CareSentinel

Federal Nursing-Home Survey Record

MARLBOROUGH HILLS REHABILITATION & HEALTH CARE CEN

CCN 225063 · 121 NORTHBORO ROAD, MARLBOROUGH, MA, 01752 · Operated within the ATHENA HEALTHCARE SYSTEMS chain

Does MARLBOROUGH HILLS REHABILITATION & HEALTH CARE CEN have a federal violation or abuse history?

According to the public federal record on file with the Centers for Medicare & Medicaid Services (CMS), MARLBOROUGH HILLS REHABILITATION & HEALTH CARE CEN (CCN 225063), in MARLBOROUGH, MA, has federal inspection findings on its record. In its current inspection cycle, CMS cited the facility for 17 deficiencies; the most serious carries scope/severity J on CMS's A–L scale, a level CMS classifies as Immediate Jeopardy. The most recent federal survey on file is dated 2025-03-11. Citations from earlier inspection cycles appear in the dated timeline below as historical findings, not current ones. CMS has $71,202 in civil money penalties on file against the facility. This page restates the federal record as published by CMS and draws no conclusion of its own. Strict time limits can apply to claims like these — consider consulting a qualified attorney promptly.

The Federal Record

At its most recent federal inspection, CMS cited this facility for an Immediate Jeopardy deficiency.

Below is this facility's federal survey record as on file with federal regulators (CMS). Strict time limits can apply to claims like these — consider consulting a qualified attorney promptly.

Scope & Severity — current cycle

ANo Harm
BNo Harm
CNo Harm
DPotential
EPotential
FPotential
GActual Harm
HActual Harm
IActual Harm
JImm. Jeopardy
KImm. Jeopardy
LImm. Jeopardy

CMS's own A–L scope/severity grid. Plotted cells mark this facility's most recent (current-cycle) citations, as on file with federal regulators (CMS).

Civil money penalties on file

$71,202

CMS has $71,202 in civil money penalties on file against this facility.

Overall CMS star rating: this facility vs the CMS-published state average

This facility: 1  ·  CMS state average: 3.1

Side-by-side with the CMS-published Overall CMS star rating for this state. This is the government's own published state average — not a CareSentinel-computed figure or delta.

Deficiency timeline — full federal history

2025-10-14
CURRENT CYCLE
F656S/S D

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

2025-05-21
CURRENT CYCLE
F742S/S D

Provide the appropriate treatment and services to a resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder.

2025-05-21
CURRENT CYCLE
F656S/S D

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

2025-05-21
CURRENT CYCLE
F689S/S D

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

2025-03-19
HISTORICAL
F623S/S D

Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.

2025-03-19
HISTORICAL
F553S/S D

Allow resident to participate in the development and implementation of his or her person-centered plan of care.

2025-03-11
CURRENT CYCLE
F689S/S J

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

2025-03-11
CURRENT CYCLE
F686S/S G

Provide appropriate pressure ulcer care and prevent new ulcers from developing.

2025-03-11
CURRENT CYCLE
F880S/S F

Provide and implement an infection prevention and control program.

2025-03-11
CURRENT CYCLE
F838S/S F

Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies.

2025-03-11
CURRENT CYCLE
F760S/S E

Ensure that residents are free from significant medication errors.

2025-03-11
CURRENT CYCLE
F609S/S D

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

2025-03-11
CURRENT CYCLE
F641S/S D

Ensure each resident receives an accurate assessment.

2025-03-11
CURRENT CYCLE
F655S/S D

Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted

2025-03-11
CURRENT CYCLE
F552S/S D

Ensure that residents are fully informed and understand their health status, care and treatments.

2025-03-11
CURRENT CYCLE
F698S/S D

Provide safe, appropriate dialysis care/services for a resident who requires such services.

2025-03-11
CURRENT CYCLE
F726S/S D

Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.

2025-03-11
CURRENT CYCLE
F694S/S D

Provide for the safe, appropriate administration of IV fluids for a resident when needed.

2025-03-11
CURRENT CYCLE
F732S/S B

Post nurse staffing information every day.

2024-02-28
HISTORICAL
F842S/S D

Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

2023-12-22
HISTORICAL
F552S/S D

Ensure that residents are fully informed and understand their health status, care and treatments.

2023-12-22
HISTORICAL
F553S/S D

Allow resident to participate in the development and implementation of his or her person-centered plan of care.

2023-12-22
HISTORICAL
F656S/S D

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

2023-12-22
HISTORICAL
F658S/S D

Ensure services provided by the nursing facility meet professional standards of quality.

2023-12-22
HISTORICAL
F755S/S D

Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

2023-12-22
HISTORICAL
F761S/S D

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.

2023-12-22
HISTORICAL
F842S/S D

Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

2023-11-30
HISTORICAL
F842S/S D

Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

2023-11-30
HISTORICAL
F658S/S D

Ensure services provided by the nursing facility meet professional standards of quality.

2022-12-05
HISTORICAL
F730S/S E

Observe each nurse aide's job performance and give regular training.

2022-12-05
HISTORICAL
F725S/S E

Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.

2022-12-05
HISTORICAL
F684S/S D

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

2022-12-05
HISTORICAL
F655S/S D

Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted

2022-12-05
HISTORICAL
F689S/S D

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

2022-12-05
HISTORICAL
F842S/S D

Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

2022-12-05
HISTORICAL
F656S/S D

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

2022-12-05
HISTORICAL
F883S/S D

Develop and implement policies and procedures for flu and pneumonia vaccinations.

2022-12-05
HISTORICAL
F695S/S D

Provide safe and appropriate respiratory care for a resident when needed.

2022-12-05
HISTORICAL
F698S/S D

Provide safe, appropriate dialysis care/services for a resident who requires such services.

2022-12-05
HISTORICAL
F744S/S D

Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia.

Each citation below is a federal survey finding, dated and labeled with its CMS deficiency tag, as on file with federal regulators (CMS). Older inspection cycles are de-emphasized; only the most recent cycle is current.

Document what happened

Were you or a loved one harmed at MARLBOROUGH HILLS REHABILITATION & HEALTH CARE CEN?

Share a few details to put your inquiry on file. CareSentinel is an independent service that compiles the public CMS record and does not provide legal advice. As qualified attorneys join our network in your area, one may reach out — we can’t guarantee contact yet, so we encourage you to consult a qualified attorney promptly on your own as well. There is no cost, and your information is handled with care.

Strict time limits can apply to claims like these — consider consulting a qualified attorney promptly.

Step 1 of 3 · What happened

Your relationship to the resident
What happened? Select all that apply.

Physical injury

Skin & wounds

Medical & clinical

Safety & abuse

Loss

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The resident is…