Carleton-Willard Village Retirement & Nursing Ctr
100 Old Billerica Road, Bedford, MA 01730 · Middlesex County · 179 certified beds · avg 92 residents/day · certified since Dec 13, 1983
What health inspectors found (on-site government inspections — the most independent evidence available)
Health inspection rating: ★★★☆☆3/5 · CMS overall rating: 5/5
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 · Jun 10, 2025 · F-0600 · triggered by a complaint
The facility did not protect residents from abuse or neglect. This covers physical, mental, and sexual abuse, physical punishment, and neglect, by anyone — staff, other residents, or visitors.
Why it matters: Abuse and neglect cause direct physical and emotional harm and are among the most serious failures a nursing home can have.
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: Jun 9, 2025 (Past Non-Compliance)
▲ Immediate jeopardy, one-off · Jun 10, 2025 · F-0656 · triggered by a complaint
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.
Why it matters: Without a complete, working care plan, important needs can slip through the cracks and no one is accountable for results.
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: Jun 9, 2025 (Past Non-Compliance)
▲ Immediate jeopardy, one-off · Jun 10, 2025 · F-0689 · triggered by a complaint
The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls.
Why it matters: This is one of the most common citations and directly relates to falls and injuries, which can be devastating for older adults.
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: Jun 9, 2025 (Past Non-Compliance)
▲ Actual harm, one-off · May 29, 2024 · F-0656 · triggered by a complaint
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.
Why it matters: Without a complete, working care plan, important needs can slip through the cracks and no one is accountable for results.
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: Jul 5, 2024 (Deficient, Provider has date of correction)
▲ Actual harm, one-off · May 29, 2024 · F-0689 · triggered by a complaint
The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls.
Why it matters: This is one of the most common citations and directly relates to falls and injuries, which can be devastating for older adults.
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: Jul 5, 2024 (Deficient, Provider has date of correction)
All citations in the current public record (11)
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 |
|---|---|---|
| Jun 10, 2025 | ▲ J · Immediate jeopardy, one-off | The facility did not protect residents from abuse or neglect. This covers physical, mental, and sexual abuse, physical punishment, and neglect, by anyone — staff, other residents, or visitors. · from a complaint |
| Jun 10, 2025 | ▲ J · Immediate jeopardy, 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. · from a complaint |
| Jun 10, 2025 | ▲ J · Immediate jeopardy, one-off | The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls. · from a complaint |
| Feb 7, 2025 | E · Potential for harm, repeated | The facility did not label drugs according to professional standards or did not store them in locked compartments, with controlled drugs (medications with a high risk of misuse) kept under a separate lock. |
| Feb 7, 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. |
| May 29, 2024 | ▲ G · Actual 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. · from a complaint |
| May 29, 2024 | ▲ G · Actual harm, one-off | The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls. · from a complaint |
| May 29, 2024 | 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 |
| Sep 13, 2023 | D · Potential for harm, one-off | The facility provided care that did not meet professional standards of quality — the accepted standards that nurses and other clinicians are expected to follow. · from a complaint |
| Sep 13, 2023 | D · Potential for harm, one-off | The facility did not keep residents free from significant medication errors — such as giving the wrong drug, the wrong dose, or missing a critical medication. · from a complaint |
| Sep 13, 2023 | D · Potential for harm, one-off | The facility did not protect residents' personal information or did not keep complete, accurate medical records that meet professional standards. · from a complaint |
Inspection trend by year
| Year | Citations | Serious (G–L) | Worst severity that year |
|---|---|---|---|
| 2023 | 3 | 0 | D |
| 2024 | 3 | 2 | G ▲ |
| 2025 | 5 | 3 | 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)
2 fines totaling $25,497.
| Date | Type | Amount / length |
|---|---|---|
| Jun 10, 2025 | Fine | $16,985 |
| May 29, 2024 | Fine | $8,512 |
Nurse staffing (from payroll records, adjusted for how much care residents need)
| Measure | This facility | Massachusetts avg | U.S. avg | Where it stands |
|---|---|---|---|---|
| Total nurse staffing (hours per resident per day) | 5.68 | 3.89 | 3.95 | top 4% in Massachusetts; top 6% in the U.S. |
| Registered Nurse hours | 1.07 | 0.65 | 0.69 | top 6% in Massachusetts; top 13% in the U.S. |
| Weekend total nurse staffing | 5.41 | 3.51 | 3.50 | top 2% in Massachusetts; top 4% in the U.S. |
| Weekend RN hours (not acuity-adjusted) | 0.87 | 0.46 | 0.48 | top 6% in Massachusetts; top 9% in the U.S. |
| Total nursing staff turnover (%) | 32.3 | 38.2 | 45.8 | top 34% in Massachusetts; top 18% in the U.S. |
| RN turnover (%) | 25.9 | 42.6 | 42.9 | top 19% in Massachusetts; top 23% 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 5.17, RN 0.97, weekend 4.93. Staffing rating: 5/5.
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: 5/5 · long-stay residents: 4/5 · short-stay residents: 5/5
Who owns this facility
Non profit - Corporation
| Owner / manager | Type | Role | Stake | Since |
|---|---|---|---|---|
| Carleton-Willard Homes INC | Organization | 5% or Greater Direct Ownership Interest | 100% | 12/23/1980 |
| Mancini, Lauren | Individual | Operational/Managerial Control | NOT APPLICABLE | 03/17/2025 |
| Matthews, Michael | Individual | Corporate Officer | NOT APPLICABLE | 05/10/2023 |
| Matthews, Michael | Individual | ADP of the SNF | NOT APPLICABLE | 05/10/2023 |
Questions to ask on your visit
Generated from this facility's actual citation record — bring them to a tour and ask the administrator directly.
- "Tell me about this abuse or neglect citation — what happened, and what specific changes did you make afterward?"
- "Can you show me an example care plan, and how are families included when it's created and updated?"
- "What is your falls rate, and what specific steps do you take to prevent falls and supervise residents at risk?"
- "Can you show me how medications are stored and secured on the units, including controlled drugs?"
- "How do you make sure each resident's care follows the doctor's orders, and what changed after this citation?"
- "Can you tell me what this citation involved and what steps you took to bring care back up to standard?"
- "What systems do you use to prevent medication errors, and what happens when one occurs?"
- "How do you keep residents' medical records accurate, complete, and secure?"
- "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 |
|---|---|---|---|---|---|
| Meadow Green Nursing and Rehabilitation Center | 4.2 mi | Waltham, MA | ★☆☆☆☆ | 2/5 | |
| The Commons Skilled Nursing & Rehabilitation | 4.8 mi | Lincoln, MA | ★★★★★ | 4/5 | |
| Woburn Rehabilitation and Nursing Center | 5.2 mi | Woburn, MA | ★★☆☆☆ | 2/5 | |
| Care One at Lexington | 5.4 mi | Lexington, MA | ★★★☆☆ | 2/5 | |
| Care One at Wilmington | 6.0 mi | Wilmington, MA | ★★★★★ | 5/5 | |
| Brookhaven at Lexington | 6.0 mi | Lexington, MA | ★★★★★ | 5/5 | |
| Pine Knoll Nursing Center | 6.1 mi | Lexington, MA | —/5 | abuseSFF | |
| Park Avenue Health Center | 6.3 mi | Arlington, MA | ★☆☆☆☆ | 1/5 | |
| Winchester Rehabilitation and Nursing Center | 6.5 mi | Winchester, MA | ★★★★★ | 4/5 | |
| Aberjona Rehabilitation and Nursing Center | 6.5 mi | Winchester, MA | ★★★★★ | 5/5 | |
| Willow Brook Rehabilitation and Healthcare Center | 6.5 mi | Wilmington, MA | ★★☆☆☆ | 2/5 | abuse |
| Care One at Concord | 6.6 mi | W Concord, MA | ★★★★☆ | 4/5 |
Compare this facility with the 3 closest →
Facility data as of CMS processing date 2026-08-01. CCN 225273.