Sapphire Care and Rehab Center, East Stroudsburg, PA

The Essentials

Summary

Across 8 inspections from October 2023 to August 2026, state surveyors documented 47 findings at Sapphire Care and Rehab Center; 46 have a recorded correction and 1 awaits one; CMS lists no enforcement action in the window.

Inspections: 8; 2023–2026, complaint and standard
Findings: 47; Deficiencies cited by state inspectors
Corrected: 46; Of 47 findings, with a recorded correction date
Penalties: 0; No fines or payment denials in the window

Findings by Year

Findings
Of which, actual harm (level G or above)

* Partial year, through October 1, 2026.

Findings by year
Year	Inspections	Findings
2023	1	2
2024	1	20
2025	3	13
2026	3	12

What the Record Shows

46 of 47 findings have a recorded correction date.
CMS lists no fines or payment denials in this window.
7 visits in this window included a complaint investigation. CMS publishes what a complaint investigation cited, not what the complaint alleged.
The latest standard inspection, June 30, 2026, recorded 10 findings (most serious: Level E).

What to Ask About

Accident Hazards and Supervision, Cited in Three Inspections
Nutrition and Hydration, Cited in Three Inspections
Needs and Preferences, Cited in Two Inspections
Accurate Assessments, Cited in Two Inspections
Quality of Care, Cited in Two Inspections
Mobility and Range of Motion, Cited in Two Inspections
Respiratory Care, Cited in Two Inspections
Citation F740, Cited in Two Inspections
Pharmacy Services, Cited in Two Inspections
Medication Labeling and Storage, Cited in Two Inspections
Provide or obtain dental services for each resident, Cited in Two Inspections
Infection Control, Cited in Two Inspections
Telling Families About Changes, No Recorded Correction

Report at a Glance

Facility: Sapphire Care and Rehab Center
Address: 221 East Brown Street, East Stroudsburg, PA 18301
CMS Certification Number: 395288
Provider Type: Skilled nursing facility and nursing facility
Certified Beds: 127
Ownership: For profit - Limited Liability company
Record Window: October 11, 2023 to October 1, 2026

Chronology

Inspection History

Every inspection in the record window, newest first. A finding is a deficiency an inspector cited. CMS publishes what a complaint investigation cited, not what the complaint alleged.

Aug 192026
Complaint investigation
1 finding
- F580Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.Level DNo actual harm, potential for moreDeficient, Provider has no plan of correction
Source: Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Jun 302026
Standard health inspection
10 findings
The same visit included a complaint investigation.
- F688Provide 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.Level ENo actual harm, potential for moreCorrected Aug 11, 2026
- F692Provide enough food/fluids to maintain a resident's health.Level ENo actual harm, potential for moreCorrected Aug 11, 2026
- F740Ensure each resident must receive and the facility must provide necessary behavioral health care and services.Level ENo actual harm, potential for moreCorrected Aug 11, 2026
- F880Provide and implement an infection prevention and control program.Level ENo actual harm, potential for moreCorrected Aug 11, 2026
- F558Reasonably accommodate the needs and preferences of each resident.Level DNo actual harm, potential for moreCorrected Aug 11, 2026
- F689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.Level DNo actual harm, potential for moreCorrected Aug 11, 2026
- F695Provide safe and appropriate respiratory care for a resident when needed.Level DNo actual harm, potential for moreCorrected Aug 11, 2026
- F697Provide safe, appropriate pain management for a resident who requires such services.Level DNo actual harm, potential for moreCorrected Aug 11, 2026
- F791Provide or obtain dental services for each resident.Level DNo actual harm, potential for moreCorrected Aug 11, 2026
- F926Have policies on smoking.Level DNo actual harm, potential for moreCorrected Aug 11, 2026
Source: Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Apr 152026
Complaint investigation
1 finding
- F605Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.Level DNo actual harm, potential for moreCorrected May 1, 2026
Source: Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Dec 292025
Complaint investigation
1 finding
- F580Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.Level DNo actual harm, potential for moreCorrected Feb 4, 2026
Source: Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Aug 152025
Standard health inspection
11 findings
The same visit included a complaint investigation.
- F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.Level ENo actual harm, potential for moreCorrected Sep 29, 2025
- F689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.Level ENo actual harm, potential for moreCorrected Sep 29, 2025
- F692Provide enough food/fluids to maintain a resident's health.Level ENo actual harm, potential for moreCorrected Sep 29, 2025
- F909Regularly inspect all bed frames, mattresses, and bed rails (if any) for safety; and all bed rails and mattresses must attach safely to the bed frame.Level ENo actual harm, potential for moreCorrected Sep 29, 2025
- F558Reasonably accommodate the needs and preferences of each resident.Level DNo actual harm, potential for moreCorrected Sep 29, 2025
- F627Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge.Level DNo actual harm, potential for moreCorrected Sep 29, 2025
- F641Ensure each resident receives an accurate assessment.Level DNo actual harm, potential for moreCorrected Sep 29, 2025
- F686Provide appropriate pressure ulcer care and prevent new ulcers from developing.Level DNo actual harm, potential for moreCorrected Sep 29, 2025
- F688Provide 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.Level DNo actual harm, potential for moreCorrected Sep 29, 2025
- F755Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.Level DNo actual harm, potential for moreCorrected Sep 29, 2025
- F761Ensure 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.Level DNo actual harm, potential for moreCorrected Sep 29, 2025
Source: Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Feb 252025
Complaint investigation
1 finding
- F580Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.Level DNo actual harm, potential for moreCorrected Apr 18, 2025
Source: Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Oct 252024
Standard health inspection
20 findings
- F880Provide and implement an infection prevention and control program.Level FNo actual harm, potential for moreCorrected Dec 10, 2024
- F882Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.Level FNo actual harm, potential for moreCorrected Dec 10, 2024
- F607Develop and implement policies and procedures to prevent abuse, neglect, and theft.Level ENo actual harm, potential for moreCorrected Dec 10, 2024
- F689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.Level ENo actual harm, potential for moreCorrected Dec 10, 2024
- F690Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.Level ENo actual harm, potential for moreCorrected Dec 10, 2024
- F695Provide safe and appropriate respiratory care for a resident when needed.Level ENo actual harm, potential for moreCorrected Dec 10, 2024
- F755Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.Level ENo actual harm, potential for moreCorrected Dec 10, 2024
- F756Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.Level ENo actual harm, potential for moreCorrected Dec 10, 2024
- F758Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.Level ENo actual harm, potential for moreCorrected Dec 10, 2024
- F761Ensure 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.Level ENo actual harm, potential for moreCorrected Dec 10, 2024
- F791Provide or obtain dental services for each resident.Level ENo actual harm, potential for moreCorrected Dec 10, 2024
- F881Implement a program that monitors antibiotic use.Level ENo actual harm, potential for moreCorrected Dec 10, 2024
- F550Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.Level DNo actual harm, potential for moreCorrected Dec 10, 2024
- F641Ensure each resident receives an accurate assessment.Level DNo actual harm, potential for moreCorrected Dec 10, 2024
- F656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.Level DNo actual harm, potential for moreCorrected Dec 10, 2024
- F657Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.Level DNo actual harm, potential for moreCorrected Dec 10, 2024
- F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.Level DNo actual harm, potential for moreCorrected Dec 10, 2024
- F692Provide enough food/fluids to maintain a resident's health.Level DNo actual harm, potential for moreCorrected Dec 10, 2024
- F698Provide safe, appropriate dialysis care/services for a resident who requires such services.Level DNo actual harm, potential for moreCorrected Dec 10, 2024
- F740Ensure each resident must receive and the facility must provide necessary behavioral health care and services.Level DNo actual harm, potential for moreCorrected Dec 10, 2024
Source: Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Oct 112023
Complaint investigation
2 findings
- F584Honor 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.Level ENo actual harm, potential for moreCorrected Dec 4, 2023
- F917Make sure each resident has 1) at least one window to the outside in a room; 2) a room at or above ground level; 3) adequate bedding; 4) furniture that meets the resident's needs; or 5) adequate closet space.Level ENo actual harm, potential for moreCorrected Dec 4, 2023
Source: Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)

Severity levels follow the CMS scope and severity grid. A–C: potential for minimal harm. D–F: no actual harm, potential for more than minimal harm. G–I: actual harm. J–L: immediate jeopardy.

Context

Patterns Worth Examining

A repeated citation can merit attention, but context and corrective action must be reviewed before drawing a conclusion.

1
Accident Hazards and Supervision, Cited in Three Inspections
Inspectors cited F689 in October 2024, August 2025 and June 2026. This citation covers whether residents are protected from accident hazards and supervised closely enough to prevent accidents, including falls. None rose above level E (no actual harm, potential for more). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
2324252525262626F689 across all 8 inspections, oldest to newest
2
Nutrition and Hydration, Cited in Three Inspections
Inspectors cited F692 in October 2024, August 2025 and June 2026. This citation covers whether residents get enough food and fluids to stay healthy. None rose above level E (no actual harm, potential for more). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
2324252525262626F692 across all 8 inspections, oldest to newest
3
Needs and Preferences, Cited in Two Inspections
Inspectors cited F558 in August 2025 and June 2026. This citation covers whether the home reasonably accommodates each resident’s needs and preferences. None rose above level D (no actual harm, potential for more). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
2324252525262626F558 across all 8 inspections, oldest to newest
4
Accurate Assessments, Cited in Two Inspections
Inspectors cited F641 in October 2024 and August 2025. This citation covers whether each resident’s assessment correctly records their condition. None rose above level D (no actual harm, potential for more). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
2324252525262626F641 across all 8 inspections, oldest to newest
5
Quality of Care, Cited in Two Inspections
Inspectors cited F684 in October 2024 and August 2025. This citation covers whether residents receive the treatment their orders, preferences and goals call for. None rose above level E (no actual harm, potential for more). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
2324252525262626F684 across all 8 inspections, oldest to newest
6
Mobility and Range of Motion, Cited in Two Inspections
Inspectors cited F688 in August 2025 and June 2026. This citation covers care that keeps or improves a resident’s movement and mobility. None rose above level E (no actual harm, potential for more). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
2324252525262626F688 across all 8 inspections, oldest to newest
7
Respiratory Care, Cited in Two Inspections
Inspectors cited F695 in October 2024 and June 2026. This citation covers oxygen, breathing treatments and other respiratory care. None rose above level E (no actual harm, potential for more). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
2324252525262626F695 across all 8 inspections, oldest to newest
8
Citation F740, Cited in Two Inspections
Inspectors cited F740 in October 2024 and June 2026. The agency describes it this way: Ensure each resident must receive and the facility must provide necessary behavioral health care and services. None rose above level E (no actual harm, potential for more). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
2324252525262626F740 across all 8 inspections, oldest to newest
9
Pharmacy Services, Cited in Two Inspections
Inspectors cited F755 in October 2024 and August 2025. This citation covers pharmacy services and the licensed pharmacist who oversees them. None rose above level E (no actual harm, potential for more). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
2324252525262626F755 across all 8 inspections, oldest to newest
10
Medication Labeling and Storage, Cited in Two Inspections
Inspectors cited F761 in October 2024 and August 2025. This citation covers how drugs are labeled and kept locked, including controlled drugs. None rose above level E (no actual harm, potential for more). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
2324252525262626F761 across all 8 inspections, oldest to newest
11
Provide or obtain dental services for each resident, Cited in Two Inspections
Inspectors cited F791 in October 2024 and June 2026. The agency describes it this way: Provide or obtain dental services for each resident. None rose above level E (no actual harm, potential for more). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
2324252525262626F791 across all 8 inspections, oldest to newest
12
Infection Control, Cited in Two Inspections
Inspectors cited F880 in October 2024 and June 2026. This citation covers hand hygiene, isolation practice and the home’s infection-prevention program. None rose above level F (no actual harm, potential for more). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
2324252525262626F880 across all 8 inspections, oldest to newest
13
Telling Families About Changes, No Recorded Correction
F580 was cited in February 2025, December 2025 and August 2026. This citation covers whether the resident, their doctor and a family member are told promptly about an injury, a decline or another significant change. The most serious was level D (no actual harm, potential for more). The August 2026 citation has no recorded correction date; its status reads “Deficient, Provider has no plan of correction.” The record does not show whether the problem was fixed.
2324252525262626F580 across all 8 inspections, oldest to newest

For Your Next Visit

Questions to Ask on Your Visit

Bring these to the tour. Each one comes from something in the record; the reason is under the question.

01
What changed in fall prevention and supervision after the last citation, and how do you check that it is still working?
Accident Hazards and Supervision: cited in three inspections, most seriously at level E.
02
How are weight and fluid intake tracked, and what happens when a resident starts losing weight?
Nutrition and Hydration: cited in three inspections, most seriously at level E.
03
How do you adjust rooms, schedules and routines to a resident’s needs and preferences?
Needs and Preferences: cited in two inspections, most seriously at level D.
04
Who completes resident assessments, and how are they checked for accuracy?
Accurate Assessments: cited in two inspections, most seriously at level D.
05
How do nurses make sure a doctor’s orders are carried out, and how are families told when something is missed?
Quality of Care: cited in two inspections, most seriously at level E.
06
What do you do to keep residents moving, and who provides range-of-motion care?
Mobility and Range of Motion: cited in two inspections, most seriously at level E.
07
Who manages oxygen and breathing treatments on each shift, and how is the equipment checked?
Respiratory Care: cited in two inspections, most seriously at level E.
08
What changed after F740 was cited, and how do you check it now?
Citation F740: cited in two inspections, most seriously at level E.
09
How often does the consultant pharmacist review each resident’s medications?
Pharmacy Services: cited in two inspections, most seriously at level E.
10
How are medications stored and secured, and who checks the medication carts?
Medication Labeling and Storage: cited in two inspections, most seriously at level E.
11
What changed after F791 was cited, and how do you check it now?
Provide or obtain dental services for each resident: cited in two inspections, most seriously at level E.
12
Who leads infection control here, and how often are hand-hygiene and isolation practices audited?
Infection Control: cited in two inspections, most seriously at level F.
13
How quickly will we hear about a fall, an injury or a change in condition, and from whom?
Telling Families About Changes: cited in three inspections, most seriously at level D. The August 19, 2026 citation has no recorded correction date.
14
How many nurses and aides are on each shift, including nights and weekends, for the unit we are considering?
No staffing citation appears in this window. Staffing levels are published separately by CMS and are worth asking about directly.
15
Has the home been fined or had payments denied before this record begins?
CMS lists no fines or payment denials in this window. The record starts October 11, 2023; anything earlier is not in it.

The Evidence

Sources and Coverage

Inspection results and penalties are published by the Centers for Medicare & Medicaid Services from surveys conducted by the Pennsylvania state survey agency.

Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Pennsylvania state survey agency
Inspection Oct 11, 2023 · Published Oct 1, 2026 · Retrieved Nov 1, 2026
Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Pennsylvania state survey agency
Inspection Oct 25, 2024 · Published Oct 1, 2026 · Retrieved Nov 1, 2026
Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Pennsylvania state survey agency
Inspection Feb 25, 2025 · Published Oct 1, 2026 · Retrieved Nov 1, 2026
Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Pennsylvania state survey agency
Inspection Aug 15, 2025 · Published Oct 1, 2026 · Retrieved Nov 1, 2026
Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Pennsylvania state survey agency
Inspection Dec 29, 2025 · Published Oct 1, 2026 · Retrieved Nov 1, 2026
Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Pennsylvania state survey agency
Inspection Apr 15, 2026 · Published Oct 1, 2026 · Retrieved Nov 1, 2026
Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Pennsylvania state survey agency
Inspection Jun 30, 2026 · Published Oct 1, 2026 · Retrieved Nov 1, 2026
Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Pennsylvania state survey agency
Inspection Aug 19, 2026 · Published Oct 1, 2026 · Retrieved Nov 1, 2026
Provider Information, Provider Data Catalog
Centers for Medicare & Medicaid Services · 395288
Published Oct 1, 2026 · Retrieved Nov 1, 2026
View Dataset ↗

Coverage

Record windowOctober 11, 2023 – October 1, 2026

CMS publishes about three inspection cycles; inspections before October 2023 are not in this release.
CMS refreshes these files monthly, after statements of deficiencies are processed, so an inspection from the last two months may not appear yet.

What This Report Cannot Tell You

Complaints not investigated onsite: Allegations screened out by the state before an onsite visit are not published.
Complaint allegations: CMS publishes the deficiencies a complaint survey cited, not the allegation itself.
Facility-reported incidents: Self-reported incidents appear only if they led to an inspection.
Follow-up visits: CMS's files list standard, complaint and infection control surveys, not revisits; a correction date is the one CMS records.
Fire safety inspections: Published by CMS separately and not included in this record yet.
Staffing levels and ownership history: Published by CMS separately and not included in this record.

Historical coverage varies by agency and location. Missing records do not mean that no complaint or violation occurred.

Data architecture: Cierto supplies the source-backed machine-readable bundle. Life by Vardell independently creates the narrative, design, and consumer report.