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

The Orchards at Three Rivers

Three Rivers, MI · 87 certified beds · Last Life Safety survey March 5, 2026

CMS Certification Number 235354 · first certified January 1978

Ownership

Operated by THE ORCHARDS MICHIGAN · For profit - Corporation

  • New ownershipOwnership changed November 1, 2025 (change of ownership)from THREE RIVERS MI OPCO LLC
23
Citations on file
Rolling three-year window
3
Life Safety surveys
In the same window
4
Tags cited more than once
Across separate surveys
12
Inspection & testing records
Of the citations on file

Position within MI

23 citations — more than 79% of the 422 certified nursing homes in MI. Compared within MI 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

Slippingmore citations at the latest survey than at its earlier surveys in the window.

The latest survey found 10 citations; the earlier surveys in the window averaged 6.5. With 3 surveys on file this is a direction of travel, not a conclusion.

When is the next survey likely?

The window opens February 2027 — about 5 months from now. This facility’s last Life Safety survey was March 2026. Facilities in MI are typically surveyed 12–14 months after the last one (median 13), measured over 723 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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Which alerts

3 inspection-and-testing tags have been cited here at more than one survey. Nationally, that pattern is common: about three quarters of cited facilities have at least one repeated tag, and half of the facilities ever cited for sprinkler inspection and testing are cited for it again. A repeat is usually a recordkeeping gap rather than a new hazard.

Emergency preparedness

3 of the 23 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)

14 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 23 Life Safety citations above. The Physical Environment Index

  • F-0584 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.
  • F-0880 Provide and implement an infection prevention and control program.
  • F-0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
  • F-0921 Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.

How that compares

Citations on file over three years

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

This facility23MI median14National median11
Citations on file over three years, compared
MeasureCitations
This facility23
Median facility in MI14
Median facility nationally11

Survey history

Citations at each Life Safety survey
32023-10102024-11102026-03
Citations at each Life Safety survey
Survey dateCitations
October 4, 20233
November 15, 202410
March 5, 202610

Most-cited tags

Most-cited tags at this facility
K-03452K-02112K-03632K-05112K-03241K-09201K-03531K-03721
Most-cited tags at this facility
TagWhat the surveyor checksTimes citedLast cited
K-0345Have approved installation, maintenance and testing program for fire alarm systems.22024-11-15
K-0211Keep aisles, corridors, and exits free of obstruction in case of emergency.22026-03-05
K-0363Install corridor and hallway doors that block smoke.22024-11-15
K-0511Have properly installed electrical wiring and gas equipment.22026-03-05
K-0324Provide properly protected cooking facilities.12026-03-05
K-0920Ensure proper usage of power strips and extension cords.12026-03-05
K-0353Inspect, test, and maintain automatic sprinkler systems.12024-11-15
K-0372Ensure smoke barriers are constructed to a 1 hour fire resistance rating.12023-10-04

What the citations cover

Citations by CMS category
  • Smoke Deficiencies 11
  • Egress Deficiencies 3
  • Emergency Preparedness Deficiencies 3
  • Gas, Vacuum, and Electrical Systems Deficiencies 2
  • Other 4
Citations by CMS category
CategoryCitations
Smoke Deficiencies11
Egress Deficiencies3
Emergency Preparedness Deficiencies3
Gas, Vacuum, and Electrical Systems Deficiencies2
Services Deficiencies2
Construction Deficiencies1
Miscellaneous Deficiencies1

Every citation on file

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

March 5, 2026 — 10 citations

Citations issued on March 5, 2026
TagWhat the surveyor checksStatus
K-0100Meet other general requirements.Deficient, Provider has date of correction (May 5, 2026)
K-0211Keep aisles, corridors, and exits free of obstruction in case of emergency.Deficient, Provider has date of correction (March 30, 2026)
K-0222Add 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.Deficient, Provider has date of correction (March 30, 2026)
K-0324Provide properly protected cooking facilities.Deficient, Provider has date of correction (March 30, 2026)
K-0342Have a complete alarm system manually initiated and initiated by fire sprinkler system connection.Deficient, Provider has date of correction (March 30, 2026)
K-0355Properly select, install, inspect, or maintain portable fire extinguishes.Deficient, Provider has date of correction (March 30, 2026)
K-0371Have properly sized and located compartments to protect residents from smoke.Deficient, Provider has date of correction (March 30, 2026)
K-0511Have properly installed electrical wiring and gas equipment.Deficient, Provider has date of correction (March 30, 2026)
K-0920Ensure proper usage of power strips and extension cords.Deficient, Provider has date of correction (March 30, 2026)
K-0923Have proper medical gas storage and administration areas.Deficient, Provider has date of correction (March 30, 2026)

November 15, 2024 — 10 citations

Citations issued on November 15, 2024
TagWhat the surveyor checksStatus
E-0004Develop and maintain an Emergency Preparedness Program (EP).Deficient, Provider has date of correction (December 13, 2024)
E-0006Conduct risk assessment and an All-Hazards approach.Deficient, Provider has date of correction (December 13, 2024)
E-0039Conduct testing and exercise requirements.Deficient, Provider has date of correction (December 13, 2024)
K-0211Keep aisles, corridors, and exits free of obstruction in case of emergency.Deficient, Provider has date of correction (December 13, 2024)
K-0321Ensure 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 (December 13, 2024)
K-0345Have approved installation, maintenance and testing program for fire alarm systems.Deficient, Provider has date of correction (December 13, 2024)
K-0353Inspect, test, and maintain automatic sprinkler systems.Deficient, Provider has date of correction (December 13, 2024)
K-0363Install corridor and hallway doors that block smoke.Deficient, Provider has date of correction (December 13, 2024)
K-0511Have properly installed electrical wiring and gas equipment.Deficient, Provider has date of correction (December 13, 2024)
K-0712Have simulated fire drills held at unexpected times.Deficient, Provider has date of correction (December 13, 2024)

October 4, 2023 — 3 citations

Citations issued on October 4, 2023
TagWhat the surveyor checksStatus
K-0345Have approved installation, maintenance and testing program for fire alarm systems.Deficient, Provider has date of correction (October 30, 2023)
K-0363Install corridor and hallway doors that block smoke.Deficient, Provider has date of correction (October 30, 2023)
K-0372Ensure smoke barriers are constructed to a 1 hour fire resistance rating.Deficient, Provider has date of correction (October 30, 2023)

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