What is the overall CMS rating of COVENANT SHORES HEALTH CENTER?

COVENANT SHORES HEALTH CENTER has a 3-star overall rating from CMS, based on health inspections, staffing, and quality measures.

How many deficiency citations does COVENANT SHORES HEALTH CENTER have?

COVENANT SHORES HEALTH CENTER has 40 health inspection citations recorded across the most recent three CMS inspection cycles. 1 are classified as "immediate jeopardy" (the most serious CMS severity level).

Has COVENANT SHORES HEALTH CENTER been fined by CMS?

COVENANT SHORES HEALTH CENTER has accumulated $190,005 in CMS fines across 1 separate penalties in the current three-year window.

Who owns COVENANT SHORES HEALTH CENTER?

COVENANT SHORES HEALTH CENTER is affiliated with the COVENANT LIVING chain, which operates 15 facilities nationally. See the facility's ownership section for the full CMS Form 855A ownership disclosure.

Starfile / Washington

COVENANT SHORES HEALTH CENTER

9107 FORTUNA DRIVE, MERCER ISLAND, WA 98040 · CCN 505504

Ratings

Overall: ★★★☆☆ 3
Health inspection: ★★★☆☆ 3
Quality measures: ★★★★☆ 4
Staffing: ★★★★☆ 4

Facility

Ownership type: For profit - Corporation
Certified beds: 43
Avg residents/day: 37.9
Phone: 2063168042

Inspection history vs Washington & national averages

Cycle 1 is the most recent standard health inspection. Lower total deficiency counts are better.

Cycle	Inspection date	This facility	Washington avg	National avg	vs state
1	2024-12-16	9	17.0	9.5	-8.0 better
2	2023-09-01	15	17.2	9.8	-2.2 better
3	2022-06-24	16	15.5	9.3	+0.5 worse

Cycle 1 deficiencies by category

Category	Deficiencies
Abuse, neglect, exploitation	1
Quality of life and care	1
Resident assessment and care planning	2
Resident rights	4
Pharmacy service	1

Staffing (hours per resident per day)

Metric	This facility	Turnover
Total nurse staffing (reported)	4.22	46.4%
RN staffing (reported)	1.39	29.4%
Total nurse staffing (adjusted)	4.08	—

Fines & penalties

Total fines: $190,005
Number of fines: 1
Number of penalties: 1
Payment denials: 0

Chain

Chain: COVENANT LIVING
Facilities in chain: 15
Chain avg overall: 4.30 / 5

Inspection citations (40)1 immediate jeopardy

DF0552Ensure that residents are fully informed and understand their health status, care and treatments.2024-12-16 · Health · corrected 2025-01-17
Potential for more than minimal harm
DF0554Allow residents to self-administer drugs if determined clinically appropriate.2024-12-16 · Health · corrected 2025-01-17
Potential for more than minimal harm
DF0578Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.2024-12-16 · Health · corrected 2025-01-17
Potential for more than minimal harm
DF0610Respond appropriately to all alleged violations.2024-12-16 · Health · corrected 2025-01-17
Potential for more than minimal harm
FF0623Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.2024-12-16 · Health · corrected 2025-01-17
Potential for more than minimal harm
EF0645PASARR screening for Mental disorders or Intellectual Disabilities2024-12-16 · Health · corrected 2025-01-17
Potential for more than minimal harm
DF0656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.2024-12-16 · Health · corrected 2025-01-17
Potential for more than minimal harm
DF0684Provide appropriate treatment and care according to orders, resident’s preferences and goals.2024-12-16 · Health · corrected 2025-01-17
Potential for more than minimal harm
DF0761Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.2024-12-16 · Health · corrected 2025-01-17
Potential for more than minimal harm
DF0641Ensure each resident receives an accurate assessment.2023-09-01 · Health · corrected 2023-09-29
Potential for more than minimal harm
DF0645PASARR screening for Mental disorders or Intellectual Disabilities2023-09-01 · Health · corrected 2023-09-29
Potential for more than minimal harm
DF0656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.2023-09-01 · Health · corrected 2023-09-29
Potential for more than minimal harm
EF0657Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.2023-09-01 · Health · corrected 2023-09-29
Potential for more than minimal harm
DF0658Ensure services provided by the nursing facility meet professional standards of quality.2023-09-01 · Health · corrected 2023-09-29
Potential for more than minimal harm
DF0684Provide appropriate treatment and care according to orders, resident’s preferences and goals.2023-09-01 · Health · corrected 2023-09-29
Potential for more than minimal harm
DF0686Provide appropriate pressure ulcer care and prevent new ulcers from developing.2023-09-01 · Health · corrected 2023-09-29
Potential for more than minimal harm
DF0688Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.2023-09-01 · Health · corrected 2023-09-29
Potential for more than minimal harm
DF0689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.2023-09-01 · Health · corrected 2023-09-29
Potential for more than minimal harm
DF0695Provide safe and appropriate respiratory care for a resident when needed.2023-09-01 · Health · corrected 2023-09-29
Potential for more than minimal harm
DF0697Provide safe, appropriate pain management for a resident who requires such services.2023-09-01 · Health · corrected 2023-09-29
Potential for more than minimal harm
DF0758Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.2023-09-01 · Health · corrected 2023-09-29
Potential for more than minimal harm
EF0761Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.2023-09-01 · Health · corrected 2023-09-29
Potential for more than minimal harm
FF0812Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.2023-09-01 · Health · corrected 2023-09-29
Potential for more than minimal harm
EF0880Provide and implement an infection prevention and control program.2023-09-01 · Health · corrected 2023-09-29
Potential for more than minimal harm
EF0835Administer the facility in a manner that enables it to use its resources effectively and efficiently.2023-04-04 · Health · corrected 2023-04-23
Potential for more than minimal harm
KF0880Provide and implement an infection prevention and control program.2023-04-04 · Health · corrected 2023-04-23
Immediate jeopardy
EF0578Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.2022-06-24 · Health · corrected 2022-07-26
Potential for more than minimal harm
DF0607Develop and implement policies and procedures to prevent abuse, neglect, and theft.2022-06-24 · Health · corrected 2022-07-26
Potential for more than minimal harm
DF0641Ensure each resident receives an accurate assessment.2022-06-24 · Health · corrected 2022-07-26
Potential for more than minimal harm
EF0656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.2022-06-24 · Health · corrected 2022-07-26
Potential for more than minimal harm
DF0658Ensure services provided by the nursing facility meet professional standards of quality.2022-06-24 · Health · corrected 2022-07-26
Potential for more than minimal harm
EF0689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.2022-06-24 · Health · corrected 2022-07-26
Potential for more than minimal harm
DF0690Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.2022-06-24 · Health · corrected 2022-07-26
Potential for more than minimal harm
DF0700Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.2022-06-24 · Health · corrected 2022-07-26
Potential for more than minimal harm
EF0758Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.2022-06-24 · Health · corrected 2022-07-26
Potential for more than minimal harm
DF0761Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.2022-06-24 · Health · corrected 2022-07-26
Potential for more than minimal harm
DF0825Provide or get specialized rehabilitative services as required for a resident.2022-06-24 · Health · corrected 2022-07-26
Potential for more than minimal harm
EF0880Provide and implement an infection prevention and control program.2022-06-24 · Health · corrected 2022-07-26
Potential for more than minimal harm
EF0881Implement a program that monitors antibiotic use.2022-06-24 · Health · corrected 2022-07-26
Potential for more than minimal harm
EF0886Perform COVID19 testing on residents and staff.2022-06-24 · Health · corrected 2022-07-26
Potential for more than minimal harm

Ownership

Owner	Type	Role	Percent	Since
COVENANT LIVING COMMUNITIES & SERVICES	Organization	OPERATIONAL/MANAGERIAL CONTROL	—	1975-12-23
EASTBURG, MARK	Individual	OPERATIONAL/MANAGERIAL CONTROL	—	2012-07-01
ESPINOSA, MARC	Individual	OPERATIONAL/MANAGERIAL CONTROL	—	2012-07-01
HODGKINSON, DONALD	Individual	OPERATIONAL/MANAGERIAL CONTROL	—	2012-07-01
MANLOVE, MATT	Individual	OPERATIONAL/MANAGERIAL CONTROL	—	2017-07-01
OXENDALE, ROGER	Individual	OPERATIONAL/MANAGERIAL CONTROL	—	2017-07-01
STANTE, MARLENE	Individual	OPERATIONAL/MANAGERIAL CONTROL	—	2012-07-01
VINING, ANNE	Individual	OPERATIONAL/MANAGERIAL CONTROL	—	2012-07-01
CUNLIFFE, TERRI	Individual	CORPORATE OFFICER	—	2010-03-01
ERICKSON, DAVID	Individual	CORPORATE OFFICER	—	2008-01-31
HOLT, JODY	Individual	CORPORATE OFFICER	—	2017-06-02
CUNLIFFE, TERRI	Individual	W-2 MANAGING EMPLOYEE	—	2009-03-19

Other facilities in MERCER ISLAND

Name	Overall	Beds

Source: CMS Provider Data Catalog, Nursing Home Care Compare files (processed 2026-03-01). Citations show the 3 most recent inspection cycles.