Oakwood Healthcare & Rehabilitation Center

Name: Oakwood Healthcare & Rehabilitation Center
Address: 2109 RED LION ROAD, Philadelphia, PA, 19115, US
Telephone: 2156737000

2109 Red Lion Road, Philadelphia, PA 19115 · Philadelphia County · 148 certified beds · avg 135 residents/day · certified since Jan 1, 1967

Part of chain: COLEV GESTETNER (7 facilities, chain avg rating 4.6★)

4/5

Health inspection rating (on-site)

Serious findings on record

$5,269

Fines, last 3 years

3.80

Nurse hours/resident/day (adjusted)

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

Health inspection rating: ★★★★☆4/5 · CMS overall rating: 4/5

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 (22)

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
May 7, 2026	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.
May 7, 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.
May 7, 2026	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.
May 7, 2026	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.
Jun 5, 2025	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
Jun 5, 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.
Jun 5, 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
Jun 5, 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
Jun 5, 2025	D · Potential for harm, one-off	The facility did not provide safe and appropriate pain management for a resident who needed it.
Jun 5, 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.
Mar 10, 2025	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
Aug 29, 2024	E · Potential for harm, repeated	The facility did not have enough nursing staff each day to meet every resident's needs, or did not have a licensed nurse in charge on each shift. Adequate staffing is one of the strongest predictors of good care.
Aug 29, 2024	D · Potential for harm, one-off	The facility did not keep residents' personal and medical information private and confidential.
Aug 29, 2024	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.
Aug 29, 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.
Aug 29, 2024	D · Potential for harm, one-off	The facility did not help a resident get vision and hearing services — such as eye exams, glasses, hearing tests, or hearing aids.
Aug 29, 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.
Aug 29, 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.
Aug 29, 2024	D · Potential for harm, one-off	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.
Aug 29, 2024	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.
Aug 29, 2024	B · Minimal risk, repeated	The facility did not make its inspection results easy for residents to see, or made it hard for residents to contact advocacy agencies like the ombudsman.
May 30, 2024	E · Potential for harm, repeated	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

Inspection trend by year

Citations from standard inspections decreased between the last two inspection cycles (6 → 4).

Year	Citations	Worst severity that year
2024	11	E
2025	7	D
2026	4	E

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 $5,269.

Date	Type	Amount / length
Feb 12, 2024	Fine	$1,882
Jan 22, 2024	Fine	$3,387

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

Measure	This facility	Pennsylvania avg	U.S. avg	Where it stands
Total nurse staffing (hours per resident per day)	3.80	3.94	3.95	top 44% in Pennsylvania; top 48% in the U.S.
Registered Nurse hours	0.50	0.80	0.69	bottom 26% in Pennsylvania; bottom 38% in the U.S.
Weekend total nurse staffing	3.45	3.58	3.50	top 45% in Pennsylvania; top 45% in the U.S.
Weekend RN hours (not acuity-adjusted)	0.40	0.56	0.48	bottom 44% in Pennsylvania; top 48% in the U.S.
Total nursing staff turnover (%)	50.0	44.5	45.8	bottom 34% in Pennsylvania; bottom 38% in the U.S.
RN turnover (%)	0.0	39.9	42.9	top 1% in Pennsylvania; 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 4.04, RN 0.53, weekend 3.67. Staffing rating: 3/5.

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: 4/5 · short-stay residents: 3/5

Who owns this facility

For profit - Corporation

Owner / manager	Type	Role	Stake	Since
Gestetner, Colev	Individual	5% or Greater Indirect Ownership Interest	50%	01/01/2014
Grossman, Eliezer	Individual	5% or Greater Indirect Ownership Interest	—	01/01/2014
Oakwood Senior Holdings, LLC	Organization	5% or Greater Direct Ownership Interest	100%	01/01/2014
Gestetner, Colev	Individual	Operational/Managerial Control	NOT APPLICABLE	01/01/2014
Grossman, Eliezer	Individual	Operational/Managerial Control	NOT APPLICABLE	01/01/2014
Oakwood Senior Holdings, LLC	Organization	Operational/Managerial Control	NOT APPLICABLE	01/01/2014
Smith, Samuel	Individual	Corporate Director	NOT APPLICABLE	05/30/2018

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 did your most recent kitchen inspection find, and can I see how food is stored and prepared?"
"How many residents here use oxygen or breathing equipment, and who checks that equipment each shift?"
"Can you show me how medications are stored and secured on the units, including controlled drugs?"
"Who leads your infection prevention program, and how do you make sure staff follow practices like hand hygiene every day?"
"When abuse or theft is suspected, who do you notify, how fast, and how do you inform the family?"
"Who is on the team that builds each resident's care plan, and how quickly is it in place after admission?"
"How many aides are on each shift, and how do you make sure every resident gets timely help with bathing, dressing, and meals?"
"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
St John Neumann Ctr for Rehab & Healthcare	0.3 mi	Philadelphia, PA	★★☆☆☆	2/5
Paul's Run	0.7 mi	Philadelphia, PA	★★★★★	4/5
Chapel Manor	1.6 mi	Philadelphia, PA	★★☆☆☆	2/5	abuse
Delaware Valley Veteran's Home	2.0 mi	Philadelphia, PA	★★★★☆	2/5	abuse
Accela Rehab and Care Center at Somerton	2.3 mi	Philadelphia, PA	★☆☆☆☆	2/5
Lafayette-Redeemer, the	2.7 mi	Philadelphia, PA	★★★★★	5/5
The Pines at Philadelphia Rehab and Healthcare Ctr	2.7 mi	Philadelphia, PA	★★★★★	4/5
Wesley Enhanced Living Pennypack Park	2.7 mi	Philadelphia, PA	★★★☆☆	3/5
Deer Meadows Rehabilitation Center	2.8 mi	Philadelphia, PA	★★☆☆☆	2/5
Immaculatemarycenter for Rehabilitation&healthcare	2.9 mi	Philadelphia, PA	★☆☆☆☆	2/5
Transitional Care Unit at Nazareth Hospital	3.0 mi	Philadelphia, PA	★★★★★	4/5
Pennypack Rehab and Care Center	3.3 mi	Philadelphia, PA	★★★★☆	4/5

Compare this facility with the 3 closest →

All facilities in Philadelphia →

Facility data as of CMS processing date 2026-08-01. CCN 395110.

The Care File

Visit checklist — Oakwood Healthcare & Rehabilitation Center

2109 Red Lion Road, Philadelphia, PA 19115 · 2156737000

Health inspection rating 4/5 · CMS overall 4/5· Fines (3y): $5,269

Questions for the administrator:

☐ "What did your most recent kitchen inspection find, and can I see how food is stored and prepared?"
☐ "How many residents here use oxygen or breathing equipment, and who checks that equipment each shift?"
☐ "Can you show me how medications are stored and secured on the units, including controlled drugs?"
☐ "Who leads your infection prevention program, and how do you make sure staff follow practices like hand hygiene every day?"
☐ "When abuse or theft is suspected, who do you notify, how fast, and how do you inform the family?"
☐ "Who is on the team that builds each resident's care plan, and how quickly is it in place after admission?"
☐ "How many aides are on each shift, and how do you make sure every resident gets timely help with bathing, dressing, and meals?"
☐ "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 395110 · Verify at medicare.gov/care-compare · Printed from The Care File (thecarefile.com)