01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2026-03-12 | 6 | 2026-03-12 | 8 |
| Cycle 2 | 2025-02-05 | 9 | 2025-02-05 | 1 |
| Cycle 3 | 2024-01-26 | 9 | 2024-01-26 | 7 |
CMS CCN 2354402026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Holland Home - Raybrook Manor
2121 Raybrook Se · Grand Rapids, MI 49546 · Kent County
Certified beds101CMS provider file
Recent citation rows40current CMS citation release
Penalty rows1current CMS penalties file
Read this record carefully.
The citation files cover the three most recent standard inspections plus qualifying complaint and infection-control inspections in the prior three years. A correction date is a CMS field; this site does not independently verify conditions. Absence from a file is not proof that no issue exists.
02 / CITATION DETAIL
40 rows in the current release
2 rows carry G–L scope/severity codes; 1 carry J–L. 8 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2026-06-24 · HEALTHF0580Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Correction field: Deficient, Provider has plan of correction · 2026-07-28 · complaint · under IDR/IIDR2026-06-24 · HEALTHF0684Severity J · isolated immediate jeopardy
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Correction field: Deficient, Provider has plan of correction · 2026-07-28 · complaint · under IDR/IIDR2026-06-24 · HEALTHF0842Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Correction field: Deficient, Provider has plan of correction · 2026-07-28 · complaint2026-03-12 · HEALTHF0584Severity E · pattern; potential for more than minimal harm
Resident Rights Deficiencies
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.
Correction field: Deficient, Provider has date of correction · 2026-04-142026-03-12 · FIREK0211Severity E · pattern; potential for more than minimal harm
Egress Deficiencies
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Correction field: Deficient, Provider has date of correction · 2026-04-142026-03-12 · FIREK0324Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Provide properly protected cooking facilities.
Correction field: Deficient, Provider has date of correction · 2026-04-142026-03-12 · FIREK0363Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Install corridor and hallway doors that block smoke.
Correction field: Deficient, Provider has date of correction · 2026-04-142026-03-12 · FIREK0372Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Correction field: Deficient, Provider has date of correction · 2026-04-142026-03-12 · FIREK0511Severity E · pattern; potential for more than minimal harm
Services Deficiencies
Have properly installed electrical wiring and gas equipment.
Correction field: Deficient, Provider has date of correction · 2026-04-142026-03-12 · FIREK0711Severity E · pattern; potential for more than minimal harm
Miscellaneous Deficiencies
Provide a written emergency evacuation plan.
Correction field: Deficient, Provider has date of correction · 2026-04-142026-03-12 · FIREK0753Severity E · pattern; potential for more than minimal harm
Miscellaneous Deficiencies
Have restrictions on the use of highly flammable decorations.
Correction field: Deficient, Provider has date of correction · 2026-04-142026-03-12 · FIREK0781Severity E · pattern; potential for more than minimal harm
Miscellaneous Deficiencies
Have restrictions on the use of portable space heaters.
Correction field: Deficient, Provider has date of correction · 2026-04-142025-12-23 · HEALTHF0600Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Correction field: Deficient, Provider has date of correction · 2026-01-27 · complaint2025-12-23 · HEALTHF0761Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
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.
Correction field: Deficient, Provider has date of correction · 2026-01-27 · complaint2025-02-05 · HEALTHF0550Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Correction field: Deficient, Provider has date of correction · 2025-03-112025-02-05 · HEALTHF0583Severity F · widespread; potential for more than minimal harm
Resident Rights Deficiencies
Keep residents' personal and medical records private and confidential.
Correction field: Deficient, Provider has date of correction · 2025-03-112025-02-05 · HEALTHF0585Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
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.
Correction field: Deficient, Provider has date of correction · 2025-03-112025-02-05 · HEALTHF0609Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Correction field: Deficient, Provider has date of correction · 2025-03-112025-02-05 · HEALTHF0657Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Correction field: Deficient, Provider has date of correction · 2025-03-112025-02-05 · HEALTHF0689Severity G · isolated actual harm
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Correction field: Deficient, Provider has date of correction · 2025-03-112025-02-05 · HEALTHF0810Severity D · isolated; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Provide special eating equipment and utensils for residents who need them and appropriate assistance.
Correction field: Deficient, Provider has date of correction · 2025-03-112025-02-05 · HEALTHF0812Severity F · widespread; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Correction field: Deficient, Provider has date of correction · 2025-03-112025-02-05 · HEALTHF0880Severity D · isolated; potential for more than minimal harm
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Correction field: Deficient, Provider has date of correction · 2025-03-112025-02-05 · FIREK0211Severity F · widespread; potential for more than minimal harm
Egress Deficiencies
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Correction field: Deficient, Provider has date of correction · 2025-03-1103 / ENFORCEMENT FILE
Penalties reported by CMS
Fine amounts and payment-denial days are shown exactly as aggregated from the current penalties file. They do not imply an unpaid balance.
| Date | Type | Fine amount | Payment-denial days |
|---|---|---|---|
| 2025-02-05 | Payment Denial | $0 | 10 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- CHRISTIAN LIVING SERVICESOrganization · 5% OR GREATER DIRECT OWNERSHIP INTEREST100% · since 01/01/2009
- DEMAAGD, SCOTTIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2025
- HIDALGO, CARLOSIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2022
- JOHNSON, MARKIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/21/2021
- KNIBBE, DAVIDIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 12/01/2016
- MALBURG, GARYIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2012
- NAGELKERK, JEANIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2015
- SANCHEZ, NELSONIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2017
- SEGOVIA, GILBERTIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2022
- SMITH, DAVIDIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2022
- THOLE, NICKIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 12/01/2016
- URSUL, MARYIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2012
- VANDERKOOI, MARIEIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2025
- VOGEL-VANDERSON, SUSANIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2011
- VUGTEVEEN, TROYIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 01/01/2022
- WATSON, SAMIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2017
- JOHNSON, MARKIndividual · CORPORATE OFFICERNOT APPLICABLE · since 07/01/2025
- KINDER, ADAMIndividual · CORPORATE OFFICERNOT APPLICABLE · since 04/04/2021
Names and roles are self-reported CMS disclosure fields. Exact-name pages do not prove that similarly named people or organizations are the same entity.
05 / CMS STAFFING FIELDS
Reported hours and turnover
Staffing fields are provider-reported and case-mix context matters. CMS applies footnotes and exclusions not reproduced as a new score here.
Total nurse hours4.77per resident day
RN hours0.93per resident day
Weekend nurse hours4.23per resident day
Staff turnover31.3%CMS reported field
06 / LOCAL RECORDS
Open the Grand Rapids ledger →Other published facilities nearby
Clark Retirement Community39 beds · CMS overall 2/537 citation rowsCorewell Health Grand Rapids Hospitals Rehabilitat120 beds · CMS overall 5/529 citation rowsCorewell Health Rehabilitation & Nursing Center -165 beds · CMS overall 5/531 citation rowsCorewell Health Rehabilitation & Nursing Center -80 beds · CMS overall 5/54 citation rowsCovenant Village Of The Great Lakes37 beds · CMS overall 4/524 citation rowsEdison Christian Health Center136 beds · CMS overall 5/523 citation rowsHolland Home Breton Rehabilitation & Living Centre58 beds · CMS overall 5/515 citation rowsMary Free Bed Sub-Acute Rehabilitation48 beds · CMS overall 4/514 citation rows