Carter Nursing and Rehabilitation
250 McDavid Boulevard, Grayson, KY 41143 · Carter County · 120 certified beds · avg 110 residents/day · certified since Feb 21, 1991
Abuse citation flag (CMS)
Part of chain: DAVID MARX (10 facilities, chain avg rating 2.9★)
The abuse flag means inspectors cited this facility for abuse that caused harm to a resident within the past year, or potential for harm in each of the last two years. Source: CMS.
What health inspectors found (on-site government inspections — the most independent evidence available)
Health inspection rating: ★☆☆☆☆1/5 · CMS overall rating: 1/5
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, repeated · Jul 17, 2023 · F-0689
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 (K): A life-threatening or extremely dangerous situation affected several residents. Among the most serious findings an inspection can produce.
Corrected: Aug 6, 2023 (Deficient, Provider has date of correction)
▲ Actual harm, one-off · Aug 29, 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 (G): One or a few residents were actually harmed — physically or emotionally — though not put in immediate danger of serious injury or death.
Corrected: Sep 12, 2025 (Deficient, Provider has date of correction)
▲ Actual harm, one-off · Aug 29, 2025 · F-0609 · triggered by a complaint
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.
Why it matters: When incidents aren't reported promptly, abusers may continue harming residents and outside authorities can't step in.
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: Sep 12, 2025 (Deficient, Provider has date of correction)
All citations in the current public record (16)
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 |
|---|---|---|
| Aug 29, 2025 | ▲ G · Actual harm, 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 |
| Aug 29, 2025 | ▲ G · Actual 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 |
| Aug 29, 2025 | F · Potential for harm, facility-wide | 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. |
| Aug 29, 2025 | 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 |
| Aug 29, 2025 | D · Potential for harm, one-off | The facility did not have or follow an effective program to prevent and control infections — such as proper hand washing, cleaning, and isolation practices. This is the most commonly cited deficiency nationwide. |
| Jul 17, 2023 | ▲ K · Immediate jeopardy, repeated | The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls. |
| Jul 17, 2023 | E · Potential for harm, repeated | The facility's medication error rate was 5 percent or higher — meaning too many doses were given incorrectly, such as the wrong drug, dose, or time. |
| Jul 17, 2023 | 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. |
| Jul 17, 2023 | D · Potential for harm, one-off | The facility did not protect residents from misuse of their belongings or money — this is called misappropriation, and it includes theft or improper use of a resident's property or funds. |
| Jul 17, 2023 | D · Potential for harm, one-off | The facility hired someone with an official finding of abuse, neglect, exploitation, or theft against them. Facilities are not allowed to employ people with such findings. |
| Jul 17, 2023 | 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. |
| Jul 17, 2023 | 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. |
| Jul 17, 2023 | D · Potential for harm, one-off | 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. |
| Jul 17, 2023 | D · Potential for harm, one-off | The facility did not provide food that accounts for each resident's allergies, intolerances, and personal preferences, or did not offer appealing alternatives. |
| Jul 17, 2023 | D · Potential for harm, one-off | The facility did not have or follow an effective program to prevent and control infections — such as proper hand washing, cleaning, and isolation practices. This is the most commonly cited deficiency nationwide. |
| Nov 7, 2019 | D · Potential for harm, one-off | 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. |
Inspection trend by year
Citations from standard inspections decreased between the last two inspection cycles (10 → 5).
| Year | Citations | Serious (G–L) | Worst severity that year |
|---|---|---|---|
| 2019 | 1 | 0 | D |
| 2023 | 10 | 1 | K ▲ |
| 2025 | 5 | 2 | G ▲ |
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 $18,000.
| Date | Type | Amount / length |
|---|---|---|
| Aug 29, 2025 | Fine | $8,000 |
| Aug 29, 2025 | Fine | $10,000 |
Nurse staffing (from payroll records, adjusted for how much care residents need)
| Measure | This facility | Kentucky avg | U.S. avg | Where it stands |
|---|---|---|---|---|
| Total nurse staffing (hours per resident per day) | 3.21 | 3.71 | 3.95 | bottom 36% in Kentucky; bottom 22% in the U.S. |
| Registered Nurse hours | 0.37 | 0.74 | 0.69 | bottom 11% in Kentucky; bottom 18% in the U.S. |
| Weekend total nurse staffing | 2.54 | 3.27 | 3.50 | bottom 15% in Kentucky; bottom 10% in the U.S. |
| Weekend RN hours (not acuity-adjusted) | 0.21 | 0.53 | 0.48 | bottom 10% in Kentucky; bottom 13% in the U.S. |
| Total nursing staff turnover (%) | 68.5 | 46.4 | 45.8 | bottom 5% in Kentucky; bottom 7% in the U.S. |
| RN turnover (%) | 61.5 | 41.8 | 42.9 | bottom 16% in Kentucky; bottom 20% 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 3.21, RN 0.37, weekend 2.54. Staffing rating: 1/5.
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: 3/5 · long-stay residents: 5/5 · short-stay residents: 1/5
Who owns this facility
For profit - Corporation
| Owner / manager | Type | Role | Stake | Since |
|---|---|---|---|---|
| Carter Nursing and Rehabilitation Holdings LLC | Organization | 5% or Greater Direct Ownership Interest | 100% | 07/25/2019 |
| 250 McDavid Blvd SNF Realty Holdings LLC | Organization | ADP of the SNF | NOT APPLICABLE | 09/01/2019 |
| 250 McDavid Blvd SNF Realty LLC | Organization | Operational/Managerial Control | NOT APPLICABLE | 09/01/2019 |
| 250 McDavid Blvd SNF Realty LLC | Organization | ADP of the SNF | NOT APPLICABLE | 09/01/2019 |
| Alexander, David | Individual | Operational/Managerial Control | NOT APPLICABLE | 05/01/2023 |
| Alexander, David | Individual | ADP of the SNF | NOT APPLICABLE | 05/01/2023 |
| Bluegrass Consulting Group LLC | Organization | Operational/Managerial Control | NOT APPLICABLE | 09/01/2019 |
| Bluegrass Consulting Group LLC | Organization | ADP of the SNF | NOT APPLICABLE | 07/16/2025 |
| Chamberlain, Margaret | Individual | Operational/Managerial Control | NOT APPLICABLE | 09/11/2023 |
| Chamberlain, Margaret | Individual | ADP of the SNF | NOT APPLICABLE | 09/11/2023 |
| Gibbs, Sarah | Individual | Operational/Managerial Control | NOT APPLICABLE | 01/01/2025 |
| Gibbs, Sarah | Individual | ADP of the SNF | NOT APPLICABLE | 01/01/2025 |
| Kentucky SNF Realty Holdings LLC | Organization | ADP of the SNF | NOT APPLICABLE | 09/01/2019 |
| Marx, David | Individual | Operational/Managerial Control | NOT APPLICABLE | 09/01/2019 |
| Marx, David | Individual | ADP of the SNF | NOT APPLICABLE | 09/01/2019 |
| MDG Real Estate Global Limited | Organization | ADP of the SNF | NOT APPLICABLE | 09/01/2019 |
| Pruitt, Paul | Individual | Managing Control - Governing Body | NOT APPLICABLE | 05/01/2023 |
| Pruitt, Paul | Individual | Operational/Managerial Control | NOT APPLICABLE | 05/01/2023 |
| Pruitt, Paul | Individual | ADP of the SNF | NOT APPLICABLE | 05/01/2023 |
| Rewa, Angela | Individual | Operational/Managerial Control | NOT APPLICABLE | 10/23/2023 |
Questions to ask on your visit
Generated from this facility's actual citation record — bring them to a tour and ask the administrator directly.
- "What is your falls rate, and what specific steps do you take to prevent falls and supervise residents at risk?"
- "Tell me about this abuse or neglect citation — what happened, and what specific changes did you make afterward?"
- "When abuse or theft is suspected, who do you notify, how fast, and how do you inform the family?"
- "What did your most recent kitchen inspection find, and can I see how food is stored and prepared?"
- "Can you tell me what this citation involved and what steps you took to bring care back up to standard?"
- "Who leads your infection prevention program, and how do you make sure staff follow practices like hand hygiene every day?"
- "What is your current medication error rate, and what have you changed to bring errors down?"
- "What safeguards do you have to protect residents' money and belongings, and what happens when something goes missing?"
- "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 |
|---|---|---|---|---|---|
| Boyd Nursing and Rehabilitation | 10.1 mi | Ashland, KY | ★★★☆☆ | 2/5 | |
| Kingsbrook Lifecare Center | 14.3 mi | Ashland, KY | ★★★★☆ | 3/5 | |
| Wurtland Nursing and Rehabilitation | 17.1 mi | Wurtland, KY | ★☆☆☆☆ | 1/5 | |
| Woodland Oaks | 17.7 mi | Ashland, KY | ★★★★☆ | 4/5 | |
| Oakmont Manor | 18.2 mi | Flatwoods, KY | ★★★☆☆ | 3/5 | |
| Sanctuary at Ohio Valley | 18.9 mi | Ironton, OH | ★★★★☆ | 4/5 | |
| Harbor Healthcare of Ironton | 19.3 mi | Ironton, OH | ★★★★☆ | 3/5 | |
| Crystal Care of Coal Grove | 19.5 mi | Coal Grove, OH | ★★★☆☆ | 3/5 |
Compare this facility with the 3 closest →
Facility data as of CMS processing date 2026-08-01. CCN 185253.