Orem Rehabilitation and Nursing Center
575 East 1400 South, Orem, UT 84097 · Utah County · 120 certified beds · avg 77 residents/day · certified since Sep 4, 1986
Part of chain: THE ENSIGN GROUP (342 facilities, chain avg rating 3.2★)
What health inspectors found (on-site government inspections — the most independent evidence available)
Health inspection rating: ★★☆☆☆2/5 · 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, repeated · Jul 18, 2023 · F-0600
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 (K): A life-threatening or extremely dangerous situation affected several residents. Among the most serious findings an inspection can produce.
Corrected: Aug 29, 2023 (Deficient, Provider has date of correction)
▲ Immediate jeopardy, repeated · Jul 18, 2023 · F-0610
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.
Why it matters: When allegations aren't investigated, harm to residents can continue unchecked.
Severity (K): A life-threatening or extremely dangerous situation affected several residents. Among the most serious findings an inspection can produce.
Corrected: Aug 29, 2023 (Deficient, Provider has date of correction)
▲ Actual harm, one-off · May 22, 2024 · F-0603 · triggered by a complaint
The facility did not protect residents from being involuntarily separated — kept apart from other residents, kept out of their own room, or confined to their room. Isolating a resident this way is a form of mistreatment.
Why it matters: Forced isolation is emotionally harmful and can hide neglect or abuse from view.
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: Jun 19, 2024 (Deficient, Provider has date of correction)
▲ Actual harm, one-off · Jul 18, 2023 · F-0835
The facility was not managed in a way that uses its money, staff, and resources effectively and efficiently to care for residents.
Why it matters: Poor administration often shows up as understaffing, supply shortages, and care problems across the whole facility.
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: Aug 29, 2023 (Deficient, Provider has date of correction)
▲ Actual harm, one-off · Jul 18, 2023 · F-0867
The facility did not run an ongoing quality assurance committee that reviews care problems and creates plans to fix them.
Why it matters: Without a working quality program, the same care problems tend to repeat instead of getting fixed.
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: Aug 29, 2023 (Deficient, Provider has date of correction)
All citations in the current public record (29)
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 1, 2025 | E · Potential for harm, repeated | The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls. |
| May 1, 2025 | E · Potential for harm, repeated | The facility did not make sure its nurse aides were properly trained — aides working more than 4 months must be trained and competent, and newer aides must be enrolled in training. |
| May 1, 2025 | E · Potential for harm, repeated | The facility did not serve food and drinks that were appetizing, attractive, and at a safe and pleasant temperature. |
| May 1, 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. |
| May 1, 2025 | D · Potential for harm, one-off | The facility did not make reasonable adjustments to fit each resident's individual needs and preferences — things like call buttons within reach, preferred wake-up times, or accessible room setups. |
| May 1, 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. |
| May 1, 2025 | D · Potential for harm, one-off | The facility did not post its nurse staffing information every day. Nursing homes must publicly display how many nurses and aides are on duty each day. |
| May 1, 2025 | D · Potential for harm, one-off | The facility did not keep complete, dated laboratory records in residents' files. |
| May 1, 2025 | D · Potential for harm, one-off | The facility did not have a working program to monitor how antibiotics are used. Tracking antibiotic use helps make sure these drugs are given only when needed and remain effective. |
| May 1, 2025 | 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. · from a complaint |
| May 22, 2024 | ▲ G · Actual harm, one-off | The facility did not protect residents from being involuntarily separated — kept apart from other residents, kept out of their own room, or confined to their room. Isolating a resident this way is a form of mistreatment. · from a complaint |
| May 22, 2024 | 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 |
| Jul 18, 2023 | ▲ K · Immediate jeopardy, repeated | 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. |
| Jul 18, 2023 | ▲ K · Immediate jeopardy, repeated | 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. |
| Jul 18, 2023 | ▲ G · Actual harm, one-off | The facility was not managed in a way that uses its money, staff, and resources effectively and efficiently to care for residents. |
| Jul 18, 2023 | ▲ G · Actual harm, one-off | The facility did not run an ongoing quality assurance committee that reviews care problems and creates plans to fix them. |
| Jul 18, 2023 | 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. |
| Jul 18, 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 18, 2023 | 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. |
| Jul 18, 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 18, 2023 | 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. |
| Jul 18, 2023 | D · Potential for harm, one-off | The facility did not safely and appropriately administer IV fluids (fluids given through a vein) for residents who needed them. |
| Jul 18, 2023 | D · Potential for harm, one-off | The facility did not provide necessary behavioral health care and services — support for residents' mental and emotional wellbeing, including conditions like depression and anxiety. |
| Jul 18, 2023 | 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. |
| Jul 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. |
| Jul 18, 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. |
| Feb 10, 2022 | 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 10, 2022 | 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. |
| Feb 10, 2022 | D · Potential for harm, one-off | The facility did not designate a qualified infection preventionist — a trained person responsible for running the infection prevention and control program. |
Inspection trend by year
Citations from standard inspections decreased between the last two inspection cycles (14 → 9).
| Year | Citations | Serious (G–L) | Worst severity that year |
|---|---|---|---|
| 2022 | 3 | 0 | D |
| 2023 | 14 | 4 | K ▲ |
| 2024 | 2 | 1 | G ▲ |
| 2025 | 10 | 0 | 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)
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 | Utah avg | U.S. avg | Where it stands |
|---|---|---|---|---|
| Total nurse staffing (hours per resident per day) | 3.61 | 3.87 | 3.95 | top 49% in Utah; bottom 42% in the U.S. |
| Registered Nurse hours | 0.92 | 1.17 | 0.69 | bottom 39% in Utah; top 20% in the U.S. |
| Weekend total nurse staffing | 3.13 | 3.39 | 3.50 | top 50% in Utah; bottom 38% in the U.S. |
| Weekend RN hours (not acuity-adjusted) | 0.61 | 0.88 | 0.48 | bottom 32% in Utah; top 22% in the U.S. |
| Total nursing staff turnover (%) | 0.0 | 50.7 | 45.8 | — |
| RN turnover (%) | 0.0 | 40.6 | 42.9 | — |
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 3.45, RN 0.88, weekend 2.99. 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: 5/5 · long-stay residents: 5/5 · short-stay residents: 4/5
Who owns this facility
For profit - Corporation
| Owner / manager | Type | Role | Stake | Since |
|---|---|---|---|---|
| Albrechtsen, Joshua | Individual | Managing Control - Governing Body | NOT APPLICABLE | 05/01/2008 |
| Albrechtsen, Joshua | Individual | Operational/Managerial Control | NOT APPLICABLE | 05/01/2008 |
| Albrechtsen, Joshua | Individual | ADP of the SNF | NOT APPLICABLE | 05/01/2008 |
| Anderson, Aaron | Individual | Managing Control - Governing Body | NOT APPLICABLE | 11/15/2021 |
| Anderson, Aaron | Individual | Operational/Managerial Control | NOT APPLICABLE | 11/15/2021 |
| Anderson, Aaron | Individual | ADP of the SNF | NOT APPLICABLE | 11/15/2021 |
| Burnam, Soon | Individual | Corporate Officer | NOT APPLICABLE | 05/01/2008 |
| Caretrust GP LLC | Organization | ADP of the SNF | NOT APPLICABLE | 05/01/2016 |
| Caretrust Reit INC | Organization | ADP of the SNF | NOT APPLICABLE | 05/01/2016 |
| Ctr Partnership LP | Organization | ADP of the SNF | NOT APPLICABLE | 05/01/2016 |
| Ensign Services INC | Organization | ADP of the SNF | NOT APPLICABLE | 05/01/2008 |
| Hueneme Healthcare, INC. | Organization | Operational/Managerial Control | NOT APPLICABLE | 05/01/2016 |
| Hueneme Healthcare, INC. | Organization | ADP of the SNF | NOT APPLICABLE | 09/16/2025 |
| Keetch, Chad | Individual | Corporate Officer | NOT APPLICABLE | 03/01/2011 |
| Moss, Tyler | Individual | Corporate Officer | NOT APPLICABLE | 01/01/2019 |
| Orem Health Holdings LLC | Organization | ADP of the SNF | NOT APPLICABLE | 05/01/2016 |
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?"
- "If someone reports suspected abuse or neglect here, what happens in the first 24 hours?"
- "Under what circumstances, if any, would a resident ever be kept in their room or separated from others?"
- "What were the findings behind this administration citation, and what has leadership changed since?"
- "How does your quality committee work, and can you give an example of a problem it recently identified and fixed?"
- "What is your falls rate, and what specific steps do you take to prevent falls and supervise residents at risk?"
- "What training and competency checks do your nurse aides go through, and how do you keep their skills current?"
- "Could I join residents for a meal to see the food quality and temperature for myself?"
- "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 |
|---|---|---|---|---|---|
| Aspen Ridge of Utah Valley | 0.7 mi | Orem, UT | ★★★★★ | 5/5 | |
| Provo Rehabilitation and Nursing | 1.8 mi | Provo, UT | ★☆☆☆☆ | 1/5 | abuseSFF |
| Stonehenge of Orem | 2.4 mi | Orem, UT | ★★★★★ | 5/5 | |
| Cascades at Orchard Park | 2.8 mi | Orem, UT | ★★★★☆ | 4/5 | |
| Mission at Alpine Rehabilitation Center | 6.7 mi | Pleasant Grove, UT | ★★☆☆☆ | 1/5 | abuseSFF |
| Stonehenge of Springville | 7.8 mi | Springville, UT | ★★★★★ | 4/5 | |
| Stonehenge of American Fork | 8.8 mi | American Fork, UT | ★★★★☆ | 4/5 | |
| Monument Healthcare American Fork | 9.6 mi | American Fork, UT | ★★★☆☆ | 2/5 | |
| Spanish Fork Rehabilitation and Nursing | 11.3 mi | Spanish Fork, UT | ★★★☆☆ | 4/5 | |
| Mervyn Sharp Bennion Central Utah Veterans Home | 15.2 mi | Payson, UT | ★★★★★ | 5/5 | |
| Pointe Meadows Health and Rehabilitation | 15.5 mi | Lehi, UT | ★★★★★ | 4/5 | |
| Rocky Mountain Care - Maple Dell | 15.8 mi | Payson, UT | ★★☆☆☆ | 1/5 |
Compare this facility with the 3 closest →
Facility data as of CMS processing date 2026-08-01. CCN 465104.