Below average — CMS composite of the measures below.
A standard survey is most likely before around August 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 Ridgeway Nursing & Rehabilitation Facility during CMS and state inspections, most recent first.
The facility did not maintain required advance directive documentation for two residents, one with moderate cognitive impairment and another who was cognitively intact. In both cases, records indicated that advance directives had been executed, but the facility either lacked the appropriate medical power of attorney documentation or had no advance directive on file, despite staff interviews confirming that such documentation should be obtained and maintained.
A resident with chronic kidney disease, stroke, and dementia received crushed medications, including a potassium chloride ER tablet that should not have been crushed, due to the facility's failure to include specific medication administration instructions in the care plan. Staff routinely crushed all medications except for a capsule, and the care plan lacked special instructions despite facility policy requiring them for residents needing medications crushed.
A resident with an indwelling Foley catheter repeatedly placed his catheter bag on the floor, contrary to facility policy and infection control guidelines. Despite staff observations, interviews, and education provided to the resident, the care plan was not updated to address this behavior or document interventions. This resulted in a deficiency related to the facility's failure to review and revise the comprehensive care plan as required.
A medication aide crushed and administered an extended release potassium chloride tablet to a resident with chronic kidney disease and dementia, despite facility policy and pharmacy guidance indicating the medication should not be crushed. Staff interviews revealed inconsistent awareness of which medications could be safely crushed, and available resources such as a 'Do Not Crush' list were not consistently accessed or located.
Three residents experienced lapses in infection prevention, including delayed implementation of Enhanced Barrier Precautions for residents with open wounds and repeated failures to keep a Foley catheter bag off the floor despite staff awareness and education. Staff interviews confirmed that required precautions and documentation were not consistently followed or implemented in a timely manner.
A resident with a history of aggressive behaviors and severe cognitive impairment physically struck another cognitively impaired resident in the face during a dispute over a personal item, despite existing care plan interventions intended to prevent such incidents. The event was witnessed by staff, and another resident also reported being hit by the same individual during the episode. The facility's policies required prevention and reporting of abuse, but these measures were not effective in this case.
A resident with pain management needs received an extra dose of oxycodone due to discrepancies between the controlled substance log and the MAR. An LPN signed out more doses than were documented as administered, and the facility could not provide required controlled substance count sheets for several dates. The DON's investigation confirmed the extra dose, and the administrator could not clarify if the resident was charged for the missing medication.
Failure to Maintain Advance Directive Documentation for Two Residents
Penalty
Summary
The facility failed to maintain proper documentation of advance directive information for two residents. For one resident with dementia, diabetes, and chronic kidney disease, the facility's records indicated that an advance directive had been executed, but only a general power of attorney document related to financial decisions was available in the electronic medical record. The facility was unable to provide documentation of a medical power of attorney for this resident. For another resident with diabetes, cerebral infarction, and interstitial pulmonary disease, the records also indicated that an advance directive had been executed, but there was no documentation of the advance directive in the resident's electronic medical record. A notation in the records stated that the family never provided the document, and when requested, the facility could not produce a copy. Interviews with facility staff, including the Admissions Coordinator, Social Service Director, Director of Nursing, and Administrator, confirmed that advance directives were addressed during the admission process and followed up on if not initially provided. However, despite these procedures, the facility did not have the required documentation for the two residents, and staff were unable to specify a clear timeframe for obtaining missing advance directive paperwork. The lack of documentation meant the facility did not have current information on the residents' wishes or designated responsible parties for medical decisions.
Failure to Develop and Implement Comprehensive Care Plan for Medication Administration
Penalty
Summary
The facility failed to develop and implement a comprehensive, person-centered care plan with measurable objectives and timeframes to meet the medical and nursing needs of a resident with chronic kidney disease, stroke, and dementia. The resident, who was moderately cognitively impaired, had a care plan that included a general intervention for medications to be crushed when appropriate. However, the care plan did not specify which medications should or should not be crushed, nor did it include special instructions for medication administration, despite facility policy requiring such instructions for residents needing medications crushed. During medication administration, staff routinely crushed all of the resident's medications except for an esomeprazole capsule, including a potassium chloride extended-release (ER) tablet, which was specifically listed by the facility as a medication not to be crushed due to its time-release formulation. Both medication aides interviewed confirmed they crushed the resident's medications except for the capsule. The facility's pharmacist verified that the potassium chloride ER tablet provided to the resident could not be crushed or dissolved and should be administered whole. The Director of Nursing and Administrator both acknowledged that special instructions, such as the need for crushed medications, should be included in the care plan and followed by staff.
Failure to Revise Care Plan for Catheter Bag Placement
Penalty
Summary
The facility failed to review and revise the Comprehensive Care Plan (CCP) for one resident who consistently placed his catheter bag on the floor, despite repeated observations and interviews confirming this behavior. The resident, who was cognitively intact and had a history of benign prostatic hyperplasia, peripheral vascular disease, hypertension, and chronic kidney disease, was care planned for urinary catheterization and related risks, but the care plan did not address his specific practice of placing the catheter bag on the floor. Multiple observations over several days documented the catheter bag lying on the floor without a dignity cover, and the resident stated his preference for keeping the bag on the floor so he could see the urine output. Facility policies required that care plans be person-centered, revised as necessary, and incorporate identified problem areas and risk factors. The Catheter Associated Urinary Tract Infection (CAUTI) Prevention policy specifically stated that catheter bags and tubing should be kept off the floor. Despite these policies and the resident's ongoing behavior, the CCP was not updated to reflect the resident's actions or the education provided to him regarding the risks of placing the catheter bag on the floor. Interviews with staff, including nurse aides, the unit manager, LPN, assistant directors of nursing, and the director of nursing, confirmed that the resident repeatedly placed his catheter bag on the floor and that staff had educated him about the importance of keeping the bag off the floor. However, there was no documentation in the resident's medical record of this education or any updates to the care plan to address the issue. The failure to revise the care plan and document interventions and education represented a deficiency in the facility's care planning process.
Crushing of Extended Release Potassium Tablet During Medication Administration
Penalty
Summary
A deficiency occurred when a medication aide crushed and administered a potassium chloride extended release (ER) tablet to a resident, despite facility policy and manufacturer guidance indicating that ER medications should not be crushed. The aide prepared the resident’s medications by crushing all except an esomeprazole capsule, mixing them into pudding, and administering them. The aide was unaware of a 'Do Not Crush' list on the medication cart and did not consult available resources to verify which medications could be safely crushed. The resident involved had a history of chronic kidney disease, stroke, and dementia, and was moderately cognitively impaired. The resident’s care plan allowed for medications to be crushed when appropriate, but the physician’s order specified potassium chloride 10 mEq ER tablet, which was not to be crushed. The facility’s own documentation and pharmacy guidance confirmed that this specific ER tablet should be administered whole, as crushing it could alter its intended release properties. Interviews with staff revealed inconsistent knowledge and practices regarding which medications could be crushed. Some staff believed ER medications could sometimes be dissolved, while others were unaware that the resident was receiving an ER potassium tablet. The facility had resources such as a drug reference book and a 'Do Not Crush' list, but these were not consistently located or utilized by staff during medication administration.
Failure to Implement Infection Control Precautions and Proper Catheter Care
Penalty
Summary
The facility failed to establish and maintain an effective infection prevention and control program for three residents, resulting in lapses in the implementation of Enhanced Barrier Precautions (EBP) and proper catheter care. For one resident with liver disease, immune system defects, and an unstageable pressure ulcer, there was no isolation signage or PPE at the room entrance upon admission, despite the presence of an open wound and orders for wound management. Staff interviews confirmed that EBP should have been implemented upon admission, but it was delayed until after the wound nurse practitioner identified drainage, and the infection preventionist and DON acknowledged the delay was unacceptable. Another resident with a history of benign prostatic hyperplasia, peripheral vascular disease, hypertension, and chronic kidney disease, and who was cognitively intact, was observed multiple times with a Foley catheter bag placed directly on the floor without a dignity cover. Despite repeated staff education and interventions to keep the catheter bag off the floor, the resident continued to place it there, and there was no documentation of education or care plan interventions addressing this behavior. Staff interviews confirmed awareness of the issue and the infection control risks, but no formal documentation or care plan adjustments were made. A third resident with congestive heart failure, COPD, diabetes, and a history of a deep tissue injury and unstageable wound to the left heel, was not placed on EBP when the wound became open. Observations revealed a lack of EBP signage and PPE at the room, and staff only implemented precautions after being notified by the wound nurse practitioner. The infection preventionist and DON both stated that EBP should have been initiated when the wound opened, and that the delay in implementing precautions was not in line with facility expectations for infection control.
Failure to Prevent Resident-to-Resident Physical Abuse
Penalty
Summary
A deficiency occurred when a resident with a history of aggressive behaviors physically struck another resident in the face after a dispute over a personal item. The incident was witnessed by a State Registered Nurse Aide, who observed the aggressor resident become upset and swat the other resident on the nose twice. The resident who was struck reported feeling as though her nose had been broken, though no follow-up care was recommended by the nurse practitioner at the time. The incident took place in a common area near the nurses' station, and another resident also reported being hit by the same aggressor during the same episode. The resident who committed the physical abuse had a documented history of behavioral issues, including physical and verbal aggression toward others, as well as severe cognitive impairment. Her care plan prior to the incident included interventions such as allowing space, redirecting as needed, and removing her from public areas when behaviors posed a risk for harm. Despite these interventions, the resident was able to physically harm another resident, indicating a failure to prevent resident-to-resident abuse as outlined in the facility's abuse prevention and resident rights policies. The resident who was struck was also severely cognitively impaired and had multiple medical diagnoses, including acute kidney failure and malignant neoplasm of the lung. Interviews with staff and family members confirmed the occurrence of the incident and the aggressor's history of similar behaviors. The facility's policies required the prevention, identification, and reporting of abuse, but the incident demonstrates that these measures were not sufficient to protect the resident from physical abuse by another resident.
Failure to Ensure Accurate Accountability and Protection of Resident's Controlled Medication
Penalty
Summary
A deficiency occurred when a resident with chronic obstructive pulmonary disease and pain due to internal orthopedic devices was not properly protected from the misappropriation of their controlled medication. The facility's policies required that the nurse who prepares and administers a controlled substance must immediately document the administration on both the controlled substance log and the Medication Administration Record (MAR), ensuring accurate accountability of all controlled drugs at all times. However, on the date in question, the controlled drug record showed that an LPN signed out four doses of oxycodone for the resident, but the MAR only reflected two administrations, and a medication error report later confirmed that an extra dose was given. Interviews with staff revealed that controlled substances were kept locked and that a count was performed at each shift change. On the shift in question, the oncoming LPN found that several residents were unable to receive their pain medication because the log indicated the medications had already been dispensed, even though the MAR did not reflect this. The oncoming nurse reported the discrepancy to the DON, who initiated an investigation, including a full narcotic count and MAR review. The investigation determined that an extra dose of oxycodone had been administered to the resident, and the resident was assessed for adverse reactions, with none found. Further review showed that the facility was unable to provide requested shift change controlled substance count sheets for several dates, and the LPN involved was no longer employed at the facility and could not be interviewed. The administrator could not confirm whether the resident was charged for the unaccounted-for medication. The deficiency was attributed to the failure to ensure that the controlled substance log and MAR matched for each administration, resulting in improper documentation and potential misappropriation of the resident's medication.
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What surveyors actually found near you
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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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Risk indicators are statistical estimates from public CMS data — not predictions, findings, or compliance advice.
Nursing homes near Owingsville
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Mt. Sterling Health & Rehab, Llc | 12.8 mi | ★★★★★ | 14 | 0 |
| Menifee Meadows Nursing & Rehab Llc | 17.3 mi | ★★★★★ | 0 | 0 |
| Life Care Center Of Morehead | 17.8 mi | ★★★★★ | 6 | 0 |
| Pioneer Trace Group Llc | 18.6 mi | ★★★★★ | 14 | 3 |
| Willowbrook Healthcare | 19.6 mi | — | 0 | 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.