St. Elizabeth Rehabilitation & Nursing Center
3320 Benson Avenue · Baltimore, MD · 21227 · 6676002600
162 certified beds For profit - Limited Liability company Chain: Vierra Communities
Why this verdict
- Carries CMS’s abuse warning icon.
- Inspection record is far worse than the national median (deficiency count and severity).
Red flags
CMS abuse warning
CMS flags this facility with its abuse icon: cited for abuse that caused harm in the past year, or potential harm in the past two years.
1 immediate-jeopardy citation in prior inspection cycles
Serious past findings — check whether the underlying problems were fixed and stayed fixed.
1 abuse-related citation at the actual-harm level
Inspectors cited failures in the abuse-prevention rules (F600–F610) that resulted in actual harm to a resident.
2 actual-harm citations in the most recent cycle
Inspectors found deficiencies that caused real harm to residents, beyond potential-harm paperwork findings.
$66,996 in federal fines in the last 24 months
2 fines — CMS fines are reserved for verified, serious non-compliance.
70% of nursing staff left within a year
High turnover disrupts continuity of care; the national median is 45%.
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: 2 of 5 Inspections: 2 of 5 Staffing: 2 of 5 Quality measures: 4 of 5
| Total nurse hours / resident-day | 3.80 | 3.48 min · 4.1 strong |
|---|---|---|
| RN hours / resident-day | 0.87 | 0.55–0.75 |
| Weekend hours / resident-day | 3.36 | ≈ weekday level |
| Nursing turnover / year | 70% | median 45% |
| Fines (3-yr window) | 2 · $66,996 |
Inspection citations (43 in the current record)
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Potential for harm · D February 26, 2026
Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
Corrected March 31, 2026 · Resident Rights
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Potential for harm · D February 26, 2026
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Corrected March 31, 2026 · Resident Assessment and Care Planning
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Potential for harm · E February 26, 2026
Provide safe and appropriate respiratory care for a resident when needed.
Corrected March 31, 2026 · Quality of Life and Care
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Potential for harm · D February 26, 2026
Provide safe, appropriate pain management for a resident who requires such services.
Corrected March 31, 2026 · Quality of Life and Care
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Potential for harm · D February 26, 2026
Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.
Corrected March 31, 2026 · Nutrition and Dietary
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Potential for harm · E February 26, 2026
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Corrected March 31, 2026 · Nutrition and Dietary
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Potential for harm · F February 26, 2026
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected March 31, 2026 · Nutrition and Dietary
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Actual harm · G August 29, 2025 · found via complaint
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected October 7, 2025 · Freedom from Abuse, Neglect, and Exploitation
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Actual harm · G August 29, 2025 · found via complaint
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected October 7, 2025 · Quality of Life and Care
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Potential for harm · D August 29, 2025 · found via complaint
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
Corrected October 7, 2025 · Resident Rights
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Potential for harm · D August 29, 2025 · found via complaint
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Corrected October 7, 2025 · Resident Rights
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Potential for harm · D August 29, 2025 · found via complaint
Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.
Corrected October 7, 2025 · Resident Rights
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Potential for harm · D August 29, 2025 · found via complaint
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected October 7, 2025 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · D August 29, 2025 · found via complaint
Respond appropriately to all alleged violations.
Corrected October 7, 2025 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · D August 29, 2025 · found via complaint
Ensure each resident receives an accurate assessment.
Corrected October 7, 2025 · Resident Assessment and Care Planning
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Potential for harm · D August 29, 2025 · found via complaint
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected October 7, 2025 · Resident Assessment and Care Planning
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Potential for harm · D August 29, 2025 · found via complaint
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.
Corrected October 7, 2025 · Quality of Life and Care
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Potential for harm · D August 29, 2025 · found via complaint
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected October 7, 2025 · Quality of Life and Care
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Potential for harm · E August 29, 2025 · found via complaint
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected October 7, 2025 · Quality of Life and Care
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Potential for harm · D August 29, 2025 · found via complaint
Provide enough food/fluids to maintain a resident's health.
Corrected October 7, 2025 · Quality of Life and Care
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Potential for harm · D August 29, 2025 · found via complaint
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Corrected October 7, 2025 · Resident Assessment and Care Planning
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Immediate jeopardy · J October 16, 2024 · found via complaint
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected June 26, 2023 · Quality of Life and Care
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Potential for harm · D October 16, 2024 · found via complaint
Ensure that residents are fully informed and understand their health status, care and treatments.
Corrected November 13, 2024 · Resident Rights
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Potential for harm · D October 16, 2024 · found via complaint
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected November 13, 2024 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · D October 16, 2024 · found via complaint
Respond appropriately to all alleged violations.
Corrected November 13, 2024 · Freedom from Abuse, Neglect, and Exploitation
Showing the 25 most recent. The Safety Report includes every citation with full findings.
Federal penalties
| Date | Type | Amount / length |
|---|---|---|
| August 29, 2025 | Fine | $50,655 |
| October 16, 2024 | Fine | $16,341 |
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 215044 · certified since April 24, 1967. The score is a screen, not a verdict on any one resident's experience — read how it's computed, then visit in person.