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Enniscourt Nursing Care

13315 Detroit Ave, Lakewood, OH 44107 · For profit - Individual · 50 certified beds · (216) 226-3858 Medicare & Medicaid certified

Need help choosing, fast? Free, unbiased: Eldercare Locator 1-800-677-1116
Abuse/neglect citation on record (F0602) — cited Jun 20251 immediate-jeopardy citation$40,803 in federal fines
Insights

This home has serious findings on its record. Read them closely before you consider it.

In its favor
  • a high payroll-based staffing rating (4/5)
Worth asking about
  • it has an abuse, neglect, or exploitation citation (F0602), cited Jun 2025
  • it has citations for its abuse-prevention policies, restraint use, or reporting and investigating of allegations (F0604, F0607, F0609) — cited below the harm level, meaning inspectors found the process wanting but did not find a resident harmed
  • inspectors cited 1 immediate-jeopardy problem — the most serious level
  • a high number of inspection citations overall (22) — worth reading through, though larger and more-often-surveyed homes tend to accrue more lower-severity tags
  • the CMS record shows $40,803 in federal fines (most recent 2026-02-25)
  • its payroll- and facility-reported staffing and quality-measure scores sit well above its independent inspection score
  • its independent health-inspection rating is low (2/5)
  • its last standard health inspection was over 3 years ago — the star rating may not reflect current conditions

One thing this read cannot see: what residents and families actually experience day to day. Public data misses the feel of a place — visit unannounced, ideally at a mealtime or on a weekend, talk to staff and families, and ask your tour questions.

A plain-English summary of the public record below — not a rating, ranking, or recommendation. We take no money from any facility.

2/5
CMS overall
2 of 5
Health inspectionSurveyor-assigned, ranked within your stateInspector-verified 2 of 5
StaffingFrom payroll records (PBJ) 4 of 5
Quality measuresSelf-reported by the facility 4 of 5

Worth a closer look. This home's staffing and quality-measure ratings run 2 stars above its independent health-inspection score. The inspection is done by state surveyors; the quality-measure score leans on data the facility reports about itself, and staffing on its payroll (PBJ) submissions — so a gap this large is worth reading the inspection record for.

Location & what’s nearby

Hospital
★★★★★ 5/5 CMS · Emergency dept. usually open 24/7 · ER 24/7
Urgent care / clinic
11716 Detroit Ave · (216) 712-7818 · Call to confirm hours
Pharmacy
13123 Detroit Ave · (216) 529-9100 · Call to confirm hours
Grocery
12500 Detroit Ave · (216) 226-3101 · Call to confirm hours
Park
13823 Merl Ave · (216) 529-6815 · Typically dawn to dusk
Place of worship
13216 Detroit Ave · (216) 521-8727

Nearest of each type, straight-line distance. Hospitals come from the CMS Hospital General Information registry; everything else from Overture Maps (public data). Hospital and park hours are typical — call ahead to confirm.

Quality measures — how residents actually fare

Overall quality measures 4 of 5
Long-stay residentspeople who live here 5 of 5
Short-stay residentsrehab / post-hospital 2 of 5

Quality-measure stars summarize outcomes CMS tracks from the assessments each home submits — avoidable hospitalizations and ER visits, falls with injury, pressure ulcers, unplanned weight loss, and long-term antipsychotic use. Because the underlying data is self-reported, weigh a high score against the independent inspection record. Long-stay = permanent residents; short-stay = rehab and post-hospital stays.

Trend — is this home getting better or worse?

Over 2025-02 to 2026-06, this home’s CMS overall rating fell from 5 to 3 stars. From monthly CMS archive snapshots.

Horizontal axis runs 2025-02 to 2026-06. That is where CMS’s monthly archive ends, so the right-hand edge of each line is that month — not today.

Overall rating3★
Inspection scorelower = better
See all quality measures vs. state & national benchmarks
MeasureThis homeState avgTypical statevs typical state
Long-stay residents whose need for help with daily activities increased6.6%5.3%15.4%worse than state — see note marked double-dagger below the table
Long-stay residents who lose too much weight5.8%6.2%5.4%typical
Long-stay residents with a catheter left in their bladder0.4%0.2%0.9%worse than state — see note marked double-dagger below the table
Long-stay residents with a urinary tract infection0.0%0.4%2.0%better than state — see note marked double-dagger below the table
Long-stay residents with depressive symptoms2.3%30.1%6.5%better than state — see note marked double-dagger below the table
Long-stay residents who were physically restrained0.0%0.1%0.1%better
Long-stay residents with falls causing major injury0.7%3.2%3.3%better
Long-stay residents whose ability to walk worsened5.5%6.1%16.1%better than state — see note marked double-dagger below the table
Long-stay residents on antianxiety or hypnotic medication21.3%25.5%18.9%worse
Long-stay residents given the seasonal flu vaccine100.0%94.5%95.3%typical
Long-stay residents with pressure ulcers11.2%3.4%4.7%worse
Long-stay residents with worsening bladder/bowel control5.8%21.4%21.2%better
Long-stay residents who got an antipsychotic medication — see the note below the table11.1%8.8%17.1%better
Short-stay residents who newly got an antipsychotic medication1.4%1.2%1.4%typical
Short-stay residents given the seasonal flu vaccine85.0%75.6%79.4%typical
Short-stay residents rehospitalized after admission20.4%24.9%22.6%typical
Short-stay residents with an outpatient ER visit10.0%12.9%12.0%better

On this measure the state average is at least twice (or half) the typical state — a gap that size is usually how the state codes and reports the measure, not how its homes actually perform. Against a benchmark this state does not sit on, a “vs typical state” verdict would mostly be measuring the state, so we compare this home with its own state instead and show both averages.

§ Antipsychotics carry an FDA boxed warning — they raise the risk of death in older people with dementia-related psychosis, and are not approved for that use. So this measure is partly a read on whether a home sedates residents instead of staffing for them. But read a low rate carefully in both directions: CMS excludes residents coded with schizophrenia (and Tourette's or Huntington's) from this measure, and federal auditors have found implausible increases in schizophrenia coding since the measure was published — so a very low rate can reflect recoding rather than less prescribing. Ask the home what share of its residents carry a schizophrenia diagnosis, and how it handles behavioral symptoms without medication.

CMS quality measures, as Care Compare shows them. For most rows lower is better (fewer falls, ulcers, hospitalizations); vaccination rates are the exception. Not every row is risk-adjusted. CMS adjusts some measures for resident mix, but falls with major injury, antipsychotic use, physical restraints and the vaccination rates are unadjusted rates — so a home caring for heavier or more behaviorally complex residents can look worse on them without providing worse care. The “typical state” column is the median of the 50 state averages — not a national average of all homes. We use it because a plain average across homes is pulled badly off course by a few states’ reporting habits (long-stay depressive symptoms is the clearest case: Illinois codes it several times higher than most states, which alone lifted the all-homes figure to about twice what a typical state records). The median of state averages resists that — but it does weigh every state equally, so a large state counts no more than a small one, and it is a benchmark of our construction rather than a CMS-published figure. better/worse means the home differs from that benchmark by more than 10% of it; closer than that reads typical. CMS does not publish how many residents each measure covers, and the counts are often small — a single resident can move a rate by several points — so treat small gaps as noise. These come from data the facility reports, so weigh them against the independent inspection record above.

Short-stay rehab — if you are coming here from a hospital

Arriving from a hospital right now? Read the discharge guide → — your appeal rights, how to slow a rushed discharge, and what to ask about the numbers below.

40.2% of the Medicare patients who left this home got back to the community and stayed there for at least 31 days — which CMS reads as no different from the national rate. This is CMS’s risk-adjusted rate over 66 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.

40.2%U.S. median 51.5%
Got home and stayed home
9.8%U.S. median 10.7%
Went back to hospital
55.6%U.S. median 56.6%
Met the expected recovery
0.46U.S. median 0.31
Therapy hours / resident / day
0.26hours / resident / day
Physical therapy
0.10hours / resident / day
Occupational therapy
0.10hours / resident / day
Speech therapy

Met the expected recovery: 55.6% of this home’s Medicare short-stay residents left it at or above the ability to care for themselves and move around that CMS predicted for them, across 27 stays in Oct 2024–Sep 2025. The median of the 11,061 homes CMS publishes this for is 56.6%. Read it beside the getting-home figure, not instead of it: unlike the two measures above, CMS makes no better-or-worse call on this one and publishes no confidence interval for it, so this is a comparison and not a verdict — but it is the short-stay measure that separates homes most, and the one to ask about.

Therapy staffing: this home’s payroll records show 0.46 therapist hours per resident per day in 2026Q1 — more than 77% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 24% of this home’s weekday level — it runs some therapy at the weekend, at a lower level than on weekdays. The median home that reports therapy runs 13% — weekday-focused therapy is the industry norm, not a shortfall. But recovery does not pause on a Saturday: ask what the weekend actually looks like here.

This section is about rehab stays, not living here. Most of this page — the stars, the quality measures, the inspection record — describes the home the way a permanent resident experiences it. These figures describe the short Medicare stay after a hospital discharge: a hip, a stroke, a bad infection, six weeks and home. They are different residents, different staff, often a different wing. Therapy hours are per resident in the building, not per rehab patient — the count includes every long-stay resident, and they mostly get no therapy at all. So a home with a small rehab wing inside a large nursing population reads low here even if its rehab patients get plenty of therapy, and a mostly-rehab home reads high. Use it to compare homes doing similar work, ask what a rehab resident actually gets in a day, and remember that CMS does not publish therapy minutes per patient — nobody does.

See every short-stay measure CMS publishes for this home
MeasureThis homeU.S. medianPeriod coveredCMS’s call
Got home and stayed homeRate of successful return to home or community from a SNF40.2%CMS range 30.8–50.851.5%Oct 2022–Sep 2024no different from U.S.
Went back to hospitalRate of potentially preventable hospital readmissions 30 days after discharge from a SNF9.8%CMS range 6.9–15.310.7%Oct 2022–Sep 2024no different from U.S.
Met the expected recoveryPercentage of residents who are at or above an expected ability to care for themselves and move around at discharge55.6%56.6%Oct 2024–Sep 2025CMS makes no comparison for this measure
Self-care at dischargePercentage of residents who are at or above an expected ability to care for themselves at discharge51.9%52.8%Oct 2024–Sep 2025CMS makes no comparison for this measure
Moving around at dischargePercentage of residents who are at or above an expected ability to move around at discharge55.6%50.0%Oct 2024–Sep 2025CMS makes no comparison for this measure
Medication problems followed upPercentage of residents whose medications were reviewed and who received follow-up care when medication issues were identified100.0%98.7%Oct 2024–Sep 2025CMS makes no comparison for this measure
Medication list to the next providerPercentage of residents where the SNF provided a current medication list to the next health care settingnot reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
Medication list to the familyPercentage of residents where the SNF provided a current medication list to the resident, family, and/or caregiver at final dischargenot reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
Falls with major injuryPercentage of SNF residents who experience one or more falls with major injury during their SNF stay0.0%0.0%Oct 2024–Sep 2025CMS makes no comparison for this measure
New or worsened pressure ulcersPercentage of residents with pressure ulcers/pressure injuries that are new or worsened13.2%1.9%Oct 2024–Sep 2025CMS makes no comparison for this measure
Infections that led to hospitalPercentage of infections residents got during their SNF stay that resulted in hospitalization6.4%CMS range 3.5–11.27.1%Oct 2023–Sep 2024no different from U.S.
Medicare spending per stayMedicare Spending Per Beneficiary (MSPB) for residents in SNFs1.241.02Oct 2022–Sep 2024CMS makes no comparison for this measure

From the CMS Skilled Nursing Facility Quality Reporting Program — Medicare short-stay outcomes, which is a different dataset from the long-stay quality measures above and describes a different set of residents. Where CMS risk-adjusts a measure we show its adjusted rate, and the CMS range beside it is the confidence interval CMS publishes: a home whose range is wide is a home with few stays, where one patient moves the number several points. Read the period column. These measures do not share a window — the claims-based ones (getting home, readmission, spending) lag by a year or more, because a stay has to finish and its claims settle before it can be counted. CMS’s call is CMS’s, not ours: it is the only place anyone tests whether this home differs from the national rate at all, and most homes on most measures do not. Two caveats on it. CMS tests only three of these measures — getting home, readmission, and infections that led to hospital; on the other nine it publishes a rate and no comparison, and rather than compute a verdict CMS declined to make, we say so in the column. And on readmission almost every home in the country lands on “no different”, so that row separates homes far less than getting-home does — which is why met the expected recovery, a measure CMS does not test but which spreads across the whole range, is called out above the table rather than left in this list. The U.S. median column is our own, taken across every home CMS publishes that measure for in this same file; it is not a CMS-published benchmark. Homes CMS gives no rate for are left out of it rather than counted as zero. Medicare spending per stay is a ratio, not a percentage — 1.00 means this home’s Medicare spending for a stay matched the national figure CMS compares it against, and it measures cost to Medicare, not quality of care.

Staffing

1.40
RN hours/ resident / day
0.59
LPN hours/ resident / day
2.18
Aide hours/ resident / day
4.18
Total nurse hours/ resident / day
1.20
RN hoursweekends
52.9%
Total nursing turnover
50.0%
RN turnover

How full it usually is: this home is certified for 50 beds and averages 42.7 residents a day — about 85% occupied, or roughly 7 beds typically open. It runs fairly full. This is a CMS average, not live availability — no public source publishes real-time vacancies, and a home can be full the day you call. Confirm with the home, and if you need a Medicaid bed specifically, ask about that separately: a home with open beds may still not have an open Medicaid bed.

Against a benchmark — not a legal minimum. In May 2024 CMS finalized the first federal staffing floor for nursing homes: 3.48 total nurse hours per resident per day, including 0.55 RN hours and 2.45 nurse-aide hours. Its hour requirements never took effect and are no longer on the books. Homes had until 2026 (2027 if rural) to comply, and that deadline never arrived: a federal court vacated the hour requirements in April 2025 (CMS has appealed), Congress then barred enforcement until 2034, and CMS formally repealed them by rule effective February 2026. This home is not required to meet these numbers, and is not violating anything by missing them. We still show the comparison because the figures are CMS’s own published estimate of adequate staffing, which makes them a useful yardstick — but they are our benchmark, not federal law: this home’s total nurse staffing of 4.18 hrs/resident/day is at or above the 3.48-hour benchmark and RN staffing of 1.40 is at or above the 0.55-hour RN benchmark and nurse-aide staffing of 2.18 is below the 2.45-hour aide benchmark. What federal law does require today is unchanged: “sufficient” nursing staff for residents’ needs and an RN on duty at least 8 consecutive hours a day, 7 days a week (42 CFR 483.35). Those are judged by inspectors on site, not by these averages, so read this comparison alongside the inspection record rather than as a pass/fail.

Weekend coverage: total nurse staffing is 3.54 hrs/resident/day on weekends vs 4.43 on weekdays — 20% thinner on weekends — a notable drop. RN hours go from 1.49 to 1.20 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 53% is about the same as the national median of 45%.

Payroll-based (PBJ) staffing hours, as reported for Jan–Mar 2026 (CMS PBJ CY2026Q1) — the most recent quarter CMS has published, so they can lag a change of operator or staffing agency. Higher is generally better. Registered-nurse coverage and weekend staffing are the numbers families most often overlook — an RN on site matters most when something goes wrong, and coverage usually thins on weekends. High turnover means residents rarely see the same caregiver twice. One caveat: these are hours as reported, not adjusted for how sick or heavy-care this home’s residents are. CMS separately publishes a case-mix-adjusted view; we show the reported hours. A home caring for higher-acuity residents needs more hours to deliver the same care, so compare these figures against homes doing similar work, and read them next to the inspection record rather than alone.

Inspection trend

7
deficiencies at the latest standard inspection (2023-09-07)
7
at the previous standard inspection (2021-06-21)

Deficiencies are unchanged from the previous inspection. Fewer citations over time suggests a home is fixing problems; a rising count is a warning sign — though two surveys are a short record, and survey teams differ. These counts are from the standard annual health survey only; the full citation list below may also include findings from complaint investigations, so the two won’t always add up.

This trend is not current. The most recent of these two inspections was over 3 years ago; the arrow describes what inspectors found then, not what the home is like now.

Inspection deficiencies

State health-inspection citations, most serious first. Each carries an F-code (the federal rule it cites, e.g. F-684 = quality of care) and a letter A–L marking how serious and how widespread the problem was — we translate that grid into the plain tiers shown here. Wording is the official federal description.

ABCDEFGHIJKL

Each letter is a CMS scope-severity level; highlighted ones are where this home has citations. A–C = no harm found; D–F = potential for harm; G–I = actual harm; J–L = immediate jeopardy. Within each band the later letter is the more widespread finding (an isolated G is one resident; a widespread I is a pattern), so rightward and downward is worse.

22 citations, most serious first. The 11 most serious are shown; the remaining 11 are one tap away and print in full.

  • Immediate jeopardy · Jcited before2026-02-25 · tag F0684 — failed to provide proper treatment and quality of care — isolated
    Provide appropriate treatment and care according to orders, resident’s preferences and goals.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on closed medical record review, interview, review of the emergency medical services (EMS) run report, and facility policy review, the facility failed to provide timely, necessary and adequate care and services following an acute change in condition. Resident #45 had a recent hospitalization and a significant cardiac history including cardiac coronary disease, history of a heart attack, atrial fibrillation, and congestive heart failure. The facility failed to ensure changes in the resident's medical condition were adequately assessed, failed to have documented evidence of notification to the physician and that adequate care and services were implemented for Resident #45 when the resident had repeatedly complained of chest pain and tightness. This resulted in Immediate Jeopardy with subsequent death beginning on [DATE] when Resident #45's repeated complaints of chest pain and tightness were not adequately addressed. This affected one (Resident #45) of three residents reviewed for change in condition. The…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2026-02-25 · tag F0609 — failed to report abuse allegations — isolated
    Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on the medical record review, review of the emergency medical services (EMS) run report, facility policy and procedure review and interview, the facility failed to report an allegation of neglect to the State agency. This affected one (Resident #45) of three residents reviewed for change in condition. The facility census was 42.Findings include:Review of the closed medical record revealed Resident #45 was admitted to the facility on [DATE] and expired in the facility on [DATE]. Diagnoses included acute on chronic congestive heart failure, atrial fibrillation, atherosclerotic coronary heart disease, hypertensive heart disease with heart failure, muscle weakness, and ischemic cardiomyopathy. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #45's memory was intact, and he had modified independence for cognitive skills for daily decision making. The assessment indicated the resident required supervision with eating, was dependent on staff for toileting hygiene, and…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2025-06-16 · tag F0602 — failed to protect residents from theft of their belongings — isolated
    Protect each resident from the wrongful use of the resident's belongings or money.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY THE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NON-COMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Based on observation, interview, record review, review of facility self-reported incidents (SRI) and facility policy review, the facility failed to ensure Resident #4 was free from misappropriation. This affected one resident (#4) of three residents reviewed for abuse, neglect and misappropriation of property. The facility census was 44. Findings include: Review of the medical record revealed Resident #4 was admitted to the facility on [DATE] with diagnoses that included dementia, recurrent urinary tract infection (UTI), chronic kidney disease, atrial fibrillation and peripheral vascular disease. Review of the most recent Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #4 was cognitively impaired and required extensive assistance with activities of daily living. Review of a facility self-reported incident (SRI) control number 260103 dated 05/06/25 revealed Resident…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Freedom from Abuse, Neglect, and Exploitation Deficiencies · Past Non-Compliance
  • Potential for harm · D2025-01-29 · tag F0695 — failed to provide proper breathing / tracheostomy care — isolated
    Provide safe and appropriate respiratory care for a resident when needed.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, interview and review of the facility policy, the facility failed to correctly transcribe and record oxygen orders upon admission to ensure oxygen was administered properly. This affected one resident (#43) of three residents reviewed for oxygen. Facility census was 40. Findings include: Review of Resident #43's closed medical record revealed an admission date of [DATE] and diagnoses including right arm humorous fracture, acute on chronic congestive heart failure, hypertensive heart disease with heart failure, hyperlipidemia, chronic obstructive pulmonary disease, type two diabetes and chronic kidney disease stage four. Resident #43 expired in the facility on [DATE]. Review of Resident #43's 5-day minimum data set (MDS) 3.0 assessment dated [DATE] revealed he was cognitively intact and was dependent on staff for toileting and transfers. The assessment indicated Resident #43 expired in the facility. Review of Resident #43's hospital paperwork dated [DATE] revealed additional discharge…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · F2023-09-07 · tag F0583 — failed to protect personal privacy — widespread
    Keep residents' personal and medical records private and confidential.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on record review, observation and interview, the facility did not ensure private and confidential handling of resident medical information for Residents #14, #15, #19, #20, #29 and #31. This affected six residents ( #14, #25, #19, #20, #29 and #31) of six residents reviewed for weights and had the potential to affect all residents living in the facility. The facility census was 42. Findings include: Record review of weight documentation and physician orders for weights revealed Residents #14, #15, #19, #20, #29, and #31 each had an order to be weighed at least once a month and each had multiple weights missing from the medical record of weights. Interview on 09/06/23 at 8:50 A.M. with the Director of Nursing (DON) revealed the system in place for recording resident weights consisted of weights obtained by State Tested Nursing Assistant (STNA) #944 who recorded the weights in a paper logbook and those weights were then transposed into the electronic medical record (EMR) by the DON. Interview on 09/06/23 at 2:18 P.M. with STNA #944 revealed he was the staff person who was…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Resident Rights Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · E2023-09-07 · tag F0692 — failed to prevent malnutrition and dehydration — pattern
    Provide enough food/fluids to maintain a resident's health.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, observation and interview, the facility failed to ensure adequate and sufficient documentation of residents' weights in the medical record for the monitoring of residents at nutrition risk and identification and assessment of significant weight changes. This affected six residents (#14, #15, #19, #20, #29, and #31) of six reviewed for nutrition. The facility census was 42. Findings include: 1. Review of the medical record for Resident #14 revealed an admission date of 12/04/22. Diagnoses included feeding tube, muscle weakness, hypothyroidism, lupus, dementia, and history of cancer of the uterus. Review of the quarterly minimum data set (MDS) assessment dated [DATE] revealed the resident had impaired cognition, required supervision with set up help for eating, weight was 124 pounds, with no weight changes, received mechanically altered diet, and received 26%-50% of calories and 501 ml or more per day of fluids from a feeding tube. Review of Resident #14 weight history revealed on 12/04/22…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2023-09-07 · tag F0558 — failed to accommodate residents' needs and preferences — isolated
    Reasonably accommodate the needs and preferences of each resident.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, staff and resident interviews, and policy review, the facility failed to ensure call lights were within reach and accessible. This affected two residents (#5 and #31) of two residents reviewed for call light placement. The facility census was 42. Findings Include: 1. Review of the medical record for Resident #5 revealed she was admitted to the facility on [DATE] with diagnoses including dementia, dysphagia and difficulty walking. Review of the annual, Minimum Data Set (MDS) assessment, dated 07/16/23, revealed Resident #5 had a Brief Interview for Mental Status (BIMS) score of 10 indicating she was alert and oriented with long-term and short-term cognition impairment. Review of the MDS assessment revealed Resident #5 was a one-person extensive assist for activities of daily living (ADLs). Review of the care plan dated 07/14/23 revealed Resident #5 was at risk for falls and falls with injury due to a history of falls with interventions including call light within reach.…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Resident Rights Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2023-09-07 · tag F0698 — failed to provide proper dialysis care — isolated
    Provide safe, appropriate dialysis care/services for a resident who requires such services.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, the facility failed to ensure a physician order was written for dialysis treatments, a dialysis contract was in place between the facility and the dialysis center, and also failed to ensure assessments before and after dialysis treatments were completed for Resident #145. This affected one resident (#145) of one resident reviewed for dialysis services. The facility census was 42. Findings include: Review of the medical record for Resident #145 revealed an admission date of [DATE]. Diagnoses included end stage renal disease (ESRD), dependence on renal dialysis, and congestive heart failure. Review of the 48 hour care plan dated [DATE] revealed the resident received dialysis on Tuesdays, Thursdays, and Saturday. Review of the care plan dated [DATE] revealed the resident was on dialysis and received treatments two to three times per week. At risk for infection, diagnosis of ESRD. Resident had a history of choosing not to go to dialysis as scheduled. Review of the [DATE]…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · F2021-06-21 · tag F0607 — failed to have anti-abuse policies — widespread
    Develop and implement policies and procedures to prevent abuse, neglect, and theft.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on staff interview, review of personnel files and the abuse policy and procedure, the facility failed to develop and implement policies and procedures to include screening of all employees against the State of Ohio Nurse Aide Registry to identify if an employee had a finding concerning abuse, neglect, exploitation, mistreatment of residents or misappropriation of resident property This affected nine of nine employees whose personnel files were reviewed for screening against the State of Ohio Nurse Aide Registry (Dietary Aide (DA) #587 , Registered Nurse (RN) #570, Maintenance Director (MD) #505, Activities Assistant (AA) #533 and State Tested Nursing Assistants (STNAs) #507, #526, #536, #540, #567). This had the potential to affect all 43 residents residing in the facility. Findings include: Review of the personnel files for DA #587 , RN #570, MD #505, AA #533 and STNA's #507, #526, #536, #540, #567 revealed no evidence they were screened using the State of Ohio Nurse Aide Registry. The identification of findings would be necessary to determine if any employee had actions…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2021-06-21 · tag F0582 — isolated
    Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on review of Notice of Medicare Non-Coverage (NOMNC) letters and staff interviews, the facility failed to provide the correct Quality Improvement Organization (QIO) information to residents who were completing therapy. This affected three (Resident #22, Resident #243 and Resident #244) of three reviewed for liability notices. The facility also failed to provide 48-hour notice of the non coverage to the residents. This affected two (Resident #243 and Resident #244) of three reviewed for liability notices. The census was 43. Findings include: 1. Review of Resident #22's medical record revealed the resident was admitted to the facility on [DATE]. A Notice of Medicare Non-Coverage letter revealed services were ended on 06/10/21. The letter did not provide the correct QIO information if the resident wanted to appeal. 2. Review of Resident #243's medical record revealed the resident was admitted to the facility on [DATE]. A Notice of Medicare Non-Coverage letter revealed services were ended on 12/15/20. The…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Resident Rights Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2021-06-21 · tag F0604 — failed to not use physical restraints improperly — isolated
    Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, policy review and resident interview the facility failed to ensure Resident #5 was free from unnecessary restraint. This affected one (Resident #5) of two residents reviewed for elopement. The facility census was 43. Findings Include: Resident #5 was admitted to the facility on [DATE] with diagnoses that included dementia, major depressive disorder and psychotic disorder. Review of the Minimum Data Set 3.0 assessment dated [DATE] revealed Resident #5 had a Brief Interview for Mental Status (BIMS) score of 15 indicating no cognitive impairment and exhibited no physical, verbal or wandering behaviors. Review of the physician orders dated 12/17/19 revealed an order for a wanderguard to right wrist and to check placement every shift. A Wanderguard Bracelet triggers alarms and locks monitored doors to prevent the wearer from leaving an area unattended. Review of the policy entitled Wanderguard System dated 06/12/12 revealed ongoing assessment of the resident shall occur to identify changes in…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
Show the remaining 11 citations
  • Potential for harm · D2021-06-21 · tag F0645 — isolated
    PASARR screening for Mental disorders or Intellectual Disabilities
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and staff interview the facility failed to ensure Pre admission Screen and Resident Review (PASRR) forms were completed timely as required and addressed all applicable mental health and developmental disability diagnoses. This affected two of three residents reviewed for PASRR compliance. The facility census was 43. Findings Include: 1. Resident #12 was admitted to the facility on [DATE] with diagnoses that included major depressive disorder, overactive bladder and constipation. Further review of the medical record revealed Resident #12 was admitted to the facility on a hospital exemption form which in turn required the completion of the PASRR form within thirty days of admission. Review of the PASRR in the medical record revealed Resident #12's PASRR was completed on 06/16/21. 2. Resident #19 was admitted to the facility on [DATE] with diagnoses that included alcohol dependence, cerebral palsy and lack of coordination. Further review of the medical record revealed Resident #19 was…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2021-06-21 · tag F0657 — failed to keep the care plan current — isolated
    Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and staff interview the facility failed to ensure resident care plans were revised to reflect current resident medical/behavioral conditions. This affected one (Resident #5) of two residents reviewed for elopement. The facility census was 43. Findings Include: Resident #5 was admitted to the facility on [DATE] with diagnoses that included dementia, major depressive disorder and psychotic disorder. Review of the Minimum Data Set 3.0 assessment dated [DATE] revealed Resident #5 was cognitively intact and exhibited no physical, verbal or wandering behaviors. Review of the physician order dated 12/17/19 revealed an order for a wanderguard to right wrist and to check placement every shift. Review of the elopement/wandering assessment for 12/16/19 revealed Resident #5 was at a high risk for wandering. Review of subsequent elopement/wandering assessments from 06/10/21, 03/12/21, 12/11/20, 09/21/20 and 06/22/20 revealed the resident was at a low risk for wandering and elopement. The medical record…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Dcited before2021-06-21 · tag F0684 — failed to provide proper treatment and quality of care — isolated
    Provide appropriate treatment and care according to orders, resident’s preferences and goals.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and staff interview the facility failed to ensure physician orders were followed as written and medication was not given without a physician order. This affected two (Residents #5 and #42) of fifteen sampled residents. The facility census was 43. Findings Include: 1. Resident #5 was admitted to the facility on [DATE] with diagnoses that included dementia, major depressive disorder and psychotic disorder. Review of the Minimum Data Set 3.0 assessment dated [DATE] revealed Resident #5 was cognitively intact and exhibited no physical, verbal or wandering behaviors. Review of the physician order dated 12/17/19 revealed an order for a wanderguard to right wrist and to check placement every shift. Review of both the electronic and paper medical records revealed no evidence of monitoring of the placement of Resident #5's Wanderguard. Interview with the Assistant Director of Nursing (ADON) on 06/15/21 at 11:30 A.M. verified their was no evidence of monitoring of the Wanderguard placement. The ADON…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2021-06-21 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — isolated
    Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and staff interview the facility failed to ensure a Wanderguard (device used for alerting staff of exit seeking from a resident) was functioning properly. This affected one (Resident #5) of two residents reviewed for elopement. The facility census was 43. Findings Include: Resident #5 was admitted to the facility on [DATE] with diagnoses that included dementia, major depressive disorder and psychotic disorder. Review of the Minimum Data Set 3.0 assessment dated [DATE] revealed Resident #5 was cognitively intact and exhibited no physical, verbal or wandering behaviors. Review of the physician order dated 12/17/19 revealed an order for a wanderguard to right wrist and to check placement every shift. Observation of Resident #5 ambulating on 06/15/21 at 11:20 A.M. with the Director of Nursing revealed Resident #5's Wanderguard bracelet did not set off any alarms as designed when Resident #5 was near an exit door. The Director of Nursing verified Resident #5's Wanderguard was not functioning…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Dcited before2019-02-21 · tag F0641 — isolated
    Ensure each resident receives an accurate assessment.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, the facility failed to ensure accurate resident assessments. This affected two residents (Resident's #14 and #31) of 21 residents reviewed for accurate assessments. The facility census was 40. Findings include: 1. Review of the medical record revealed Resident #14 was admitted to the facility on [DATE] with diagnoses that included acute respiratory failure, dementia with behavioral disturbances, dysphagia, and acquired absence of kidney. Review of Resident #14's Minimum Data Set (MDS) 3.0 assessment, dated 12/21/18, indicated the resident exhibited severe cognitive impairment and did not receive any opioids for pain. Review of Resident #14's medical record, physician orders, medication administration records (MAR) and treatment administration records (TAR) for December 2018 revealed Resident #14 received three doses of the opioid Ultram during the assessment period. Interview on 02/22/19 at 10:10 A.M. with MDS Nurse #32 confirmed Resident #14's comprehensive MDS 3.0…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2019-02-21 · tag F0880 — failed to prevent and control infections — isolated
    Provide and implement an infection prevention and control program.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, staff interview, medical record review, review of Centers for Disease Control (CDC) guidelines and policy review, the facility failed to ensure appropriate infection control procedures were enacted for two residents (Resident #194 and Resident #38) of 22 residents reviewed for infection control procedures. The facility census was 40. Findings Include: 1. Review of the medical record revealed Resident #194 was admitted to the facility on [DATE] with diagnoses including post-operative therapy after cervical spinal surgery, a positive test for the Influenza A virus, neuromuscular dysfunction of the bladder (a condition causing difficulty with bladder control), heart disease, chronic obstructive pulmonary disease, and chronic kidney disease. Review of the medical record revealed on 02/17/19 Resident #194 developed a fever of 101.7 degrees Fahrenheit (F), a low oxygen saturation rate of 90% on room air (the normal range should be 94% to 100% on room air), and increased pain with periods of…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Infection Control Deficiencies · Deficient, Provider has date of correction
  • No harm found · C2024-04-23 · tag F0851 — widespread
    Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on interviews, review of the Payroll Based Journal (PBJ) staffing report, review of facility staffing schedules and timecard punches revealed the facility failed to submit accurate staffing information to the Centers for Medicare and Medicaid Services (CMS). This had the potential to affect all 39 residents residing in the facility. Findings include: Review of the PBJ Staffing Data Report for Fiscal Year Quarter one for 2024 revealed the facility triggered for failing to have licensed Nursing Coverage 24 hours per day for 12/16/23 (Saturday), 12/17/23 (Sunday), 12/23/23 (Saturday), 12/24/23 (Sunday) and 12/31/23 (Sunday). Review of facility schedules and assignments sheets for the above listed dates revealed there was nursing staff present 24 hours for each day listed in the PBJ report. Review of the December 2023 timecard punch details report submitted for the PBJ report revealed inconsistencies between the actual time punches and the information on the submitted report. Interview on 04/23/24 at 10:30 A.M. with Financial Officer (FO) #47 and the Administrator revealed FO #47…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Administration Deficiencies · Deficient, Provider has plan of correction
  • No harm found · Ccited before2023-09-07 · tag F0623 — widespread
    Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY 2. Review of Resident #43's medical record identified admission to the facility occurred on 01/17/22 with medical diagnoses including stroke, dementia, alzheimer's, skin cancer, and depression. The record identified Resident #43 discharged to the hospital on [DATE] and did not re-enter the facility. Review of both the electronic medical record and hard chart revealed no evidence Resident #43 and/or representative received notification in writing for transfer to the hospital dated 07/12/23. Interview on 09/07/23 at 9:30 A.M. with Registered Nurse (RN) #964 revealed he was responsible for notifying the ombudsman of discharges and transfers to the hospital and did so via email. RN #964 said he was also responsible to give bed hold notices to residents/resident respresentativees when discharging or transferring to the hospital, but was not doing this because instead all residents were provided the policy on bed holds, discharges and transfers during the admission process and no follow-up information was provided to…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Resident Rights Deficiencies · Deficient, Provider has plan of correction
  • No harm found · C2023-09-07 · tag F0625 — widespread
    Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, review of facility bed hold policy and staff interviews, the facility failed to ensure Resident #40 and #43 were provided bed hold notices. This affected two residents (#40 and #43) of two residents reviewed for hospitalization and had the potential to affect all residents living in the facility. The facility census was 42. Findings include: 1. Review of Resident #40's medical record identified admission to the facility occurred on 06/06/23, with medical diagnoses that included sepsis, dementia, and dysphagia. The record identified Resident #40 required hospitalization on 06/25/23, 07/04/23, and 07/17/23. Review of both the electronic and hard charts revealed no evidence Resident #40 or her family/representative were given information regarding bed hold days remaining and other related procedures for her return to the facility upon each discharge to the hospital. 2. Review of Resident #43's medical record identified admission to the facility occurred on 01/17/22, with medical…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Resident Rights Deficiencies · Deficient, Provider has plan of correction
  • No harm found · Bcited before2023-09-07 · tag F0641 — pattern
    Ensure each resident receives an accurate assessment.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and staff interview the facility failed to ensure the pre admission screen and resident review status was coded correctly on the Minimum data set (MDS) assessment. This affected two (Residents #1 and #2) of two residents with a level two mental illness currently residing at the facility. The facility census was 42. Findings Include: 1. Record review revealed Resident #1 was admitted to the facility on [DATE] with diagnoses that included schizoaffective disorder, type two diabetes and hypothyroidism. Review of the pre-admission screen and resident review (PASRR) level two evaluation from the state department of mental health dated 11/06/97 revealed Resident #8 had level two mental illness. Review of section A of the most recent comprehensive MDS 3.0 assessment dated [DATE] revealed the facility answered no to the question of Is the resident currently considered by the state level II PASRR process to have serious mental illness and/or intellectual disability (mental retardation in federal…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Resident Assessment and Care Planning Deficiencies · Deficient, Provider has plan of correction
  • No harm found · Bcited before2019-02-21 · tag F0623 — pattern
    Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to notify the office of the Long-Term Care Ombudsman of resident's transfers to the hospital. This affected two (Resident's #11 and #44) of two residents reviewed for hospitalization. The facility census was 40. Findings include: Record review revealed Resident #11 was admitted on [DATE]. Diagnoses included dementia, anxiety, hypertension, tachycardia (a fast heart rate) and bradycardia (a slow heart rate). Review of Resident #11's progress notes revealed on 02/05/19 at 12:22 P.M., Resident #11 had a low-grade temperature and was slow in responding to staff. The physician was notified and gave a new order to send resident to the hospital. There was no documentation found to indicate the office of the Long-Term Care Ombudsman was notified of Resident #11's transfer to the hospital. Record review revealed Resident #44 was admitted on [DATE]. Diagnoses included seizures, dementia, hypertension, atrial fibrillation an irregular heartbeat. Review of Resident's…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Resident Rights Deficiencies · Deficient, Provider has date of correction

“Cited before” means this same F-tag appears on at least one other survey date in the record we hold — counting complaint investigations as well as standard surveys, with no time limit. It is our own read of the data, not CMS’s: CMS uses repeat deficiency as a formal term tied to consecutive standard surveys, and that is a narrower test than this one. A tag marked here may or may not meet it.

Worried about a resident here? There are three different people you can turn to, and they do different jobs:
  • Long-Term Care Ombudsman — a free, confidential advocate for the resident. They act only with the resident’s consent and work to resolve the problem. Find yours at theconsumervoice.org/get_help.
  • Adult Protective Services — the state agency that investigates suspected abuse, neglect, or exploitation of a vulnerable adult. Not sure of your state’s APS number? The federal Eldercare Locator will route you: 1-800-677-1116 or eldercare.acl.gov.
  • State survey agency — the regulator that licenses and inspects the home. Every state has an official nursing-home complaint line and most take complaints online; the Ombudsman or Eldercare Locator can connect you.
Not sure where to start, or need other help? Dial 2-1-1 for local resources — and if a call is hard or impossible for you, many local 211s also take a text (send your ZIP code to 898-211) or a web chat at 211.org; both vary by area, and 211.org will show what yours offers. Deaf or hard of hearing: dial 711 for the telecommunications relay service, then any number above. In an emergency, call 911.
It is illegal for a facility to retaliate against a resident or family for reporting a concern: federal law gives a resident the right to voice grievances — to the home or to any outside agency — without discrimination or reprisal (42 CFR §483.10(j)(1)). You may report anonymously.

Fines & penalties

$40,803 in federal fines across 1 penalty.

  • $40,803 — penalty dated 2026-02-25

Dates are the dates CMS records the penalty, not the date of the conduct behind it. CMS publishes penalties on a rolling window, so this is what is currently on the public file — not the home’s lifetime history, and an older fine may attach to a problem that has since been corrected. The amounts are as imposed: the CMS file does not record whether a penalty was appealed, reduced, or paid, so we don’t say. Ask the home what each one was for and what changed since.

Who owns this facility

Owner / managerTypeRoleShareSince
CAMPBELL, PATRICEIndividual5% OR GREATER DIRECT OWNERSHIP INTEREST; 5% OR GREATER MORTGAGE INTEREST; CORPORATE DIRECTOR; OPERATIONAL/MANAGERIAL CONTROL; TRUSTEE OF THE SNF; ADP OF THE SNF100%since 09/10/2000
LANG, ALICIAIndividualCORPORATE OFFICER; OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNFsince 04/01/2023
CITRIN COOPERMAN ADVISORS LLCOrganizationOPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNFsince 01/01/2007
PREMIER THERAPY LLCOrganizationOPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNFsince 06/01/2004
BIELOPETROVICH, JOSEPHIndividualOPERATIONAL/MANAGERIAL CONTROLsince 09/20/2004
DONOVAN, DAVIDIndividualOPERATIONAL/MANAGERIAL CONTROLsince 09/14/1992
KLOPMAN, HEATHERIndividualOPERATIONAL/MANAGERIAL CONTROLsince 01/13/2025
MAGURA, VASYLIndividualOPERATIONAL/MANAGERIAL CONTROLsince 04/01/2000
VILCHECK, JOHNIndividualOPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNFsince 02/03/2015
DAYEM HEALTH SERVICES LLCOrganizationADP OF THE SNFsince 03/19/2019
DAYEM, MICHAELIndividualADP OF THE SNFsince 03/19/2019
GOVANI, NITINIndividualADP OF THE SNFsince 01/01/2017

CMS files one row per role, so the 22 rows in the source record cover these 12 parties — each is shown once here with every role it holds. Nothing is omitted.

3 organizational owners listed — a facility can be part of a larger chain. CMS ownership data is known to under-report private-equity and REIT ties; treat as a starting point.

Follow the money — this home’s finances

Where a nursing home’s revenue comes from and where it goes — including money paid to companies under the same ownership. Most consumer sites never show this; we reproduce it straight from the Medicare cost report.

$9.4M
Net patient revenuemost recent cost report
-6.6%
Operating marginrevenue minus expenses
Who pays — share of resident-days
Medicaid 14%Medicare 7%Other / private 79%

A reported operating loss is common in this industry and is not by itself a sign of trouble — but paired with large related-party payments it can mean profit is being taken elsewhere in the ownership structure.

Source: CMS Healthcare Provider Cost Reporting Information System (HCRIS), Medicare cost report Form CMS-2540 · fiscal year 2023. Facilities self-file these reports; figures are unaudited and a year or two behind. A home with no Medicare cost report on file shows no figures here.

Cost & finances

$380per resident / day
operating cost
$11,550per month
≈ monthly operating cost
$357per day
avg. revenue, all payers

Straight from this home’s Medicare cost report (CMS, FY2023). These are its operating economics — what it costs to run per resident-day and what it collects on average across Medicare, Medicaid, and private pay — not a private-pay quote. Your out-of-pocket cost depends on payer and room type, so ask the facility directly; a higher operating cost can reflect richer staffing or a sicker population. The cost-of-care planner shows regional benchmarks by care type.

What families pay in OH

Paying with Medicaid

This is a Medicare- and Medicaid-certified nursing home, so it can accept Medicaid for long-term care — like nearly all U.S. nursing homes. The private-pay figures below are what families without Medicaid pay; once a resident qualifies for Medicaid, out-of-pocket cost for covered nursing-home care is typically close to $0 (almost all of their income goes to the home as their share of the cost; they keep a small personal needs allowance — for clothing, haircuts, a phone — and Medicaid pays the rest). The amount of that allowance is set by each state. Confirm Medicaid-bed availability with the home, and see the Ohio Medicaid page.

Typical monthly cost in Ohio
$9,186/mo
Nursing home (semi-private)
$10,389/mo
Nursing home (private)
$6,103/mo
Assisted living

Median private-pay cost, CareScout (Genworth) 2025 Cost of Care Survey — a regional midpoint, not any single community’s rate. Private rooms and higher care levels cost more; ask for a current quote. Project your own in the cost-of-care planner.

Every figure above is reproduced from the CMS Provider Data Catalog (a public record), from the CMS extract processed 2026-08-01 — CMS provider number 366266. CMS refreshes its data monthly, and the star rating rests on the last standard inspection — dated 2023-09-07, which can lag current conditions. Staffing hours are CMS PBJ CY2026Q1 (Jan–Mar 2026). Check this record against the government’s own page for it: this home on Medicare Care Compare ↗ — the authoritative source, and the place to confirm anything here before you act on it. How we present it →

Not a government site. Eldercare Lens is not affiliated with, endorsed by, or authorized by the Centers for Medicare & Medicaid Services (CMS), Medicare, or any government agency. The star ratings, citations, and inspection wording on this page are reproduced from the public CMS record; the plain-English summaries, tiers, and comparisons around them are ours. We do not speak for CMS, and CMS has not reviewed this page. For the official record, go to Medicare Care Compare. How we’re funded →

Are you this operator? If the record here is out of date, or misses what you have since fixed, tell us and we will look: hello@eldercarelens.com. We reproduce the public CMS record and cannot change what it says — corrections to the underlying data go through CMS and your state survey agency — but we will correct anything we have got wrong about it, and we will say so on the page.

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