Bay Terrace Rehabilitation and Health Center
889 South Little Creek Road, Dover, DE 19901 · Kent County · 85 certified beds · avg 70 residents/day · certified since May 1, 1979
Part of chain: PRESTIGE HEALTHCARE ADMINISTRATIVE SERVICES (15 facilities, chain avg rating 3.2★)
What health inspectors found (on-site government inspections — the most independent evidence available)
Health inspection rating: ★★★☆☆3/5 · CMS overall rating: 3/5
The health inspection star above is graded on a curve within each state — a set share of each state's facilities gets each star level — so a facility can have few citations and still rate 2–3 stars if others in its state did even better. The overall rating combines that inspection score with staffing and self-reported quality measures.
Most serious findings (actual harm or immediate jeopardy)
▲ Immediate jeopardy, one-off · Feb 24, 2026 · F-0627 · triggered by a complaint
The facility did not make sure a transfer or discharge met the resident's needs and preferences, or did not properly prepare the resident to leave safely.
Why it matters: A rushed or poorly planned move can leave a resident somewhere that can't meet their needs.
Severity (J): Inspectors found a situation that put a resident's life or safety in immediate danger, affecting one or a few residents. The facility must fix it immediately — these citations often come with large fines.
Corrected: Mar 23, 2026 (Deficient, Provider has date of correction)
▲ Actual harm, one-off · Dec 2, 2024 · F-0684 · triggered by a complaint
The facility did not provide treatment and care that follows the doctor's orders and matches the resident's own preferences and goals.
Why it matters: Care that strays from doctor's orders or ignores the resident's wishes can lead to declining health and avoidable harm.
Severity (G): One or a few residents were actually harmed — physically or emotionally — though not put in immediate danger of serious injury or death.
Corrected: Jan 20, 2025 (Deficient, Provider has date of correction)
All citations in the current public record (38)
CMS publishes roughly the last three inspection cycles plus recent complaint investigations. Older surveys drop out of the record as new ones are completed.
| Date | Severity | What the facility was cited for |
|---|---|---|
| Apr 23, 2026 | D · Potential for harm, one-off | The facility did not report suspected abuse, neglect, or theft to the proper authorities quickly enough, or did not report the results of its investigation. · from a complaint |
| Apr 23, 2026 | D · Potential for harm, one-off | The facility did not respond appropriately to alleged violations, such as reports of abuse, neglect, or mistreatment. Facilities must investigate every allegation and protect residents while they do. · from a complaint |
| Apr 23, 2026 | D · Potential for harm, one-off | The facility did not provide the help residents need with basic daily activities — like bathing, dressing, eating, and using the bathroom — for residents who cannot do these things on their own. |
| Apr 23, 2026 | D · Potential for harm, one-off | The facility did not provide treatment and care that follows the doctor's orders and matches the resident's own preferences and goals. · from a complaint |
| Apr 23, 2026 | D · Potential for harm, one-off | The facility did not keep residents' medications free from unnecessary drugs. Residents should only take medicines they truly need, at the right dose, for a clear reason. |
| Feb 24, 2026 | ▲ J · Immediate jeopardy, one-off | The facility did not make sure a transfer or discharge met the resident's needs and preferences, or did not properly prepare the resident to leave safely. · from a complaint |
| Feb 19, 2025 | E · Potential for harm, repeated | The facility did not provide safe and appropriate pain management for a resident who needed it. |
| Feb 19, 2025 | E · Potential for harm, repeated | The facility did not get its food from approved, safe sources, or did not store, prepare, and serve food according to professional food safety standards. |
| Feb 19, 2025 | D · Potential for harm, one-off | The facility did not treat residents with dignity and respect, or did not honor their rights to make their own decisions and communicate freely. This is one of the most fundamental resident rights. |
| Feb 19, 2025 | D · Potential for harm, one-off | The facility did not properly hold, secure, and manage residents' personal money that was deposited with it for safekeeping. Facilities holding residents' funds must keep careful, honest accounts. |
| Feb 19, 2025 | D · Potential for harm, one-off | The facility did not keep residents' personal and medical information private and confidential. |
| Feb 19, 2025 | D · Potential for harm, one-off | The facility did not give residents (and their representatives and the ombudsman, a state advocate for residents) proper advance notice before a transfer or discharge, including information about their right to appeal. |
| Feb 19, 2025 | D · Potential for harm, one-off | The facility did not coordinate resident assessments with the state's pre-admission screening program for mental illness and intellectual disabilities, or failed to refer residents for the special services they need. |
| Feb 19, 2025 | D · Potential for harm, one-off | The facility did not create and follow a basic care plan covering a new resident's most immediate needs within 48 hours of admission. The first days are when a new resident is most vulnerable. |
| Feb 19, 2025 | D · Potential for harm, one-off | The facility did not develop or follow a complete care plan for each resident — the written roadmap covering all of a resident's needs, with measurable goals and timelines. |
| Feb 19, 2025 | D · Potential for harm, one-off | The facility did not develop a resident's complete plan of care within 7 days of the full assessment, or the plan wasn't prepared, reviewed, and updated by a team of health professionals as required. · from a complaint |
| Feb 19, 2025 | D · Potential for harm, one-off | The facility did not provide the help residents need with basic daily activities — like bathing, dressing, eating, and using the bathroom — for residents who cannot do these things on their own. · from a complaint |
| Feb 19, 2025 | D · Potential for harm, one-off | The facility did not provide treatment and care that follows the doctor's orders and matches the resident's own preferences and goals. |
| Feb 19, 2025 | D · Potential for harm, one-off | The facility did not provide the care needed to maintain or improve residents' movement and flexibility — such as range-of-motion exercises — leading to avoidable decline. |
| Feb 19, 2025 | D · Potential for harm, one-off | The facility did not provide appropriate care related to bladder and bowel needs — including care for residents who use catheters and steps to prevent urinary tract infections. |
| Feb 19, 2025 | D · Potential for harm, one-off | The facility did not provide safe and appropriate respiratory care — such as oxygen, breathing treatments, or care for residents on breathing equipment — for residents who needed it. |
| Feb 19, 2025 | D · Potential for harm, one-off | The facility did not try to gradually reduce doses of mood- and mind-altering medications or use non-drug approaches first, as required, or used 'as needed' psychiatric drugs without proper limits. |
| Feb 19, 2025 | D · Potential for harm, one-off | The facility did not provide or arrange dental services for its residents. Nursing homes are responsible for making sure residents can get dental care. |
| Feb 19, 2025 | C · Minimal risk, facility-wide | The facility did not have a licensed pharmacist review each resident's complete medication regimen and medical chart every month, or did not follow its own rules for reporting medication problems. |
| Dec 2, 2024 | ▲ G · Actual harm, one-off | The facility did not provide treatment and care that follows the doctor's orders and matches the resident's own preferences and goals. · from a complaint |
| Dec 2, 2024 | D · Potential for harm, one-off | The facility did not honor residents' right to make their own choices about their daily lives, such as when to wake up, what to eat, or how to spend their time. · from a complaint |
| Dec 2, 2024 | D · Potential for harm, one-off | The facility did not honor residents' rights to request, refuse, or stop treatment, to decline participation in medical research, or to make an advance directive — a written statement of their wishes for future medical care. · from a complaint |
| Dec 2, 2024 | D · Potential for harm, one-off | The facility did not provide the help residents need with basic daily activities — like bathing, dressing, eating, and using the bathroom — for residents who cannot do these things on their own. · from a complaint |
| Feb 23, 2024 | E · Potential for harm, repeated | The facility did not develop a resident's complete plan of care within 7 days of the full assessment, or the plan wasn't prepared, reviewed, and updated by a team of health professionals as required. |
| Feb 23, 2024 | E · Potential for harm, repeated | The facility did not have enough support staff to safely and effectively run its food and nutrition service. |
| Feb 23, 2024 | E · Potential for harm, repeated | The facility did not get its food from approved, safe sources, or did not store, prepare, and serve food according to professional food safety standards. |
| Feb 23, 2024 | E · Potential for harm, repeated | The facility did not dispose of garbage and refuse properly. |
| Feb 23, 2024 | D · Potential for harm, one-off | The facility did not develop or follow a complete care plan for each resident — the written roadmap covering all of a resident's needs, with measurable goals and timelines. |
| Feb 23, 2024 | D · Potential for harm, one-off | The facility allowed residents to lose the ability to do daily activities — like bathing, dressing, and eating — when there was no medical reason for the decline. Good care helps residents keep the abilities they have. |
| Feb 23, 2024 | D · Potential for harm, one-off | The facility did not provide enough food and fluids to keep residents healthy, such as preventing unplanned weight loss or dehydration. |
| Feb 23, 2024 | D · Potential for harm, one-off | The facility used feeding tubes without a valid medical reason or the resident's agreement, or did not provide proper care to residents who have feeding tubes. |
| Feb 23, 2024 | D · Potential for harm, one-off | The facility did not provide safe and appropriate respiratory care — such as oxygen, breathing treatments, or care for residents on breathing equipment — for residents who needed it. |
| Feb 23, 2024 | D · Potential for harm, one-off | The facility did not provide or arrange dental services for its residents. Nursing homes are responsible for making sure residents can get dental care. |
Inspection trend by year
Citations from standard inspections decreased between the last two inspection cycles (18 → 5).
| Year | Citations | Serious (G–L) | Worst severity that year |
|---|---|---|---|
| 2024 | 14 | 1 | G ▲ |
| 2025 | 18 | 0 | E |
| 2026 | 6 | 1 | J ▲ |
Counts reflect the current CMS public record (~3 inspection cycles plus complaint investigations); years with no surveys show no row. Inspection frequency varies, so compare severity as well as counts.
Fines and enforcement (last 3 years)
3 fines totaling $34,838.
| Date | Type | Amount / length |
|---|---|---|
| Feb 24, 2026 | Fine | $14,901 |
| Apr 11, 2025 | Fine | $9,113 |
| Dec 2, 2024 | Fine | $10,824 |
Nurse staffing (from payroll records, adjusted for how much care residents need)
| Measure | This facility | Delaware avg | U.S. avg | Where it stands |
|---|---|---|---|---|
| Total nurse staffing (hours per resident per day) | 4.16 | 4.67 | 3.95 | bottom 42% in Delaware; top 33% in the U.S. |
| Registered Nurse hours | 0.91 | 1.04 | 0.69 | top 49% in Delaware; top 20% in the U.S. |
| Weekend total nurse staffing | 3.75 | 4.18 | 3.50 | bottom 42% in Delaware; top 31% in the U.S. |
| Weekend RN hours (not acuity-adjusted) | 0.58 | 0.64 | 0.48 | top 49% in Delaware; top 25% in the U.S. |
| Total nursing staff turnover (%) | 36.6 | 41.3 | 45.8 | top 37% in Delaware; top 28% in the U.S. |
| RN turnover (%) | 42.1 | 41.2 | 42.9 | bottom 45% in Delaware; bottom 49% in the U.S. |
Hours are per resident per day, case-mix adjusted by CMS so facilities caring for sicker residents can be compared fairly (same basis as the CMS staffing star). "Top X%" means better than most facilities: more staffing hours, or lower turnover. Raw (unadjusted) reported hours: total 4.19, RN 0.92, weekend 3.77. Staffing rating: 4/5.
Self-reported quality measures
Note: these ratings are based on data the facility reports about itself to CMS. They are not independently verified by inspectors, and can look better than inspection findings. Give more weight to the inspection results above.
Quality measures rating: 4/5 · long-stay residents: 5/5 · short-stay residents: 3/5
Who owns this facility
For profit - Corporation
| Owner / manager | Type | Role | Stake | Since |
|---|---|---|---|---|
| Aysan Tr | Organization | 5% or Greater Indirect Ownership Interest | — | 03/01/2024 |
| BTRC Holdings LLC | Organization | 5% or Greater Direct Ownership Interest | 100% | 03/01/2024 |
| Copper de Trust | Organization | 5% or Greater Indirect Ownership Interest | — | 03/01/2024 |
| Gold de Trust | Organization | 5% or Greater Indirect Ownership Interest | — | 03/01/2024 |
| Pa & de Noble Parentco LLC | Organization | 5% or Greater Indirect Ownership Interest | — | 03/01/2024 |
| Silver de Trust | Organization | 5% or Greater Indirect Ownership Interest | — | 03/01/2024 |
| Star de I Holdings LLC | Organization | 5% or Greater Indirect Ownership Interest | — | 03/01/2024 |
| Star de I Trust | Organization | 5% or Greater Indirect Ownership Interest | — | 03/01/2024 |
| Apex Global Solutions LLC | Organization | ADP of the SNF | NOT APPLICABLE | 03/01/2024 |
| Ellenbogen, Moss | Individual | Operational/Managerial Control | NOT APPLICABLE | 03/01/2024 |
| Olowo, Abimbola | Individual | ADP of the SNF | NOT APPLICABLE | 03/01/2024 |
| Studd, Anne | Individual | Operational/Managerial Control | NOT APPLICABLE | 01/01/2025 |
| Studd, Anne | Individual | ADP of the SNF | NOT APPLICABLE | 05/07/2025 |
Questions to ask on your visit
Generated from this facility's actual citation record — bring them to a tour and ask the administrator directly.
- "Before a resident is discharged or transferred, how do you make sure the new place can actually meet their needs?"
- "How do you make sure each resident's care follows the doctor's orders, and what changed after this citation?"
- "When abuse or theft is suspected, who do you notify, how fast, and how do you inform the family?"
- "If someone reports suspected abuse or neglect here, what happens in the first 24 hours?"
- "How many aides are on each shift, and how do you make sure every resident gets timely help with bathing, dressing, and meals?"
- "How often is each resident's medication list reviewed, and who decides when a drug can be reduced or stopped?"
- "How do you assess and manage residents' pain, especially for those who have trouble communicating?"
- "What did your most recent kitchen inspection find, and can I see how food is stored and prepared?"
- "What is your current ratio of nursing staff to residents on day, evening, and weekend shifts?"
- "Can I see the results and plan of correction from your most recent state inspection?"
Nearby facilities (within 20 miles)
| Facility | Distance | City | Overall | Inspection | Flags |
|---|---|---|---|---|---|
| Center at Eden Hill, LLC | 1.7 mi | Dover, DE | ★★★★★ | 4/5 | |
| Complete Care at Silver Lake LLC | 2.5 mi | Dover, DE | ★★★☆☆ | 3/5 | |
| Cadia Rehabilitation Capitol | 2.9 mi | Dover, DE | ★★★☆☆ | 3/5 | |
| Westminster Village Health | 3.0 mi | Dover, DE | ★★★★☆ | 3/5 | |
| Evergreen Post Acute | 8.6 mi | Smyrna, DE | ★★☆☆☆ | 1/5 | |
| Delaware Hospital F/T Chronically Ill (dhci) | 10.6 mi | Smyrna, DE | ★★☆☆☆ | 1/5 | SFF |
| Delaware Veterans Home | 15.5 mi | Milford, DE | ★★★★☆ | 2/5 | abuse |
| Milford Center | 17.6 mi | Milford, DE | ★★☆☆☆ | 2/5 | |
| Polaris Healthcare and Rehabilitation Center | 17.7 mi | Milford, DE | ★★☆☆☆ | 2/5 |
Compare this facility with the 3 closest →
Facility data as of CMS processing date 2026-08-01. CCN 085019.