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 Parkview Haven Nursing Home during CMS and state inspections, most recent first.
A resident with hemiplegia and severe cognitive impairment experienced a fall from a wheelchair, after which a nursing assistant used a Hoyer lift to transfer the resident without the required assistance of a second staff member and without a nurse assessment prior to the move. The resident subsequently showed increased pain and swelling in the right arm, and facility investigation confirmed that established transfer and assessment protocols were not followed.
A resident who uses a wheelchair was unable to comfortably use the bathroom sink and medicine cabinet due to the sink's height and difficulty operating the faucet handles. The resident struggled to access personal items and could not retrieve them if dropped. Facility staff acknowledged the concerns but had not acted on them prior to the survey.
A resident with severe cognitive impairment and multiple physical limitations was found with a loose and improperly positioned bed positioning rail, creating a significant gap between the mattress and the rail. Despite facility policy requiring regular inspection and proper installation, the maintenance log indicated checks were completed, but the maintenance supervisor acknowledged some checks may have been missed. The deficiency was confirmed during the survey by both the maintenance supervisor and the administrator.
Staff did not follow hand hygiene and PPE protocols during care of two residents, including one with a suprapubic catheter and another with a gastrostomy tube. Staff failed to wash hands before donning gloves, did not change gloves or perform hand hygiene between care tasks, and did not consistently wear gowns as required by enhanced barrier precautions. These lapses were confirmed by staff interviews and were not in accordance with facility policy.
The facility did not submit required 5-day investigation reports to the State Agency within the mandated timeframe for two residents who experienced significant incidents, including a transfer-related injury and a fall with severe pain. In both cases, the reports were sent late, and the Administrator confirmed the delay, which did not comply with regulatory requirements.
Ten occupied rooms had non-functional bathroom ventilation, with vents covered in dust and a persistent ammonia odor. Maintenance staff confirmed the systems were off and had not been cleaned as required, despite documentation indicating otherwise. The administrator acknowledged that regular cleaning and checks were expected but not performed.
The facility failed to ensure routine bowel movements for three residents, leading to significant periods without documented bowel movements and inadequate follow-up care. Despite having orders for bowel care interventions, these were not consistently administered or documented, and there was no follow-up assessment or provider notification as required by the facility's protocol. The residents' care plans also lacked a focus on constipation, further contributing to the deficiency.
Failure to Ensure Safe Transfer and Assessment After Resident Fall
Penalty
Summary
A deficiency occurred when staff failed to ensure safe transfers and proper assessment for a resident with significant physical and cognitive impairments. The resident had a history of hemiplegia and hemiparesis following a stroke, was dependent for all activities of daily living, and required the use of a Hoyer lift for transfers. The care plan specified that two staff members should be present for Hoyer lift transfers, and that a nurse should assess the resident before moving them after a fall. On the day of the incident, the resident slipped from their wheelchair onto the foot pedals. A nursing assistant attempted to transfer the resident back to bed using the Hoyer lift, but did so without the required assistance of a second staff member. There was no documented assessment by a nurse prior to moving the resident after the fall, as required by facility policy. The incident was later reported to the DON, who then notified the primary care provider and the resident's power of attorney. Following the incident, the resident exhibited increased pain and swelling in the right arm, as documented in pain assessments and progress notes. The facility's investigation confirmed that the transfer was performed by a single staff member and that the required nursing assessment prior to moving the resident after the fall did not occur. Interviews with staff corroborated that the Hoyer lift was used without a second staff member and that the nurse assessment was not completed before the transfer.
Failure to Accommodate Wheelchair User's Access to Bathroom Fixtures
Penalty
Summary
A resident who uses a wheelchair was unable to use the bathroom sink and medicine cabinet without difficulty. The resident reported that the sink was too high, struggled to turn the faucets on to brush teeth and wash, and could not access the medicine cabinet easily. During observation, the resident was seen attempting to use the sink and medicine cabinet, managing to open the cabinet only after struggling and being unable to remove any items. The resident kept personal items on a stand between the sink and toilet, but items would fall between the bars, and the resident was unable to pick them up once they hit the floor. Maintenance staff confirmed that the sink height was 34 inches, which meets code for handicap accessibility, but acknowledged that the faucet handles could be changed to improve access. The maintenance staff was unsure if the sink could be lowered further. The administrator confirmed that the facility had previously discussed the resident's concerns about the bathroom but had not taken action to address them until the time of the survey.
Improper Installation and Maintenance of Bed Positioning Rail
Penalty
Summary
A deficiency was identified when a positioning rail on a resident's bed was found to be loose and improperly positioned, creating a gap of at least 10 inches between the mattress and the rail. This was observed during a survey, with the rail leaning outward at an approximate 120-degree angle. The maintenance supervisor confirmed that the positioning bar was not in the correct position and needed to be fixed. The maintenance log indicated that monthly checks had been documented as completed, but the supervisor admitted that some checks might have been missed, especially if the resident was in bed or the nurse was present. The resident involved had a complex medical history, including Alzheimer's disease, hemiplegia, hemiparesis, aphagia, and a cognitive communication deficit. The resident was assessed as having severe cognitive impairment, daily wandering, and required varying levels of assistance for activities of daily living. The care plan included the use of a positioning bar to assist with transfers and positioning in bed, as well as a fall mat due to frequent attempts to transfer independently. The resident was identified as high risk for falls due to confusion, gait and balance problems, paralysis, poor communication, and sensory deficits. Facility policy required that bed rails be assessed for appropriateness, installed correctly, and regularly inspected for safety, including ensuring no gaps that could lead to entrapment. Despite these policies, the improper installation and maintenance of the positioning rail were directly observed, and the maintenance log did not accurately reflect the actual condition of the equipment. The deficiency was confirmed by both the maintenance supervisor and the administrator during the survey.
Failure to Perform Hand Hygiene and Use PPE During Resident Care
Penalty
Summary
Staff failed to perform proper hand hygiene and use appropriate personal protective equipment (PPE) during direct care of two residents. In the case of one resident with a suprapubic catheter and a history of urinary retention and incontinence, staff did not wash their hands before donning gloves, did not wear gowns as required by enhanced barrier precautions, and failed to change gloves or perform hand hygiene between glove changes during perineal and catheter care. Both the nurse aide and medication aide involved acknowledged these lapses during interviews, and the Director of Nursing confirmed that the expected procedures were not followed. For another resident with hemiplegia, aphagia, and a gastrostomy tube, an LPN donned gown and gloves without performing hand hygiene before administering medications and providing gastrostomy care. The LPN also failed to change gloves or perform hand hygiene when transitioning from medication administration to gastrostomy care, and did not wash hands before leaving the resident's room. The LPN later confirmed these omissions during an interview, and the Director of Nursing reiterated that hand hygiene should have been performed at each step as outlined in facility policy. Facility policies reviewed by surveyors clearly required hand hygiene before donning gloves, after glove removal, and between care tasks, as well as the use of gowns and gloves for high-contact care activities under enhanced barrier precautions. These policies were not followed during the observed care of both residents, as confirmed by staff interviews and direct observation.
Failure to Timely Submit 5-Day Investigation Reports to State Agency
Penalty
Summary
The facility failed to submit investigation reports to the State Agency within the required 5 working days for two residents who experienced significant incidents. For one resident, after being transferred onto a bed with a Hoyer lift by a nurse aide without assistance, the resident sustained a right arm injury resulting in pain and swelling. The incident was reported internally, and the resident was assessed and treated, but the investigation summary was not sent to the State Agency until several days after the required timeframe. Facility policy mandates that such reports be sent within five working days, but this was not followed. In another case, a resident fell while walking in the hall, resulting in severe pain and a hospital visit. The incident was reported to Adult Protective Services on the same day, but the 5-day investigation report was not sent to the State Agency until the sixth day. In both cases, interviews with the Administrator confirmed that the reports were not submitted within the required timeframe, constituting a failure to respond appropriately to alleged violations as required by regulation.
Non-Functional Bathroom Ventilation and Inadequate Maintenance Documentation
Penalty
Summary
The facility failed to ensure that the bathroom ventilation systems in ten occupied resident rooms were functioning properly, as required by licensure regulations. Observations on two consecutive days revealed that the ventilation in rooms 103, 104, 105, 106, 107, 109, 110, 113, 115, and 117 was not operational, as demonstrated by a lack of air draw when tested with a piece of toilet paper. Additionally, all vents in these rooms had a visible white substance on the air grills, and a stale ammonia odor was present in the rooms, indicating inadequate ventilation and cleaning. Interviews with maintenance staff confirmed that the ventilation systems in the affected rooms were not working due to a switch being turned off, and that the vents had not been cleaned during the current month. Despite this, a review of the monthly maintenance checklist for May 2025 indicated that all fans were marked as clean, free of debris, and in working order. The administrator confirmed that the expectation is for vents to be cleaned monthly and checked daily, especially since a resident had previously turned off the switch, but these procedures were not followed.
Failure to Ensure Routine Bowel Movements for Residents
Penalty
Summary
The facility failed to ensure routine bowel movements for three residents, leading to significant periods without documented bowel movements and inadequate follow-up care. Resident 10, diagnosed with Alzheimer's disease and constipation, did not have a bowel movement documented for multiple days on two separate occasions. Despite having orders for bowel care interventions, these were not consistently administered or documented, and there was no follow-up assessment or provider notification as required by the facility's protocol. The resident's care plan also lacked a focus on constipation, further contributing to the deficiency. Resident 13, with diagnoses including diverticulitis and constipation, also experienced a prolonged period without a bowel movement. The resident's care plan included specific interventions for constipation, but these were not effectively implemented. A Dulcolax suppository was given but was ineffective, and no further bowel care or assessment was documented. The Director of Nursing confirmed the lack of follow-up and provider notification, which was expected per the facility's protocol. Resident 21, diagnosed with constipation, had multiple instances of not having a bowel movement for several days. Despite having orders for various bowel care medications, these interventions were documented as ineffective, and there was no follow-up assessment or provider notification. The resident's care plan included detailed interventions for constipation, but these were not adequately followed. The Director of Nursing confirmed the lack of effective interventions and follow-up documentation, highlighting a systemic issue in the facility's bowel management protocol.
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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 Deshler
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Blue Valley Lutheran Nursing Home | 7.1 mi | ★★★★★ | 0 | 0 |
| Good Samaritan Society - Superior | 19.5 mi | ★★★★★ | 0 | 0 |
| Belleville Healthcare And Rehabilitation Center | 22.7 mi | ★★★★★ | 17 | 0 |
| Heritage Crossings | 28.1 mi | ★★★★★ | 9 | 0 |
| Jefferson Community Health & Life Gardenside | 28.9 mi | ★★★★★ | 11 | 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.