Below average — CMS composite of the measures below.
Past the typical resurvey interval — a standard survey could occur at any time
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 Avenue At Macedonia during CMS and state inspections, most recent first.
The facility failed to implement and follow transmission-based precautions (TBP) and enhanced barrier precautions (EBP) for several residents. A resident with COVID-19 was not properly protected by a CNA who entered without full PPE. Another resident with ESBL was not placed on appropriate isolation, and a nurse entered without PPE. Additionally, a resident requiring EBP due to an indwelling device and wound lacked proper signage and PPE availability.
The facility failed to document that the COVID-19 vaccine was offered and education was provided to four residents. An LPN, serving as the Infection Control Preventionist, could not provide evidence of vaccine offers or education. The facility's policy required offering the vaccine and providing information to representatives if residents were unable to decide.
A resident with cognitive impairment and dependency for transfers fell between the bed and wall due to the bed's movement, despite safety measures in place. The bed was supposed to be locked and positioned against the wall to prevent falls, but it moved, allowing the fall to occur. Staff confirmed the bed should not have moved if properly locked.
The facility failed to ensure call lights were within reach for two residents, both with significant impairments, preventing them from calling for help. Despite facility policy, staff did not position the call lights correctly after providing care, as confirmed by observations and staff interviews.
The facility failed to complete accurate MDS assessments for two residents. One resident was discharged without a discharge return not anticipated MDS assessment, while another had an in-house acquired stage two pressure ulcer inaccurately documented as present on admission. These deficiencies were confirmed by facility staff.
A facility failed to monitor Vancomycin levels for a resident with bacteremia and streptococcal polyarthritis, despite having a physician's order for the medication. An LPN was unable to explain how the facility monitored the serum levels, and the DON confirmed the absence of necessary laboratory orders. The facility's medication policy lacked directives for Vancomycin serum level monitoring.
A facility failed to assist a resident with recommended vision services, specifically cataract surgery. Despite being cognitively intact and having significant cataracts, the resident did not receive the necessary assistance to schedule surgery. The facility's inaction violated the resident's right to adequate medical care as per Ohio Revised Code Section 3721.13.
A resident with cerebral palsy, dependent on staff for eating, did not receive enteral feeding according to physician's orders. The feeding, set to run from 11:00 P.M. to 11:00 A.M., continued past the prescribed time, with the pump beeping due to an empty bag. An LPN confirmed the feeding should have been stopped, indicating a lapse in following medical orders and facility protocols.
A facility failed to maintain a clean environment in a resident's room, affecting a resident with hemiplegia and gastrostomy. Observations revealed yellow dried enteral feeding on the floor, feeding tube pole, and tray table. The trash can lacked a liner and contained dried feeding residue. A CNA confirmed these findings, noting that rooms should be cleaned daily.
The facility failed to provide necessary ADL assistance to residents, including oral care, incontinence care, and feeding supervision. A resident with multiple sclerosis was found with food debris on her teeth, indicating a lack of oral care. Another resident with cerebral infarction was left in wet sheets due to inadequate incontinence care, exacerbated by staff shortages. A third resident, requiring supervision for eating, was left unsupervised, consuming a meal without assistance, contrary to her care plan.
The facility failed to ensure the activities program was directed by a qualified professional, affecting all 88 residents. The Activity Director lacked evidence of appropriate qualifications, and the Human Resource Director was unaware of these qualifications. The former AD, now the Admissions Director, who trained the current AD, also did not meet the necessary qualifications. The job description for the Activity Director lacked specific qualification details.
A facility failed to prevent an inappropriate relationship between a laundry aide and a resident, leading to an allegation of sexual abuse. The resident, who was cognitively intact, left the facility with the aide, spent time at a motel, and consumed alcohol. The aide admitted to intimate moments with the resident, but the facility's investigation did not substantiate the abuse allegation. The facility lacked a policy on staff-resident relationships outside of work, and the police investigation was ongoing.
Two residents in an LTC facility experienced harm due to the facility's failure to provide timely and necessary care following changes in their conditions. One resident, with severe cognitive impairment, showed signs of pain and bruising but was not assessed or treated promptly, leading to a hip fracture. Another resident, also cognitively impaired, fell and was not assessed or documented, resulting in a pelvic fracture. Both residents were hospitalized and did not return to the facility.
A resident with Alzheimer's and severe cognitive impairment did not receive timely quarterly care plan meetings as required. The facility's policy mandates these meetings upon admission, quarterly, annually, and with significant changes, but the schedule was not followed, with meetings delayed and missing. Staff interviews confirmed the oversight, and the Administrator acknowledged the failure to adhere to policy.
A facility failed to include necessary accommodations for a deaf resident's communication needs in her care plan. Despite being informed of the resident's reliance on sign language, the facility did not provide an effective means of communication, leading to reliance on a dry erase board and video calls with the resident's son. The care plan lacked provisions for the resident's hearing impairment, resulting in a deficiency.
A facility failed to provide proper personal hygiene care to a resident with dementia, who was observed with long chin hairs, indicating a lack of shaving assistance. The care plan was revised during a survey to include the resident's refusal to shave, but there was no prior documentation of such refusal. Staff confirmed the oversight, and the facility's policy required daily shaving during routine bathing.
Failure to Implement Transmission-Based and Enhanced Barrier Precautions
Penalty
Summary
The facility failed to implement and follow transmission-based precautions (TBP) and enhanced barrier precautions (EBP) for several residents. Resident #73, who was severely cognitively impaired and tested positive for COVID-19, was on droplet precautions. However, a Certified Nurse Aid (CNA) entered the resident's room without wearing gloves, shoe coverings, or eye protection, contrary to the facility's policy requiring masks, gowns, gloves, and goggles for droplet precautions. Additionally, Resident #5, diagnosed with extended-spectrum beta-lactamases (ESBL), was not placed on the appropriate isolation precautions. A Registered Nurse (RN) entered the room without personal protective equipment (PPE) and took a medication cart inside, despite the resident having an order for contact isolation due to ESBL. Resident #195, who required EBP due to an indwelling device and wound, did not have appropriate signage or PPE available outside her room. The care plan indicated the need for EBP to reduce the transmission of multidrug-resistant organisms, but these precautions were not visibly implemented. The facility's policy required EBP for residents with wounds and/or indwelling medical devices, yet this was not adhered to, as confirmed by a Licensed Practical Nurse (LPN) and the Regional Director of Clinical Services.
Failure to Document COVID-19 Vaccine Offer and Education
Penalty
Summary
The facility failed to maintain proper documentation indicating that the COVID-19 vaccine was offered to residents and that they were educated about the benefits and risks associated with the vaccine annually. This deficiency affected four residents out of five reviewed for immunizations, with a total census of 88. Specifically, the medical records for Residents #1, #31, #42, and #76 showed no evidence that they had been offered or educated about the COVID-19 vaccination within the past year. An interview with the LPN who served as the Infection Control Preventionist revealed that there was no evidence available to show that these residents had been offered or had declined the COVID-19 vaccination. The facility's policy, dated January 2, 2024, stated that all residents should be offered the COVID-19 vaccination, and if a resident was unable to make decisions due to decreased mental capacity, their designated representative should be provided with a fact sheet and given the option to administer the vaccine on the resident's behalf.
Failure to Prevent Fall Due to Bed Movement
Penalty
Summary
The facility failed to ensure safety measures were in place to prevent a fall for Resident #197, who was cognitively impaired and dependent on assistance for transfers. The resident had a care plan aimed at minimizing fall risks and injuries, which included implementing preventative fall interventions and rearranging furniture. However, on 01/05/25, the resident was found with her head, shoulders, and torso between the wall and the bed, indicating a fall. The bed was positioned against the wall due to previous falls, with a floor mat on the opposite side, but the incident suggested that the bed had moved, allowing the resident to fall between the bed and the wall. Interviews with facility staff, including a CNA and the Administrator, revealed that the bed should not have moved if it was locked and functional. The CNA demonstrated that a locked bed would not move when pushed or pulled, suggesting a failure in the locking mechanism or its application. The Administrator and Regional Director of Clinical Operations confirmed awareness of the fall and acknowledged the family's photograph showing the resident on the floor. This deficiency was investigated under Complaint Number OH00161919.
Failure to Ensure Call Lights Within Reach for Residents
Penalty
Summary
The facility failed to ensure that call lights were within reach for two residents, leading to a deficiency in accommodating their needs and preferences. Resident #6, who has multiple sclerosis and severe cognitive impairment, was observed with her paddle push call light out of reach on multiple occasions. Despite being dependent on staff for activities of daily living, the staff did not position the call light correctly, preventing her from calling for help. Interviews with staff confirmed that the call light was not placed within reach after assistance was provided. Similarly, Resident #8, who has hemiplegia, contractures, and moderate cognitive impairment, was also found with her soft touch call light button out of reach. Observations revealed that the call light was not positioned correctly for her to use, as she could only activate it with her right shoulder due to her condition. Staff interviews verified that the call light was not placed within reach after care was provided. The facility's policy requires staff to ensure call lights are within reach when leaving the room, which was not adhered to in these cases.
Inaccurate and Incomplete MDS Assessments for Two Residents
Penalty
Summary
The facility failed to ensure accurate and timely completion of Minimum Data Set (MDS) assessments for two residents, leading to deficiencies in resident assessments. Resident #79, who had diagnoses including Alzheimer's disease, anxiety, and hypertension, was discharged to the hospital and did not return to the facility. However, the facility did not complete a discharge return not anticipated MDS assessment for this resident after her discharge, as confirmed by an interview with RN #526. Resident #197, with diagnoses including diabetes mellitus, hypertension, and dementia, was observed to have a dark red area on her left heel, which was later assessed as a stage two pressure ulcer acquired in-house. Despite this, the quarterly MDS assessment inaccurately documented the pressure ulcer as present on admission. This inaccuracy was verified by the Regional Director of Clinical Services #599, indicating a failure in accurately assessing and documenting the resident's condition.
Failure to Monitor Vancomycin Levels
Penalty
Summary
The facility failed to ensure that Vancomycin levels were monitored for a resident, which was necessary to ensure appropriate levels and efficacy of the medication. The resident, who was admitted with diagnoses including bacteremia and streptococcal polyarthritis, had a physician's order for Vancomycin intravenous solution to be administered every 12 hours. However, there were no laboratory orders to monitor the Vancomycin serum levels. During an observation and interview, an LPN administering the medication was unable to state how the facility was monitoring the Vancomycin serum levels. The Regional Director of Nursing confirmed that there were no orders for Vancomycin serum monitoring, acknowledging that the nurse practitioner had failed to order the necessary laboratory testing. The facility's medication administration policy did not include directives related to Vancomycin serum levels.
Failure to Assist Resident with Vision Services
Penalty
Summary
The facility failed to ensure that a resident received recommended ancillary services, specifically related to vision care. The resident, who was cognitively intact and had a history of kidney disease, diabetes, heart failure, and depression, was identified as having visually significant cataracts. Despite a recommendation for a cataract evaluation, the facility did not assist the resident in scheduling the necessary surgery. The resident had an appointment for cataract surgery, but it was not performed, and subsequent attempts to have the resident seen by an optometrist were unsuccessful due to time constraints, resident refusal, and the facility's failure to assist in locating the resident. The Director of Nursing confirmed that there was no evidence of efforts made by the facility to assist the resident in scheduling the cataract surgery. This lack of action is in violation of the Ohio Revised Code Section 3721.13, which states that residents have the right to adequate and appropriate medical care and services, including ancillary services. The facility's inaction resulted in the resident not receiving the necessary vision care services as recommended by the optometrist.
Failure to Adhere to Enteral Feeding Schedule
Penalty
Summary
The facility failed to ensure that a resident's enteral feeding was administered according to the physician's orders. The resident, who has cerebral palsy and is dependent on staff for eating, was supposed to receive enteral feeding at 70 mL per hour from 11:00 P.M. to 11:00 A.M. daily. However, on the day of observation, the feeding was still running past the prescribed time, and the delivery pump was beeping to alert the nurse that the feeding bag was empty. Despite the physician's orders and the facility's policy on enteral feeding, the feeding was not turned off at the designated time. An LPN confirmed that the feeding should have been stopped at 11:00 A.M., but it continued until at least 1:33 P.M., as observed. This oversight in adhering to the prescribed feeding schedule indicates a lapse in following medical orders and facility protocols, affecting the resident's care.
Failure to Maintain Cleanliness in Resident Room
Penalty
Summary
The facility failed to maintain a clean and sanitary environment in the room of a resident receiving enteral feedings. The resident, who was admitted with diagnoses including hemiplegia and gastrostomy, was observed to have yellow dried enteral feeding on the floor and feeding tube pole at multiple times throughout the day. Additionally, the trash can in the resident's room was found to be without a liner and contained thick yellow dried enteral feeding at the bottom. The tray table and the area beneath it also had dried tube feeding residue. A Certified Nursing Assistant confirmed these observations and stated that resident rooms were supposed to be cleaned daily. This deficiency was identified during an investigation under Complaint Number OH00161919.
Failure to Provide Necessary ADL Assistance
Penalty
Summary
The facility failed to provide necessary assistance for activities of daily living (ADLs) to residents who were unable to perform them independently. Resident #6, diagnosed with multiple sclerosis and contractures, was observed with significant food debris on her teeth, indicating a lack of oral care. Despite being dependent on staff for oral hygiene, Resident #6 reported not receiving mouth care, and her call light was out of reach, preventing her from requesting assistance. Resident #59, with a history of cerebral infarction and epilepsy, was found lying in bed with wet sheets and a strong odor of urine, suggesting inadequate incontinence care. Despite needing substantial assistance with toileting, Resident #59 had not been changed for an extended period. Staff shortages were noted, with only two CNAs available to assist a high volume of residents requiring maximum assistance, contributing to the neglect of Resident #59's care needs. Resident #56, who required supervision for eating due to schizoaffective disorder and quadriplegia, was left unsupervised in a hallway with an untouched breakfast tray. The resident, on a pureed diet to prevent aspiration, consumed the meal without assistance, contrary to the care plan that mandated supervision during meals. Staff interviews confirmed the lack of supervision, highlighting a failure to adhere to the facility's policy on providing necessary ADL assistance.
Unqualified Activity Director in Facility
Penalty
Summary
The facility failed to ensure that the activities program was directed by a qualified professional, which had the potential to affect all 88 residents. The personnel file for the Activity Director (AD) revealed no evidence of appropriate qualifications for the position. The Human Resource Director was unaware of the qualifications held by the AD and mentioned that the AD was in the process of completing a state-approved training course. Additionally, the former AD, now the Admissions Director, who trained the current AD, also did not meet the qualifications to direct the activities program and had not completed a state-approved training course. The job description for the Activity Director lacked specific qualification details, and the AD signed this incomplete job description.
Inappropriate Relationship Between Staff and Resident
Penalty
Summary
The facility failed to prevent an inappropriate relationship between an employee, Laundry Aide #201, and Resident #91, which had the potential to be considered an abuse of power and resulted in an allegation of staff-to-resident sexual abuse. Resident #91, who was cognitively intact with a BIMS score of 15, had a history of alcohol abuse and depressive disorder. The incident involved the resident leaving the facility with the aide, spending time at a motel, and consuming alcohol, which was against the resident's will according to his later statements. The incident began when Resident #91 left a note stating he was on a leave of absence to visit a friend in the hospital. The Administrator later found the resident at a motel with Laundry Aide #201, who admitted to taking the resident out of the facility and engaging in intimate moments, including consensual kissing. The facility's investigation revealed that the resident initially stated he was not forced to leave or drink but later alleged that the aide essentially raped him. The facility did not have a policy addressing staff relationships with residents outside of work, and the Administrator did not initially question the aide about her actions because she was not on duty at the time. The facility's investigation did not substantiate the allegation of sexual abuse, as communications between the resident and the aide suggested they were consenting adults. However, the Centers for Medicare and Medicaid guidance indicates that any sexual relationship between staff and residents is considered an abuse of power, regardless of consent. The police investigation into the incident was still pending at the time of the report.
Failure to Provide Timely Care Leads to Harm
Penalty
Summary
The facility failed to provide timely and necessary care for two residents following changes in their conditions, resulting in actual harm. Resident #100, who was severely cognitively impaired, was noted by a CNA to be favoring her right side with bruising, but there was no evidence of a licensed nurse assessing the resident or providing necessary intervention. Despite signs of increased pain, an x-ray could not be obtained due to positioning issues. Five days after the initial change was identified, the resident was transferred to the hospital and diagnosed with a right hip fracture requiring surgery. The resident did not return to the facility after being transported to the hospital. Resident #102, also severely cognitively impaired, sustained a witnessed fall resulting in a fracture. However, the resident was not comprehensively assessed for injury or need for additional medical treatment, nor was there documentation of the incident at the time it occurred. Three days after the fall, the resident was transported to the hospital with bilateral hip pain and diagnosed with a pelvic fracture. The resident did not return to the facility after being transported to the hospital. The facility's failure to provide timely and necessary care affected two of the three residents reviewed for changes in condition. The facility's policy required staff to provide timely and appropriate care and services when a resident experienced a change in condition. However, in both cases, the facility did not adhere to its policy, resulting in harm to the residents.
Failure to Conduct Timely Care Plan Meetings
Penalty
Summary
The facility failed to ensure that a resident received quarterly care conferences as required. The resident, who was admitted with diagnoses including Alzheimer's Disease, Dementia, adult failure to thrive, and delusional disorders, had severely impaired cognition according to a quarterly Minimum Data Set (MDS) assessment. The care plan meetings for this resident were not held in a timely manner, with the first meeting occurring later than expected and subsequent meetings not adhering to the quarterly schedule. Specifically, the meetings were held on 05/30/23, 11/02/23, 02/01/24, and 04/18/24, missing the expected August 2023 meeting. Interviews with the Social Service Designee and the MDS Nurse revealed that they were unable to provide explanations for the delays in scheduling the care plan meetings. The facility's policy required care conferences to be scheduled upon admission, quarterly, annually, with significant changes, or if requested by the family or resident. The Administrator confirmed that the care plan meetings were not held in a timely manner, indicating a failure to adhere to the facility's policy and procedures. This deficiency was identified during an investigation under complaint number OH0018928.
Failure to Address Communication Needs for Deaf Resident
Penalty
Summary
The facility failed to ensure that the comprehensive care plan for a resident with hearing impairment included the necessary accommodations for her primary means of communication, which was sign language. The resident, who was deaf and non-speaking, was admitted with multiple diagnoses including staphylococcal arthritis, esophageal varices, and diabetes. Despite the referral information from Cleveland Clinic hospitals clearly stating the need for sign language communication, the facility's care plan did not address this requirement. Instead, the care plan included interventions such as asking simple yes or no questions and allowing adequate time to respond, which did not cater to the resident's communication needs. The resident's son reported that the facility initially provided an electronic tablet with a sign language app, but it was not functional and took a week to get working, only to find it did not interpret words correctly. As a result, the facility resorted to using a dry erase board, which was ineffective for the resident. The son had to frequently use video calls to communicate with his mother on behalf of the staff. An interview with a reimbursement specialist confirmed that the care plan did not address the resident's hearing impairment or need for sign language, leading to the deficiency identified in the complaint investigation.
Failure to Provide Personal Hygiene Care
Penalty
Summary
The facility failed to ensure that a dependent resident, identified as Resident #48, received appropriate personal hygiene care, specifically the removal of facial hair. Resident #48, who has diagnoses including dementia and major depressive disorder, was observed with long chin hairs, indicating a lack of shaving assistance during bathing. The care plan for Resident #48, dated 08/07/23, did not initially include a behavior of refusing to be shaved during bathing, although it was later revised during the survey to include this behavior. The facility's policy stated that shaving should be offered daily during routine bathing, but this was not adhered to in the case of Resident #48. Interviews with facility staff, including an LPN and an RN, confirmed the presence of long chin hairs on Resident #48 and acknowledged that shaving should occur during showers. The Administrator disagreed with the citation, believing the refusal to shave was already documented in the care plan before the survey. However, there was no documentation of Resident #48 refusing to be shaved in the progress notes from 05/28/24 to 07/25/24. This deficiency was identified during the investigation of specific complaint numbers and represents noncompliance with the facility's personal care policy.
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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 Macedonia
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Northfield Village Retirement Community | 2.1 mi | ★★★★★ | 0 | 0 |
| Manor Of Grande Village | 2.9 mi | ★★★★★ | 0 | 0 |
| Aventura At Walton Hills | 3.4 mi | ★★★★★ | 21 | 0 |
| Heritage Health Care Center | 3.5 mi | ★★★★★ | 1 | 0 |
| Grande Oaks | 3.5 mi | ★★★★★ | 44 | 0 |
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