01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2026-05-06 | 7 | 2026-05-06 | 4 |
| Cycle 2 | 2025-04-10 | 11 | 2025-04-10 | 5 |
| Cycle 3 | 2024-04-25 | 27 | 2024-04-25 | 6 |
CMS CCN 2355882026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Maple Valley Nursing Home
1086 W. Burdickville Road · Maple Valley, MI 49664 · Leelanau County
Certified beds25CMS provider file
Recent citation rows60current CMS citation release
Penalty rows3current 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
60 rows in the current release
4 rows carry G–L scope/severity codes; 1 carry J–L. 11 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2026-05-06 · HEALTHF0602Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Protect each resident from the wrongful use of the resident's belongings or money.
Correction field: Deficient, Provider has date of correction · 2026-06-18 · complaint2026-05-06 · HEALTHF0628Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
Correction field: Deficient, Provider has date of correction · 2026-06-182026-05-06 · HEALTHF0658Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Ensure services provided by the nursing facility meet professional standards of quality.
Correction field: Deficient, Provider has date of correction · 2026-06-182026-05-06 · 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 · 2026-06-182026-05-06 · HEALTHF0695Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
Correction field: Deficient, Provider has date of correction · 2026-06-182026-05-06 · HEALTHF0756Severity E · pattern; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Correction field: Deficient, Provider has date of correction · 2026-06-182026-05-06 · HEALTHF0851Severity F · widespread; potential for more than minimal harm
Administration Deficiencies
Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data.
Correction field: Deficient, Provider has date of correction · 2026-06-182026-05-06 · FIREK0324Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Provide properly protected cooking facilities.
Correction field: Deficient, Provider has date of correction · 2026-05-282026-05-06 · FIREK0345Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Have approved installation, maintenance and testing program for fire alarm systems.
Correction field: Deficient, Provider has date of correction · 2026-07-102026-05-06 · 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 · 2026-07-102026-05-06 · FIREK0761Severity D · isolated; potential for more than minimal harm
Miscellaneous Deficiencies
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
Correction field: Deficient, Provider has date of correction · 2026-07-102025-04-10 · 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 · 2025-05-192025-04-10 · HEALTHF0658Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Ensure services provided by the nursing facility meet professional standards of quality.
Correction field: Deficient, Provider has date of correction · 2025-05-19 · complaint2025-04-10 · HEALTHF0678Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives.
Correction field: Deficient, Provider has date of correction · 2025-05-192025-04-10 · 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 · 2025-05-192025-04-10 · HEALTHF0756Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Correction field: Deficient, Provider has date of correction · 2025-05-192025-04-10 · HEALTHF0760Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure that residents are free from significant medication errors.
Correction field: Deficient, Provider has date of correction · 2025-05-19 · complaint2025-04-10 · 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 · 2025-05-192025-04-10 · HEALTHF0880Severity F · widespread; 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 · 2025-05-192025-04-10 · HEALTHF0883Severity D · isolated; potential for more than minimal harm
Infection Control Deficiencies
Develop and implement policies and procedures for flu and pneumonia vaccinations.
Correction field: Deficient, Provider has date of correction · 2025-05-192025-04-10 · FIREK0291Severity F · widespread; potential for more than minimal harm
Egress Deficiencies
Install emergency lighting that can last at least 1 1/2 hours.
Correction field: Deficient, Provider has date of correction · 2025-06-062025-04-10 · FIREK0321Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Correction field: Deficient, Provider has date of correction · 2025-06-062025-04-10 · FIREK0345Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Have approved installation, maintenance and testing program for fire alarm systems.
Correction field: Deficient, Provider has date of correction · 2025-06-062025-04-10 · 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 · 2025-06-0603 / 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 |
|---|---|---|---|
| 2024-08-20 | Fine | $68,045 | 0 |
| 2024-03-13 | Fine | $51,220 | 0 |
| 2024-03-13 | Payment Denial | $0 | 56 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- KASBEN, DONNAIndividual · 5% OR GREATER DIRECT OWNERSHIP INTEREST50% · since 03/08/1996
- KASBEN, JOHNIndividual · 5% OR GREATER DIRECT OWNERSHIP INTEREST50% · since 03/08/1996
- KASBEN, DONNAIndividual · CORPORATE OFFICERNOT APPLICABLE · since 03/08/1996
- KASBEN, JOHNIndividual · CORPORATE OFFICERNOT APPLICABLE · since 03/08/1996
- CLEMENS GRAY, MICHELLEIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 04/03/2024
- DYKSTRA, SANTIAGOIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 09/24/2023
- HULBERT, AMYIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 01/30/2022
- HULBERT, RICHARDIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 11/13/2023
- KASBEN, JENNIFERIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 07/29/2019
- KASBEN, JOHNIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 03/08/1996
- KASBEN, SERENAIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 10/15/1997
- LANGLOIS, MARKIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 02/01/2020
- MOORE, KENDRAIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 10/20/2024
- PORTER, MISTYIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 01/01/2023
- KASBEN, DONNAIndividual · ADP OF THE SNFNOT APPLICABLE · since 03/08/1996
- KASBEN, JOHNIndividual · ADP OF THE SNFNOT APPLICABLE · since 07/02/2019
- LANGLOIS, MARKIndividual · ADP OF THE SNFNOT APPLICABLE · since 02/01/2020
- PORTER, MISTYIndividual · ADP OF THE SNFNOT APPLICABLE · since 05/01/2001
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 hours3.96per resident day
RN hours1.12per resident day
Weekend nurse hours3.33per resident day
Staff turnover55.2%CMS reported field
06 / LOCAL RECORDS
Open the Michigan ledger →Other published facilities nearby
No second facility in the same city met the directory rule.