nursing home in Rochester, NY
Kirkhaven
254 Alexander Street, Rochester, NY 14607 · (585) 461-1991
★★★★★1
Much below average
CMS overall star rating
CMS overall star rating
- Health inspections★★★★★1
- Staffing★★★★★1
- Quality measures★★★★★3
Source: Centers for Medicare & Medicaid Services (CMS), Medicare Care Compare. We refresh our information from this source. About our data
Kirkhaven at a glance
Kirkhaven is a 147-bed non-profit nursing home in Rochester, New York (Monroe County).
CMS gives it 1 out of 5 stars on its overall star rating, worse than the New York average of 3.
Its most recent standard health inspection (December 9, 2024) found 21 health citations. The New York average is 8.
Federal regulators fined it 1 time in the past three years, totaling $8,278.
Facility details
- Type
- Nursing home
- Ownership
- Non Profit - Corporation
- Beds
- 147
- Certified for
- Medicare and Medicaid
- Medicare-certified since
- February 20, 1984
- Resident/family council
- Resident
- County
- Monroe County
- CMS Certification Number
- 335668
Ratings
| Measure | This facility | New York avg. | U.S. avg. | vs. U.S. |
|---|---|---|---|---|
| Overall star rating ⓘ (higher is better) | 1 / 5 | 3 / 5 | 3 / 5 | Worse |
| Health inspection rating ⓘ (higher is better) | 1 / 5 | 2.7 / 5 | 2.8 / 5 | Worse |
| Staffing rating ⓘ (higher is better) | 1 / 5 | 2.8 / 5 | 2.9 / 5 | Worse |
| Quality measures rating ⓘ (higher is better) | 3 / 5 | 3.8 / 5 | 3.6 / 5 | Worse |
| Long-stay quality rating (higher is better) | 4 / 5 | 4 / 5 | 3.8 / 5 | Average |
| Short-stay (rehab) quality rating (higher is better) | 3 / 5 | 3.6 / 5 | 3.3 / 5 | Average |
Inspections
| Measure | This facility | New York avg. | U.S. avg. | vs. U.S. |
|---|---|---|---|---|
| Health citations in the most recent inspection (lower is better) | 21 | 8 | 9 | Worse |
| Citations from complaint investigations (latest cycle) (lower is better) | 12 | 3 | 3 | Worse |
| Weighted health inspection score ⓘ (lower is better) | 114 | 62.2 | 80.6 | Worse |
Penalties
| Measure | This facility | New York avg. | U.S. avg. | vs. U.S. |
|---|---|---|---|---|
| Fines in the past 3 years (lower is better) | 1 | 1 | 1 | Worse |
| Total fines in the past 3 years (lower is better) | $8,278 | $23,070 | $30,972 | Better |
| All federal penalties in the past 3 years (lower is better) | 1 | 1 | 1 | Average |
Size
| Measure | This facility | New York avg. | U.S. avg. | vs. U.S. |
|---|---|---|---|---|
| Certified beds | 147 | 188 | 107 | |
| Average residents per day | 136 | 168 | 86 | |
| Occupancy | 92.7% | 90.5% | 80.9% |
Long-stay residents
| Measure | This facility | New York avg. | U.S. avg. | vs. U.S. |
|---|---|---|---|---|
| Long-stay residents with a fall causing major injury (lower is better) | 4.4% | 3.1% | 3.2% | Worse |
| Long-stay residents with pressure ulcers (lower is better) | 8.4% | 6.5% | 4.6% | Worse |
| Long-stay residents given antipsychotic medication (lower is better) | 22% | 13.7% | 15.4% | Worse |
| Long-stay residents with a urinary tract infection (lower is better) | 0.2% | 1.3% | 1.6% | Better |
| Long-stay residents with a catheter left in the bladder (lower is better) | 0.3% | 0.5% | 0.8% | Better |
| Long-stay residents needing more help with daily activities (lower is better) | 12.2% | 14.1% | 13.9% | Better |
| Long-stay residents whose walking worsened (lower is better) | 7.8% | 12.5% | 14.1% | Better |
| Long-stay residents who lose too much weight (lower is better) | 11.4% | 5.8% | 5.2% | Worse |
| Long-stay residents with depressive symptoms (lower is better) | 15.9% | 19.5% | 12.8% | Worse |
| Long-stay residents who were physically restrained (lower is better) | 0% | 0.2% | 0.1% | Better |
| Long-stay residents given anti-anxiety or sleep medication (lower is better) | 7.1% | 13.2% | 19.5% | Better |
| Long-stay residents with new or worse incontinence (lower is better) | 15.3% | 19.5% | 19% | Better |
| Long-stay residents given a flu vaccine (higher is better) | 91.5% | 95.3% | 95.5% | Average |
| Long-stay residents given a pneumonia vaccine (higher is better) | 31.5% | 91.5% | 93.6% | Worse |
Short-stay residents
| Measure | This facility | New York avg. | U.S. avg. | vs. U.S. |
|---|---|---|---|---|
| Short-stay residents newly given antipsychotic medication (lower is better) | 1.6% | 1.2% | 1.6% | Average |
| Short-stay residents given a flu vaccine (higher is better) | 56.2% | 78.8% | 79.8% | Worse |
| Short-stay residents given a pneumonia vaccine (higher is better) | 31.2% | 77.4% | 82% | Worse |
Inspection citations
State inspectors cited this home for 30 health deficiencies and 14 fire safety deficiencies in the inspection records CMS currently publishes. 1 citation involved actual harm.
| Date | Citation | Severity | Status |
|---|---|---|---|
| March 18, 2026 Complaint | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Quality of Life and Care Deficiencies · Tag F0689 | E Potential harm, pattern | Corrected May 15, 2026 |
| March 18, 2026 Complaint | Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. Nursing and Physician Services Deficiencies · Tag F0725 | E Potential harm, pattern | Corrected May 15, 2026 |
| March 18, 2026 Complaint | Provide care and assistance to perform activities of daily living for any resident who is unable. Quality of Life and Care Deficiencies · Tag F0677 | E Potential harm, pattern | Corrected May 15, 2026 |
| March 18, 2026 Complaint | Respond appropriately to all alleged violations. Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0610 | E Potential harm, pattern | Corrected May 15, 2026 |
| March 18, 2026 Complaint | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Resident Rights Deficiencies · Tag F0550 | D Potential harm, isolated | Corrected May 15, 2026 |
| March 18, 2026 Complaint | Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. Nutrition and Dietary Deficiencies · Tag F0803 | D Potential harm, isolated | Corrected May 15, 2026 |
| December 8, 2025 Complaint | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Resident Rights Deficiencies · Tag F0550 | G Actual harm, isolated | Corrected February 6, 2026 |
| December 8, 2025 Complaint | Provide care and assistance to perform activities of daily living for any resident who is unable. Quality of Life and Care Deficiencies · Tag F0677 | E Potential harm, pattern | Corrected February 6, 2026 |
| December 8, 2025 Complaint | Ensure 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. Pharmacy Service Deficiencies · Tag F0761 | E Potential harm, pattern | Corrected February 6, 2026 |
| December 8, 2025 Complaint | Ensure services provided by the nursing facility meet professional standards of quality. Resident Assessment and Care Planning Deficiencies · Tag F0658 | D Potential harm, isolated | Corrected February 6, 2026 |
| July 16, 2025 Complaint | Provide appropriate treatment and care according to orders, resident’s preferences and goals. Quality of Life and Care Deficiencies · Tag F0684 | D Potential harm, isolated | Corrected September 10, 2025 |
| December 9, 2024 Fire safety | Inspect, test, and maintain automatic sprinkler systems. Smoke Deficiencies · Tag K0353 | F Potential harm, widespread | Corrected February 28, 2025 |
| December 9, 2024 Fire safety | Have approved installation, maintenance and testing program for fire alarm systems. Smoke Deficiencies · Tag K0345 | E Potential harm, pattern | Corrected February 5, 2025 |
| December 9, 2024 Fire safety | Have generator or other power source capable of supplying service within 10 seconds. Gas, Vacuum, and Electrical Systems Deficiencies · Tag K0918 | E Potential harm, pattern | Corrected February 19, 2025 |
| December 9, 2024 Fire safety | Have restrictions on the use of portable space heaters. Miscellaneous Deficiencies · Tag K0781 | D Potential harm, isolated | Corrected February 5, 2025 |
| December 9, 2024 Fire safety | Install a fire alarm system that can be heard throughout the facility. Smoke Deficiencies · Tag K0341 | D Potential harm, isolated | Corrected February 5, 2025 |
| December 9, 2024 Standard | Provide safe and appropriate respiratory care for a resident when needed. Quality of Life and Care Deficiencies · Tag F0695 | E Potential harm, pattern | Corrected February 5, 2025 |
| December 9, 2024 Standard | Provide and implement an infection prevention and control program. Infection Control Deficiencies · Tag F0880 | E Potential harm, pattern | Corrected February 5, 2025 |
| December 9, 2024 Standard | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Nutrition and Dietary Deficiencies · Tag F0812 | E Potential harm, pattern | Corrected February 5, 2025 |
| December 9, 2024 Standard | Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. Resident Assessment and Care Planning Deficiencies · Tag F0644 | E Potential harm, pattern | Corrected February 5, 2025 |
| December 9, 2024 Complaint | Provide enough food/fluids to maintain a resident's health. Quality of Life and Care Deficiencies · Tag F0692 | D Potential harm, isolated | Corrected February 5, 2025 |
| December 9, 2024 Standard | Honor 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. Resident Rights Deficiencies · Tag F0578 | D Potential harm, isolated | Corrected February 5, 2025 |
| December 9, 2024 Standard | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Resident Assessment and Care Planning Deficiencies · Tag F0656 | D Potential harm, isolated | Corrected February 5, 2025 |
| December 9, 2024 Standard | Provide appropriate treatment and care according to orders, resident’s preferences and goals. Quality of Life and Care Deficiencies · Tag F0684 | D Potential harm, isolated | Corrected February 5, 2025 |
| December 9, 2024 Standard | Assist a resident in gaining access to vision and hearing services. Quality of Life and Care Deficiencies · Tag F0685 | D Potential harm, isolated | Corrected February 5, 2025 |
| December 9, 2024 Complaint | Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia. Quality of Life and Care Deficiencies · Tag F0744 | D Potential harm, isolated | Corrected February 5, 2025 |
| December 9, 2024 Standard | Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. Nutrition and Dietary Deficiencies · Tag F0805 | D Potential harm, isolated | Corrected February 5, 2025 |
| March 16, 2023 Fire safety | Inspect, test, and maintain automatic sprinkler systems. Smoke Deficiencies · Tag K0353 | F Potential harm, widespread | Corrected May 15, 2023 |
| March 16, 2023 Fire safety | Have generator or other power source capable of supplying service within 10 seconds. Gas, Vacuum, and Electrical Systems Deficiencies · Tag K0918 | E Potential harm, pattern | Corrected May 15, 2023 |
| March 16, 2023 Fire safety | Install emergency lighting that can last at least 1 1/2 hours. Egress Deficiencies · Tag K0291 | D Potential harm, isolated | Corrected May 15, 2023 |
| March 16, 2023 Fire safety | Ensure that building systems meet requirements determined by risk assessment procedures performed by qualified personnel. Electrical Deficiencies · Tag K0901 | C No harm, widespread | Corrected May 15, 2023 |
| March 16, 2023 Fire safety | Develop a communication plan. Emergency Preparedness Deficiencies · Tag E0029 | C No harm, widespread | Corrected May 15, 2023 |
| March 16, 2023 Standard | Provide safe, appropriate dialysis care/services for a resident who requires such services. Quality of Life and Care Deficiencies · Tag F0698 | E Potential harm, pattern | Corrected May 15, 2023 |
| March 16, 2023 Standard | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Nutrition and Dietary Deficiencies · Tag F0812 | E Potential harm, pattern | Corrected May 15, 2023 |
| March 16, 2023 Standard | Ensure that residents are free from significant medication errors. Pharmacy Service Deficiencies · Tag F0760 | D Potential harm, isolated | Corrected May 15, 2023 |
| March 16, 2023 Standard | Respond appropriately to all alleged violations. Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0610 | D Potential harm, isolated | Corrected May 15, 2023 |
| March 16, 2023 Standard | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0600 | D Potential harm, isolated | Corrected May 15, 2023 |
| March 16, 2023 Standard | Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. Resident Rights Deficiencies · Tag F0561 | D Potential harm, isolated | Corrected May 15, 2023 |
| April 2, 2021 Fire safety | Ensure smoke barriers are constructed to a 1 hour fire resistance rating. Smoke Deficiencies · Tag K0372 | E Potential harm, pattern | Corrected June 1, 2021 |
| April 2, 2021 Fire safety | Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector. Egress Deficiencies · Tag K0223 | D Potential harm, isolated | Corrected June 1, 2021 |
| April 2, 2021 Fire safety | Have approved installation, maintenance and testing program for fire alarm systems. Smoke Deficiencies · Tag K0345 | D Potential harm, isolated | Corrected June 1, 2021 |
| April 2, 2021 Fire safety | Have a battery powered remote alarm panel in a location accessible by operating personnel. Gas, Vacuum, and Electrical Systems Deficiencies · Tag K0916 | C No harm, widespread | Corrected June 1, 2021 |
| April 2, 2021 Standard | Provide safe and appropriate respiratory care for a resident when needed. Quality of Life and Care Deficiencies · Tag F0695 | D Potential harm, isolated | Corrected June 1, 2021 |
| April 2, 2021 Standard | Provide safe, appropriate dialysis care/services for a resident who requires such services. Quality of Life and Care Deficiencies · Tag F0698 | D Potential harm, isolated | Corrected June 1, 2021 |
Severity letters follow the CMS scope-and-severity grid: A–C no actual harm with potential for minimal harm; D–F potential for more than minimal harm; G–I actual harm; J–L immediate jeopardy to resident health or safety. How to read inspection citations.
Fines and payment denials
CMS reports 1 federal penalty in the past three years, including $8,278 in fines.
| Date | Penalty | Amount / length |
|---|---|---|
| December 8, 2025 | Fine | $8,278 |
Owners and managers
Individuals and organizations reported to CMS as owning or operating this nursing home.
| Name | Role | Share | Since |
|---|---|---|---|
| FORNATARO, LETICIA Individual | corporate director | NOT APPLICABLE | 01/01/2019 |
| MUTHIG, MARK Individual | corporate director | NOT APPLICABLE | 01/01/2021 |
| MAAR, SCOTT Individual | corporate officer | NOT APPLICABLE | 05/04/2005 |
| SCHALLER, CHRISTINE Individual | corporate officer | NOT APPLICABLE | 12/19/2022 |
| SCHALLER, CHRISTINE Individual | operational/managerial control | NOT APPLICABLE | 12/19/2022 |
Other nursing homes near Kirkhaven
Lilac Manor Rehabilitation and Nursing Center
3 Upton Park, Rochester, NY 14607 · under 1 mi
For-profit · 200 beds
★★★★★1Much below averageChurch Home of the Protestant Episcopal Church
505 Mt. Hope Avenue, Rochester, NY 14620 · 1.2 mi
Non-profit · 182 beds
★★★★★3AverageSt. John's Health Care Corporation
150 Highland Avenue, Rochester, NY 14620 · 1.7 mi
For-profit · 455 beds
★★★★★1Much below averageThe Brightonian, INC
1919 Elmwood Avenue, Rochester, NY 14620 · 1.9 mi
For-profit · 54 beds · Part of Hurlbut Care
★★★★★5Much above averageUnity Living Center
89 Genesee Street, Rochester, NY 14611 · 2 mi
Non-profit · 120 beds · Part of Rochester Regional Health
★★★★★3Average- ★★★★★1Much below average
Frequently asked questions
What is Kirkhaven's rating?
Kirkhaven has 1 out of 5 stars on the CMS overall star rating. The average for New York nursing homes is 3 stars.
How many inspection citations did Kirkhaven receive?
Its most recent standard health inspection found 21 citations, compared with a New York average of 8. Every citation is listed on this page with its severity.
Does Kirkhaven accept Medicare and Medicaid?
CMS lists it as certified for: Medicare and Medicaid. Call the facility to confirm bed availability and whether it accepts your specific plan.
Who owns Kirkhaven?
It is non profit - corporation. The ownership section on this page lists the owners and managers reported to CMS.
Where is Kirkhaven and how do I contact it?
Kirkhaven is at 254 Alexander Street, Rochester, NY 14607. Phone: (585) 461-1991.
About this data
Ratings and measures come from the Centers for Medicare & Medicaid Services (CMS), Medicare Care Compare. They're based on state inspections, patient surveys and facility reports, and they describe the past. Facilities change, so visit in person and confirm details directly. About our data · Spotted an error? Let us know.