Autumn Lake Healthcare at Oak Manor
3415 Greencastle Road · Burtonsville, MD · 20866 · 2409705600
145 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 results are getting worse cycle over cycle, not better.
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.
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: 4 of 5 Inspections: 4 of 5 Staffing: 3 of 5 Quality measures: 4 of 5
| Total nurse hours / resident-day | 3.64 | 3.48 min · 4.1 strong |
|---|---|---|
| RN hours / resident-day | 0.62 | 0.55–0.75 |
| Weekend hours / resident-day | 3.30 | ≈ weekday level |
| Nursing turnover / year | 35% | median 45% |
| Fines (3-yr window) | 1 · $11,381 |
Inspection citations (36 in the current record)
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Immediate jeopardy · J July 1, 2025 · found via complaint
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected June 30, 2025 · Quality of Life and Care
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Potential for harm · D February 19, 2025
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Corrected May 2, 2025 · Resident Rights
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Potential for harm · D February 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 May 2, 2025 · Resident Rights
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Potential for harm · D February 19, 2025
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected May 2, 2025 · Quality of Life and Care
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Potential for harm · D February 19, 2025
Provide enough food/fluids to maintain a resident's health.
Corrected May 2, 2025 · Quality of Life and Care
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Potential for harm · D February 19, 2025
Ensure the resident's doctor reviews the resident's care, writes, signs and dates progress notes and orders, at each required visit.
Corrected May 2, 2025 · Nursing and Physician Services
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Potential for harm · D February 19, 2025
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Corrected May 2, 2025 · Nutrition and Dietary
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Potential for harm · D February 19, 2025
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected May 2, 2025 · Nutrition and Dietary
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Potential for harm · D February 19, 2025
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Corrected May 2, 2025 · Resident Assessment and Care Planning
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Potential for harm · D February 19, 2025
Provide and implement an infection prevention and control program.
Corrected May 2, 2025 · Infection Control
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Potential for harm · E February 19, 2025 · found via complaint
Obtain a doctor's order to admit a resident and ensure the resident is under a doctor's care.
Corrected May 2, 2025 · Nursing and Physician Services
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Potential for harm · D February 19, 2025 · found via complaint
Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.
Corrected May 2, 2025 · Nutrition and Dietary
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Potential for harm · D November 20, 2024 · found via complaint
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected January 15, 2025 · Quality of Life and Care
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Potential for harm · D October 20, 2020
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Corrected December 4, 2020 · Resident Rights
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Potential for harm · D October 20, 2020
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Corrected December 4, 2020 · Resident Rights
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Potential for harm · D October 20, 2020
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
Corrected December 4, 2020 · Resident Rights
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Potential for harm · E October 20, 2020
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected December 4, 2020 · Resident Assessment and Care Planning
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Potential for harm · D October 20, 2020
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Corrected December 4, 2020 · Resident Assessment and Care Planning
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Potential for harm · D October 20, 2020
Ensure services provided by the nursing facility meet professional standards of quality.
Corrected December 4, 2020 · Resident Assessment and Care Planning
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Potential for harm · D October 20, 2020
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected December 4, 2020 · Quality of Life and Care
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Potential for harm · E October 20, 2020
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 December 4, 2020 · Pharmacy Service
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Potential for harm · D October 20, 2020
Provide and implement an infection prevention and control program.
Corrected December 4, 2020 · Infection Control
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No harm found · C October 20, 2020
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected December 4, 2020 · Nutrition and Dietary
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Potential for harm · D January 22, 2019
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected March 8, 2019 · Resident Assessment and Care Planning
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Potential for harm · E January 22, 2019
Ensure services provided by the nursing facility meet professional standards of quality.
Corrected March 8, 2019 · Resident Assessment and Care Planning
Showing the 25 most recent. The Safety Report includes every citation with full findings.
Federal penalties
| Date | Type | Amount / length |
|---|---|---|
| July 1, 2025 | Fine | $11,381 |
Family & resident reviews — a separate signal, never mixed into the score
No approved reviews yet. If your family has experience with this facility, yours could be the review that helps the next family decide.
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Source: CMS Care Compare (public domain), data as of June 1, 2026 · CCN 215315 · certified since December 24, 1998. The score is a screen, not a verdict on any one resident's experience — read how it's computed, then visit in person.