Above average — CMS composite of the measures below.
A standard survey is most likely before around December 2026
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Summit City Nursing And Rehabilitation during CMS and state inspections, most recent first.
A resident with multiple chronic conditions, including COPD, CKD, hepatic encephalopathy, seizures, and CHF, was found with morning medications left in a pill cup on the bedside table without staff present. The resident and a QMA reported that the resident self-administered medications and that staff routinely left medications at the bedside for later use, but record review showed no provider order or assessment authorizing self-administration, contrary to facility policy requiring a physician order and evaluation. The DON confirmed there was no self-administration assessment or order and that staff should remain with residents until medications are taken.
A resident with chronic pain syndrome and a history of substance use disorder did not receive adequate information or involvement in decisions regarding changes to his methadone regimen. Facility staff altered the resident's methadone dosage and considered transitioning to Suboxone without proper documentation of informed consent or discussion of risks, benefits, and alternatives. The resident's methadone clinic was not notified of his admission, leading to confusion and distress for the resident, and the facility failed to ensure the resident's participation in care planning as required by policy.
Failure to Provide Hair and Nail Care: A resident with depression, an above-knee amputation, and difficulty walking was repeatedly observed with greasy, disheveled hair, long fingernails, and visible debris under the nails, along with stained clothing. An LPN asked to cut the resident’s nails after showing the debris, and the resident said she did not care, while staff reported the resident often refused showers and nail care. Records showed repeated refusals of shampoo, nail care, oral care, and general care on shower sheets, but no documentation of refusals in progress notes and no indication that bed baths or reattempts were offered.
Staff at the facility failed to ensure resident dignity by entering rooms without proper procedure, such as knocking and waiting for permission. A resident with moderate cognitive impairment and depression expressed embarrassment about her appearance and being in a gown. Staff interviews confirmed the correct procedure was not followed, and the facility lacked a policy covering resident rights to dignity.
A resident with a history of severe back pain did not receive adequate pain management in the facility. Despite expressing her pain and requesting more effective medication than Tylenol, the resident was not provided with alternative pain relief options or comprehensive assessment. The facility's records showed limited documentation of pain complaints and interventions, leading to a deficiency in pain management.
Unsupervised Medication Left at Bedside Without Self-Administration Order
Penalty
Summary
The deficiency involves the facility’s failure to ensure proper medication administration and adherence to its self-administration policy for one resident. During an observation, the resident’s morning medications were found in a pill cup on the bedside table without staff present. The resident stated that he self-administered his medications and that nursing staff often placed his medications at the bedside until he was ready to take them, indicating that this was a routine practice. At the time, these medications were his scheduled morning medications, which he preferred to take later in the morning. A QMA reported that he had placed the medications at the bedside for the resident to take when ready and confirmed that the resident self-administered his medications, but he was unable to locate any provider order authorizing self-administration. Record review showed the resident had multiple diagnoses, including COPD, chronic kidney disease, hepatic encephalopathy, seizures, and congestive heart failure, and an admission MDS indicating he was cognitively intact with a BIMS score of 15/15. However, there was no completed self-administration of medications assessment and no orders for self-administration in the record, despite the facility’s policy requiring a physician order and an assessment to determine the ability to self-administer medications. The DON confirmed there was no evaluation or order for self-administration and stated that nurses should remain with residents until medications are consumed.
Failure to Involve Resident in Medication and Treatment Decisions
Penalty
Summary
The facility failed to ensure that a resident was informed of and able to participate in treatment decisions regarding significant changes to his medication regimen. The resident, who had chronic pain syndrome and a history of polysubstance abuse, was admitted with an established methadone prescription managed by an external methadone clinic. Upon admission, the facility staff initiated changes to the resident's methadone dosage and considered transitioning him to Suboxone without adequately informing the resident or involving him in the decision-making process. Documentation did not reflect that the risks, benefits, or alternatives to these changes were discussed with the resident, nor that he agreed to the modifications. The resident's care plans and progress notes lacked evidence that his chronic pain and substance use disorder were being managed in coordination with his methadone clinic. The methadone clinic was not notified of the resident's placement at the facility, resulting in a lack of communication regarding medication management. The resident expressed confusion and distress about the changes to his methadone dosing, indicating he did not understand the reasons for the adjustments, especially given his long-term use and established care with the methadone clinic. Staff interviews confirmed that documentation of resident involvement and informed consent for medication changes was insufficient or absent. Facility policy states that residents have the right to be informed about their medical condition and prescriptions, to participate in decisions affecting their care, and to be involved in developing their care plan. Despite this, the resident was not included in key care conferences or medication decisions, and the methadone clinic responsible for his ongoing treatment was not consulted or informed in a timely manner. This resulted in the resident not receiving his usual dosage and being excluded from decisions about his care.
Failure to Provide Hair and Nail Care
Penalty
Summary
The facility failed to ensure hair and nail care was completed for Resident 3, who had diagnoses including depression, an acquired absence of the right leg above the knee, and difficulty walking. During multiple observations, Resident 3 was seen with greasy, disheveled hair, fingernails approximately half an inch long, brown substance under the right index and pinky fingernails, and a hospital gown with brown and yellow stains. On one observation, the resident was also seen with the gown scrunched to the waist and a light pink incontinence brief exposed. LPN 8 asked Resident 3 if her nails could be cut and showed her the brown and green substance under her thumb and pointer fingernails. Resident 3 stated she did not care, although LPN 8 said the resident typically refused nail cutting and that her grandchildren sometimes painted her nails. LPN 8 also stated the resident typically refused showers and did not want to get up, but complete bed baths should have included hair washing. The resident's progress notes did not document refusal of hair or nail care, and the shower sheets documented repeated refusals of nail care, shampoo, oral care, and care in general, with no indication that bed baths were offered or that care was reattempted. The care plan included AM and PM cares such as bathing, dressing, hair combing, and oral care, but had no interventions for refusal of care.
Failure to Ensure Resident Dignity in Room Entry Procedures
Penalty
Summary
The facility failed to ensure the dignity of residents by not adhering to proper procedures when entering resident rooms. Observations revealed that staff from various departments entered rooms without waiting for permission or an answer after knocking softly, or in some cases, not knocking at all. Staff members, including CNAs and housekeeping, were seen entering rooms without announcing themselves or asking for permission, which is against the facility's protocol. This behavior was observed in multiple rooms, including the room of Resident 22, where staff entered without knocking or announcing themselves, causing the resident to stop talking mid-sentence. Resident 22, who has diagnoses including schizoaffective disorder, muscle weakness, major depression, and lack of coordination, expressed embarrassment about her appearance and being in a gown near noon. She indicated that she did not want her husband to see her in such a condition. The resident's record did not document any skin conditions or treatments for her scalp, despite her concerns. Interviews with staff confirmed that the proper procedure was to knock, wait for an answer, and announce oneself before entering a resident's room. However, the facility's policy and procedure for Abuse and Neglect did not cover resident rights to dignity, and no policy was available at the time of the survey exit.
Inadequate Pain Management for Resident
Penalty
Summary
The facility failed to provide adequate pain management for a resident, identified as Resident 22, who frequently experienced severe back pain. Despite expressing her pain to the nursing staff, Resident 22 reported that she was often given Tylenol, which was ineffective, and was not offered any non-pharmaceutical relief options. During an observation, Resident 22 was visibly in pain, with grimacing and tearfulness, and rated her pain as a 10 out of 10. A registered nurse assessed her pain but did not offer any immediate relief or alternative pain management strategies, such as repositioning or environmental adjustments. Resident 22's medical records indicated a history of schizoaffective disorder, muscle weakness, diabetes, asthma, swelling, and pain. Her care plan included interventions for pain management, but these were not consistently implemented. The facility's policy on pain management required assessment and appropriate medication based on pain intensity, but Resident 22's records showed limited documentation of pain complaints and interventions. The lack of comprehensive pain assessment and management for Resident 22 led to the deficiency identified in the report.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Fort Wayne
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Glenbrook Rehabilitation & Skilled Nursing Center | 0.9 mi | ★★★★★ | 10 | 0 |
| Life Care Center Of Fort Wayne | 0.9 mi | ★★★★★ | 9 | 0 |
| Saint Anne Home | 1.5 mi | ★★★★★ | 4 | 0 |
| University Park Rehabilitation And Healthcare | 1.7 mi | ★★★★★ | 4 | 0 |
| Byron Health Center | 2 mi | ★★★★★ | 15 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release July 2026) and official state health department websites.