01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-05-09 | 8 | 2025-05-09 | 6 |
| Cycle 2 | 2024-02-27 | 12 | 2024-02-27 | 7 |
| Cycle 3 | 2023-02-28 | 13 | 2023-02-28 | 1 |
CMS CCN 3852412026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Keizer Nursing And Rehabilitation
4062 Arleta Avenue Ne · Keizer, OR 97303 · Marion County
Certified beds49CMS provider file
Recent citation rows47current 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
47 rows in the current release
1 rows carry G–L scope/severity codes; 0 carry J–L. 12 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2025-12-17 · HEALTHF0684Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Correction field: Deficient, Provider has date of correction · 2026-01-26 · complaint2025-12-17 · 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 · 2026-01-26 · complaint2025-12-17 · HEALTHF0813Severity E · pattern; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Have a policy regarding use and storage of foods brought to residents by family and other visitors.
Correction field: Deficient, Provider has date of correction · 2026-01-26 · complaint2025-05-09 · FIREE0007Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Address patient/client population and determine types of services needed.
Correction field: Deficient, Provider has date of correction · 2025-06-122025-05-09 · FIREE0020Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Establish policies and procedures including evacuation.
Correction field: Deficient, Provider has date of correction · 2025-06-122025-05-09 · 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 date of correction · 2025-06-122025-05-09 · 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 · 2025-06-122025-05-09 · HEALTHF0677Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide care and assistance to perform activities of daily living for any resident who is unable.
Correction field: Deficient, Provider has date of correction · 2025-06-122025-05-09 · HEALTHF0699Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide care or services that was trauma informed and/or culturally competent.
Correction field: Deficient, Provider has date of correction · 2025-06-122025-05-09 · 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 · 2025-06-122025-05-09 · FIREK0355Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Properly select, install, inspect, or maintain portable fire extinguishes.
Correction field: Deficient, Provider has date of correction · 2025-06-122025-05-09 · FIREK0372Severity D · isolated; 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 · 2025-06-122025-05-09 · FIREK0712Severity F · widespread; potential for more than minimal harm
Miscellaneous Deficiencies
Have simulated fire drills held at unexpected times.
Correction field: Deficient, Provider has date of correction · 2025-06-122025-05-09 · FIREK0923Severity D · isolated; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Have proper medical gas storage and administration areas.
Correction field: Deficient, Provider has date of correction · 2025-06-122024-02-27 · FIREE0007Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Address patient/client population and determine types of services needed.
Correction field: Deficient, Provider has date of correction · 2024-04-162024-02-27 · FIREE0013Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Develop Emergency Preparedness policies and procedures.
Correction field: Deficient, Provider has date of correction · 2024-04-162024-02-27 · FIREE0034Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Provide a means of sharing information on occupancy/needs.
Correction field: Deficient, Provider has date of correction · 2024-04-162024-02-27 · 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 date of correction · 2024-04-15 · complaint2024-02-27 · HEALTHF0676Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.
Correction field: Deficient, Provider has date of correction · 2024-04-15 · complaint2024-02-27 · HEALTHF0684Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Correction field: Deficient, Provider has date of correction · 2024-04-15 · complaint2024-02-27 · HEALTHF0689Severity D · isolated; potential for more than minimal 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 · 2024-04-15 · complaint2024-02-27 · HEALTHF0725Severity E · pattern; potential for more than minimal harm
Nursing and Physician Services Deficiencies
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
Correction field: Deficient, Provider has date of correction · 2024-04-15 · complaint2024-02-27 · HEALTHF0730Severity D · isolated; potential for more than minimal harm
Nursing and Physician Services Deficiencies
Observe each nurse aide's job performance and give regular training.
Correction field: Deficient, Provider has date of correction · 2024-04-15 · complaint2024-02-27 · HEALTHF0732Severity F · widespread; potential for more than minimal harm
Nursing and Physician Services Deficiencies
Post nurse staffing information every day.
Correction field: Deficient, Provider has date of correction · 2024-04-15 · complaint03 / 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 |
|---|---|---|---|
| 2024-02-22 | Payment Denial | $0 | 8 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- PAC 12 OPCO HOLDCO LLCOrganization · 5% OR GREATER DIRECT OWNERSHIP INTEREST100% · since 03/01/2023
- KNOX HEALTHCARE PAC 12 HOLDINGS LLCOrganization · 5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 03/01/2023
- PAC 12 HOLDINGS LLCOrganization · 5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 03/01/2023
- PAC 12 PINNACLE HOLDCO LLCOrganization · 5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 03/01/2023
- HAGLER, ALEXANDERIndividual · 5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 03/01/2023
- KNOX, DONALDIndividual · 5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 03/01/2023
- KEIZER PROPCO LLCOrganization · 5% OR GREATER MORTGAGE INTERESTNOT APPLICABLE · since 03/01/2023
- KNOX, DONALDIndividual · CORPORATE OFFICERNOT APPLICABLE · since 03/01/2023
- SMITH, BRIANIndividual · CORPORATE OFFICERNOT APPLICABLE · since 03/27/2023
- VOLARE HEALTH LLCOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 03/01/2023
- DUNHAM, SARAHIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 04/01/2025
- HANSON, KANDISIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 03/01/2023
- KNOX, DONALDIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 03/01/2023
- SCHWARTZ, ELIEZERIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 03/01/2023
- KEIZER PROPCO LLCOrganization · ADP OF THE SNFNOT APPLICABLE · since 03/01/2023
- PAC 12 HOLDINGS LLCOrganization · ADP OF THE SNFNOT APPLICABLE · since 03/01/2023
- PAC 12 PINNACLE HOLDCO LLCOrganization · ADP OF THE SNFNOT APPLICABLE · since 03/01/2023
- VOLARE HEALTH LLCOrganization · ADP OF THE SNFNOT APPLICABLE · since 08/19/2025
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 hours4.57per resident day
RN hours0.44per resident day
Weekend nurse hours4.01per resident day
Staff turnover54.8%CMS reported field
06 / LOCAL RECORDS
Open the Keizer ledger →