The Waterview Shores LLC

Name: The Waterview Shores LLC
Address: 402 - 13TH AVENUE, Two Harbors, MN, 55616, US
Telephone: 2188348437

402 - 13th Avenue, Two Harbors, MN 55616 · Lake County · 44 certified beds · avg 36 residents/day · certified since May 1, 1987

Part of chain: MONARCH HEALTHCARE MANAGEMENT (45 facilities, chain avg rating 2.2★)

1/5

Health inspection rating (on-site)

Serious findings on record

$334,488

Fines, last 3 years

3.90

Nurse hours/resident/day (adjusted)

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, one-off · May 4, 2026 · F-0760 · triggered by a complaint

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.

Why it matters: A serious medication error can cause real harm, hospitalization, or worse.

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: May 1, 2026 (Deficient, Provider has date of correction)

▲ Actual harm, one-off · Sep 11, 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 (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, 2025 (Past Non-Compliance)

All citations in the current public record (26)

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 4, 2026	▲ J · Immediate jeopardy, 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
May 4, 2026	D · Potential for harm, one-off	The facility did not provide pharmacy services that meet each resident's needs, or did not employ or contract with a licensed pharmacist. · from a complaint
Sep 11, 2025	▲ 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
Aug 22, 2025	E · Potential for harm, repeated	The facility did not treat residents with dignity and respect, or did not honor their rights to make their own decisions and communicate freely. This is one of the most fundamental resident rights. · from a complaint
Jun 5, 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.
Jun 5, 2025	F · Potential for harm, facility-wide	The facility did not electronically submit complete and accurate staffing information to the government, based on payroll and other verifiable records.
Jun 5, 2025	F · Potential for harm, facility-wide	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 accurately assess a resident's health and needs. Assessments are the foundation for all the care a resident receives.
Jun 5, 2025	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.
Jun 5, 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.
Nov 6, 2024	D · Potential for harm, one-off	The facility did not treat residents with dignity and respect, or did not honor their rights to make their own decisions and communicate freely. This is one of the most fundamental resident rights. · from a complaint
Nov 6, 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. · from a complaint
Apr 25, 2024	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.
Apr 25, 2024	D · Potential for harm, one-off	The facility did not allow residents to take their own medications when a clinical review showed they could do so safely. Residents have this right if their care team determines it's appropriate.
Apr 25, 2024	D · Potential for harm, one-off	The facility did not keep residents' personal and medical information private and confidential.
Apr 25, 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.
Apr 25, 2024	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.
Apr 25, 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.
Apr 25, 2024	D · Potential for harm, one-off	The facility did not have a working call system — the button or cord residents use to summon help — in each resident's bathroom and bathing area.
Jan 25, 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 27, 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 27, 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.
Jul 27, 2023	D · Potential for harm, one-off	The facility did not provide proper care for pressure ulcers (bedsores) or did not do enough to prevent new ones from forming. Bedsores develop when residents stay in one position too long without help moving.
Jul 27, 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 27, 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 27, 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.

Inspection trend by year

Citations from standard inspections stayed about the same across the last two inspection cycles (7 → 6).

Year	Citations	Serious (G–L)	Worst severity that year
2023	6	0	D
2024	10	0	E
2025	8	1	G ▲
2026	2	1	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)

1 fine totaling $334,488.

Date	Type	Amount / length
May 4, 2026	Fine	$334,488

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

Measure	This facility	Minnesota avg	U.S. avg	Where it stands
Total nurse staffing (hours per resident per day)	3.90	4.83	3.95	bottom 12% in Minnesota; top 44% in the U.S.
Registered Nurse hours	0.88	1.22	0.69	bottom 19% in Minnesota; top 22% in the U.S.
Weekend total nurse staffing	3.43	4.27	3.50	bottom 11% in Minnesota; top 46% in the U.S.
Weekend RN hours (not acuity-adjusted)	0.64	0.69	0.48	top 45% in Minnesota; top 20% in the U.S.
Total nursing staff turnover (%)	64.4	42.2	45.8	bottom 8% in Minnesota; bottom 11% in the U.S.
RN turnover (%)	55.6	38.6	42.9	bottom 21% in Minnesota; bottom 28% 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 3.32, RN 0.74, weekend 2.91. 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: 4/5 · long-stay residents: 4/5 · short-stay residents: —/5

Who owns this facility

For profit - Limited Liability company

Owner / manager	Type	Role	Stake	Since
Halpert, Marc	Individual	5% or Greater Indirect Ownership Interest	30%	06/01/2019
Jaffa, Noam	Individual	5% or Greater Indirect Ownership Interest	10%	06/01/2019
Jca Holdings LLC	Organization	5% or Greater Indirect Ownership Interest	10%	06/01/2019
Legum, Joshua	Individual	5% or Greater Indirect Ownership Interest	30%	06/01/2019
Nij LLC	Organization	5% or Greater Direct Ownership Interest	10%	06/01/2019
Spartan Healthcare LLC	Organization	5% or Greater Direct Ownership Interest	30%	06/01/2019
Stern, William	Individual	5% or Greater Indirect Ownership Interest	20%	06/01/2019
WBS Holdings LLC	Organization	5% or Greater Direct Ownership Interest	20%	06/01/2019
Yazoma Holdings, LLC	Organization	5% or Greater Direct Ownership Interest	30%	06/01/2019
Halpert, Marc	Individual	Corporate Officer	NOT APPLICABLE	06/01/2019
Jaffa, Noam	Individual	Corporate Director	NOT APPLICABLE	06/01/2019
Legum, Joshua	Individual	Contracted Managing Employee	NOT APPLICABLE	06/01/2019
Monarch Healthcare Operating VIII LLC	Organization	Operational/Managerial Control	NOT APPLICABLE	06/01/2019
Stern, William	Individual	Corporate Officer	NOT APPLICABLE	06/01/2019

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 systems do you use to prevent medication errors, and what happens when one occurs?"
"Can you show me an example care plan, and how are families included when it's created and updated?"
"How does your pharmacist review residents' medications, and how quickly can you fill new or urgent prescriptions?"
"Can you give me examples of how your staff protect residents' dignity in everyday care, like bathing and dressing?"
"What did your most recent kitchen inspection find, and can I see how food is stored and prepared?"
"How do your actual daily staffing levels compare to what's reported on Medicare's Care Compare website?"
"Who leads your infection prevention program, and how do you make sure staff follow practices like hand hygiene every day?"
"Who completes resident assessments here, and how do you check them for accuracy?"
"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
Ecumen Lakeshore	22.8 mi	Duluth, MN	★★★★★	5/5
Aftenro Home	25.0 mi	Duluth, MN	★☆☆☆☆	1/5
Benedictine Health Center	25.4 mi	Duluth, MN	★☆☆☆☆	1/5	abuse
Hilltop Healthcare Rehabilitation and Skilled Nurs	26.1 mi	Duluth, MN	★★☆☆☆	2/5
Minnesota Veterans Home Silver Bay	26.5 mi	Silver Bay, MN	★★★★☆	4/5
Bayshore Residence and Rehabilitation Center	26.9 mi	Duluth, MN	★★☆☆☆	2/5
Franciscan Health Center	27.4 mi	Duluth, MN	★☆☆☆☆	2/5
Viewcrest Health Center	28.9 mi	Duluth, MN	★★★☆☆	3/5
Villa Marina Health and Rehabilitation Center	29.7 mi	Superior, WI	★★★★☆	3/5
Dove Healthcare - Superior	30.9 mi	Superior, WI	★★☆☆☆	2/5
Twin Ports Health Services	31.0 mi	Superior, WI	★★★★★	4/5
The North Shore Estates LLC	32.8 mi	Duluth, MN	★★☆☆☆	2/5

Compare this facility with the 3 closest →

All facilities in Two Harbors →

Facility data as of CMS processing date 2026-08-01. CCN 245471.

The Care File

Visit checklist — The Waterview Shores LLC

402 - 13th Avenue, Two Harbors, MN 55616 · 2188348437

Health inspection rating 1/5 · CMS overall 1/5· Fines (3y): $334,488

Most serious findings on record:

▲ May 4, 2026 (F-0760, Immediate jeopardy, 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.
▲ Sep 11, 2025 (F-0656, 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.

Questions for the administrator:

☐ "What systems do you use to prevent medication errors, and what happens when one occurs?"
☐ "Can you show me an example care plan, and how are families included when it's created and updated?"
☐ "How does your pharmacist review residents' medications, and how quickly can you fill new or urgent prescriptions?"
☐ "Can you give me examples of how your staff protect residents' dignity in everyday care, like bathing and dressing?"
☐ "What did your most recent kitchen inspection find, and can I see how food is stored and prepared?"
☐ "How do your actual daily staffing levels compare to what's reported on Medicare's Care Compare website?"
☐ "Who leads your infection prevention program, and how do you make sure staff follow practices like hand hygiene every day?"
☐ "Who completes resident assessments here, and how do you check them for accuracy?"
☐ "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 245471 · Verify at medicare.gov/care-compare · Printed from The Care File (thecarefile.com)