The Mulberry at Waverly
Below-average Medicare ratings — review the inspection history and ask the administrator about recent corrections before visiting.
based on 36 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 (12 vs median 5)
- High staff turnover (84%)
- High RN turnover (67%)
Bottom 25% in NE · Below recommended RN staffing · Very high staff turnover · Worst in AVID HEALTHCARE GROUP chain · $25,642 in fines
What this means for your family
While some families report positive experiences with the facility's recent leadership and activities, the recurring, serious allegations regarding medical neglect and administrative unresponsiveness are a major red flag. If you are considering this facility, we strongly recommend conducting an unannounced visit and specifically asking how they handle medical emergencies and family communication concerns.
Google Reviews
Google Reviews
36 reviews on Google“The Mulberry at Waverly receives highly polarized reviews, with recent feedback highlighting a significant divide between those who praise the facility's cleanliness and staff engagement and those who report severe neglect. While some families describe a caring, communicative environment, others allege critical failures in medical care, including medication errors, poor wound management, and unresponsiveness from administration. Prospective families should be aware of these extreme inconsistencies in care quality.”
Quality Themes
Tap a score for detailsStrengths
- Clean, well-maintained facility
- Engaging community activities and events
- Attentive and compassionate nursing staff (reported by some)
- Improved leadership and organization
Concerns
- Neglect and poor medical care (medication errors, hygiene, wound care) (mentioned by 6 reviewers)
- Unresponsive or rude administration and communication (mentioned by 5 reviewers)
- Staffing issues (inattentiveness, unprofessionalism) (mentioned by 4 reviewers)
Rating Trends
Tap a year to see what changed
Distribution · 38 analyzed
How They Respond to Reviews
Questions for Your Tour
- 1Given the recent focus on facility improvements, what specific changes have been implemented to ensure consistent medication management and timely administration?
- 2I noticed the facility has a very active social calendar; could you walk me through how you encourage residents to participate in these daily activities?
- 3How does your leadership team ensure that communication with families remains proactive and transparent regarding any changes in a resident's health status?
- 4With the current staffing levels, what protocols are in place to ensure that residents receive prompt assistance with daily hygiene and wound care needs?
- 5How do you handle medical emergencies or urgent health concerns after hours to ensure residents receive immediate and appropriate care?
- 6I appreciate that the facility is well-maintained; what steps are you taking to ensure that the quality of clinical oversight matches the high standard of the physical environment?
Personalized based on this facility's data
Key Review Excerpts
“I’ve been coming into The Mulberry as a community partner for some time, and I’ve seen a huge improvement in how the facility is run since the change in leadership. The staff is more organized, welcoming, and engaged with residents and visitors.”
“My mom was here and received horrible care. It took them weeks to get lab work , ua , no follow through with recommendations. Therapy was terrible when she was doing rehab . She became wheelchair bound . I’m the one that found her necrotic, cellulitic foot that went septic because it wasn’t caught soon enough .”
“The nurses neglect your love ones. The nurses don't give correct/forget to give medications. Let your love one sit in soiled clothes. The nurses refuse to feed your love one correctly, when your love one relies on the nurses to feed them.”
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
4
measures
8
measures
5
measures
Residents on antipsychotic medication
Residents vaccinated for the flu
Residents on anti-anxiety or sleep medication
Residents whose walking got worse
Residents needing more daily help over time
Residents with depression symptoms
Highly dependent on how each facility screens and codes depressive symptoms, so it varies widely between facilities.
Short-stay residents vaccinated for the flu
Short-stay residents vaccinated for pneumonia
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 that triggered inspections, revealing concerning patterns in medication errors, treatment care, and safety hazards that persist across surveys. The facility has shown recurring problems with medication management, resident care according to treatment orders, and accident prevention, with some issues like medication errors appearing as recently as 2025. While all deficiencies were reportedly corrected, the repeated nature of complaints and similar violations suggests ongoing challenges with care quality and safety oversight.
Jun 24, 2025Complaint1
Pharmacy Service Deficiencies
Ensure that residents are free from significant medication errors.
Apr 8, 2025Complaint2
Environmental Deficiencies
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
Dec 5, 2024Routine20
Nursing and Physician Services Deficiencies
Post nurse staffing information every day.
Emergency Preparedness Deficiencies
Implement emergency and standby power systems.
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
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Smoke Deficiencies
Provide properly protected cooking facilities.
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Smoke Deficiencies
Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours.
Smoke Deficiencies
Install smoke barrier doors that can resist smoke for at least 20 minutes.
Miscellaneous Deficiencies
Provide a written emergency evacuation plan.
Gas, Vacuum, and Electrical Systems Deficiencies
Have generator or other power source capable of supplying service within 10 seconds.
Gas, Vacuum, and Electrical Systems Deficiencies
Meet requirements for the use of electrical equipment.
Gas, Vacuum, and Electrical Systems Deficiencies
Ensure that testing and maintenance of electrical equipment is performed.
Smoke Deficiencies
Install corridor and hallway doors that block smoke.
Gas, Vacuum, and Electrical Systems Deficiencies
Ensure proper usage of power strips and extension cords.
Gas, Vacuum, and Electrical Systems Deficiencies
Meet requirements for the use and maintenance of medical gas equipment.
Gas, Vacuum, and Electrical Systems Deficiencies
Have proper medical gas storage and administration areas.
Resident Assessment and Care Planning Deficiencies
Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Dec 5, 2024Complaint6
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
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.
Pharmacy Service Deficiencies
Ensure medication error rates are not 5 percent or greater.
Pharmacy Service Deficiencies
Ensure that residents are free from significant medication errors.
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
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Aug 28, 2024Complaint2
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Nursing and Physician Services Deficiencies
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
Aug 8, 2024Complaint2
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Quality of Life and Care Deficiencies
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Federal Penalties
Payment Denial
Dec 5, 2024
26-day denial
Fine
Jun 17, 2024
$9,805
Fine
Dec 12, 2023
$15,837
Ownership & Operations
Who Operates This Facility
The Mulberry at Waverly
for profit
Chain Affiliation
Avid Healthcare Group
11 facilities nationwide
Chain avg rating: 1.5/5 · Rank 8 of 10 (Worst)
Ownership & Management
Owners
Douro Valley Investment, LLC
Owner · Organization
Ne 11 Holdings Opco LLC
Owner · Organization
Brass Ne Trust
Owner (parent company) · Organization
Bsd Beis Health Trust
Owner (parent company) · Organization
Copper Ne Trust
Owner (parent company) · Organization
Gold Ne Trust
Owner (parent company) · Organization
Ne Snf Holdings LLC
Owner (parent company) · Organization
Sf 4140 Olde Washington Boulevard Real Property LLC
Owner (parent company) · Organization
Silver Ne Trust
Owner (parent company) · Organization
Tulip Investments Ne LLC
Owner (parent company) · Organization
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
36 reviews from families & visitors
Official Website
Visit avidhcg.com
Medicare data downloads
Original nursing home datasets
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