Federal nursing home survey record · CMS-certified nursing home· Not a state assisted-living licensing record

PROVIDENCE KODIAK ISLAND MED LTC

KODIAK, AK · 22 certified beds · Last Life Safety survey December 5, 2025

CMS Certification Number 025030 · first certified September 1994

Ownership

Independently operated (no chain recorded by CMS) · Non profit - Corporation

No change of ownership on CMS record since January 1, 2016, when the records begin.

15
Citations on file
Rolling three-year window
3
Life Safety surveys
In the same window
0
Tags cited more than once
Across separate surveys
4
Inspection & testing records
Of the citations on file

Position within AK

15 citations — more than 47% of the 20 certified nursing homes in AK. Compared within AK rather than nationally because which state a facility is in explains about 30% of the variation in citation counts between facilities, while bed count explains under 1%. State survey agencies differ far more than the buildings do. How this is calculated

Holding steadyabout the same at the latest survey as at its earlier surveys in the window.

The latest survey found 5 citations; the earlier surveys in the window averaged 5. With 3 surveys on file this is a direction of travel, not a conclusion.

When is the next survey likely?

The window opens December 2026 — about 3 months from now. This facility’s last Life Safety survey was December 2025. Nursing homes nationally are typically surveyed 12–17 months after the last one (median 14), measured over 19,385 consecutive surveys in the last two years of CMS records. AK has too few recent surveys to measure on its own, so the national interval is used.

A range the record supports, not a prediction of a date. State agencies vary widely — from about 11 months in Pennsylvania to three years in Maryland. How the window is measured

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Which alerts

Emergency preparedness

6 of the 15 citations on file are Emergency Preparedness E-tags. E-tags are cited under 42 CFR §483.73 and concern the emergency plan, training, drills, communications and supplies. Nationally about half of certified facilities have at least one. The Emergency Preparedness Index

Physical environment (health survey)

2 physical-environment citations on the health survey. Cited by the health surveyors under Appendix PP, not the Life Safety Code surveyor: equipment in safe operating condition, the call system, bed rails, pest control, hazards, the environment. Counted separately from the 15 Life Safety citations above. The Physical Environment Index

  • F-0880 Provide and implement an infection prevention and control program.
  • F-0908 Keep all essential equipment working safely.

How that compares

Citations on file over three years

Compared with the median facility in AK, and nationally. Surveyors differ markedly between states, so the AK figure is the meaningful one.

This facility15AK median16National median11
Citations on file over three years, compared
MeasureCitations
This facility15
Median facility in AK16
Median facility nationally11

Survey history

Citations at each Life Safety survey
72023-0932024-1152025-12
Citations at each Life Safety survey
Survey dateCitations
September 22, 20237
November 22, 20243
December 5, 20255

Most-cited tags

Most-cited tags at this facility
K-09211E-00061E-00391E-00301K-03001E-00071K-03531K-09201
Most-cited tags at this facility
TagWhat the surveyor checksTimes citedLast cited
K-0921Ensure that testing and maintenance of electrical equipment is performed.12025-12-05
E-0006Conduct risk assessment and an All-Hazards approach.12023-09-22
E-0039Conduct testing and exercise requirements.12023-09-22
E-0030List the names and contact information of those in the facility.12023-09-22
K-0300Meet other general requirements that are deficient.12025-12-05
E-0007Address patient/client population and determine types of services needed.12023-09-22
K-0353Inspect, test, and maintain automatic sprinkler systems.12023-09-22
K-0920Ensure proper usage of power strips and extension cords.12024-11-22

What the citations cover

Citations by CMS category
  • Emergency Preparedness Deficiencies 6
  • Gas, Vacuum, and Electrical Systems Deficiencies 4
  • Smoke Deficiencies 3
  • Miscellaneous Deficiencies 1
  • Other 1
Citations by CMS category
CategoryCitations
Emergency Preparedness Deficiencies6
Gas, Vacuum, and Electrical Systems Deficiencies4
Smoke Deficiencies3
Miscellaneous Deficiencies1
Egress Deficiencies1

Every citation on file

As published by CMS, newest survey first. Descriptions are CMS’s own wording.

December 5, 2025 — 5 citations

Citations issued on December 5, 2025
TagWhat the surveyor checksStatus
E-0015Address subsistence needs for staff and patients.Deficient, Provider has date of correction (January 19, 2026)
K-0300Meet other general requirements that are deficient.Deficient, Provider has date of correction (January 19, 2026)
K-0712Have simulated fire drills held at unexpected times.Deficient, Provider has date of correction (January 19, 2026)
K-0921Ensure that testing and maintenance of electrical equipment is performed.Deficient, Provider has date of correction (January 19, 2026)
K-0923Have proper medical gas storage and administration areas.Deficient, Provider has date of correction (January 19, 2026)

November 22, 2024 — 3 citations

Citations issued on November 22, 2024
TagWhat the surveyor checksStatus
K-0345Have approved installation, maintenance and testing program for fire alarm systems.Deficient, Provider has date of correction (January 5, 2025)
K-0351Install an approved automatic sprinkler system.Deficient, Provider has date of correction (January 5, 2025)
K-0920Ensure proper usage of power strips and extension cords.Deficient, Provider has date of correction (January 5, 2025)

September 22, 2023 — 7 citations

Citations issued on September 22, 2023
TagWhat the surveyor checksStatus
E-0006Conduct risk assessment and an All-Hazards approach.Deficient, Provider has date of correction (December 13, 2023)
E-0007Address patient/client population and determine types of services needed.Deficient, Provider has date of correction (December 13, 2023)
E-0026Establish roles under a Waiver declared by secretary.Deficient, Provider has date of correction (December 13, 2023)
E-0030List the names and contact information of those in the facility.Deficient, Provider has date of correction (December 13, 2023)
E-0039Conduct testing and exercise requirements.Deficient, Provider has date of correction (December 13, 2023)
K-0353Inspect, test, and maintain automatic sprinkler systems.Deficient, Provider has date of correction (December 13, 2023)
K-0926Ensure that personnel concerned with handling of medical gases and cylinders are trained on the risk.Deficient, Provider has date of correction (December 13, 2023)

Reflects the CMS posting of August 1, 2026. Surveys conducted in the last few months may not appear yet.