Average — CMS composite of the measures below.
The next survey window likely opens around November 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 Altercare Coshocton Inc. during CMS and state inspections, most recent first.
Failure to provide routine podiatry and toenail care. A resident with DM, PAD, kidney disease, and other comorbidities had thick, painful mycotic toenails and required repeated podiatry debridement earlier in the year, but there was no documented ongoing foot care for months after the last treatment. Staff said aides did not cut toenails and nurses referred diabetic residents to podiatry, while the resident reported asking for toenail care and being told it was not allowed. The resident later developed an infected ingrown toenail treated by the PCP, and the record showed no staff communication to the prior podiatrist during the gap in services.
A resident with multiple comorbidities and high risk for skin breakdown developed a new Stage 2 pressure ulcer while under care. Despite a care plan outlining preventive measures, observations showed the resident was not consistently repositioned, and staff did not implement additional interventions or timely wound physician evaluation after the new ulcer appeared.
Failure to Obtain Informed Consent for Psychoactive Medications: A resident with multiple chronic conditions, including anxiety and major depressive disorder, was started on lorazepam, hydroxyzine, and sertraline without documented consent in the record at the time the meds were initiated. RN confirmed the facility did not have psychoactive med consents before the later informed consent form was completed, despite the care plan addressing psychotropic and antidepressant meds and the facility policy requiring documentation that the resident and RP were informed of risks and benefits.
Resident funds were not kept in an interest-bearing account. A cognitively intact resident with multiple chronic conditions had repeated AR refunds and overages posted to a non-interest-bearing AR account, and record review found no interest accumulated on those funds. RN and cash/collections staff confirmed the money stayed in the AR account unless the guardian directed a transfer to the resident’s interest-bearing account, and facility RFMS training did not address interest-bearing requirements for resident personal funds above the monthly allowance.
A resident with dementia, schizoaffective disorder, CKD, COPD, depression, bipolar disorder, schizophrenia, and anxiety had funds split between an interest-bearing resident account and the facility AR account. Staff confirmed the facility kept money in the AR account in case patient liability or cost of care changed, and training materials did not address keeping resident money from being co-mingled across accounts.
SNF ABNs were not completed to show the resident or POA choice when Medicare skilled coverage ended for two residents. One resident with CHF, muscle weakness, and difficulty walking, and another with muscle weakness, encephalopathy, CHF, and MI had notices listing the coverage-ending date and options for continued skilled care, but no option was marked. An Admissions Coordinator said she verbally reviewed the forms with the POA and mailed them certified, but the decisions were not documented.
A resident with cerebral palsy, pyoderma, and MRSA of the scalp was observed in bed with a privacy curtain, pillow, and wall next to the bed stained with brown smears and blood, while the scalp had scattered open, bleeding areas. Staff later stated the staining was probably dried blood but were not completely sure.
Failure to review and provide the baseline care plan to a newly admitted resident within the required timeframe. A resident admitted with a hip replacement revision and DM had an unsigned baseline care plan in the record, no evidence of a signed copy or review, and stated no staff had discussed the plan of care or provided the care plan since admission. An SSC was observed asking questions about code status, PTSD, therapy, discharge plans, and paperwork, and an RN verified the resident had not been given or explained the baseline care plan.
Failure to provide nail care to a dependent resident. A resident with cerebral palsy, schizoaffective disorder, pyoderma, and CVA was documented as dependent on staff for nail care and personal hygiene. Observations showed jagged, unclean fingernails, and an RN verified the condition. A CNA later stated the resident was dependent on staff for ADL care and was providing nail care because the nails were jagged; the facility policy required daily cleaning and regular trimming.
The facility failed to provide ordered treatment and care for two residents. One resident with cerebral palsy, chronic constipation, bowel incontinence, and opioid use had multiple days without a documented BM, did not receive ordered laxatives as needed, and later received incorrect cranberry dosing and timing for UTI prevention. Another resident after a hip revision did not receive several ordered post-op meds, including an antibiotic, NSAIDs, antihypertensive, statin, and anticoagulant, because the meds were not available from the pharmacy.
A resident with respiratory failure, COPD, CHF, and other significant conditions had an order for continuous O2 at 4 L via NC. During observation, the resident was wearing O2 by NC, but the concentrator was set at 5 L; an LPN confirmed the incorrect setting and the ordered flow rate.
The facility failed to provide appropriate pain management for two residents. One resident had PRN acetaminophen and oxycodone ordered, but staff used the same pain parameters for both medications instead of distinct criteria for the weaker versus stronger PRN. Another resident with post-op hip pain reported pain rated 5/10, but there was no comprehensive assessment or intervention documented, and the ordered PRN opioids were not available until later, with no evidence that emergency supply medication was used.
The facility failed to ensure food items were labeled and not kept past expiration dates, with expired deli meats and uncooked grilled cheese found in the kitchen refrigerator. Additionally, unit refrigerators containing resident food were not kept clean, with food debris and stains observed. Staff interviews revealed uncertainty about cleaning responsibilities, contrary to facility policy.
A resident with a history of weight loss did not receive prescribed nutritional supplements due to supply issues at the facility. The resident, who had multiple medical conditions and was on a specialized diet, was supposed to receive supplements three times a day. However, the supplements were often unavailable, and there was no documentation or notification to the physician or dietitian about this issue. Staff interviews confirmed supply problems and inadequate communication regarding alternative supplements.
Failure to Provide Routine Podiatry and Toenail Care
Penalty
Summary
The facility failed to ensure routine podiatry services and toenail trimming were provided to a resident with diabetes and multiple related comorbidities, including diabetic peripheral angiopathy, peripheral vascular disease, kidney disease, heart disease, morbid obesity, and repeated falls. The resident was admitted with diagnoses that placed her at increased risk for diabetic foot complications, and her record showed ongoing diabetes management with multiple medications, blood sugar monitoring four times daily, and hemoglobin A1C testing every three months. Her most recent A1C was 7.8%, and the care plan identified the need to observe her feet for ulcer formation, but the plan was non-specific regarding ongoing foot and nail monitoring. The resident had repeated podiatry visits earlier in the year, during which the podiatrist documented long, thick, discolored, layered, and painful toenails on both feet and performed nail debridement. One visit also documented paronychia of the second toe on the right foot and treatment with an oral antibiotic. After the last documented podiatry treatment in late May, there was no additional documentation of foot or toenail care in the resident’s record for several months. In late August, nursing documented a warm, red left great toe, and the primary care physician evaluated the resident for an infected ingrown toenail and prescribed an oral antibiotic. The resident reported that she had asked staff to cut her toenails and was told nurses were not allowed to do so, and she stated the facility podiatrist was no longer coming to the facility. Staff interviews confirmed that aides did not cut toenails and that nurses would refer diabetic residents to podiatry. The administrator and regional nurse stated the facility had obtained a new podiatry contract and that the prior podiatrist had taken emergency medical leave, but no documentation of that notification was provided. Review of the record showed no communication from facility staff to the prior podiatrist from August through early December, and the only later podiatry note in the record was an unsigned, non-chargeable visit without nail debridement. The facility policy allowed licensed nurses to trim toenails, including for diabetic residents and residents with circulatory impairments, but the resident did not receive routine podiatry or toenail care at the frequency recommended for a high-risk diabetic resident.
Failure to Implement Effective Pressure Ulcer Prevention Program
Penalty
Summary
The facility failed to implement an adequate and effective pressure ulcer prevention program for a resident who was at high risk for skin breakdown. The resident, admitted with multiple diagnoses including metabolic encephalopathy, chronic respiratory failure, COPD, and impaired mobility, was dependent on staff for most activities of daily living and was assessed as being at risk for pressure injuries. The care plan included interventions such as use of a pressure redistribution cushion, frequent turning and repositioning, incontinence care, and nutritional support. Despite these interventions being documented, observations during the survey revealed the resident was repeatedly found positioned on his back in bed during multiple checks over two days. Further review showed that the resident developed a new Stage 2 pressure ulcer to the right buttock while in the facility, in addition to an existing wound on the left buttock. Nursing staff confirmed that wound measurements were performed only twice weekly and that the resident had not been evaluated by the wound physician for the new ulcer. No additional interventions were implemented for prevention beyond those already in place, and the facility's policy required identification of at-risk residents and implementation of preventive measures. The lack of timely evaluation and absence of enhanced preventive interventions contributed to the development of the new pressure ulcer.
Failure to Obtain Informed Consent for Psychoactive Medications
Penalty
Summary
The facility failed to ensure that Resident #10 or the resident representative was informed in advance of the risks and benefits of proposed psychoactive medications, the treatment alternatives or other options, and was able to choose the preferred option. Resident #10 was admitted with multiple diagnoses including acute and chronic respiratory failure with hypoxia, COPD with acute exacerbation, chronic diastolic CHF, difficulty walking, muscle weakness, unsteadiness on feet, dysphagia, obstructive and reflux uropathy, type 2 DM, paroxysmal atrial fibrillation, secondary pulmonary arterial hypertension, major depressive disorder, hypotension, hyperlipidemia, neuropathy, GERD, morbid obesity, anxiety disorder, electrolyte disorders, and a history of breast cancer. The medical record showed orders for lorazepam for anxiety, hydroxyzine for anxiety, and sertraline as an antidepressant. The record did not contain consent for psychotropic medications when these medications were started. RN #212 confirmed that the facility did not have psychoactive medication consents for Resident #10 prior to 08/10/25, and the informed consent form that included lorazepam, hydroxyzine, and sertraline was completed after the medications had already been initiated. The care plan identified psychotropic and antidepressant medications and included interventions related to side effects, what to report, and non-pharmacological interventions, and the facility policy stated the medical record would contain documentation that the resident and responsible party had been made aware of the risks and benefits of these medications.
Resident Funds Not Kept in Interest-Bearing Account
Penalty
Summary
The facility failed to ensure all resident funds were placed in an interest-bearing account for one resident reviewed for financial accounts. Resident #44 was admitted with multiple diagnoses including dementia, schizoaffective disorder, chronic kidney disease stage III, COPD, diabetes, schizophrenia, bipolar disorder, anxiety disorder, depression, and cognitive communication deficit. His MDS dated 10/08/25 indicated he was cognitively intact. Review of his financial records showed multiple facility AR refunds and overages were posted to his non-interest-bearing AR account from 09/17/24 through 08/19/25, including amounts of $500, $600, $500, $500, $500, $500, and $1,000, with the same transactions also reflected in his interest-bearing funds account as Cash Receipt RFMS transfers. The record review found no interest accumulated on the overages that were held in the facility AR account. Regional RN #212 confirmed the resident had overages in the facility AR account and stated the money would be transferred to the interest-bearing resident account at the direction of the guardian when needed. Cash and Collections Supervisor #300 confirmed the resident currently had overages/credits in the facility AR account due to a miscalculation by the state Medicaid office and stated the AR account was not interest-bearing, though transfers would be made when the guardian directed it. Email communication further confirmed the overages/refunds placed into the AR account were the result of miscalculations and overages over the last four years. Facility RFMS training guidelines stated a Medicaid resident would have a $50 monthly allowance at minimum, but did not address placing resident personal funds in an interest-bearing account when the total exceeded $50.
Resident Funds Co-Mingled in Facility Accounts
Penalty
Summary
The facility failed to ensure resident funds deposited with the nursing home were not co-mingled in other facility accounts. Resident #44 was admitted with diagnoses including dementia, schizoaffective disorder, dysphagia, chronic obstructive pulmonary disease, chronic kidney disease stage III, depression, bipolar disorder, schizophrenia, anxiety disorder, and other chronic conditions. His MDS assessment dated 10/08/25 indicated he was cognitively intact. Review of his financial records showed $0.58 in his personal interest-bearing spending/needs account and an overage total of $730.58 in his non-interest-bearing accounts receivable account. Interviews with the Regional RN and the Cash and Collections Supervisor confirmed that Resident #44 had personal money in both his interest-bearing resident account and his facility AR account. The Cash and Collections Supervisor stated the facility kept money in the AR account in case the resident’s patient liability and cost of care changed so he would not owe the facility money. She also stated money would be moved from the AR account to the interest-bearing resident account at the direction of the resident’s guardian because he would spend all of his money if it were all in his resident account. Facility RFMS training guidelines were reviewed and did not include information about resident money not being co-mingled between multiple accounts.
SNF ABNs Missing Resident or POA Coverage Decisions
Penalty
Summary
The facility failed to ensure residents were offered and that their decisions were documented regarding continuation of skilled therapy services and their inpatient stay when Medicare coverage ended. Based on medical record review, SNF ABN review, policy review, and interview, two residents out of three sampled were affected. Resident #60 was admitted with diagnoses including congestive heart failure, muscle weakness, and difficulty walking. The SNF ABN dated 08/11/25 stated that the resident’s inpatient skilled facility services, including the inpatient stay, would no longer be covered as of 08/14/25, and listed three options for the resident to choose from; however, none of the options were marked. Resident #53 was admitted with diagnoses including muscle weakness, metabolic encephalopathy, congestive heart failure, and myocardial infarction. The SNF ABN dated 05/06/25 stated the last covered day for Medicare Part A skilled services was 05/06/25 and listed three options for the resident to choose from, but none were marked. The form also documented that on 05/01/25 at 10:00 A.M., the Admissions Coordinator verbally notified the resident’s POA by phone of the non-coverage, explained appeal rights, and advised that financial liability would begin on 05/07/25, but no decision was documented. During interview, Social Services #211 and Admissions Coordinator #201 verified that the beneficiary notices for Residents #53 and #60 did not indicate the resident or POA decisions regarding discontinuation of skilled services, and the Admissions Coordinator stated she had reviewed the forms by phone and mailed them certified, but had not documented the choices made.
Unclean Resident Environment With Blood Staining
Penalty
Summary
The facility failed to maintain a clean and sanitary environment for Resident #22, who was admitted with diagnoses including cerebral palsy, pyoderma, and MRSA infection of the scalp. A Dermatology Physician Assistant progress note dated 08/21/25 ordered thick application of gentamicin 0.1% ointment to the red areas on the scalp and inside the nose twice daily until healed. On 09/29/25, observation found the resident’s privacy curtain and the wall next to the bed with a dried brown substance smeared on both surfaces. On 09/30/25, the resident was observed lying in bed with the privacy curtain, pillow, and wall next to the bed stained brown and smeared with blood, and the resident’s scalp had scattered open areas that were bleeding. A Registered Nurse later observed the same areas and stated the brown staining on the wall, pillow case, and privacy curtain was probably dried blood but was not completely sure.
Failure to Review and Provide Baseline Care Plan to Newly Admitted Resident
Penalty
Summary
The facility failed to review and provide the baseline care plan to a newly admitted resident within the required timeframe. Resident #81 was admitted with diagnoses including left hip replacement revision and diabetes mellitus, and the admission nursing assessment documented an unsigned baseline care plan dated 09/27/25. The clinical admission documentation assessment indicated the resident was cognitively intact for daily decision-making and that the facility was to obtain the resident’s signature and date confirming the baseline care plan was provided, but the record contained no evidence this was completed. The resident stated that no facility staff had spoken with him, discussed his plan of care, or provided a copy of his baseline care plan since admission. During observation, the Social Service Coordinator was heard asking the resident questions about code status, PTSD, needs at home, therapy, discharge plans, and paperwork, and later verified she was unable to provide a signed copy of the baseline care plan. The Registered Nurse also verified the resident had not been provided a copy or explanation of the baseline care plan during the required time frame.
Failure to Provide Nail Care to a Dependent Resident
Penalty
Summary
The facility failed to provide nail care to a dependent resident. Resident #22 was admitted with diagnoses including cerebral palsy, schizoaffective disorder, pyoderma, and cerebral vascular accident. The resident’s electronic profile sheet showed dependence on staff for nail care, and the quarterly MDS indicated the resident was cognitively intact for daily decision-making, had functional impairment of the upper and lower extremities, and was dependent on staff for personal hygiene including nail care. The care plan also identified impaired ability to perform ADLs due to weakness and cerebral palsy and included an intervention to provide nail care per weekly schedule. Review of the resident’s shower sheets showed a shower was provided, but there was no evidence nail care was completed. Observation on two separate occasions revealed the resident’s left fingernails were jagged and unclean, and the resident’s right hand could not be fully observed because the fingers were tightly pressed into the palm. An RN verified the left fingernails were jagged and unclean, and a CNA later stated the resident was dependent on staff for ADL care and was providing nail care because the resident’s nails were jagged. The facility policy stated nail care included daily cleaning and regular trimming.
Failure to Provide Ordered Constipation Care, UTI Prevention, and Post-Op Medications
Penalty
Summary
The facility failed to provide adequate care and services related to constipation management for a resident with cerebral palsy, schizoaffective disorder, chronic idiopathic constipation, bowel incontinence, dependence on staff for toileting, and use of opioid medication. The resident had multiple days with no documented bowel movement in the bowel record, including periods in late July and early August and again in September. Although the resident was receiving tramadol 50 mg twice daily and had PRN orders for Senna and milk of magnesia, there was no evidence those constipation medications were administered during the period without bowel movements. After a urogynecology consult changed the bowel regimen to Fibercon and Miralax, the physician was not notified that the resident still had no bowel movement over several days, and the constipation was not addressed. RN #212 later verified the resident did not receive interventions or medications as ordered to treat the constipation. The facility also failed to follow ordered preventive treatment for urinary tract infections for the same resident. A urogynecology consult ordered cranberry tablets 500 mg twice daily and D-Mannose 1000 mg twice daily, with instructions to give the two medications two hours apart. The eMAR showed the resident instead received cranberry 450 mg once daily and D-Mannose 1000 mg twice daily, and both were given within the same timeframe. RN #212 verified the cranberry dose and frequency were incorrect and that the instruction to separate administration by two hours was not transcribed or implemented. In a separate event, a resident admitted after a left hip joint replacement revision did not receive several ordered post-operative medications until several days after admission because the medications were unavailable from the pharmacy. Ordered medications including cefadroxil, etodolac, lisinopril-HCTZ, meloxicam, pravastatin, and Xarelto were not started until 09/29/25, and RN #212 verified the delay was not timely and occurred because the medications had not been delivered.
Oxygen Flow Rate Not Set as Ordered
Penalty
Summary
The facility failed to provide oxygen to Resident #10 at the flow rate ordered by the physician. Resident #10 was admitted on 07/14/25 with diagnoses including acute and chronic respiratory failure with hypoxia, COPD with acute exacerbation, chronic diastolic CHF, secondary pulmonary arterial hypertension, and other significant medical conditions. The medical record included an order dated 08/05/25 for continuous oxygen at 4 liters per nasal cannula with placement checked every shift. During observation on 09/30/25 at 10:28 A.M., the resident was wearing oxygen by nasal cannula, and the oxygen concentrator was set at 5 liters. LPN #137 confirmed the setting at the time of observation and later confirmed that the ordered flow rate was 4 liters per nasal cannula, not 5 liters.
Pain Management and PRN Medication Availability Deficiencies
Penalty
Summary
The facility failed to provide safe, appropriate pain management for two residents. For one resident with diagnoses including chronic respiratory failure, COPD, CHF, dementia, anxiety, and depression, the record showed PRN acetaminophen and oxycodone were ordered for pain rated one to ten, but staff confirmed there were no distinct parameters for when to give the weaker versus stronger medication. The MAR showed both medications were used with similar pain ratings, and the regional RN confirmed the same pain parameters were being used for both PRN pain medications. The facility pain medication policy stated pain medications are to be administered in accordance with professional standards of practice. For another resident admitted after a left hip joint replacement revision, the discharge orders included meloxicam scheduled, oxycodone IR PRN for severe pain, and tramadol PRN for moderate pain. The resident was cognitively intact and reported pain rated five out of ten on the night shift, but there was no evidence of a comprehensive assessment or interventions to address the pain. The ordered PRN oxycodone and tramadol were not available at the facility until the following day, and there was no evidence that pain medication was given from the emergency supply. The resident stated he did not receive timely pain management over the weekend, and the RN verified the PRN opioids were not available to be administered until later and that the pain complaint was not addressed.
Expired and Unclean Food Storage in Facility
Penalty
Summary
The facility failed to ensure that food items in the kitchen walk-in refrigerator were properly labeled and not kept past their expiration dates. During an observation, it was found that there were several opened bags of deli meats and a pan of uncooked grilled cheese with use-by dates that had already passed. This was verified by a staff member who subsequently discarded the expired items. The facility's policy requires that food storage areas be monitored for expiration, but this was not adhered to, leading to the presence of expired food items. Additionally, the facility did not maintain cleanliness in unit refrigerators that contained resident food. Observations revealed food debris, splatters, and other contaminants in the memory care refrigerator, as well as sticky surfaces and food stains in the 200 and 100 hall unit refrigerators. Interviews with various staff members, including a Registered Nurse Supervisor and a Hospitality Aide, indicated a lack of clarity regarding who was responsible for cleaning these refrigerators. The facility's policy outlines that designated staff should complete cleaning procedures for food storage areas, but this was not being followed, resulting in unclean conditions.
Failure to Provide Nutritional Supplements as Ordered
Penalty
Summary
The facility failed to ensure that a resident with a history of weight loss was provided with nutritional supplements as ordered. The resident, who had multiple medical conditions including cerebral atherosclerosis, hemiplegia, and dysphagia, was on a no added salt and puree textured diet with an order for house supplements to be given three times a day. However, the Medication Administration Record (MAR) indicated that the supplement was unavailable on multiple occasions, and the resident did not receive the prescribed supplements. There was no documentation in the progress notes about the unavailability of the supplements, nor was there any indication that the physician or dietitian was notified of this issue. Interviews with facility staff revealed that there were supply issues with the house supplement, ReadyCare Shake Plus, which was supposed to be substituted with ReadyCare 2.0. However, the substitute product received was expired, leading to the use of fortified ice cream and pudding as alternatives. The Assistant Director of Dietary confirmed the supply issues but was unsure how this was communicated to the nursing staff. The Regional Nurse Consultant verified the documentation of the supplement's unavailability but was uncertain if the resident consumed any alternative. The facility lacked relevant policies to address this situation, contributing to the deficiency.
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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 Coshocton
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Roscoe Gardens Skilled Nursing And Rehab | 2.1 mi | ★★★★★ | 20 | 0 |
| Lafayette Pointe Nursing & Rehab Ctr | 6 mi | ★★★★★ | 1 | 0 |
| Riverside Manor Nrsg & Rehab Ctr | 14 mi | ★★★★★ | 4 | 0 |
| Oak Pointe Nursing & Rehabilitation | 15.8 mi | ★★★★★ | 0 | 0 |
| Continuing Healthcare At Beckett House | 17.9 mi | ★★★★★ | 2 | 0 |
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