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Altercare Somerset Inc.

411 South Columbus Street, Somerset, OH 43783 · For profit - Corporation · 79 certified beds · (740) 743-2924 Medicare & Medicaid certified

Call the home — (740) 743-2924 Need help choosing, fast? Free, unbiased: Eldercare Locator 1-800-677-1116
Abuse/neglect citation on record (F0602) — cited Oct 2024Resident-funds citation (F0569)Behavioral-health or dementia-care citation — no harm found (F0740)1 actual-harm citation
Insights

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

In its favor
  • a middle-of-the-pack inspection score (3/5)
  • no federal fines or payment denials on record
Worth asking about
  • it has an abuse, neglect, or exploitation citation (F0602), cited Oct 2024
  • it has a citation for mishandling residents’ money or property (F0569)
  • it has 1 actual-harm citation
  • a high number of inspection citations overall (29) — worth reading through, though larger and more-often-surveyed homes tend to accrue more lower-severity tags
  • its payroll-based staffing rating is low (2/5)
  • nursing-staff turnover (64%) runs well above the national median (45%)

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.

3/5
CMS overall
3 of 5
Health inspectionSurveyor-assigned, ranked within your stateInspector-verified 3 of 5
StaffingFrom payroll records (PBJ) 2 of 5
Quality measuresSelf-reported by the facility 4 of 5

Location & what’s nearby

Hospital
★★ 2/5 CMS · Emergency dept. usually open 24/7 · ER 24/7
Urgent care / clinic
103 Public Sq · (740) 900-0070 · Call to confirm hours
Pharmacy
110 W Main St · (740) 743-2185 · Call to confirm hours
Grocery
105 W Main St · (740) 753-7132 · Call to confirm hours
Park
Typically dawn to dusk
Place of worship
225 S Columbus St · (614) 554-9036

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 held steady at 2 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 rating2★
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 increased4.3%5.3%15.4%better than state — see note marked double-dagger below the table
Long-stay residents who lose too much weight8.9%6.2%5.4%worse
Long-stay residents with a catheter left in their bladder0.0%0.2%0.9%better than state — see note marked double-dagger below the table
Long-stay residents with a urinary tract infection0.9%0.4%2.0%worse than state — see note marked double-dagger below the table
Long-stay residents with depressive symptoms20.1%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 injury3.4%3.2%3.3%typical
Long-stay residents whose ability to walk worsened5.3%6.1%16.1%better than state — see note marked double-dagger below the table
Long-stay residents on antianxiety or hypnotic medication24.9%25.5%18.9%worse
Long-stay residents given the seasonal flu vaccine94.6%94.5%95.3%typical
Long-stay residents with pressure ulcers1.6%3.4%4.7%better
Long-stay residents with worsening bladder/bowel control26.1%21.4%21.2%worse
Long-stay residents who got an antipsychotic medication — see the note below the table15.4%8.8%17.1%typical
Short-stay residents who newly got an antipsychotic medication1.1%1.2%1.4%better
Short-stay residents given the seasonal flu vaccine69.8%75.6%79.4%worse
Short-stay residents rehospitalized after admission27.3%24.9%22.6%worse
Short-stay residents with an outpatient ER visit18.2%12.9%12.0%worse

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.

58.3% 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 53 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.

58.3%U.S. median 51.5%
Got home and stayed home
11.4%U.S. median 10.7%
Went back to hospital
30.0%U.S. median 56.6%
Met the expected recovery
0.17U.S. median 0.31
Therapy hours / resident / day
0.07hours / resident / day
Physical therapy
0.09hours / resident / day
Occupational therapy
<0.01hours / resident / day
Speech therapy

Met the expected recovery: 30.0% 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 30 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 0.17 therapist hours per resident per day in 2026Q1 — more than 15% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 3% of this home’s weekday level — it runs therapy on weekdays, with essentially none at the weekend. 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 SNF58.3%CMS range 48.9–71.551.5%Oct 2022–Sep 2024no different from U.S.
Went back to hospitalRate of potentially preventable hospital readmissions 30 days after discharge from a SNF11.4%CMS range 7.9–16.810.7%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 discharge30.0%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 discharge30.0%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 discharge26.7%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 setting100.0%100.0%Oct 2024–Sep 2025CMS makes no comparison for this 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 worsened0.0%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 hospitalization6.0%CMS range 2.7–11.97.1%Oct 2023–Sep 2024no different from U.S.
Medicare spending per stayMedicare Spending Per Beneficiary (MSPB) for residents in SNFs0.831.02Oct 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

0.61
RN hours/ resident / day
0.68
LPN hours/ resident / day
2.00
Aide hours/ resident / day
3.29
Total nurse hours/ resident / day
0.44
RN hoursweekends
64.4%
Total nursing turnover
28.6%
RN turnover

How full it usually is: this home is certified for 79 beds and averages 68.4 residents a day — about 87% occupied, or roughly 11 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 3.29 hrs/resident/day is below the 3.48-hour benchmark and RN staffing of 0.61 is at or above the 0.55-hour RN benchmark and nurse-aide staffing of 2.00 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 2.70 hrs/resident/day on weekends vs 3.52 on weekdays — 23% thinner on weekends — a notable drop. RN hours go from 0.68 to 0.44 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 64% is well above 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

10
deficiencies at the latest standard inspection (2026-02-26)
9
at the previous standard inspection (2024-07-18)

Deficiencies are more than at the previous inspection — worsening. 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.

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.

29 citations, most serious first. The 11 most serious are shown; the remaining 18 are one tap away and print in full.

  • Actual harm · Gcited before2024-07-18 · tag F0692 — failed to prevent malnutrition and dehydration — isolated
    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 medical record review, interview, and review of facility policy, the facility failed to develop and implement a comprehensive, effective and individualized nutritional program to ensure nutritional recommendations were implemented timely, weights and assessments were completed timely, care plans were updated appropriately, and significant/severe weight changes were addressed for Resident #264. Actual harm occurred when Resident #264 who was cognitively impaired and weighed 104 pounds on 05/19/24 experienced a gradual weight loss until 06/24/24 when she experienced a severe 8.5% (9 pounds) weight loss. The nutritional recommendations for Resident #264 that were made on 05/19/24 were not put in place until they were recommended again on 06/09/24. A nutritional assessment was not completed again following the 06/09/24 recommendation, and as of 07/18/24 Resident #264 weighed 93.8 pounds which was severe 6.7% (6.8 pound) weight loss from 06/20/24. This affected one resident (#264) of two residents reviewed…

    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 before2026-05-19 · tag F0677 — failed to help fully-dependent residents with daily care — isolated
    Provide care and assistance to perform activities of daily living for any resident who is unable.
    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 closed record review, the facility failed to ensure a resident received showers or bed baths at least twice weekly. This affected one resident (#70) of six residents sampled for showering. The facility census was 68.Findings include:Review of Resident #70's closed medical record revealed an admission date of 04/21/26, a discharge date of 05/16/26 and diagnoses including age-related osteoporosis with current pathological fracture, right lower leg, subsequent encounter for fracture with routine healing, paroxysmal atrial fibrillation, cerebral infarction, congestive heart failure, anemia, asthma, hypothyroidism, and pulmonary hypertension.Review of Resident #70's admission Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of 15 indicating the resident was cognitively intact. Further review of the MDS revealed Former Resident #70 used a wheelchair for mobility and required partial/moderate assistance with toileting hygiene,…

    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 · E2026-02-26 · tag F0921 — failed to keep a safe, functional, sanitary building — pattern
    Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
    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, medical record review, interview and facility policy review, the facility failed to ensure resident equipment was maintained in a clean and sanitary manner. This affected three residents (#9, #44 and #54) of 25 sampled residents. The facility census was 69. Findings Include:1. Review of the medical record for Resident #44 revealed an initial admission date of 08/20/23 with the latest readmission of 05/21/24 diagnoses included the protein calorie malnutrition, urinary tract infection (UTI), depression, mood disorder, hypothyroidism, anemia, metabolic encephalopathy, solitary pulmonary nodule, chronic pain, atrial fibrillation, anorexia, osteoarthritis, dementia, macular degeneration and cerebral atherosclerosis. Review of the resident's quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had a severe cognitive deficit. Observation of Resident #44 on 02/23/26 at 10:58 A.M., revealed Resident #44's custom wheelchair was extremely dirty with food debris in 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.

    Environmental Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2026-02-26 · tag F0561 — failed to honor residents' choices — isolated
    Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
    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 family interview, the facility failed to honor a resident's stated beverage preference. This affected one, (Resident #22) of two residents reviewed for choices. The facility census was 69. Findings include:Review of Resident #22's medical record revealed the resident was admitted on [DATE] with diagnoses including dementia and chronic kidney disease. Review of the the most recent Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #22 was cognitively impaired, and required supervision and assistance with eating and drinking. Resident #22 relied on staff to ensure adequate hydration was maintained.Review of the facility document titled Resident Centered Care Food Preferences revealed juice was identified as the resident's preferred beverage at meals. There was no documentation indicating the resident preferred water over juice. During an interview on 02/23/26 at 10:45 A.M., Resident #22's daughter and Power of Attorney (POA) revealed the resident does…

    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 · D2026-02-26 · tag F0655 — isolated
    Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
    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, interview, and review of facility policy review, the facility failed to ensure the baseline care plan was timely reviewed and provided to one ((Resident #74) of 24 residents reviewed. The census was 69.Findings include:Review of Resident #74's medical record revealed the resident was admitted on [DATE] with diagnoses including hypertensive emergency, repeated falls, dementia, and major depressive disorder.Review of the admission Nursing assessment dated [DATE] revealed an unsigned Baseline Care Plan dated 01/28/26. There was no evidence that the resident was provided with the baseline care plan or that it had been reviewed with her or the resident representative.Review of the initial Resident Care Conference dated 02/03/26 revealed no evidence the resident or resident representative was provided with a copy of the baseline care plan.Review of the care conference progress notes authored by Social Services Coordinator #178 dated 02/03/26 revealed current medications, all orders,…

    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 before2026-02-26 · tag F0656 — failed to write and follow a full care plan — isolated
    Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
    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, interview, and facility policy review, the facility failed to develop and implement a person-centered comprehensive care plan for one, (Resident #22) of 24 residents reviewed. The facility census was 69.Findings include:Findings include:Review of Resident #22's medical record revealed the resident was admitted on [DATE] with diagnoses including dementia and chronic kidney disease.Review of the most recent Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #22 was cognitively impaired reflected cognitive impairment and needed for supervision and assistance with eating and drinking. The MDS revealed Resident #22 required staff assistance to ensure adequate hydration.During an interview on 02/23/26 at 10:45 A.M., Resident #22's daughter and Power of Attorney (POA) stated the resident does not want water to drink and prefers juice. The POA stated staff continued to provide water despite the resident's stated preference.Review of the facility document titled 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.

    Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Dcited before2026-02-26 · tag F0677 — failed to help fully-dependent residents with daily care — isolated
    Provide care and assistance to perform activities of daily living for any resident who is unable.
    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, medical record review, interviews and facility policy review, the facility failed to ensure residents who were dependent on staff were provided routine bathing. This affected two residents (#10 and #36) of six residents reviewed for activities of daily living (ADL). The facility census was 69. Findings Include: 1. Review of the medical record for Resident #10 revealed an initial admission date of 08/14/24 with the latest readmission date of 07/15/25. Diagnoses included but were not limited to spinal stenosis lumbar region, dementia, chronic obstructive pulmonary disease, palliative care, chronic respiratory failure, chronic pain, hyperlipidemia, hypertension, myasthenia gravis, diabetes mellitus, depression, anxiety, migraine, atrial fibrillation, congestive heart failure, cardiomyopathy, arthritis, candidiasis and anemia. Review of the resident's significant change MDS assessment dated [DATE] revealed the resident had no cognitive deficit. Review of the mood and behavior revealed 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 · D2026-02-26 · 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

    Based on observation, medical record review, staff interview, and facility policy review, the facility failed to ensure fall prevention interventions were implemented as indicated. This affected one resident (#47) of three residents reviewed for falls. The facility census was 69.Findings include:Review of the medical record for Resident #47 revealed an admission date of 12/08/18 with diagnoses including cerebral infarction, difficulty in walking, vascular dementia, muscle weakness, lack of coordination, other abnormalities of gait and mobility, and unsteadiness on feet.Review of the physicians orders revealed an order dated 03/10/25 to encourage resident to wear gripper socks when non-skid footwear not in place for safety three times a day and an order dated 01/18/26 or gripper sock on while out of bed.Review of the falls care plan last reviewed/revised 02/09/26 revealed Resident #47 was at risk for falls/injury related to incontinent of bowel/urine and impaired gait. Interventions included gripper socks applied for safety dated 07/08/25, encourage resident to wear gripper socks…

    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 before2026-02-26 · tag F0690 — failed to manage incontinence, catheters, and urinary infections — isolated
    Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
    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, and staff interview, this facility failed to ensure a resident who required an indwelling foley catheter for bladder elimination was monitored for appropriate daily urine output as well as documenting urine output each shift. This affected one (Resident #46) of the three residents reviewed for bladder elimination. The facility census was 69.Findings include:Review of the medical record for Resident #46 revealed an admission date of 08/04/2023. Diagnoses included sepsis due to a urinary tract infection, acidosis, metabolic encephalopathy, and retention of urine. Review of Resident #46's quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of 10 out of 15 indicating a moderately impaired cognition for daily decision-making abilities. Resident #46 required an indwelling catheter for urine elimination. Review of the plan of care dated 07/29/2025 revealed Resident #46 had alteration in elimination related to obstructive…

    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 before2026-02-26 · tag F0692 — failed to prevent malnutrition and dehydration — isolated
    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 meal intakes were monitored and documented for three (Resident #44, #46, and #74), and the facility failed to ensure an order supplement was documented for one, (Resident #44). This affected three of six reviewed for nutrition and hydration. The facility census was 69. Findings include: 1.Review of the medical record for Resident #46 revealed an admission date of 08/04/2023. Diagnosis included sepsis due to a urinary tract infection, dysphagia oropharyngeal phase, and type two diabetes. Review of Resident #46's quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed a Brief Interview of Mental Status (BIMS) score of 10 out of 15 indicating a moderately impaired cognition for daily decision-making abilities. Resident #46 was noted to be 68 inches tall and weight 199 pounds. Resident #46 required supervision for eating. Review of the plan of care dated 07/31/24 revealed Resident #46 was at risk for dehydration or fluid…

    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 · D2026-02-26 · 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 observation, record review, facility staff interview, and facility policy review, the facility failed to follow physician 's order for oxygen administration. This affected one resident (#9) of one resident reviewed for respiratory care. The facility census was 69.Findings include: Review of medical record for Resident #9 revealed an admission date of 12/13/23 and a readmission date of 11/17/25 with diagnoses including Parkinsons disease, chronic respiratory failure with hypoxia, and dependence on supplemental oxygen. Review of the most recent Minimum Data Set (MDS) dated [DATE] revealed Resident #34 had a Brief Interview Mental Status (BIMS) score of 15 indicating no impaired cognition and she was receiving oxygen therapy. Review of the physician's orders dated 11/26/25 revealed oxygen two to four liters via nasal cannula to maintain saturations above 90 percent (%) every shift. Observation on 02/25/2026 at 10:11 A.M. of Resident #9 revealed the nasal cannula was in place and the oxygen concentrator 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.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
Show the remaining 18 citations
  • Potential for harm · D2026-02-26 · tag F0740 — failed to provide behavioral / mental-health care — isolated
    Ensure each resident must receive and the facility must provide necessary behavioral health care and services.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on medical record review and staff interview the facility failed to follow up with psychiatric recommendations in a timely manner. This affected one resident (#8) of two residents reviewed for mood and behavior. The facility census was 69.Findings include: Review of the medical record for Resident #8 revealed an admission date of 01/02/26 with diagnoses including schizophrenia, depression and muscle weakness. Review of the medical record revealed hospital clinical discharge instructions dated 01/02/26 with instructions to follow up with psychiatry in one week. Review of the hospital discharge documentation revealed Oxcarbazepine (an anticonvulsant medication sometimes used as a mood stabilizer) being down titrated to 30 milligrams (mg) and started on Lamotrigine (an anticonvulsant medication sometimes used as a mood stabilizer) 25 mg twice daily with slow up titration in outpatient setting. Review of Resident #8 ' s physicians orders revealed an order for Doxepin (antidepressant) 75 mg at bedtime, Invega Sustenna (antipsychotic) 156 mg/milliliters (ml) intramuscular injection…

    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 before2025-04-10 · tag F0677 — failed to help fully-dependent residents with daily care — isolated
    Provide care and assistance to perform activities of daily living for any resident who is unable.
    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 resident, who required assistance with personal care, received assistance with activities of daily living (ADLs). This affected one resident (#11) of six residents reviewed for ADL assistance. The facility census was 71. Findings include: Closed record review revealed Resident #11 was admitted to the facility on [DATE]. Review of the resident's Face Sheet revealed the resident had admitting diagnoses including displaced midcervical fracture of left femur, closed fracture with routine healing, respiratory failure, chronic obstructive pulmonary disease, and hypertension. Resident #11 discharged from the facility on 03/31/25 to home. Review of ADL documentation including bed mobility, transfers, eating, toileting, bathing, bowel and bladder incontinence care from 03/29/25 through 03/31/25 revealed no evidence Resident #11 received any assistance with her ADLs on 03/30/25 and 03/31/25. Interview on 04/09/25 at 8:51 A.M. with Resident #11's family…

    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 before2025-04-10 · tag F0842 — failed to keep accurate, complete medical records — isolated
    Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
    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 protect residents' confidential information. This affected three residents (#66, #88, and #99) of seven residents reviewed for HIPAA. The facility census was 71. Findings include: Record review revealed Resident #66 was admitted to the facility on [DATE] with diagnoses including type II diabetes, muscle weakness, and respiratory failure. Record review revealed Resident #88 was admitted to the facility on [DATE] with diagnoses including osteomyelitis, muscle weakness, and altered mental status. Record review revealed Resident #99 was admitted to the facility on [DATE] with diagnoses muscle weakness, syncope and collapse, and congestive heart failure. Interview on 04/09/25 at 8:51 A.M. with a resident's family member revealed they had a concern regarding the resident's HIPAA protected information laying on the nurses station visible to visitors with no staff present. Observation on 04/10/25 at 8:15 A.M. revealed while the surveyor 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 · Dcited before2024-12-23 · tag F0677 — failed to help fully-dependent residents with daily care — isolated
    Provide care and assistance to perform activities of daily living for any resident who is unable.
    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, review of the facility's shower schedules, resident interview, staff interview, and policy review, the facility failed to ensure residents, who were dependent on staff for personal care, received the assistance needed to receive showers as scheduled. This affected three (Resident #3, #9, and #30) of three residents reviewed for activities of daily living (ADL). Findings include: 1. Review of Resident #3's medical record revealed he was admitted to the facility on [DATE]. His diagnoses included a dislocation of his right hip prosthesis, unsteadiness on feet, repeated falls, diabetes mellitus with diabetic neuropathy, muscle weakness, malignant neoplasm of the prostate, congestive heart failure, and hypertension. Review of Resident #3's admission Minimum Data Set (MDS) assessment dated [DATE] revealed the resident did not have any communication issues and was cognitively intact. He was not known to display any behaviors nor was he known to reject care during the seven days of the assessment…

    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 · E2024-10-29 · tag F0584 — failed to keep a safe, clean, comfortable home — pattern
    Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation, resident interview, and staff interview, the facility failed to ensure residents had the right to a safe, clean, and sanitary environment. This affected 42 of 67 residents (25 residents were identified to not use the facility's two shower rooms (Residents #3, #4, #6, #17, #21, #22, #36, #37, #38, #39, #42, #44, #47, #48, #50, #52, #53, #54, #55, #59, #63, #64, #65, and #66). The facility's census was 67. Findings include: On 10/28/24 at 10:25 A.M., an observation of the facility's main shower room on Unit 1 revealed the commode in the shower room was missing a toilet seat. There was a black colored substance on the vinyl floor, near the left side of the shower stall where the vinyl flooring met the tiled shower stall's floor. The black substance was not a stain and transferred to a paper towel when using it to wipe over the black substance. There was also dirt and grime build-up in the grout lines of the tiled shower stall floor and in the lower half of the tiled walls that enclosed the shower stall. The dirt and grime on the tiled floor covered about half 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.

    Resident Rights Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2024-10-29 · 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

    Based on review of a facility self-reporting incident (SRI), it's related investigation, staff interview, and policy review, the facility failed to ensure resident's personal money was not misappropriated by facility staff. This affected one resident (#36) of one residents reviewed for misappropriation and one of two SRI's reviewed. Findings include: Review of SRI with tracking #251595 dated 09/06/24 revealed an allegation of misappropriation was alleged involving Resident #36 and facility staff member. The initial source of the allegation was a facility staff member. Resident #36 was indicated to have been able to provide meaningful information when interviewed. The narrative summary of the incident revealed the date and time of the occurrence was on 09/20/24 at 11:30 A.M. and in the resident's room. Resident #36 reported he had lent a staff member (Housekeeper #77) $20.00 and it had not been paid back yet. Staff notified the administrator immediately of that allegation. An interview was conducted with Resident #36 who reported Housekeeper #77 had asked to borrow $10.00 from him…

    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 · Dcited before2024-10-29 · tag F0677 — failed to help fully-dependent residents with daily care — isolated
    Provide care and assistance to perform activities of daily living for any resident who is unable.
    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, review of shower schedules, resident interview, staff interview, and policy review, the facility failed to ensure residents, who were dependent on staff for personal care, received the assistance they needed for bathing/ showers. This affected three residents (#8, #14, and #20) of four residents reviewed for showers. Findings include: 1. Review of Resident #8's closed medical record revealed the resident was admitted to the facility on [DATE]. He remained in the facility until he was discharged to an inpatient rehabilitation unit on 10/24/24. His diagnoses included orthopedic aftercare, infection of a surgical site, fracture of the upper end of the right femur, difficulty walking, muscle weakness, and pressure ulcers on his bilateral heels. Review of Resident #8's Minimum Data Set (MDS) assessment dated [DATE] revealed the resident did not have any communication issues and was cognitively intact. he was not known to have displayed any behaviors nor was he known to reject care. He 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.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Dcited before2024-10-29 · tag F0692 — failed to prevent malnutrition and dehydration — isolated
    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 and staff interview, the facility failed to ensure a resident's nutritional status was adequately monitored by recording meal percentages and fluid intake amounts that were consumed during her stay in the facility. This affected one resident (#69) of three residents reviewed for nutrition. Findings include: Review of Resident #69's closed electronic medical record (EMR) revealed she was admitted to the facility on [DATE] for a respite stay. She remained in the facility until 08/24/24, when the resident's family opted to take her home, prior to the end of her five day respite stay. Her diagnoses included Alzheimer's disease, dementia without behavioral disturbances, unspecified protein calorie malnutrition, hypertensive heart disease with heart failure, pressure ulcer to an unspecified site and at an unspecified stage, contractures of muscles of multiple sites, and a personal history of malignant neoplasm of the breast. Review of Resident #69's physician's orders revealed the resident had…

    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 before2024-10-29 · tag F0842 — failed to keep accurate, complete medical records — isolated
    Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
    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 resident's medical record was complete and accurate to reflect activities of daily living (ADL) care that was provided to the resident while in the facility. This affected one resident (#69) of four residents reviewed for accuracy of medical records. Findings include: Review of Resident #69's closed electronic medical record (EMR) revealed she was admitted to the facility on [DATE] for a respite stay. She remained in the facility until 08/24/24, when the resident's family opted to take her home, prior to the end of her five day respite stay. Her diagnoses included Alzheimer's disease, dementia without behavioral disturbances, unspecified protein calorie malnutrition, hypertensive heart disease with heart failure, pressure ulcer to an unspecified site and at an unspecified stage, contractures of muscles of multiple sites, and a personal history of malignant neoplasm of the breast. Review of Resident #69's care plans revealed she had care…

    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 · Ecited before2024-07-18 · tag F0677 — failed to help fully-dependent residents with daily care — pattern
    Provide care and assistance to perform activities of daily living for any resident who is unable.
    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, observations, resident, family and staff interviews, and policy review, the facility failed to ensure residents, who required assistance from staff for personal care, received the assistance they needed to complete activities of daily living per the residents' preferences. This affected five (#7, #20, #40, #55, and #264) of six residents reviewed for activities of daily living (ADL). The facility's census was 62. Findings include: 1. Review of Resident #40's medical record revealed she was admitted to the facility on [DATE]. Her diagnoses included low back pain, muscle weakness, difficulty walking, repeated falls, osteoarthritis, and unspecified dementia. Review of Resident #40's quarterly MDS assessment dated [DATE] revealed the resident did not have any communication issues and her cognition was coded as being moderately impaired. She was not known to display any behaviors and was not known to reject care. Her ADL function was not assessed as part of that quarterly MDS assessment. A…

    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 · D2024-07-18 · tag F0569 — isolated
    Notify each resident of certain balances and convey resident funds upon discharge, eviction, or death.
    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 interviews, the facility failed to provide spend down notification for a resident who received Medicaid benefits. This affected one (#15) of five residents reviewed for funds. The facility census was 62. Findings include: Review of the medical record for Resident #15 revealed an admission date of 11/24/21 with diagnoses including senile degeneration of brain, contracture of multiple muscle sites, dysphagia, schizoaffective disorder, depression, attention and concentration deficit, vascular dementia, and persistent mood disorder. Review of Resident #15's comprehensive Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident was unable to complete the Brief Interview for Mental Status (BIMS) assessment. She had a memory problem and severely impaired cognitive skills for daily decision making. Review of Resident #15's face sheet revealed she had a guardian. Review of Resident #15's order granting emergency guardianship revealed her current guardianship had been 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.

    Resident Rights Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Dcited before2024-07-18 · tag F0656 — failed to write and follow a full care plan — isolated
    Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
    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 and staff interview, the facility failed to ensure care plans were implemented for all residents. This affected two (Residents #55 and #28) of 20 resident care plans reviewed. The census was 62. Findings Include: 1. Resident #55 was admitted to the facility on [DATE]. His diagnoses were unspecified fracture of T5-T6 vertebra, difficulty walking, muscle weakness, hyperlipidemia, acute respiratory failure, dysphagia, anemia, type II diabetes, atherosclerotic heart disease, hypertension, atrial fibrillation, acute embolism and thrombosis, bipolar disorder, heart failure, Parkinson's disease, acute kidney failure, anxiety disorder, sleep apnea, insomnia, polyneuropathy, conjunctivitis, and altered mental status. Review of facility Minimum Data Set (MDS) assessment, dated 06/15/24, revealed he was cognitively intact. Resident #55 was assessed to need partial/moderate assistance for toilet hygiene, upper/lower body dressing, and personal hygiene. Also, he was assessed as needed…

    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 · D2024-07-18 · 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 observations, medical record review, and staff interview, the facility failed to ensure a resident was properly positioned in a wheelchair. This affected one (Resident #25) of three residents reviewed for positioning. The facility census was 62. Findings include: Review of the medical record for Resident #25 revealed an admission date of 01/23/23 and diagnoses including spastic quadriplegia, cerebral palsy, traumatic brain injury, and scoliosis. Review of the Minimum Data Set assessment dated [DATE] revealed a brief interview for mental status score of 7, indicating severe cognitive impairment. Resident #25 had impairment in range of motion bilaterally, was unable to walk, and was dependent for all activities of daily living. Review of physician orders revealed the resident had a physician's order dated 03/12/23 for a dycem mat to the wheelchair seat to prevent sliding. Review of an occupational therapy Discharge summary dated [DATE] revealed on 02/28/24 a new custom wheelchair was obtained. On 03/27/24…

    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 before2024-07-18 · tag F0690 — failed to manage incontinence, catheters, and urinary infections — isolated
    Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
    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, observations, and staff interview, the facility failed to ensure residents who were incontinent of bladder received appropriate treatment and services to prevent urinary tract infections. This affected two of two residents reviewed for urinary tract infections (Residents #8 and #20) in a sample of 24. The facility census was 62. Findings include: 1. Review of the medical record for Resident #8 revealed an admission date of 08/31/23 and diagnoses including cerebral infarction with hemiplegia, diabetes, history of urinary tract infections with ESBL resistance. Review of a Minimum Data Set assessment completed 05/10/24 revealed a brief interview for mental status score of 11, indicating moderately impaired cognition. The resident was frequently incontinent of bowel and bladder and was dependent upon staff for toileting hygiene. Review of the plan of care dated 09/13/23 revealed the resident was incontinent of bowel and bladder and was at risk for skin breakdown and urinary tract…

    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 · D2024-07-18 · tag F0691 — failed to provide colostomy / ostomy care — isolated
    Provide appropriate colostomy, urostomy, or ileostomy 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 provide evidence that urostomy care was completed as care planned and ordered for Resident #47. This affected one resident (#47) of one resident reviewed for urostomy care. The facility census was 62. Findings include: Review of the medical record for Resident #47 revealed an admission date of 01/11/23 with diagnoses including chronic kidney disease, unspecified dementia, unspecified mood disorder, obstructive and reflux uropathy, anxiety disorder, major depressive disorder, unspecified hearing loss, and malignant neoplasm of bladder. Review of Resident #47's quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident had moderately impaired cognition and had an ostomy. Review of Resident #47's plan of care dated 01/27/23 revealed the resident had an alteration in elimination related to urostomy. Interventions included keeping drainage bag below bladder and off the floor, using leg strap to prevent tubing from pulling, changing…

    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 · D2024-07-18 · tag F0725 — failed to have enough nursing staff — isolated
    Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
    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 observations, medical record review, resident and staff interview, review of staffing schedules, and policy review, the facility failed to have sufficient staff to meet the needs of each resident. This affected three of 24 sampled residents (Residents #7, #20, and #40). The facility census was 62. Findings include: 1. Review of the medical record for Resident #20 revealed an admission date of 03/22/24 and diagnoses including diabetes, chronic obstructive pulmonary disease, and schizoaffective disorder. Review of a Minimum Data Set assessment dated [DATE] revealed a brief interview for mental status score of 15, indicating intact cognition. It indicated the resident required substantial/maximal assistance with bathing. Review of the plan of care dated 04/01/24 revealed Resident #20 required substantial/maximal assistance with shower/bathing. Review of the shower schedule for Resident #20 revealed she was scheduled for showers on Tuesday, Thursday, and Saturday. Review of medical record revealed there 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.

    Nursing and Physician Services Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2024-07-18 · tag F0770 — failed to provide lab services — isolated
    Provide timely, quality laboratory services/tests to meet the needs of residents.
    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 interviews, the facility failed to ensure routine laboratory testing was completed weekly as ordered by the physician. This affected one (#61) of five residents reviewed for unnecessary medications. The facility census was 62. Findings include: Review of Resident #61's medical record revealed she was admitted to the facility on [DATE]. Her diagnoses included sepsis, Methicillin- Resistant Staphylococcus Aureus (MRSA) infection in a diabetic ulcer of her left foot, and adult onset diabetes mellitus. Review of Resident #61's physician's orders revealed the resident had an order to receive Vancomycin 1,750 milligrams intravenously (IV) twice a day from 06/20/24 through 07/22/24. The physician's orders also included an order to obtain a complete blood count (CBC) with differential, sedimentation (sed) rate, C-Reactive Protein (CRP), and a Vancomycin trough level once a day on Tuesdays. That order had been in place since 06/24/24. Review of Resident #61's laboratory test results…

    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 date of correction
  • Potential for harm · F2023-10-12 · tag F0880 — failed to prevent and control infections — widespread
    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, and policy review, the facility failed to ensure appropriate infection control practices were followed in regards to the use of personal protective equipment (PPE) and donning/ doffing procedures were followed to help limit the spread of Covid-19 throughout the facility. This had the potential to affect all residents residing in the facility. The facility's census was 64. Findings include: 1 a.) On 10/10/23 at 9:37 A.M., an observation of Housekeeping Aide #19 noted her to be cleaning Resident #20's room (who was in transmission based precautions for being Covid-19 positive). She was observed mopping his floor before doffing her PPE to include the removal of her disposable gown and gloves while in the resident's room. She came out into the hallway with her N 95 mask still on and obtained hand sanitizer from a dispenser on the wall outside the resident's room. She was then observed to remove the face shield she had on and sat it on top of her housekeeping cart, without…

    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

“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

No federal fines in the current CMS record.

Part of a chain

This home belongs to ALTERCARE — 22 facilities. Here is how its ratings compare with the chain’s average across all its homes: See the whole chain — ratings, flags, fines and finances →

RatingThis homeChain avg
Overall 3 of 53.3-0.3 vs chain
Health inspection 3 of 52.7+0.3 vs chain
Staffing 2 of 52.3-0.3 vs chain
Quality measures 4 of 54.8-0.8 vs chain
The other 21 homes this chain runs (chain average 3.3★, per CMS)

A home rated well below its chain’s average can signal local problems; a chain with a low average across the board is a bigger pattern worth researching. CMS chain data under-reports private-equity and REIT ownership, so treat this as a floor, not the full picture.

Who owns this facility

Owner / managerTypeRoleShareSince
TSG NURSING CENTERS, INCOrganization5% OR GREATER DIRECT OWNERSHIP INTEREST100%since 02/01/2018
GERALD F SCHROER DYNASTY TR UA 12312009 FBO ANDREW M SCHROEROrganization5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDEDsince 02/01/2018
GERALD F SCHROER DYNASTY TR UA 12312009 FBO GERALD F SCHROER JROrganization5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDEDsince 02/01/2018
GERALD F SCHROER DYNASTY TR UA 12312009 FBO MATTHEW SCHROEROrganization5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDEDsince 02/01/2018
GERALD F SCHROER DYNASTY TR UA 12312009 MARGARET S GOODMANOrganization5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDEDsince 02/01/2018
SUSANNE SCHROER DYNASTY TRUST U/AOrganization5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDEDsince 02/01/2018
THE SCHROER GROUP, INC.Organization5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDEDsince 02/01/2018
MOCK, DOUGLASIndividualW-2 MANAGING EMPLOYEE; CORPORATE OFFICERsince 09/20/2021
FILM, GEORGEIndividualCORPORATE OFFICERsince 02/01/2018
GOODMAN, JOHNIndividualCORPORATE OFFICERsince 02/01/2018
JOHNSON, KATHYIndividualCORPORATE OFFICERsince 02/01/2018
NUTTER, ORIANIndividualCORPORATE OFFICERsince 10/01/2021
ALTERCARE OF OHIO, INCOrganizationOPERATIONAL/MANAGERIAL CONTROLsince 02/01/2018

CMS files one row per role, so the 14 rows in the source record cover these 13 parties — each is shown once here with every role it holds. Nothing is omitted.

8 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.

$5.8M
Net patient revenuemost recent cost report
-10.2%
Operating marginrevenue minus expenses
$255K
Related-party expense4% of expenses
Who pays — share of resident-days
Medicaid 56%Medicare 5%Other / private 39%

This home reported $255K paid to related parties (affiliated landlords or management companies) in its most recent cost report. 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

$291per resident / day
operating cost
$8,840per month
≈ monthly operating cost
$264per 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 365750. CMS refreshes its data monthly, and the star rating rests on the last standard inspection — dated 2026-02-26, 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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