Oakwood Care and Rehabilitation
Below-average Medicare ratings — review the inspection history and ask the administrator about recent corrections before visiting.
based on 51 Google reviews

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Quality Concerns Identified
Medicare inspection and quality data reveal areas that families should carefully evaluate before choosing this facility.
- Low overall rating (1/5 stars)
- Above-median deficiencies (13 vs median 7)
Bottom 25% in CO · Below recommended RN staffing · Worst in THE ENSIGN GROUP chain · $235,923 in fines
What this means for your family
Oakwood is highly regarded for its compassionate staff and welcoming environment, making it a strong contender for those prioritizing social engagement. However, families should conduct a thorough walkthrough of the specific wing their loved one will occupy to assess the reported issues with facility odors.
Google Reviews
Google Reviews
51 reviews on Google“Oakwood Care and Rehabilitation is frequently praised for its friendly, welcoming staff and clean, well-appointed interior spaces. While many families express high satisfaction with the care provided to their loved ones, there are recurring reports of a persistent, strong odor of urine in the hallways. Families considering this facility should weigh the positive, compassionate staff culture against these specific environmental concerns.”
Quality Themes
Tap a score for detailsStrengths
- Friendly and welcoming staff
- Clean and well-appointed interior
- Helpful and attentive front desk
- Strong sense of community and resident engagement
Concerns
- Persistent, strong odor of urine in hallways (mentioned by 2 reviewers)
Rating Trends
Tap a year to see what changed
Distribution · 46 analyzed
How They Respond to Reviews
This facility rarely responds to reviews.
Questions for Your Tour
- 1We've heard wonderful things about how welcoming and friendly the front desk and staff are; how do you foster that sense of community among the residents?
- 2With the recent health inspections, what specific steps has the facility taken to address and resolve the identified deficiencies?
- 3How does the housekeeping team manage cleanliness and air quality in the hallways to ensure a fresh environment for everyone?
- 4Can you tell us more about the daily activities and social engagement programs available to keep residents active and involved?
- 5What is the protocol for handling medical emergencies or urgent care needs during the overnight hours?
- 6Since the staff is often described as very attentive, how do you ensure that care remains consistent even during shift changes?
Personalized based on this facility's data
Key Review Excerpts
“The building is clean and the staff is friendly. It is an environment that feels inviting, the staff stop to welcome you and offer assistance and the residents are engaged in fun activities.”
“Mom has dementia, good and bad days, but the staff love her. I'm glad she's there for now.”
“The people at Oakwood were very, very nice, no complaints there. But the stench of urine was really bad, I have a good walk to get to my brother’s room and I smelled it really strong all the way down the halls.”
Staffing
Staffing Hours
per resident/day · Medicare 2026Both RN and total nursing hours are below national benchmarks. This can mean less clinical attention per resident, so ask about their staffing plan.
Quality Measures
Quality Measures
Resident outcomes compared with national, state, and local averages · 17 measures
6
measures
10
measures
1
measures
Residents with depression symptoms
Highly dependent on how each facility screens and codes depressive symptoms, so it varies widely between facilities.
Residents needing more daily help over time
Residents whose bladder or bowel control got worse
Residents vaccinated for pneumonia
Residents on anti-anxiety or sleep medication
Residents whose walking got worse
Short-stay residents vaccinated for pneumonia
Short-stay residents vaccinated for the flu
Short-stay residents newly given antipsychotics
US average from Medicare published data
Inspection History
Medicare Inspection History
3-year lookback · Medicare 2026
Families have repeatedly filed complaints triggering 41 out of 115 deficiencies, with serious concerns about resident protection from abuse and neglect appearing across multiple surveys. Issues consistently involve neglect protection, infection control, and medication management, along with recurring problems with food safety and resident rights. While the facility corrects violations when cited, the pattern of repeated complaints about fundamental safety protections suggests ongoing challenges in maintaining consistent care standards.
Feb 26, 2026Complaint6
Administration Deficiencies
Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Quality of Life and Care Deficiencies
Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia.
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation.
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Respond appropriately to all alleged violations.
Quality of Life and Care Deficiencies
Provide care and assistance to perform activities of daily living for any resident who is unable.
Dec 18, 2025Complaint4
Resident Rights Deficiencies
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
Resident Rights Deficiencies
Allow resident to participate in the development and implementation of his or her person-centered plan of care.
Resident Rights Deficiencies
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Resident Assessment and Care Planning Deficiencies
Ensure services provided by the nursing facility meet professional standards of quality.
Sep 11, 2025Routine18
Construction Deficiencies
Use approved construction type or materials.
Egress Deficiencies
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
Egress Deficiencies
Install emergency lighting that can last at least 1 1/2 hours.
Smoke Deficiencies
Have approved installation, maintenance and testing program for fire alarm systems.
Smoke Deficiencies
Properly select, install, inspect, or maintain portable fire extinguishes.
Services Deficiencies
Install properly constructed and protected linen or trash chutes.
Miscellaneous Deficiencies
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
Gas, Vacuum, and Electrical Systems Deficiencies
Have generator or other power source capable of supplying service within 10 seconds.
Egress Deficiencies
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Egress Deficiencies
Provide at least two remote exits on each floor or fire section of the building.
Smoke Deficiencies
Provide properly protected cooking facilities.
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Smoke Deficiencies
Install corridor and hallway doors that block smoke.
Gas, Vacuum, and Electrical Systems Deficiencies
Have proper fire barriers, ventilation and signs for the transfilling of oxygen.
Quality of Life and Care Deficiencies
Provide care and assistance to perform activities of daily living for any resident who is unable.
Quality of Life and Care Deficiencies
Provide activities to meet all resident's needs.
Nursing and Physician Services Deficiencies
Observe each nurse aide's job performance and give regular training.
Nursing and Physician Services Deficiencies
Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.
Sep 11, 2025Complaint2
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Jun 12, 2025Complaint3
Resident Rights Deficiencies
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Resident Rights Deficiencies
Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
Pharmacy Service Deficiencies
Ensure that residents are free from significant medication errors.
Jan 29, 2025Complaint6
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Nutrition and Dietary Deficiencies
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Quality of Life and Care Deficiencies
Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia.
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Federal Penalties
Fine
Jan 29, 2025
$53,151
Payment Denial
Jan 29, 2025
8-day denial
Fine
Apr 10, 2024
$52,416
Fine
Oct 9, 2023
$111,704
Payment Denial
Oct 9, 2023
21-day denial
Ownership & Operations
Who Operates This Facility
Oakwood Care and Rehabilitation
for profit
Chain Affiliation
The Ensign Group
342 facilities nationwide
Chain avg rating: 3.2/5 · Rank 314 of 328 (Worst)
Ownership & Management
Owners
Port, Barry
Individual is an Owner, Partner or Trustee of Any Adp of the Snf
Key personnel
Contact
Get in Touch
Contact this facility directly and verify the details that matter most to your family.
References & Resources
Medicare Care Compare
Official Medicare quality ratings, inspections & staffing data
Google Maps
Photos, directions & neighborhood info
Google Reviews
51 reviews from families & visitors
Official Website
Visit oakwoodcareandrehab.com
Medicare data downloads
Original nursing home datasets
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