01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2024-10-03 | 2 | 2024-10-03 | 3 |
| Cycle 2 | 2022-11-17 | 2 | 2022-11-17 | 0 |
| Cycle 3 | 2021-04-01 | 3 | 2021-04-01 | 0 |
CMS CCN 1055482026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Moultrie Creek Nursing And Rehab Center
200 Mariner Health Way · Saint Augustine, FL 32086 · St. Johns County
Certified beds120CMS provider file
Recent citation rows10current CMS citation release
Penalty rows0current 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
10 rows in the current release
0 rows carry G–L scope/severity codes; 0 carry J–L. 1 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2024-10-03 · 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 · 2024-11-012024-10-03 · HEALTHF0759Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure medication error rates are not 5 percent or greater.
Correction field: Deficient, Provider has date of correction · 2024-11-012024-10-03 · FIREK0345Severity E · pattern; 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 · 2024-11-012024-10-03 · FIREK0914Severity E · pattern; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.
Correction field: Deficient, Provider has date of correction · 2024-11-012024-10-03 · FIREK0918Severity D · isolated; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Have generator or other power source capable of supplying service within 10 seconds.
Correction field: Deficient, Provider has date of correction · 2024-11-012022-11-17 · HEALTHF0812Severity D · isolated; 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 · 2022-12-232022-11-17 · 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 · 2022-12-232021-04-01 · 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 · 2021-05-072021-04-01 · 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 · 2021-05-072021-04-01 · 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 date of correction · 2021-05-0703 / 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 |
|---|---|---|---|
| No penalty row appeared in the August 2026 penalties file. | |||
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- SOVEREIGN HEALTHCARE HOLDINGS LLCOrganization · DIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 10/01/2003
- CRONQUIST 2015 FAMILY TROrganization · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 12/31/2015
- JOHN J NOTERMANN BUSINESS TROrganization · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 11/12/2017
- MANGINE, JOHNIndividual · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 06/25/2012
- BERKADIA COMMERCIAL MORTGAGE LLCOrganization · 5% OR GREATER SECURITY INTERESTNOT APPLICABLE · since 09/23/2014
- FL MOULTRIE CREEK HOLDINGS, LLCOrganization · 5% OR GREATER SECURITY INTERESTNOT APPLICABLE · since 05/19/2009
- HEALTH SERVICES PROPERTIES LLCOrganization · 5% OR GREATER SECURITY INTERESTNOT APPLICABLE · since 05/19/2009
- CHERY, DAWNIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 06/08/2017
- GERRITY, HENRYIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 04/01/2014
- KAAR, SUSANIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 10/01/2003
- SOUTHERN HEALTHCARE MANAGEMENT LLCOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 10/01/2003
- CRONQUIST, ROYCEIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 02/01/2018
- DAVIS, JASONIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 06/18/2012
- MANGINE, JOHNIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 06/25/2012
- MELTON, DONALDIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 02/15/2009
- NOTERMANN, WILLIAMIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 01/01/2025
- PATEL, JIGNESHIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 01/01/2009
- NOTERMANN, BRENDAIndividual · INDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNFNOT APPLICABLE · since 10/29/2025
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 hours3.54per resident day
RN hours0.31per resident day
Weekend nurse hours3.24per resident day
Staff turnover32.7%CMS reported field
06 / LOCAL RECORDS
Open the Saint Augustine ledger →Other published facilities nearby
Clyde E Lassen State Veterans Nursing Home120 beds · CMS overall 4/57 citation rowsLilac At Bayview, The120 beds · CMS overall 2/529 citation rowsPonce Therapy Care Center And Rehab, The120 beds · CMS overall 5/59 citation rowsSt Augustine Health And Rehabilitation Center120 beds · CMS overall 1/529 citation rowsWestminster St Augustine30 beds · CMS overall 5/514 citation rows