Windsor Nursing & Retirement Home
265 N Main St, South Yarmouth, MA 02664 · Barnstable County · 120 certified beds · avg 89 residents/day · certified since Jul 1, 1989
Part of chain: INTEGRITUS HEALTHCARE (14 facilities, chain avg rating 2.8★)
What health inspectors found (on-site government inspections — the most independent evidence available)
Health inspection rating: ★★★☆☆3/5 · 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.
Most serious findings (actual harm or immediate jeopardy)
▲ Actual harm, one-off · Oct 12, 2023 · F-0686
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.
Why it matters: Bedsores are painful, can become deeply infected, and in serious cases can be life-threatening.
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: Nov 22, 2023 (Deficient, Provider has date of correction)
All citations in the current public record (24)
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 |
|---|---|---|
| Mar 19, 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. |
| Mar 19, 2026 | E · Potential for harm, repeated | The facility employed staff who were not licensed, certified, or registered as required by state law. |
| Mar 19, 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. |
| Mar 19, 2026 | 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. |
| Mar 19, 2026 | D · Potential for harm, one-off | The facility did not educate residents and staff about COVID-19 vaccination, offer the vaccine to those eligible after that education, or properly document everyone's vaccination status. |
| Mar 19, 2026 | B · Minimal risk, repeated | The facility did not give residents proper notice about what Medicare or Medicaid covers, or about charges the resident might owe for services that aren't covered. |
| Jan 9, 2025 | E · Potential for harm, repeated | The facility did not provide a safe, clean, comfortable, and homelike environment, including safe support for residents' daily living needs. |
| Jan 9, 2025 | E · Potential for harm, repeated | The facility did not help a resident get vision and hearing services — such as eye exams, glasses, hearing tests, or hearing aids. |
| Jan 9, 2025 | E · Potential for harm, repeated | 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. |
| Jan 9, 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. |
| Jan 9, 2025 | E · Potential for harm, repeated | The facility did not protect residents' personal information or did not keep complete, accurate medical records that meet professional standards. |
| Jan 9, 2025 | 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. |
| Jan 9, 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. |
| Jan 9, 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. |
| Oct 12, 2023 | ▲ G · Actual 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. |
| Oct 12, 2023 | E · Potential for harm, repeated | The facility did not honor residents' right to form and take part in resident or family groups, such as a resident council. |
| Oct 12, 2023 | E · Potential for harm, repeated | 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. |
| Oct 12, 2023 | E · Potential for harm, repeated | The facility did not help a resident get vision and hearing services — such as eye exams, glasses, hearing tests, or hearing aids. |
| Oct 12, 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. |
| Oct 12, 2023 | 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. |
| Oct 12, 2023 | D · Potential for harm, one-off | The facility did not provide safe, appropriate care for residents who need dialysis — the treatment that filters the blood when kidneys fail. |
| Oct 12, 2023 | D · Potential for harm, one-off | The facility did not arrange hospice services for a resident who needed them, or help the resident move to a facility that could arrange hospice. Hospice provides comfort-focused care for people nearing the end of life. |
| Oct 12, 2023 | B · Minimal risk, repeated | The facility did not give residents (and their representatives and the ombudsman, a state advocate for residents) proper advance notice before a transfer or discharge, including information about their right to appeal. |
| Oct 12, 2023 | B · Minimal risk, repeated | The facility did not give the resident or their representative written notice of how long it would hold the resident's bed during a hospital stay or approved leave. |
Inspection trend by year
Citations from standard inspections stayed about the same across the last two inspection cycles (8 → 6).
| Year | Citations | Serious (G–L) | Worst severity that year |
|---|---|---|---|
| 2023 | 10 | 1 | G ▲ |
| 2025 | 8 | 0 | E |
| 2026 | 6 | 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)
1 fine totaling $12,386.
| Date | Type | Amount / length |
|---|---|---|
| Oct 12, 2023 | Fine | $12,386 |
Nurse staffing (from payroll records, adjusted for how much care residents need)
| Measure | This facility | Massachusetts avg | U.S. avg | Where it stands |
|---|---|---|---|---|
| Total nurse staffing (hours per resident per day) | 3.78 | 3.89 | 3.95 | top 46% in Massachusetts; top 49% in the U.S. |
| Registered Nurse hours | 0.61 | 0.65 | 0.69 | top 46% in Massachusetts; top 47% in the U.S. |
| Weekend total nurse staffing | 3.23 | 3.51 | 3.50 | bottom 39% in Massachusetts; bottom 44% in the U.S. |
| Weekend RN hours (not acuity-adjusted) | 0.28 | 0.46 | 0.48 | bottom 23% in Massachusetts; bottom 29% in the U.S. |
| Total nursing staff turnover (%) | 37.7 | 38.2 | 45.8 | top 50% in Massachusetts; top 30% in the U.S. |
| RN turnover (%) | 26.7 | 42.6 | 42.9 | top 19% in Massachusetts; top 24% 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 3.91, RN 0.63, weekend 3.34. 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: 1/5 · long-stay residents: 2/5 · short-stay residents: 1/5
Who owns this facility
Non profit - Corporation
| Owner / manager | Type | Role | Stake | Since |
|---|---|---|---|---|
| Fairview Extended Care Services INC | Organization | 5% or Greater Direct Ownership Interest | 100% | 03/29/1990 |
| Integritus Healthcare INC | Organization | 5% or Greater Indirect Ownership Interest | 100% | 02/01/2022 |
| Brewer, Scott | Individual | W-2 Managing Employee | NOT APPLICABLE | 12/22/2021 |
| Gingras, Marcie Jo | Individual | Corporate Officer | NOT APPLICABLE | 12/13/2021 |
| Integritus Healthcare INC | Organization | Operational/Managerial Control | NOT APPLICABLE | 03/26/1990 |
| Integritus Healthcare Management Services INC | Organization | Operational/Managerial Control | NOT APPLICABLE | 02/01/2022 |
| Jones, William | Individual | Corporate Officer | NOT APPLICABLE | 02/01/1993 |
Questions to ask on your visit
Generated from this facility's actual citation record — bring them to a tour and ask the administrator directly.
- "How do you prevent bedsores for residents who can't move themselves, and how often are at-risk residents repositioned?"
- "What did your most recent kitchen inspection find, and can I see how food is stored and prepared?"
- "How do you verify licenses and certifications for every caregiver before they start, and how often do you recheck them?"
- "What is your falls rate, and what specific steps do you take to prevent falls and supervise residents at risk?"
- "How do you monitor residents' weight and eating, and what happens when someone starts losing weight?"
- "How do you handle COVID-19 vaccination for residents and staff, and what happens during an outbreak?"
- "Before any service that isn't covered by Medicare or Medicaid, how will you notify us and get our agreement?"
- "Can we tour the resident rooms, bathrooms, and common areas today, including areas not on the usual tour route?"
- "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 |
|---|---|---|---|---|---|
| Mayflower Place Nursing & Rehabilitation Center | 4.1 mi | West Yarmouth, MA | ★★★☆☆ | 3/5 | |
| Regalcare at Harwich | 5.2 mi | Harwich, MA | ★★★☆☆ | 3/5 | |
| Pavilion , the | 7.3 mi | Hyannis, MA | ★★★★★ | 5/5 | |
| Cape Regency Rehabilitation & Health Care Center | 8.4 mi | Centerville, MA | ★☆☆☆☆ | 1/5 | |
| Cape Cod Post Acute Care | 10.1 mi | Brewster, MA | ★☆☆☆☆ | 1/5 | |
| Liberty Commons | 11.2 mi | North Chatham, MA | ★★★☆☆ | 2/5 | |
| Royal of Cotuit | 15.2 mi | Mashpee, MA | ★★☆☆☆ | 2/5 | |
| Cape Heritage Rehabilitation & Health Care Center | 18.1 mi | Sandwich, MA | ★★☆☆☆ | 2/5 |
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Facility data as of CMS processing date 2026-08-01. CCN 225349.