Community Memorial Health Center

Name: Community Memorial Health Center
Address: 1015 F Street, Burwell, NE, 68823, US
Telephone: 3083464440

1015 F Street, Burwell, NE 68823 · Garfield County · 64 certified beds · avg 60 residents/day · certified since May 1, 2004

2/5

Health inspection rating (on-site)

Serious findings on record

Fines, last 3 years

4.29

Nurse hours/resident/day (adjusted)

What health inspectors found (on-site government inspections — the most independent evidence available)

Health inspection rating: ★★☆☆☆2/5 · CMS overall rating: 2/5

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.

All citations in the current public record (32)

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
Feb 26, 2026	F · Potential for harm, facility-wide	The facility did not serve food and drinks that were appetizing, attractive, and at a safe and pleasant temperature.
Feb 26, 2026	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.
Feb 26, 2026	E · Potential for harm, repeated	The facility did not make sure residents were fully informed about their own health, care, and treatments in a way they could understand.
Feb 26, 2026	E · Potential for harm, repeated	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.
Feb 26, 2026	D · Potential for harm, one-off	The facility did not honor residents' right to voice complaints without discrimination or retaliation, or did not have a working complaint process that resolves issues promptly.
Feb 26, 2026	D · Potential for harm, one-off	The facility gave residents unnecessary mind-altering (psychotropic) medications, or used drugs in a way that restrained residents by dulling their ability to think, move, or function.
Feb 26, 2026	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 26, 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.
Feb 26, 2026	D · Potential for 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.
Feb 26, 2026	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.
Jun 12, 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. · from a complaint
Nov 21, 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.
Nov 21, 2024	E · Potential for harm, repeated	The facility did not serve food and drinks that were appetizing, attractive, and at a safe and pleasant temperature.
Nov 21, 2024	E · Potential for harm, repeated	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 21, 2024	D · Potential for harm, one-off	The facility did not immediately notify the resident, their doctor, and a family member when something significant happened — such as an injury, a decline in health, or a room change. Families and doctors are entitled to know right away.
Nov 21, 2024	D · Potential for harm, one-off	The facility did not properly complete the required screening (called PASARR) that identifies whether a person entering a nursing home has a mental illness or intellectual disability and needs specialized services.
Nov 21, 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.
Nov 21, 2024	D · Potential for 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.
Nov 21, 2024	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.
Nov 21, 2024	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.
Oct 18, 2023	F · Potential for harm, facility-wide	The facility did not provide pharmacy services that meet each resident's needs, or did not employ or contract with a licensed pharmacist.
Oct 18, 2023	E · Potential for harm, repeated	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.
Oct 18, 2023	E · Potential for harm, repeated	The facility did not serve food and drinks that were appetizing, attractive, and at a safe and pleasant temperature.
Oct 18, 2023	D · Potential for harm, one-off	The facility did not accurately assess a resident's health and needs. Assessments are the foundation for all the care a resident receives.
Oct 18, 2023	D · Potential for harm, one-off	The facility did not provide activities that meet residents' needs and interests. Nursing homes must offer meaningful activity programs, not just leave residents idle.
Oct 18, 2023	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.
Oct 18, 2023	D · Potential for 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.
Oct 18, 2023	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.
Oct 18, 2023	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.
Oct 18, 2023	D · Potential for harm, one-off	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.
Oct 18, 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.
Oct 18, 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.

Inspection trend by year

Citations from standard inspections stayed about the same across the last two inspection cycles (9 → 10).

Year	Citations	Worst severity that year
2023	12	F
2024	9	E
2025	1	D
2026	10	F

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)

No fines or payment denials in the published 3-year window.

Nurse staffing (from payroll records, adjusted for how much care residents need)

Measure	This facility	Nebraska avg	U.S. avg	Where it stands
Total nurse staffing (hours per resident per day)	4.29	4.33	3.95	bottom 49% in Nebraska; top 29% in the U.S.
Registered Nurse hours	0.50	0.72	0.69	bottom 22% in Nebraska; bottom 37% in the U.S.
Weekend total nurse staffing	3.70	3.79	3.50	top 49% in Nebraska; top 33% in the U.S.
Weekend RN hours (not acuity-adjusted)	0.36	0.47	0.48	bottom 40% in Nebraska; bottom 44% in the U.S.
Total nursing staff turnover (%)	24.3	48.7	45.8	top 6% in Nebraska; top 6% in the U.S.
RN turnover (%)	0.0	44.1	42.9	top 1% in Nebraska; top 1% 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 3.98, RN 0.46, weekend 3.43. 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: 3/5 · long-stay residents: 3/5 · short-stay residents: —/5

Who owns this facility

Non profit - Corporation

Owner / manager	Type	Role	Stake	Since
Garner, Timothy	Individual	Corporate Director	NOT APPLICABLE	01/01/2011
Groshans, Hayley	Individual	W-2 Managing Employee	NOT APPLICABLE	08/31/2022
Groshans, Hayley	Individual	Corporate Director	NOT APPLICABLE	08/31/2022
Groshans, Hayley	Individual	ADP of the SNF	NOT APPLICABLE	12/09/2024
Groshans, Timothy	Individual	Operational/Managerial Control	NOT APPLICABLE	01/01/2014
Holmquist, Brenda	Individual	Corporate Director	NOT APPLICABLE	01/01/2013
Schere, Melissa	Individual	Corporate Director	NOT APPLICABLE	01/01/2010

Questions to ask on your visit

Generated from this facility's actual citation record — bring them to a tour and ask the administrator directly.

"Could I join residents for a meal to see the food quality and temperature for myself?"
"What did your most recent kitchen inspection find, and can I see how food is stored and prepared?"
"How do you explain health changes and treatment options to residents and their families?"
"Who leads your infection prevention program, and how do you make sure staff follow practices like hand hygiene every day?"
"Walk me through what happens when a resident or family files a grievance — who responds and how fast?"
"What percentage of your residents are on antipsychotic or sedating medications, and how do you work to reduce that?"
"What does the care plan for a brand-new resident cover in the first 48 hours, and who writes it?"
"How do you make sure each resident's care follows the doctor's orders, and what changed after this citation?"
"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
Arbor Care Centers - Ord, LLC	16.1 mi	Ord, NE	★☆☆☆☆	1/5

Compare this facility with the 1 closest →

All facilities in Burwell →

Facility data as of CMS processing date 2026-08-01. CCN 285257.

The Care File

Visit checklist — Community Memorial Health Center

1015 F Street, Burwell, NE 68823 · 3083464440

Health inspection rating 2/5 · CMS overall 2/5· Fines (3y): $0

Questions for the administrator:

☐ "Could I join residents for a meal to see the food quality and temperature for myself?"
☐ "What did your most recent kitchen inspection find, and can I see how food is stored and prepared?"
☐ "How do you explain health changes and treatment options to residents and their families?"
☐ "Who leads your infection prevention program, and how do you make sure staff follow practices like hand hygiene every day?"
☐ "Walk me through what happens when a resident or family files a grievance — who responds and how fast?"
☐ "What percentage of your residents are on antipsychotic or sedating medications, and how do you work to reduce that?"
☐ "What does the care plan for a brand-new resident cover in the first 48 hours, and who writes it?"
☐ "How do you make sure each resident's care follows the doctor's orders, and what changed after this citation?"
☐ "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?"

While you're there, notice:

☐ Smell and cleanliness in hallways, not just the lobby
☐ How staff speak to residents; call lights answered promptly
☐ Residents up, dressed, and engaged (visit mealtimes and a weekend if you can)

Data: CMS Provider Data Catalog, version 2026-08-01 · CCN 285257 · Verify at medicare.gov/care-compare · Printed from The Care File (thecarefile.com)