Falls Run Nursing and Rehabilitation
140 Brimley Drive, Fredericksburg, VA 22406
Falls Run Nursing and Rehabilitation is a nursing home in Fredericksburg, Virginia. 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 rating4 of 5
- Last standard health inspectionMarch 16, 2023 (3 years ago)
- Health citations since September 6, 201928 (Virginia average 39)
- Fines in the past three yearsNone listed by CMS
- CMS flagsNone listed by CMS
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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.
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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 February 25, 2026
Star rating
The CMS staffing star rating changed from 4 of 5 to 3 of 5.
CMS update of April 30, 2025
Star rating
The CMS staffing star rating changed from 3 of 5 to 4 of 5.
CMS update of February 26, 2025
Star rating
The CMS staffing star rating changed from 4 of 5 to 3 of 5.
Health inspection on March 16, 2023
9 citationsCMS lists this as a standard inspection.
Show the 9 citations
Citation F0656. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
CMS lists it as corrected on April 14, 2023.
CMS has cited this home for F0656 3 times since 2019.
Citation F0697. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Provide safe, appropriate pain management for a resident who requires such services.
CMS lists it as corrected on April 14, 2023.
Citation F0757. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Ensure each resident’s drug regimen must be free from unnecessary drugs.
CMS lists it as corrected on April 14, 2023.
CMS has cited this home for F0757 2 times since 2021.
Citation F0585. Severity D: potential for more than minimal harm, isolated.
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 April 14, 2023.
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.
CMS lists it as corrected on March 21, 2022.
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 April 14, 2023.
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 April 14, 2023.
CMS has cited this home for F0695 3 times since 2019.
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 April 14, 2023.
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 April 14, 2023.
Fire safety inspection on March 16, 2023
1 citationCMS lists this as a standard inspection.
Show the 1 citation
Citation K0916. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Have a battery powered remote alarm panel in a location accessible by operating personnel.
CMS lists it as corrected on May 9, 2023.
Health inspection on August 26, 2021
9 citationsCMS lists this as a standard inspection.
Show the 9 citations
Citation F0623. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
CMS lists it as corrected on September 22, 2021.
CMS has cited this home for F0623 2 times since 2019.
Citation F0812. Severity E: potential for more than minimal harm, pattern.
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 September 22, 2021.
CMS has cited this home for F0812 2 times since 2019.
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 September 22, 2021.
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 September 22, 2021.
CMS has cited this home for F0655 2 times since 2019.
Citation F0656. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
CMS lists it as corrected on September 22, 2021.
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 September 22, 2021.
Citation F0730. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Observe each nurse aide's job performance and give regular training.
CMS lists it as corrected on September 22, 2021.
Citation F0757. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Ensure each resident’s drug regimen must be free from unnecessary drugs.
CMS lists it as corrected on September 22, 2021.
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 September 29, 2021.
Health inspection on September 6, 2019
10 citationsCMS lists this as a standard inspection.
Show the 10 citations
Citation F0578. Severity E: potential for more than minimal harm, pattern.
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 October 1, 2019.
Citation F0812. Severity E: potential for more than minimal harm, pattern.
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 October 1, 2019.
Citation F0583. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Keep residents' personal and medical records private and confidential.
CMS lists it as corrected on October 1, 2019.
Citation F0622. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged.
CMS lists it as corrected on October 1, 2019.
Citation F0623. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
CMS lists it as corrected on October 1, 2019.
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 October 1, 2019.
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 October 1, 2019.
Citation F0656. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
CMS lists it as corrected on October 1, 2019.
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 October 1, 2019.
Citation F0700. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.
CMS lists it as corrected on October 1, 2019.
Fire safety inspection on September 6, 2019
5 citationsCMS lists this as a standard inspection.
Show the 5 citations
Citation K0222. Severity F: potential for more than minimal harm, widespread.
The rule CMS cited:
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
CMS lists it as corrected on October 1, 2019.
Citation K0362. Severity F: potential for more than minimal harm, widespread.
The rule CMS cited:
Ensure that corridors are separated from use areas by walls constructed to limit the passage of smoke.
CMS lists it as corrected on October 1, 2019.
Citation K0223. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector.
CMS lists it as corrected on October 1, 2019.
Citation K0345. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Have approved installation, maintenance and testing program for fire alarm systems.
CMS lists it as corrected on October 1, 2019.
Citation K0531. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Have elevators that firefighters can control in the event of a fire.
CMS lists it as corrected on October 1, 2019.
CMS star ratings
- 4 of 5CMS overall star rating
- 3 of 5CMS health inspection star rating
- 3 of 5CMS staffing star rating
- 5 of 5CMS quality measures star rating
Facts from CMS
- Phone
- (540) 752-0111
- Last standard health inspection
- March 16, 2023 (3 years ago)
- Certified beds
- 90
- Residents per day, on average
- 83.7
- Ownership type
- For profit - Corporation
- Legal business name
- Stafford Healthcare Group, INC.
- Chain
- Saber Healthcare Group
- Takes part in
- Medicare and Medicaid
Fewer health citations than the Virginia average (28 vs 39).
Owners and managers
CMS lists these owners and managers for this home. Names are as CMS writes them.
- SHG MANAGEMENT LLCOperational/managerial control · not applicable · since 09/01/2019
- KULP, JEFFREYOperational/managerial control · not applicable · since 10/09/2017
Questions
When was Falls Run Nursing and Rehabilitation last inspected?
CMS lists March 16, 2023 as the date of its most recent standard health inspection.
How many citations (violations) does Falls Run Nursing and Rehabilitation have?
CMS lists 28 health citations since September 6, 2019. CMS also calls these deficiencies.
Has Falls Run Nursing and Rehabilitation been fined?
CMS lists no fines for this home in the past three years.
What is the CMS star rating of Falls Run Nursing and Rehabilitation?
Its CMS overall star rating is 4 of 5.
Is Falls Run Nursing and Rehabilitation a Special Focus Facility?
No. CMS does not list it as a Special Focus Facility or a candidate.