Deficiencies (last 4 years)
Deficiencies (over 4 years)
2 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
57% better than Ohio average
Ohio average: 4.6 deficiencies/yearDeficiencies per year
4
3
2
1
0
Inspection Report
Routine
Deficiencies: 3
Date: May 8, 2025
Visit Reason
The inspection was conducted to assess compliance with regulatory requirements related to resident transfer notifications, resident assessments, and pharmaceutical services.
Findings
The facility failed to provide written transfer and bed hold notices to residents at the time of hospital transfer, did not complete accurate resident assessments, and failed to ensure timely medication administration due to pharmacy delays. These issues affected multiple residents reviewed during the inspection.
Deficiencies (3)
F 0628: The facility failed to provide written transfer and bed hold notices to Residents #1 and #114 at the time of hospital transfer, contrary to facility policy requiring written notification.
F 0641: The facility failed to ensure resident assessments were completed accurately for Residents #116 and #117, submitting discharge return not anticipated assessments incorrectly.
F 0755: The facility failed to ensure medications were obtained timely from the pharmacy and administered as ordered for Resident #65, resulting in missed doses of Latanoprost Ophthalmic Solution.
Report Facts
Residents affected: 2
Residents reviewed for assessment accuracy: 11
Residents affected by inaccurate assessments: 2
Residents reviewed for medication administration: 8
Missed medication administration dates: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| RN #554 | Registered Nurse | Verified inaccurate resident assessments for Residents #116 and #117 |
| RN #506 | Registered Nurse | Verified missed medication administration for Resident #65 |
| SSD #586 | Social Services Designee and Admission Coordinator | Interviewed regarding transfer and bed hold notification process |
Inspection Report
Complaint Investigation
Census: 18
Deficiencies: 1
Date: Mar 14, 2023
Visit Reason
The inspection was conducted due to allegations of staff to resident physical and verbal abuse reported at the facility on 02/22/2023, which triggered an Immediate Jeopardy situation.
Complaint Details
The complaint involved allegations of staff to resident physical and verbal abuse witnessed by STNA #374 on 02/22/23 but not immediately reported. The Immediate Jeopardy began on 02/22/23 and was removed on 03/03/23 after corrective actions were implemented.
Findings
The facility failed to ensure timely reporting of staff to resident abuse incidents witnessed on 02/22/2023, resulting in continued risk to residents. Corrective actions included suspension and termination of involved staff, staff training on abuse reporting, and implementation of ongoing audits and education.
Deficiencies (1)
F 0607: The facility failed to timely report allegations of staff to resident physical and verbal abuse witnessed on 02/22/23, placing residents at immediate jeopardy. The lack of timely reporting allowed the alleged perpetrator to continue working additional shifts before suspension.
Report Facts
Residents in certified beds: 18
Staff completing abuse in-service: 122
Employees mentioned
| Name | Title | Context |
|---|---|---|
| STNA #374 | State Tested Nursing Assistant | Witnessed abuse incidents and failed to immediately report them. |
| STNA #370 | State Tested Nursing Assistant | Alleged perpetrator of physical and verbal abuse to residents. |
| RN #395 | Registered Nurse | Notified and involved in investigation and removal of alleged perpetrator from schedule. |
| LPN #319 | Licensed Practical Nurse | Failed to take abuse report seriously when initially informed. |
| Administrator | Oversaw investigation, corrective actions, and staff training implementation. | |
| Director of Nursing | Director of Nursing (DON) | Participated in investigation, staff removal, and training. |
| Human Resources Director #429 | Human Resources Director | Involved in notification, staff termination, and auditing staff knowledge. |
| Medical Director #430 | Medical Director | Notified of abuse incidents by DON. |
| Medical Secretary #301 | Medical Secretary | Responsible for new hire education on abuse reporting. |
Inspection Report
Routine
Deficiencies: 4
Date: Jun 23, 2022
Visit Reason
The inspection was conducted to assess compliance with care standards including activities of daily living assistance, pressure ulcer care, respiratory care, and food safety in the facility.
Findings
The facility failed to provide timely and adequate nail care for residents requiring assistance, did not properly assess or treat a pressure ulcer for one resident, failed to ensure oxygen equipment was dated and stored properly, and did not store an ice scoop in a sanitary manner.
Deficiencies (4)
F 0677: The facility failed to provide timely and adequate nail care to residents #5 and #8 who required staff assistance, resulting in long dirty fingernails.
F 0686: The facility failed to properly assess, stage, and treat an unstageable pressure ulcer for Resident #5, including lack of wound measurements and treatment documentation from 04/07/22 to 05/09/22.
F 0695: The facility failed to ensure oxygen equipment for Residents #8 and #15 was dated when changed and failed to properly store oxygen tubing for Resident #15 in a clean and sanitary manner.
F 0812: The facility failed to ensure an ice scoop was properly stored in a clean and sanitary manner, placing all 16 residents at potential risk of contamination.
Report Facts
Residents affected: 2
Residents affected: 1
Residents affected: 2
Residents affected: 16
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Director of Nursing | Interviewed regarding nail care and wound care policies and practices | |
| Licensed Practical Nurse (LPN) #803 | Verified Resident #5's fingernails were long and dirty | |
| Licensed Practical Nurse (LPN) #804 | Interviewed regarding oxygen tubing dating and storage | |
| State Tested Nursing Assistant (STNA) #800 | Observed handling ice scoop improperly |
Inspection Report
Deficiencies: 0
Date: Jun 20, 2019
Visit Reason
The document is a statement of deficiencies and plan of correction related to a facility survey conducted on 06/20/2019.
Findings
No health deficiencies were found during the survey.
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