of 5.
CMS update of September 26, 2024
Changed ownership in the last 12 months
CMS no longer shows a change of ownership in the past 12 months.
CMS update of July 31, 2024
Star rating
The CMS quality measures star rating changed from 2 of 5 to 3 of 5.
Changed ownership in the last 12 months
CMS records show a change of ownership in the past 12 months.
Name
CMS lists a new legal business name for this home.
Ownership
CMS ownership records list new owners for this home.
CMS update of April 25, 2024
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 March 28, 2024
Star rating
The CMS overall star rating changed from not rated by CMS to 5 of 5.
Star rating
The CMS health inspection star rating changed from not rated by CMS to 4 of 5.
Star rating
The CMS staffing star rating changed from not rated by CMS to 5 of 5.
Star rating
The CMS quality measures star rating changed from not rated by CMS to 3 of 5.
Special Focus Facility
CMS no longer lists this home as a Special Focus Facility.
Health inspection on November 16, 2023
1 citationCMS lists this as a standard inspection.
Show the 1 citation
Citation F0880. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Provide and implement an infection prevention and control program.
CMS lists it as corrected on December 8, 2023.
CMS star ratings
- 1 of 5CMS overall star rating
- 1 of 5CMS health inspection star rating
- 3 of 5CMS staffing star rating
- 2 of 5CMS quality measures star rating
Facts from CMS
- Phone
- (503) 399-1135
- Last standard health inspection
- July 13, 2026 (3 months ago)
- Certified beds
- 100
- Residents per day, on average
- 47
- Ownership type
- For profit - Corporation
- Legal business name
- Windsor SNF Operations LLC
- Chain
- Evergreen Healthcare Group
- Takes part in
- Medicare and Medicaid
More health citations than the Oregon average (36 vs 34).
Owners and managers
CMS lists these owners and managers for this home. Names are as CMS writes them.
- PACIFIC NORTHWEST SNF OPERATIONS HOLDINGS (OR) LLCDirect ownership interest · not applicable · since 08/31/2023
- CH PACIFIC NORTHWEST HOLDINGS LLCIndirect ownership interest · not applicable · since 08/31/2023
- PACIFIC NORTHWEST SNF OPERATIONS HOLDINGS LLCIndirect ownership interest · not applicable · since 08/31/2023
- WINDSOR SNF OPERATIONS LLCIndirect ownership interest · not applicable · since 08/31/2023
- WITZCORP GLOBAL LLCIndirect ownership interest · not applicable · since 08/31/2023
Show 14 more
- HERZKA, YISROELIndirect ownership interest · not applicable · since 08/31/2023
- YENOWITZ, YITZCHOKIndirect ownership interest · not applicable · since 08/31/2023
- COUVE FINANCIAL SERVICES LLCOperational/managerial control · not applicable · since 08/31/2023
- COUVE HEALTHCARE CONSULTING LLCOperational/managerial control · not applicable · since 08/31/2023
- OREGON SNF CONSULTING LLC (DE)Operational/managerial control · not applicable · since 08/31/2023
- PACIFIC NORTHWEST OPCO MANAGEMENT LLCOperational/managerial control · not applicable · since 08/31/2023
- WINDSOR SNF OPERATIONS LLCOperational/managerial control · not applicable · since 08/31/2023
- CABANEROS, CECILLEOperational/managerial control · not applicable · since 08/31/2023
- CEPEDA, MYLENEOperational/managerial control · not applicable · since 08/31/2023
- HENNING, TRACEYOperational/managerial control · not applicable · since 08/31/2023
- MORRIS, CHRISTOPHEROperational/managerial control · not applicable · since 08/31/2023
- ODENTHAL, JASONOperational/managerial control · not applicable · since 08/31/2023
- SPIELMAN, SHIMONOperational/managerial control · not applicable · since 08/31/2023
- YENOWITZ, YITZCHOKOperational/managerial control · not applicable · since 08/31/2023
Questions
When was Windsor Health and Rehabilitation last inspected?
CMS lists July 13, 2026 as the date of its most recent standard health inspection.
How many citations (violations) does Windsor Health and Rehabilitation have?
CMS lists 36 health citations since November 16, 2023. CMS also calls these deficiencies.
Has Windsor Health and Rehabilitation been fined?
CMS lists 1 fine in the past three years, $13,592 in total.
What is the CMS star rating of Windsor Health and Rehabilitation?
Its CMS overall star rating is 1 of 5.
Is Windsor Health and Rehabilitation a Special Focus Facility?
No. CMS does not list it as a Special Focus Facility or a candidate.