Federal nursing home survey record · CMS-certified nursing home· Not a state assisted-living licensing record
ENCORE AT WILMINGTON
WILMINGTON, DE · 82 certified beds · Last Life Safety survey July 2, 2024
CMS Certification Number 085031 · first certified May 1986
Ownership
Independently operated (no chain recorded by CMS) · For profit - Corporation
- Ownership changed January 1, 2020 (change of ownership)to SHIPLEY LIVING from FS TENANT POOL I TRUST
Position within DE
6 citations — more than 77% of the 44 certified nursing homes in DE. Compared within DE 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
The latest survey found 5 citations; the earlier surveys in the window averaged 0.5. With 3 surveys on file this is a direction of travel, not a conclusion.
When is the next survey likely?
Well past the typical window (June 2025 to August 2025), and past the point by which nine in ten DE facilities have been surveyed. This facility’s last Life Safety survey was July 2024. Facilities in DE are typically surveyed 12–13 months after the last one (median 12), measured over 54 consecutive surveys in the last two years of CMS records.
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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Emergency preparedness
1 of the 6 citations on file is 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)
6 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 6 Life Safety citations above. The Physical Environment Index
How that compares
Compared with the median facility in DE, and nationally. Surveyors differ markedly between states, so the DE figure is the meaningful one.
| Measure | Citations |
|---|---|
| This facility | 6 |
| Median facility in DE | 2 |
| Median facility nationally | 11 |
Survey history
| Survey date | Citations |
|---|---|
| November 1, 2019 | 0 |
| January 26, 2023 | 1 |
| July 2, 2024 | 5 |
Most-cited tags
| Tag | What the surveyor checks | Times cited | Last cited |
|---|---|---|---|
| K-0321 | Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system. | 1 | 2024-07-02 |
| K-0131 | Meet requirements for sections of health care facilities separated by fire resistive construction. | 1 | 2024-07-02 |
| K-0161 | Use approved construction type or materials. | 1 | 2023-01-26 |
| K-0353 | Inspect, test, and maintain automatic sprinkler systems. | 1 | 2024-07-02 |
| E-0037 | Establish staff and initial training requirements. | 1 | 2024-07-02 |
| K-0372 | Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | 1 | 2024-07-02 |
What the citations cover
- Smoke Deficiencies 3
- Construction Deficiencies 2
- Emergency Preparedness Deficiencies 1
| Category | Citations |
|---|---|
| Smoke Deficiencies | 3 |
| Construction Deficiencies | 2 |
| Emergency Preparedness Deficiencies | 1 |
Every citation on file
As published by CMS, newest survey first. Descriptions are CMS’s own wording.
July 2, 2024 — 5 citations
| Tag | What the surveyor checks | Status |
|---|---|---|
| E-0037 | Establish staff and initial training requirements. | Deficient, Provider has date of correction (August 9, 2024) |
| K-0131 | Meet requirements for sections of health care facilities separated by fire resistive construction. | Deficient, Provider has date of correction (September 17, 2024) |
| K-0321 | Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system. | Deficient, Provider has date of correction (September 17, 2024) |
| K-0353 | Inspect, test, and maintain automatic sprinkler systems. | Deficient, Provider has date of correction (September 17, 2024) |
| K-0372 | Ensure smoke barriers are constructed to a 1 hour fire resistance rating. | Deficient, Provider has date of correction (September 17, 2024) |
January 26, 2023 — 1 citation
| Tag | What the surveyor checks | Status |
|---|---|---|
| K-0161 | Use approved construction type or materials. | Deficient, Provider has date of correction (March 2, 2023) |
Reflects the CMS posting of August 1, 2026. Surveys conducted in the last few months may not appear yet.