CMS found that Hamburg Healthcare, a nursing home, was not in substantial compliance with the Conditions of Participation in the Medicare and Medicaid programs. After numerous surveys and visits where the nursing home was warned each time that its provider agreement might be terminated absent change, CMS terminated the nursing home’s provider agreement. There was no finding of immediate jeopardy. 42 C.F.R. § 489.53 provides that the provider must have 15 days notice of an impending termination absent a finding of immediate jeopardy. No notice was given. The nursing home sued for an injunction, which was granted due to the lack of notice.