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

Sapphire Nursing And Rehab At Goshen

Goshen, NY · 24 certified beds · Last Life Safety survey April 16, 2025

CMS Certification Number 335684 · first certified September 1985

Ownership

Operated by SAPPHIRE CARE GROUP · For profit - Individual

  • Ownership changed September 1, 2017 (change of ownership)from ELANT AT GOSHEN, INC.
18
Citations on file
Rolling three-year window
3
Life Safety surveys
In the same window
2
Tags cited more than once
Across separate surveys
7
Inspection & testing records
Of the citations on file

Position within NY

18 citations — more than 68% of the 593 certified nursing homes in NY. Compared within NY 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

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

The latest survey found 5 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 October 2026. This facility’s last Life Safety survey was April 2025. Facilities in NY are typically surveyed 18–25 months after the last one (median 22), measured over 523 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

1 inspection-and-testing tag has 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 18 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)

4 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 18 Life Safety citations above. The Physical Environment Index

  • F-0880 Provide and implement an infection prevention and control program.
  • 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-0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

How that compares

Citations on file over three years

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

This facility18NY median13National median11
Citations on file over three years, compared
MeasureCitations
This facility18
Median facility in NY13
Median facility nationally11

Survey history

Citations at each Life Safety survey
62019-1272023-0252025-04
Citations at each Life Safety survey
Survey dateCitations
December 10, 20196
February 7, 20237
April 16, 20255

Most-cited tags

Most-cited tags at this facility
K-03532K-02812E-00391K-03211K-05211K-03241E-00291K-09181
Most-cited tags at this facility
TagWhat the surveyor checksTimes citedLast cited
K-0353Inspect, test, and maintain automatic sprinkler systems.22025-04-16
K-0281Install proper backup exit lighting.22025-04-16
E-0039Conduct testing and exercise requirements.12023-02-07
K-0321Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.12019-12-10
K-0521Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.12025-04-16
K-0324Provide properly protected cooking facilities.12023-02-07
E-0029Develop a communication plan.12019-12-10
K-0918Have generator or other power source capable of supplying service within 10 seconds.12019-12-10

What the citations cover

Citations by CMS category
  • Egress Deficiencies 6
  • Smoke Deficiencies 6
  • Emergency Preparedness Deficiencies 3
  • Gas, Vacuum, and Electrical Systems Deficiencies 2
  • Other 1
Citations by CMS category
CategoryCitations
Egress Deficiencies6
Smoke Deficiencies6
Emergency Preparedness Deficiencies3
Gas, Vacuum, and Electrical Systems Deficiencies2
Services Deficiencies1

Every citation on file

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

April 16, 2025 — 5 citations

Citations issued on April 16, 2025
TagWhat the surveyor checksStatus
K-0225Have stairways and smokeproof enclosures used as exits that meet safety requirements.Deficient, Provider has date of correction (June 9, 2025)
K-0281Install proper backup exit lighting.Deficient, Provider has date of correction (June 9, 2025)
K-0293Have properly located and lighted "Exit" signs.Deficient, Provider has date of correction (June 9, 2025)
K-0353Inspect, test, and maintain automatic sprinkler systems.Deficient, Provider has date of correction (June 9, 2025)
K-0521Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.Deficient, Provider has date of correction (June 9, 2025)

February 7, 2023 — 7 citations

Citations issued on February 7, 2023
TagWhat the surveyor checksStatus
E-0039Conduct testing and exercise requirements.Deficient, Provider has date of correction (March 24, 2023)
K-0211Keep aisles, corridors, and exits free of obstruction in case of emergency.Deficient, Provider has date of correction (March 24, 2023)
K-0281Install proper backup exit lighting.Deficient, Provider has date of correction (March 24, 2023)
K-0324Provide properly protected cooking facilities.Deficient, Provider has date of correction (March 24, 2023)
K-0353Inspect, test, and maintain automatic sprinkler systems.Deficient, Provider has date of correction (March 24, 2023)
K-0355Properly select, install, inspect, or maintain portable fire extinguishes.Deficient, Provider has date of correction (March 24, 2023)
K-0372Ensure smoke barriers are constructed to a 1 hour fire resistance rating.Deficient, Provider has date of correction (March 24, 2023)

December 10, 2019 — 6 citations

Citations issued on December 10, 2019
TagWhat the surveyor checksStatus
E-0013Develop Emergency Preparedness policies and procedures.Deficient, Provider has date of correction (February 19, 2020)
E-0029Develop a communication plan.Deficient, Provider has date of correction (February 19, 2020)
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 (February 19, 2020)
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 (February 19, 2020)
K-0918Have generator or other power source capable of supplying service within 10 seconds.Deficient, Provider has date of correction (February 19, 2020)
K-0921Ensure that testing and maintenance of electrical equipment is performed.Deficient, Provider has date of correction (February 19, 2020)

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