The nursing home failed to provide proper pressure ulcer care and failed to prevent new pressure sores from developing. Cited October 2023 — isolated incident, actual harm.
View the original federal record
F-Tag 686 — 42 CFR §483.25(b) — S/S: G
Nursing home report
Windsor Nursing & Retirement Home
SOUTH YARMOUTH, MA · Medicare-certified · 120 beds
In good standing
Non-profitChain member
2 of 5 overall
Windsor Nursing & Retirement Home has a 2-star overall rating, with 2 stars for health inspections and quality measures, but 4 stars for staffing. Reported nurse staffing is 4.06 hours per resident per day, just below the federal benchmark of 4.1, and there were no fines in the last 24 months; recent inspection citations included pressure ulcer care, meeting professional standards, and resident/family group rights.
Facility ratings
Health inspections
Staffing
4.0631 hrs/resident/day
Quality measures
Last inspection: January 9, 2025Penalties, last 24 months: $0
Federal guidance recommends at least 4.1 nursing hours per resident each day. This facility reports 4.0631.
Staffing detail
- Registered nurses
- 0.59
- Licensed practical nurses
- 0.87
- Nurse aides
- 2.60
- Weekend nursing
- 3.59
Hours per resident per day.
Total staff turnover: 41%
Registered nurse turnover: 39%
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
15.9%23.6%Worsening
Residents with a fall causing major injury
2.4%5%Worsening
Residents with pressure ulcers (bedsores)
4.4%4.8%No change
Residents with a urinary tract infection
0%1.3%Worsening
Residents who lost too much weight
5.3%7.1%Worsening
Residents who were physically restrained
0%0%No change
Residents needing more help with daily activities
20.3%36.2%Worsening
Residents whose ability to walk got worse
17%39.2%Worsening
Long-stay residents on antianxiety or sleep medication
21.8%18.1%Improving
Short-stay residents newly given an antipsychotic
0%1.7%Worsening
Residents with a long-term catheter
0%0.8%Worsening
Residents with new or worsening incontinence
10%18.2%Worsening
Residents with depressive symptoms
6.8%31.9%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
—80.7%—
Long-stay residents given the pneumonia vaccine
100%96.2%Worsening
Short-stay residents given the seasonal flu vaccine
—80.4%—
Short-stay residents given the pneumonia vaccine
92.7%85.4%Worsening
What the inspectors found
The nursing home failed to provide services that met professional standards of quality. Cited April 2021 — isolated incident, actual harm.
View the original federal record
F-Tag 658 — 42 CFR §483.21(b)(3) — S/S: G
The home failed to protect residents’ right to organize and take part in resident and family groups. Cited April 2021 — widespread issue, potential for harm.
View the original federal record
F-Tag 565 — 42 CFR §483.10 — S/S: F
The home failed to conduct and document a full facility assessment to ensure it had the resources needed for daily care and emergencies. Cited April 2021 — widespread issue, potential for harm.
View the original federal record
F-Tag 838 — 42 CFR §483.70 — S/S: F
The nursing home failed to provide and carry out an infection prevention and control program to help keep residents from getting or spreading infections. Cited April 2021 — widespread issue, potential for harm.
View the original federal record
F-Tag 880 — 42 CFR §483.80(a) — S/S: F
Recent history
- STAFFING
Reported nurse staffing was below the federal recommendation of 4.1 hours per resident per day.
- INSPECTION
Health inspection found 8 health deficiencies.
See what inspectors found
- INSPECTION
Health inspection found 10 health deficiencies.
See what inspectors found
- INSPECTION
Health inspection found 1 health deficiency.
See what inspectors found
Penalties & enforcement
On record with Medicare: 1 fine · $12,386 in total fines.
- $12,386
Federal fine
Oct 12, 2023
Operator & ownership
- Ownership
- Non profit - Corporation
- Chain
- Part of INTEGRITUS HEALTHCARE · 15 homes · 2.9 stars avg
- Occupancy
- 87.8 residents on an average day (73% of 120 beds)
- Resident voice
- Resident council
- Medicare history
- Certified for 36 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.