The nursing home failed to ensure residents were free from significant medication errors. Cited November 2024 — isolated incident, immediate jeopardy to residents.
View the original federal record
F-Tag 760 — 42 CFR §483.45(f)(2) — S/S: J
Nursing home report
Oak Forest Health & Rehabilitation Center
Registered name: Oak Forest Health and Rehabilitation
Winston Salem, NC · Medicare-certified · 170 beds
Needs attention
For-profitChain member
Data as of July 1, 2026
1 of 5 overall
Oak Forest Health & Rehabilitation Center has an overall 1-star rating, with 1-star staffing and quality ratings and a 2-star health inspection rating. It also has a recent federal penalty, $29,749 in fines over the last 24 months, and reported nurse staffing of 3.83 hours per resident per day, below the 4.1-hour federal benchmark.
Facility ratings
Health inspections
Staffing
3.8253 hrs/resident/day
Quality measures
Last inspection: June 12, 2025Penalties, last 24 months: $29,749recent federal penalty
Federal guidance recommends at least 4.1 nursing hours per resident each day. This facility reports 3.8253.
Staffing detail
- Registered nurses
- 0.29
- Licensed practical nurses
- 1.42
- Nurse aides
- 2.12
- Weekend nursing
- 3.54
Hours per resident per day.
Total staff turnover: 61%
Registered nurse turnover: 59%
Resident outcomes
Each measure compares a year ago with the most recent quarter. Green means the facility moved the right way; red means the wrong way.
Negative outcomes
Lower is better — fewer affected residents. A decrease is good (green); an increase is concerning (red).
Long-stay residents on antipsychotic medication
14.4%16%Worsening
Residents with a fall causing major injury
2.3%3.7%Worsening
Residents with pressure ulcers (bedsores)
14.9%14%Improving
Residents with a urinary tract infection
3.8%2.9%Improving
Residents who lost too much weight
3.2%6.2%Worsening
Residents who were physically restrained
0%0%No change
Residents needing more help with daily activities
10.1%13.7%Worsening
Residents whose ability to walk got worse
10.1%4.5%Improving
Long-stay residents on antianxiety or sleep medication
17.1%8.6%Improving
Short-stay residents newly given an antipsychotic
1%1.9%Worsening
Residents with a long-term catheter
2.1%0%Improving
Residents with new or worsening incontinence
23.2%22.4%Improving
Residents with depressive symptoms
0%0.9%Worsening
Positive outcomes
Higher is better — e.g. vaccinations. An increase is good (green); a decrease is concerning (red).
Long-stay residents given the seasonal flu vaccine
—97.2%—
Long-stay residents given the pneumonia vaccine
93.2%94.1%Improving
Short-stay residents given the seasonal flu vaccine
—79.5%—
Short-stay residents given the pneumonia vaccine
86.8%87.3%Improving
What the inspectors found
The nursing home failed to keep the area free of hazards and provide enough supervision to prevent accidents. Cited November 2022 — limited pattern, actual harm.
View the original federal record
F-Tag 689 — 42 CFR §483.25(d) — S/S: H
The home failed to properly dispose of garbage and other waste. Cited February 2024 — widespread issue, potential for harm.
View the original federal record
F-Tag 814 — 42 CFR §483.60 — S/S: F
The home failed to have an ongoing quality review group that finds problems and makes corrective plans. Cited February 2024 — widespread issue, potential for harm.
View the original federal record
F-Tag 867 — 42 CFR §483.75 — S/S: F
The home failed to make sure food was safely sourced, stored, prepared, and served according to professional standards. Cited July 2023 — widespread issue, potential for harm.
View the original federal record
F-Tag 812 — 42 CFR §483.60(i) — S/S: F
Recent history
- STAFFING
Reported nurse staffing was below the federal recommendation of 4.1 hours per resident per day.
- PENALTY
A federal fine of $12,948 was recorded.
- INSPECTION
Health inspection found 9 health deficiencies.
See what inspectors found
- INSPECTION
Health inspection found 1 health deficiency.
See what inspectors found
- PENALTY
A federal fine of $16,801 was recorded.
- INSPECTION
Health inspection found 2 health deficiencies.
See what inspectors found
Penalties & enforcement
On record with Medicare: 3 fines · $38,527 in total fines.
- $12,948
Federal fine
Jun 12, 2025
- $16,801
Federal fine
Nov 8, 2024
- $8,778
Federal fine
Dec 18, 2023
Operator & ownership
Recent ownership change · Apr 1, 2021
Now operated by Liberty Healthcare Group LLC, previously Oak Forest Health and Rehabilitation Company.
- Ownership
- For profit - Corporation
- Chain
- Part of LIBERTY SENIOR LIVING · 37 homes · 2.8 stars avg
- Occupancy
- 154.8 residents on an average day (91% of 170 beds)
- Resident voice
- Resident council
- Medicare history
- Certified for 33 years
Things at a nursing home change — inspections, staffing, ownership, news.
Source: Centers for Medicare & Medicaid Services — public records, updated monthly. GoodStanding presents official records with plain-language summaries. Always visit a facility in person.