01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2024-09-26 | 7 | 2024-09-26 | 7 |
| Cycle 2 | 2023-08-24 | 0 | 2023-08-24 | 0 |
| Cycle 3 | 2022-05-25 | 4 | 2022-05-25 | 0 |
CMS CCN 2456132026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Waverly Gardens
5919 Centerville Road · North Oaks, MN 55127 · Ramsey County
Certified beds60CMS provider file
Recent citation rows18current 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
18 rows in the current release
2 rows carry G–L scope/severity codes; 1 carry J–L. 0 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2026-05-29 · HEALTHF0600Severity J · isolated immediate jeopardy
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 · 2026-07-02 · complaint2026-05-29 · 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 · 2026-07-02 · complaint2026-05-29 · HEALTHF0610Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Respond appropriately to all alleged violations.
Correction field: Deficient, Provider has date of correction · 2026-07-02 · complaint2024-09-26 · FIREE0018Severity C · widespread; potential for minimal harm
Emergency Preparedness Deficiencies
Establish procedures for tracking staff and patients during an emergency.
Correction field: Deficient, Provider has date of correction · 2024-11-132024-09-26 · HEALTHF0575Severity C · widespread; potential for minimal harm
Resident Rights Deficiencies
Post a list of names, addresses, and telephone numbers of all pertinent State agencies and advocacy groups and a statement that the resident may file a complaint with the State Survey Agency.
Correction field: Deficient, Provider has date of correction · 2024-11-132024-09-26 · 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 · 2024-11-132024-09-26 · HEALTHF0688Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
Correction field: Deficient, Provider has date of correction · 2024-11-132024-09-26 · 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 · 2024-11-132024-09-26 · FIREK0200Severity F · widespread; potential for more than minimal harm
Egress Deficiencies
Meet other general requirements.
Correction field: Deficient, Provider has date of correction · 2024-11-012024-09-26 · 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 · 2024-11-012024-09-26 · FIREK0293Severity F · widespread; potential for more than minimal harm
Egress Deficiencies
Have properly located and lighted "Exit" signs.
Correction field: Deficient, Provider has date of correction · 2024-11-012024-09-26 · 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 · 2024-11-012024-09-26 · FIREK0351Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Install an approved automatic sprinkler system.
Correction field: Deficient, Provider has date of correction · 2024-11-012024-09-26 · FIREK0362Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Ensure that corridors are separated from use areas by walls constructed to limit the passage of smoke.
Correction field: Deficient, Provider has date of correction · 2024-11-012024-02-07 · 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 · 2024-03-05 · complaint2022-05-25 · 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 · 2022-06-282022-05-25 · HEALTHF0686Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Correction field: Deficient, Provider has date of correction · 2022-06-282022-05-25 · 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 · 2022-06-2803 / 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 |
|---|---|---|---|
| 2026-05-29 | Fine | $113,312 | 0 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- PRESBYTERIAN HOMES AND SERVICESOrganization · 5% OR GREATER DIRECT OWNERSHIP INTEREST100% · since 03/17/2020
- COMPUTERSHARE CORPORATE TRUST COMPANY, NAOrganization · 5% OR GREATER MORTGAGE INTERESTNOT APPLICABLE · since 07/01/2024
- COMPUTERSHARE CORPORATE TRUST COMPANY, NAOrganization · 5% OR GREATER SECURITY INTERESTNOT APPLICABLE · since 07/01/2024
- FLETCHER, JONATHANIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 02/01/2025
- PEDERSON, MARKIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 01/01/2023
- PETERSON, HEIDIIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 01/01/2023
- FLETCHER, JONATHANIndividual · CORPORATE OFFICERNOT APPLICABLE · since 02/01/2025
- MEYER, MARKIndividual · CORPORATE OFFICERNOT APPLICABLE · since 03/30/2001
- PHS MANAGEMENT, LLCOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 03/11/2011
- FLETCHER, JONATHANIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 02/01/2025
- MEYER, MARKIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 03/11/2011
- PEDERSON, JANEIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 04/01/2021
- PETERSON, HEIDIIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 01/01/2023
- SAMMON, KATHERINEIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 11/21/2022
- FLETCHER, JONATHANIndividual · INDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNFNOT APPLICABLE · since 03/26/2026
- PHS MANAGEMENT, LLCOrganization · ADP OF THE SNFNOT APPLICABLE · since 02/17/2026
- FLETCHER, JONATHANIndividual · ADP OF THE SNFNOT APPLICABLE · since 02/01/2025
- MEYER, MARKIndividual · ADP OF THE SNFNOT APPLICABLE · since 03/11/2011
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 hours4.50per resident day
RN hours0.84per resident day
Weekend nurse hours4.16per resident day
Staff turnover35.5%CMS reported field
06 / LOCAL RECORDS
Open the Minnesota ledger →Other published facilities nearby
No second facility in the same city met the directory rule.