Autumn Lake Healthcare at Chesapeake Woods
525 Glenburn Avenue · Cambridge, MD · 21613 · 4102211400
98 certified beds For profit - Limited Liability company Chain: Autumn Lake Healthcare
Why this verdict
- Inspectors found immediate jeopardy — danger of serious harm or death — in the most recent cycle (1 citation).
- Inspection record is far worse than the national median (deficiency count and severity).
- Inspection results are getting worse cycle over cycle, not better.
- Staffing hours comfortably above national benchmarks.
The complete Safety Report — $19
Everything on this page plus the full citation-by-citation history with inspector findings, the complete penalty record, staffing vs benchmarks, side-by-side nearby comparisons, and the printable tour checklist. One PDF, emailed in minutes, yours to keep and share with family.
Red flags
1 immediate-jeopardy citation in the most recent inspection cycle
Immediate jeopardy is the most serious finding an inspector can make: a situation likely to cause serious injury, harm, or death.
Cited under the freedom-from-abuse rule
Cited 1 time under F600 (freedom from abuse/neglect) below the actual-harm level — worth asking about on a tour.
If someone you love was harmed at a facility with findings like these, you have options — read this.
Score breakdown
Quality-measure stars are deliberately excluded — they're largely self-reported by facilities. Full method.
CMS ratings & staffing
Overall: 3 of 5 Inspections: 3 of 5 Staffing: 4 of 5 Quality measures: 3 of 5
| Total nurse hours / resident-day | 4.06 | 3.48 min · 4.1 strong |
|---|---|---|
| RN hours / resident-day | 0.75 | 0.55–0.75 |
| Weekend hours / resident-day | 3.70 | ≈ weekday level |
| Nursing turnover / year | 41% | median 45% |
| Fines (3-yr window) | 2 · $50,879 |
Inspection citations (49 in the current record)
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Immediate jeopardy · J December 19, 2025
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected February 26, 2025 · Quality of Life and Care
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Potential for harm · E December 19, 2025
Reasonably accommodate the needs and preferences of each resident.
Corrected February 27, 2026 · Resident Rights
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Potential for harm · D December 19, 2025
Honor the resident's right to manage his or her financial affairs.
Corrected February 27, 2026 · Resident Rights
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Potential for harm · E December 19, 2025
Honor 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.
Corrected February 27, 2026 · Resident Rights
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Potential for harm · D December 19, 2025
Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
Corrected February 27, 2026 · Resident Rights
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Potential for harm · D December 19, 2025
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected February 27, 2026 · Resident Assessment and Care Planning
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Potential for harm · D December 19, 2025
Ensure services provided by the nursing facility meet professional standards of quality.
Corrected February 27, 2026 · Resident Assessment and Care Planning
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Potential for harm · D December 19, 2025
Observe each nurse aide's job performance and give regular training.
Corrected February 27, 2026 · Nursing and Physician Services
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Potential for harm · D December 19, 2025
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Corrected February 27, 2026 · Pharmacy Service
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Potential for harm · D December 19, 2025
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Corrected February 27, 2026 · Nutrition and Dietary
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Potential for harm · F December 19, 2025
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected February 27, 2026 · Nutrition and Dietary
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Potential for harm · D December 19, 2025
Establish a governing body that is legally responsible for establishing and implementing policies for managing and operating the facility and appoints a properly licensed administrator responsible for managing the facility.
Corrected February 27, 2026 · Administration
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Potential for harm · E December 19, 2025
Provide and implement an infection prevention and control program.
Corrected February 27, 2026 · Infection Control
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Potential for harm · D December 19, 2025
Keep all essential equipment working safely.
Corrected February 27, 2026 · Environmental
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Potential for harm · D December 19, 2025
Make sure that a working call system is available in each resident's bathroom and bathing area.
Corrected February 27, 2026 · Environmental
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Potential for harm · F December 19, 2025
Have enough outside ventilation via a window or mechanical ventilation, or both.
Corrected February 27, 2026 · Environmental
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Potential for harm · D December 19, 2025 · found via complaint
Respond appropriately to all alleged violations.
Corrected February 27, 2026 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · E March 5, 2024
Honor 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.
Corrected April 30, 2024 · Resident Rights
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Potential for harm · D March 5, 2024
Ensure each resident receives an accurate assessment.
Corrected April 30, 2024 · Resident Assessment and Care Planning
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Potential for harm · D March 5, 2024
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Corrected April 30, 2024 · Resident Assessment and Care Planning
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Potential for harm · D March 5, 2024
Provide safe and appropriate respiratory care for a resident when needed.
Corrected April 30, 2024 · Quality of Life and Care
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Potential for harm · D March 5, 2024
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Corrected April 30, 2024 · Pharmacy Service
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Potential for harm · D March 5, 2024
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Corrected April 30, 2024 · Pharmacy Service
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Potential for harm · D March 5, 2024
Implement 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.
Corrected April 30, 2024 · Pharmacy Service
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Potential for harm · D March 5, 2024
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.
Corrected April 30, 2024 · Pharmacy Service
Showing the 25 most recent. The Safety Report includes every citation with full findings.
Federal penalties
| Date | Type | Amount / length |
|---|---|---|
| December 9, 2025 | Fine | $14,082 |
| May 2, 2024 | Fine | $36,797 |
Better-scoring options nearby
No better-scoring facility within 25 miles in the current data. See the whole state.
Family & resident reviews — a separate signal, never mixed into the score
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Source: CMS Care Compare (public domain), data as of June 1, 2026 · CCN 215221 · certified since July 25, 1990. The score is a screen, not a verdict on any one resident's experience — read how it's computed, then visit in person.