01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2024-12-20 | 18 | 2024-12-20 | 1 |
| Cycle 2 | 2023-09-28 | 6 | 2023-09-28 | 2 |
| Cycle 3 | 2022-05-26 | 3 | 2022-05-26 | 1 |
CMS CCN 1058352026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Pine Trail Nursing And Rehab Center
4445 Pine Forest Dr · Lake Worth, FL 33463 · Palm Beach County
Certified beds52CMS provider file
Recent citation rows31current CMS citation release
Penalty rows2current 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
31 rows in the current release
1 rows carry G–L scope/severity codes; 0 carry J–L. 4 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2025-04-22 · HEALTHF0582Severity B · pattern; potential for minimal harm
Resident Rights Deficiencies
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
Correction field: Deficient, Provider has date of correction · 2025-05-22 · complaint2024-12-20 · 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 · 2025-01-312024-12-20 · HEALTHF0558Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Reasonably accommodate the needs and preferences of each resident.
Correction field: Deficient, Provider has date of correction · 2025-01-312024-12-20 · 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 · 2025-01-312024-12-20 · 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 · 2025-01-312024-12-20 · HEALTHF0638Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Assure that each resident’s assessment is updated at least once every 3 months.
Correction field: Deficient, Provider has date of correction · 2025-01-312024-12-20 · 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 · 2025-01-312024-12-20 · 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 · 2025-01-312024-12-20 · HEALTHF0694Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide for the safe, appropriate administration of IV fluids for a resident when needed.
Correction field: Deficient, Provider has date of correction · 2025-01-312024-12-20 · 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 · 2025-01-312024-12-20 · HEALTHF0757Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Correction field: Deficient, Provider has date of correction · 2025-01-312024-12-20 · 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 · 2025-01-312024-12-20 · HEALTHF0803Severity E · pattern; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.
Correction field: Deficient, Provider has date of correction · 2025-01-312024-12-20 · HEALTHF0812Severity E · pattern; 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 · 2025-01-312024-12-20 · HEALTHF0835Severity E · pattern; potential for more than minimal harm
Administration Deficiencies
Administer the facility in a manner that enables it to use its resources effectively and efficiently.
Correction field: Deficient, Provider has date of correction · 2025-01-312024-12-20 · HEALTHF0867Severity E · pattern; potential for more than minimal harm
Administration Deficiencies
Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.
Correction field: Deficient, Provider has date of correction · 2025-01-312024-12-20 · 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 · 2025-01-312024-12-20 · HEALTHF0908Severity E · pattern; potential for more than minimal harm
Environmental Deficiencies
Keep all essential equipment working safely.
Correction field: Deficient, Provider has date of correction · 2025-01-312024-12-20 · HEALTHF0925Severity E · pattern; potential for more than minimal harm
Environmental Deficiencies
Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
Correction field: Deficient, Provider has date of correction · 2025-01-312024-12-20 · FIREK0353Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Correction field: Deficient, Provider has date of correction · 2025-01-192023-09-28 · HEALTHF0803Severity F · widespread; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.
Correction field: Deficient, Provider has date of correction · 2023-10-282023-09-28 · HEALTHF0805Severity E · pattern; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.
Correction field: Deficient, Provider has date of correction · 2023-10-282023-09-28 · HEALTHF0806Severity D · isolated; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.
Correction field: Deficient, Provider has date of correction · 2023-10-282023-09-28 · 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 · 2023-10-2803 / 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 |
|---|---|---|---|
| 2024-12-20 | Fine | $5,346 | 0 |
| 2024-12-20 | Fine | $11,454 | 0 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- 4445 PINE FOREST DR LAKE HOLDCO LLCOrganization · 5% OR GREATER DIRECT OWNERSHIP INTEREST100% · since 09/01/2023
- MIRLIS, ELIYAHUIndividual · 5% OR GREATER INDIRECT OWNERSHIP INTEREST99% · since 09/01/2023
- VRD 10 HLDCO LLCOrganization · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 09/01/2023
- BECHER, SARAHIndividual · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 09/01/2023
- COLMAN, RUBENIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 09/01/2023
- OLAZABAL, JUSTINAIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 09/01/2023
- OLAZABAL, JUSTINAIndividual · W-2 MANAGING EMPLOYEENOT APPLICABLE · since 09/01/2023
- MIRLIS, ELIYAHUIndividual · CORPORATE OFFICERNOT APPLICABLE · since 08/01/2023
- COLMAN, RUBENIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 01/09/2025
- OLAZABAL, JUSTINAIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 01/09/2025
- COLMAN, RUBENIndividual · ADP OF THE SNFNOT APPLICABLE · since 01/09/2025
- OLAZABAL, JUSTINAIndividual · ADP OF THE SNFNOT APPLICABLE · since 01/09/2025
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 hours3.28per resident day
RN hours0.58per resident day
Weekend nurse hours3.30per resident day
Staff turnover56.4%CMS reported field
06 / LOCAL RECORDS
Open the Lake Worth ledger →Other published facilities nearby
Avante At Lake Worth, Inc.138 beds · CMS overall 1/570 citation rowsFinnish-American Village45 beds · CMS overall 5/515 citation rowsLake Worth Rehabilitation Center120 beds · CMS overall 2/537 citation rowsMedicana Nursing And Rehab Center116 beds · CMS overall 3/514 citation rowsPalm Beach Nursing Center120 beds · CMS overall 3/546 citation rowsTerraces Of Lake Worth Care Center And Rehab91 beds · CMS overall 4/523 citation rows