The Waterview Shores LLC

402 - 13th Avenue · Two Harbors, MN · 55616 · 2188348437

44 certified beds For profit - Limited Liability company Chain: Monarch Healthcare Management

Why this verdict

  • Inspection results are getting worse cycle over cycle, not better.
  • No federal fines or payment denials in CMS’s 3-year window.

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.

Get the Safety Report

Red flags

67% of nursing staff left within a year

High turnover disrupts continuity of care; the national median is 45%.

Score breakdown

Inspection record 30% of score 47
Serious harm & abuse 20% 94
Staffing 20% 57
Federal penalties 15% 100
Trend 10% 34
Context 5% 75

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: 3 of 5 Quality measures: 2 of 5

Total nurse hours / resident-day3.233.48 min · 4.1 strong
RN hours / resident-day0.610.55–0.75
Weekend hours / resident-day2.90≈ weekday level
Nursing turnover / year67%median 45%
Fines (3-yr window)none

Inspection citations (24 in the current record)

  • Actual harm · G September 11, 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 August 29, 2025 · Resident Assessment and Care Planning

  • Potential for harm · E August 22, 2025 · found via complaint

    Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

    Corrected September 18, 2025 · Resident Rights

  • Potential for harm · D June 5, 2025

    Ensure each resident receives an accurate assessment.

    Corrected July 3, 2025 · Resident Assessment and Care Planning

  • Potential for harm · D June 5, 2025

    Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

    Corrected July 3, 2025 · Quality of Life and Care

  • Potential for harm · D June 5, 2025

    Provide safe and appropriate respiratory care for a resident when needed.

    Corrected July 3, 2025 · Quality of Life and Care

  • Potential for harm · F June 5, 2025

    Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

    Corrected July 3, 2025 · Nutrition and Dietary

  • Potential for harm · F June 5, 2025

    Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data.

    Corrected July 3, 2025 · Administration

  • Potential for harm · F June 5, 2025

    Provide and implement an infection prevention and control program.

    Corrected July 3, 2025 · Infection Control

  • Potential for harm · D November 6, 2024 · found via complaint

    Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

    Corrected December 2, 2024 · Resident Rights

  • Potential for harm · D November 6, 2024 · 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 December 2, 2024 · Resident Assessment and Care Planning

  • Potential for harm · D April 25, 2024

    Allow residents to self-administer drugs if determined clinically appropriate.

    Corrected May 21, 2024 · Resident Rights

  • Potential for harm · D April 25, 2024

    Keep residents' personal and medical records private and confidential.

    Corrected May 21, 2024 · Resident Rights

  • Potential for harm · D April 25, 2024

    Provide appropriate treatment and care according to orders, resident’s preferences and goals.

    Corrected May 21, 2024 · Quality of Life and Care

  • Potential for harm · E April 25, 2024

    Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

    Corrected May 21, 2024 · Quality of Life and Care

  • Potential for harm · D April 25, 2024

    Ensure medication error rates are not 5 percent or greater.

    Corrected May 21, 2024 · Pharmacy Service

  • Potential for harm · D April 25, 2024

    Provide and implement an infection prevention and control program.

    Corrected May 21, 2024 · Infection Control

  • Potential for harm · D April 25, 2024

    Make sure that a working call system is available in each resident's bathroom and bathing area.

    Corrected May 21, 2024 · Environmental

  • Potential for harm · D January 25, 2024 · found via complaint

    Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

    Corrected February 2, 2024 · Freedom from Abuse, Neglect, and Exploitation

  • Potential for harm · D July 27, 2023

    Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

    Corrected September 13, 2023 · Resident Assessment and Care Planning

  • Potential for harm · D July 27, 2023

    Ensure services provided by the nursing facility meet professional standards of quality.

    Corrected September 13, 2023 · Resident Assessment and Care Planning

  • Potential for harm · D July 27, 2023

    Provide appropriate pressure ulcer care and prevent new ulcers from developing.

    Corrected September 13, 2023 · Quality of Life and Care

  • Potential for harm · D July 27, 2023

    Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

    Corrected September 13, 2023 · Quality of Life and Care

  • Potential for harm · D July 27, 2023

    Ensure each resident’s drug regimen must be free from unnecessary drugs.

    Corrected September 13, 2023 · Pharmacy Service

  • Potential for harm · D July 27, 2023

    Ensure medication error rates are not 5 percent or greater.

    Corrected September 13, 2023 · Pharmacy Service

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.

Sign in to share your family's experience — reviews are moderated and never affect the Safety Score.

Source: CMS Care Compare (public domain), data as of June 1, 2026 · CCN 245471 · certified since May 1, 1987. The score is a screen, not a verdict on any one resident's experience — read how it's computed, then visit in person.