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 Barberton Post Acute during CMS and state inspections, most recent first.
A resident with significant mobility and medical needs was discharged without timely access to required DME, including a hospital bed and wheelchair, and without immediate initiation of HHA services. Discharge documentation lacked essential provider contact information, and there was no follow-up to ensure physician approval of orders before discharge, resulting in a week-long delay in the delivery of necessary equipment and services.
Two residents were discharged without complete or accurate discharge documentation, including missing or incomplete Post-Discharge Plans of Care, medication lists, wound care instructions, and contact information for home health agencies and DME providers. Family members reported being unprepared and lacking necessary information to care for the residents at home, and staff interviews confirmed the deficiencies in discharge planning and documentation.
The facility's kitchen was found to be in an unsanitary condition, affecting 70 residents. Observations included unlabeled and undated food items, food stored improperly on the floor, and equipment with dried food residue. These findings were verified by a staff member, indicating non-compliance with the facility's food storage policy.
The facility did not complete annual performance evaluations for three CNAs, affecting the potential care of all 72 residents. The HR Director confirmed the absence of evaluations for CNAs hired in 2020, 2022, and 2023.
The facility failed to provide physician-ordered carbohydrate-controlled diets to 17 residents, serving buttered peas instead of the prescribed sauteed spinach. This discrepancy was confirmed by the Regional Director of Dietary Services and the Dietary Manager, who acknowledged that the correct dietary substitutions were not followed, affecting residents with specific dietary needs.
The facility failed to implement Enhanced Barrier Precautions (EBP) for three residents requiring such measures, as there was no signage posted to alert staff of the high contact risk. Despite physician orders for EBP, staff interviews confirmed the absence of necessary signage, which is against the facility's policy. This oversight affected residents with conditions such as urinary retention, hypertension secondary to renal disorder, and cellulitis.
The facility failed to provide necessary medications to three residents, resulting in missed doses of prescribed treatments. A resident with severe cognitive impairment did not receive levothyroxine, another with dyskinesia missed Ingrezza doses, and a third requiring dialysis did not receive auryxia. The DON confirmed the unavailability of medications but was unsure of the reasons.
A resident with cognitive impairments was denied the right to lie down in bed due to staff following the spouse's request, despite no medical orders restricting bed access. The facility's policy to honor resident preferences was not implemented, leading to the resident's distress.
The facility failed to convey a deceased resident's funds within the required 30-day timeframe. A resident was admitted and later expired, and a check for $1,676.34 was dispersed to the Treasurer of Ohio State. The Business Office Manager confirmed the delay in conveying the funds.
A facility failed to provide timely follow-up for a resident's hearing aid fitting, despite a diagnosis of hearing loss and a completed Certificate of Medical Necessity. The resident, who was cognitively intact and independent, was observed having difficulty hearing. Interviews confirmed that no follow-up appointment had been arranged, highlighting a lapse in coordinating necessary ancillary services.
A resident with chronic back pain did not receive timely pain management due to a canceled appointment that was not rescheduled. Despite physician orders for pain management, the facility failed to ensure the resident received necessary treatment, affecting their pain relief.
The facility failed to maintain a clean environment for two residents who required assistance with ADLs due to limited mobility and incontinence. A soiled brief was found on the floor between their beds while they were eating, and one resident admitted to soiling it and being unable to dispose of it properly. A CNA noticed the brief and expressed disapproval, confirming the situation during an interview.
Failure to Ensure Safe Discharge Planning and Timely Provision of DME and Home Health Services
Penalty
Summary
The facility failed to ensure a safe and adequately prepared discharge for a resident with multiple complex medical conditions, including fractures, COPD, heart failure, diabetes, muscle weakness, and anxiety disorder. The resident, who was cognitively intact and dependent on a wheelchair for mobility, required substantial assistance with activities of daily living. Upon discharge, the resident was supposed to receive home health agency (HHA) services, palliative care, physical and occupational therapy, and durable medical equipment (DME) including a hospital bed and wheelchair. However, the discharge orders did not specify a wheelchair, and the Post-Discharge Plan of Care lacked the names and contact information for the HHA and DME providers, as well as details about the equipment needed. After discharge, the resident's son reported that neither the hospital bed nor the wheelchair had been delivered, and the HHA did not arrive as expected. The son had to independently search for contact information to follow up with the DME company and HHA, only to learn that the necessary services and equipment had not yet been approved. As a result, the resident, who was unable to stand, spent the first week at home mostly on the couch, and had to cancel a primary care appointment due to mobility issues. The hospital bed, wheelchair, and HHA services were not provided until approximately a week after discharge. Interviews with facility staff revealed that the discharge planning process was incomplete, particularly because the staff member responsible for filling out the Post-Discharge Plan of Care was not present on the day of discharge, and a floor nurse completed the documentation instead. There was also a lack of follow-up to ensure that the physician approved the DME and HHA orders prior to discharge. Documentation confirmed that the orders for the hospital bed and wheelchair were not signed by the physician until several days after discharge, resulting in delayed delivery of essential equipment and services.
Failure to Provide Complete Discharge Documentation and Information
Penalty
Summary
The facility failed to provide complete and accurate discharge documentation for two residents who were discharged home. For one resident with multiple complex medical conditions, including acute respiratory failure, COPD, diabetes, and chronic embolism, there was no Post-Discharge Plan of Care found in either the electronic or hard medical record. Interviews with the resident's family and facility staff confirmed that the resident was not given a medication list, wound care instructions, or information about home health agency (HHA) services upon discharge. The family reported being unprepared and having to contact the primary care physician for assistance after discharge. For another resident with a history of fractures, COPD, heart failure, diabetes, and anxiety disorder, the discharge summary was incomplete. Although the resident was sent home with some discharge paperwork and a medication list, the Post-Discharge Plan of Care assessment lacked critical information such as the HHA's contact details, Ombudsman contact, wound care orders, primary care physician, and pharmacy information. The resident's family had difficulty arranging for durable medical equipment (DME) due to missing contact information and reported that the resident was discharged without the necessary equipment being delivered. Facility policy required that a discharge care plan be included in the medical record for resident-initiated discharges, aligning with the resident's goals and desired outcomes. However, in both cases, the required documentation was either missing or incomplete, as verified by staff interviews and record reviews. This deficiency was identified during a complaint investigation and affected two of three residents reviewed for discharges.
Kitchen Sanitation Deficiency
Penalty
Summary
The facility failed to maintain its kitchen area in a clean and sanitary condition, potentially affecting 70 out of 72 residents who receive food from the kitchen. During a tour of the kitchen, several deficiencies were observed, including a kitchen door with dry food splatter, open bags of spiral and egg noodles without open dates in the dry storeroom, and improperly labeled or dated food items in the freezer and refrigerator. Specifically, cooked omelets and an open bag of breaded chicken breasts in the freezer were not labeled or dated, and two cases of chicken breasts were found sitting on the floor. Additionally, dirty water was observed underneath the dish machine sink, a meat slicer had dried food residue on the blade, and a floor mixer had dried food splatter. These findings were verified by a staff member during a follow-up tour. The facility's policy requires all packaged and food items to be clean, dry, properly sealed, and date-marked, and stored at least six inches from the floor, which was not adhered to in this instance.
Failure to Complete Annual CNA Performance Evaluations
Penalty
Summary
The facility failed to ensure that annual performance evaluations were completed for Certified Nursing Assistants (CNAs) as required. This deficiency was identified during a review of personnel files and staff interviews, affecting three CNAs whose files were examined. Specifically, CNA #826, hired on 08/20/20, CNA #863, hired on 05/23/23, and CNA #865, hired on 05/15/22, did not have their annual performance evaluations completed for the year 2024. The Human Resources Director confirmed the absence of these evaluations, which had the potential to impact all 72 residents residing in the facility.
Failure to Provide Physician-Ordered Carbohydrate-Controlled Diets
Penalty
Summary
The facility failed to provide physician-ordered carbohydrate-controlled diets to 17 residents, affecting all residents who were supposed to receive this specific dietary regimen. During an observation of the lunch tray line service, it was noted that residents ordered a Carbohydrate Controlled Diet (CCD) were served buttered peas instead of the prescribed sauteed spinach. This discrepancy was confirmed by the Regional Director of Dietary Services and the Dietary Manager, who acknowledged that the spreadsheet indicating the correct dietary substitutions was not followed. The facility's diet and nutritional manual for a consistent carbohydrate diet, intended for individuals with diabetes or difficulty controlling blood glucose levels, was not adhered to, as evidenced by the failure to provide the correct vegetable substitution. The facility's policy on menus, which should meet the nutritional needs of residents in accordance with established national guidelines, was not implemented correctly, leading to the dietary oversight.
Failure to Implement Enhanced Barrier Precautions
Penalty
Summary
The facility failed to implement proper infection prevention and control measures by not identifying high-contact residents requiring Enhanced Barrier Precautions (EBP) during resident care activities. This deficiency affected three residents who were on EBP orders. Resident #225, diagnosed with urinary retention and weakness, was observed without the necessary signage to alert staff of the high contact risk, despite having a physician order for EBP. Similarly, Resident #130, with a diagnosis of hypertension secondary to renal disorder, and Resident #131, diagnosed with cellulitis of the right lower limb, also lacked the required signage indicating the need for EBP. Interviews with facility staff, including an LPN and the Infection Control Designee, confirmed the absence of signage for these residents, which was contrary to the facility's policy. The policy, dated March 2024, mandates that signs be posted on the door or wall outside the resident's room to indicate the type of precautions and personal protective equipment required for care. The failure to post these signs represents a lapse in the facility's infection control practices, potentially increasing the risk of spreading infections.
Medication Unavailability for Residents
Penalty
Summary
The facility failed to ensure that medications were available for administration to residents, affecting three residents out of six reviewed. Resident #29, who was severely cognitively impaired and dependent on staff for activities of daily living, did not receive the prescribed levothyroxine on two occasions because the medication was unavailable. The Director of Nursing (DON) confirmed the unavailability of the medication but was unsure of the reason. Resident #47, also severely cognitively impaired and requiring substantial assistance for ADLs, did not receive the prescribed Ingrezza for dyskinesia over a period of several days. The resident exhibited involuntary mouth movements and confirmed the need for medication. The DON verified the medication was unavailable but did not know why. Resident #18, who required dialysis and had multiple diagnoses, missed two doses of auryxia due to the medication not being delivered from the pharmacy. The facility's policy mandates that every effort be made to ensure medications are available, but this was not adhered to, leading to the deficiency.
Failure to Honor Resident's Right to Bed Access
Penalty
Summary
The facility failed to ensure that a resident's right to self-determination and choice was respected, leading to a deficiency in treating the resident with dignity and respect. Resident #23, who had cognitive impairments and required assistance with activities of daily living, was observed to be upset and yelling for staff because the bed was unmade, preventing the resident from lying down. The resident's care plan indicated that personal preferences should be honored, yet the bed was intentionally left unmade by staff at the request of the resident's wife, who wanted to keep the resident out of bed due to weight concerns. Interviews with staff, including a CNA and two LPNs, confirmed that the bed was left unmade to prevent the resident from getting into bed, despite there being no medical orders to restrict the resident's bed access. The facility's policy, as outlined in the resident's rights document, stated that residents have the right to retire and rise according to their reasonable requests unless medically inadvisable. However, this policy was not implemented, as the resident's preference to lie down was not honored, leading to the resident's distress.
Delayed Conveyance of Deceased Resident's Funds
Penalty
Summary
The facility failed to ensure the timely conveyance of funds for a resident who had passed away. Resident #175 was admitted to the facility and later expired. Upon review of the business records, it was found that a check for $1,676.34 was dispersed to the Treasurer of Ohio State. However, the Business Office Manager confirmed that the funds were conveyed outside the required timeframe of 30 days after the resident's death.
Failure to Provide Timely Hearing Aid Services
Penalty
Summary
The facility failed to ensure that a resident received necessary treatment to maintain hearing abilities. The resident, who had intact cognition and was independent in activities of daily living, was diagnosed with hearing loss following an audiologist evaluation. The plan was for the resident to return for a hearing aid fitting within one to three months. However, despite the completion of a Certificate of Medical Necessity for hearing aids, the resident had not received a follow-up appointment for the fitting. Observations revealed the resident was having difficulty hearing, and interviews confirmed that no follow-up had been arranged for the hearing aids, indicating a lapse in the facility's coordination of necessary ancillary services.
Failure to Provide Timely Pain Management for Resident
Penalty
Summary
The facility failed to ensure that a resident received appropriate pain management services. Resident #38, who has a history of chronic obstructive pulmonary disease, low back pain, anxiety disorder, and heart failure, was admitted with a recommendation for an MRI and physical therapy due to chronic back pain. The physician's orders indicated that an appointment with pain management was necessary, specifying that it should be scheduled on Mondays or Wednesdays in the morning. However, the resident did not receive the necessary pain shot because an appointment was not made. Interviews revealed that the resident was supposed to receive pain shots every few months for chronic back pain, but an appointment for the shot was canceled and not rescheduled. The Social Services Designee confirmed that neither the facility nor the physician's office followed up to schedule a new appointment, resulting in a lapse in the resident's pain management care. This oversight affected the resident's ability to receive timely and appropriate treatment for their chronic pain condition.
Failure to Maintain a Clean Environment for Residents
Penalty
Summary
The facility failed to maintain a clean and sanitary environment for two residents, both of whom required assistance with activities of daily living (ADLs) due to limited mobility and incontinence issues. Resident #7, who was alert and oriented, had a history of pulmonary fibrosis, chronic obstructive pulmonary disease, and hypertensive heart and chronic kidney disease with heart failure. Resident #22, also alert but with cognitive impairment, had a history of hemiplegia and hemiparesis following a cerebral infarction, malignant neoplasm of the tonsil, and chronic obstructive pulmonary disease. Both residents shared a room and required staff assistance for toileting and other ADLs. During an observation, a soiled brief was found on the floor between the beds of Residents #7 and #22 while they were eating lunch. Resident #7 admitted to soiling the brief and attempting to dispose of it using a reacher, but it fell to the floor. She also mentioned that there were times when she requested assistance from staff but did not receive help. A Certified Nurse Assistant (CNA) entered the room, noticed the soiled brief, and expressed disapproval of the situation, especially since the residents were eating. The CNA was unaware of who the brief belonged to and confirmed the findings during the interview and observation.
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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 Barberton
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Pleasant View Health Care Center | 0.3 mi | ★★★★★ | 2 | 0 |
| St Luke Lutheran Community-portage Lakes | 3.9 mi | ★★★★★ | 0 | 0 |
| Pebble Creek Healthcare Center | 5.2 mi | ★★★★★ | 2 | 0 |
| Green Village Skilled Nursing & Rehabilitation Ltd | 5.4 mi | ★★★★★ | 0 | 0 |
| Sanctuary Wadsworth | 5.6 mi | ★★★★★ | 1 | 0 |
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