Nursing homeActive
Bainbridge Island Health & Rehab Center
835 Madison Avenue North, Bainbridge Island, WA 98110206842476558 certified beds · 42 residentsFor profit - Limited Liability companyMedicare and Medicaid
Surveys on file
6
since 2023
Deficiencies
20
● 0● 20● 0
Penalties · 3 yrs
—
none on file
Last survey
2026-07-01
Complaint
CMS overall
5 / 5
stars as published by CMS
CMS overall 5/5
Health 5
Staffing 5
Quality 5
Star ratings as published by CMS · CMS’s caveats
Survey history
Source: CMS · Washington DSHS Aging and Long-Term Support · data as of 2026-08-01| Date | Kind | Deficiencies | Official record | Archived PDF |
|---|---|---|---|---|
| 2026-07-01 | Complaint | 010 | CMS-2567 (Care Compare) | — |
| 2026-05-06 | Complaint | 010 | CMS-2567 (Care Compare) | — |
| 2025-11-17 | Standard | 040 | CMS-2567 (Care Compare) | — |
| 2025-07-15 | Complaint | 010 | CMS-2567 (Care Compare) | — |
| 2024-09-13 | Standard | 040 | CMS-2567 (Care Compare) | — |
| 2023-09-29 | Standard | 090 | CMS-2567 (Care Compare) | — |
Counts by class: paperwork · standard · harm.
Deficiencies
CMS · Washington DSHS Aging and Long-Term Support publishes each citation’s tag, official description and scope/severity letter. The surveyor’s written findings are in the Statement of Deficiencies (CMS-2567) for each survey, linked above.
F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.Scope/severity DStandard
Care planning
Isolated; no actual harm, potential for more than minimal harm.Corrected 2026-08-01Record 505325-20260701-F684
F600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.Scope/severity DStandard
Abuse & neglect
Isolated; no actual harm, potential for more than minimal harm.Corrected 2026-06-01Record 505325-20260506-F600
F605Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.Scope/severity DStandard
Abuse & neglect
Isolated; no actual harm, potential for more than minimal harm.Corrected 2025-12-26Record 505325-20251117-F605
F658Ensure services provided by the nursing facility meet professional standards of quality.Scope/severity DStandard
Care planningRecords
Isolated; no actual harm, potential for more than minimal harm.Corrected 2025-12-26Record 505325-20251117-F658
F679Provide activities to meet all resident's needs.Scope/severity DStandard
Care planning
Isolated; no actual harm, potential for more than minimal harm.Corrected 2025-12-26Record 505325-20251117-F679
F804Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.Scope/severity DStandard
Food & nutrition
Isolated; no actual harm, potential for more than minimal harm.Corrected 2025-12-26Record 505325-20251117-F804
F760Ensure that residents are free from significant medication errors.Scope/severity DStandard
Medication
Isolated; no actual harm, potential for more than minimal harm.Corrected 2025-08-07Record 505325-20250715-F760
F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.Scope/severity DStandard
Care planning
Isolated; no actual harm, potential for more than minimal harm.Corrected 2024-10-18Record 505325-20240913-F684
F695Provide safe and appropriate respiratory care for a resident when needed.Scope/severity DStandard
Care planning
Isolated; no actual harm, potential for more than minimal harm.Corrected 2024-10-18Record 505325-20240913-F695
F812Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.Scope/severity EStandard
Food & nutrition
Pattern; no actual harm, potential for more than minimal harm.Corrected 2024-10-18Record 505325-20240913-F812
F880Provide and implement an infection prevention and control program.Scope/severity DStandard
Infection control
Isolated; no actual harm, potential for more than minimal harm.Corrected 2024-10-18Record 505325-20240913-F880
F637Assess the resident when there is a significant change in conditionScope/severity DStandard
Care planningRecords
Isolated; no actual harm, potential for more than minimal harm.Corrected 2023-11-14Record 505325-20230929-F637
F641Ensure each resident receives an accurate assessment.Scope/severity DStandard
Care planningRecords
Isolated; no actual harm, potential for more than minimal harm.Corrected 2023-11-14Record 505325-20230929-F641
F657Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.Scope/severity DStandard
Care planningRecords
Isolated; no actual harm, potential for more than minimal harm.Corrected 2023-11-14Record 505325-20230929-F657
F676Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.Scope/severity DStandard
Care planning
Isolated; no actual harm, potential for more than minimal harm.Corrected 2023-11-14Record 505325-20230929-F676
F677Provide care and assistance to perform activities of daily living for any resident who is unable.Scope/severity DStandard
Care planning
Isolated; no actual harm, potential for more than minimal harm.Corrected 2023-11-14Record 505325-20230929-F677
F757Ensure each resident’s drug regimen must be free from unnecessary drugs.Scope/severity DStandard
Medication
Isolated; no actual harm, potential for more than minimal harm.Corrected 2023-11-14Record 505325-20230929-F757
F761Ensure 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.Scope/severity DStandard
Medication
Isolated; no actual harm, potential for more than minimal harm.Corrected 2023-11-14Record 505325-20230929-F761
F812Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.Scope/severity EStandard
Food & nutrition
Pattern; no actual harm, potential for more than minimal harm.Corrected 2023-11-14Record 505325-20230929-F812
F842Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.Scope/severity DStandard
Care planningRecords
Isolated; no actual harm, potential for more than minimal harm.Corrected 2023-11-14Record 505325-20230929-F842
Staffing
CMS Payroll-Based Journal · PBJ, as published Aug 2026 · explainerRN hours per resident day1.27
Facility
Washington
National
Washington 0.94 · National 0.69
Total nurse hours per resident day3.91
Facility
Washington
National
Washington 4.37 · National 3.86
Weekend total nurse hours3.50
Facility
Washington
National
Washington 3.81 · National 3.42
Total nursing staff turnover23%
Facility
Washington
National
Washington 45% · National 46%
Registered nurse turnover15%
Facility
Washington
National
Washington 45% · National 43%
Quality measures
CMS MDS quality measures · 2025Q2-2026Q1 · definitions| Measure | Facility | Washington | National |
|---|---|---|---|
| Percentage of long-stay residents with pressure ulcers lower is better | 3.0% | 4.3% | 4.6% |
| Percentage of long-stay residents experiencing one or more falls with major injury lower is better | 2.7% | 2.6% | 3.2% |
| Percentage of long-stay residents who received an antipsychotic medication lower is better | 25.6% | 15.1% | 15.4% |
| Percentage of long-stay residents with a urinary tract infection lower is better | 0.0% | 1.6% | 1.6% |
| Percentage of long-stay residents who were physically restrained lower is better | 0.0% | 0.1% | 0.1% |
| Percentage of long-stay residents whose need for help with daily activities has increased lower is better | 6.4% | 14.2% | 13.9% |
| Percentage of long-stay residents who lose too much weight lower is better | 6.8% | 5.5% | 5.2% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication lower is better | 12.6% | 12.4% | 19.5% |
Figures verbatim from CMS, with the state and national figures from the same release. The direction that counts as better is CMS’s own and is stated on every row.
Ownership
As reported to CMS (Provider Enrollment)| Entity | Role | Interest | Since | Registry |
|---|---|---|---|---|
| De Oro, Thomas Individual | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE | — | — |
| Kretchmar, Joshua Individual | OPERATIONAL/MANAGERIAL CONTROL | NOT APPLICABLE | — | — |
| Bainbridge Health Holdings LLC Organization | ADP OF THE SNF | NOT APPLICABLE | — | — |
| Burnam, Soon Individual | CORPORATE OFFICER | NOT APPLICABLE | — | — |
| De Oro, Thomas Individual | ADP OF THE SNF | NOT APPLICABLE | — | — |
| De Oro, Thomas Individual | MANAGING CONTROL - GOVERNING BODY | NOT APPLICABLE | — | — |
| Farnsworth, Stephen Individual | CORPORATE OFFICER | NOT APPLICABLE | — | — |
| Keetch, Chad Individual | CORPORATE OFFICER | NOT APPLICABLE | — | — |
| Kretchmar, Joshua Individual | MANAGING CONTROL - GOVERNING BODY | NOT APPLICABLE | — | — |
| Kretchmar, Joshua Individual | ADP OF THE SNF | NOT APPLICABLE | — | — |
| Port, Barry Individual | INDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNF | NOT APPLICABLE | — | — |
| Standard Bearer Healthcare Op LP Organization | ADP OF THE SNF | NOT APPLICABLE | — | — |
| The Ensign Group Inc Organization | ADP OF THE SNF | NOT APPLICABLE | — | — |
Part of a chain
The Ensign Group — 342 facilities
Ownership as reported to CMS/state. CMS ownership data has known gaps; merges between entities are published only after human review.
Cost context
County figures from public surveys. Not this facility’s price. Nursing-home rates are not published by CMS or Washington.
No county cost figures on file for Kitsap.
Nearby nursing homes
| Facility | Distance | Last survey | Deficiencies · 3 yrs |
|---|---|---|---|
| Bremerton Trails Post Acute Bremerton | 6.1 mi | 2026-06-23 | 01025 |
| Belmont Terrace Bremerton | 6.1 mi | 2026-03-02 | 0770 |
| Washington Veteran Home-Retsil Pt Orchard | 7.2 mi | 2026-05-11 | 0581 |
| Avamere Rehabilitation At Park West Seattle | 6.8 mi | 2026-03-09 | 0452 |
| Port Washington Post Acute Bremerton | 8.1 mi | 2026-05-19 | 0904 |
Watch this facility
One email when a new survey, harm-class deficiency, penalty, Special Focus change or ownership change is recorded. Nothing else, ever.
Sources & provenance
| Section | Agency · dataset | Retrieved |
|---|---|---|
| Facility, ratings | CMS Provider Data · Nursing Home Provider Information | 2026-08-01 |
| Surveys | CMS · Survey Summary | 2026-08-01 |
| Deficiencies | CMS · Health Deficiencies (CMS-2567 findings via Care Compare) | 2026-08-01 |
| Penalties | CMS · Penalties | 2026-08-01 |
| Staffing | CMS · Payroll-Based Journal (PBJ, as published Aug 2026) | 2026-08-01 |
| Quality measures | CMS · MDS Quality Measures | 2026-08-01 |
| Ownership | CMS · Ownership | 2026-08-01 |