Above 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 Beechwood Home For Incurables during CMS and state inspections, most recent first.
Surveyors found that two residents did not have their call lights within reach as required by their care needs and the facility’s nurse call policy. One resident with MS, lack of coordination, and epilepsy was observed in a wheelchair with the call light on the floor and no Velcro strap attached as specified in the care plan, and repeated attempts to use the call light with the chin caused it to fall from the hand. Another resident with ALS, respiratory failure with hypercapnia, and Parkinson’s disease was observed in bed with the call light placed on a nightstand out of reach until an LPN moved it onto the resident’s stomach. Facility leadership confirmed the expectation that residents be provided with accessible call lights and appropriate assistive tools after care and ADL assistance.
A resident with impaired speech and a history of PTSD alleged that a CNA was rough during incontinence care, resulting in a bruise. The facility conducted an internal investigation but did not report the suspected abuse to law enforcement, contrary to its policy requiring immediate notification of such allegations.
A resident with documented PTSD and other diagnoses was admitted without their mental health conditions being accurately reflected on the PASARR screening form. The PASARR omitted relevant diagnoses despite these being present in the medical record and MDS assessment, and staff confirmed the form was not completed correctly.
A resident with multiple medical conditions received Midodrine HCL for hypotension despite physician orders to hold the medication when systolic blood pressure was above 120. Nursing staff administered the medication outside of these parameters on several occasions, as confirmed by MAR review and staff interviews, without proper documentation that the medication was held or the reason for holding it. Facility policy required adherence to physician orders and documentation, but these were not followed, resulting in significant medication errors.
A resident with an unstageable pressure ulcer received wound care from an LPN who did not perform hand hygiene before donning gloves, failed to change gloves or sanitize hands between dirty and clean steps, and did not perform hand hygiene after removing gloves and gown. Staff interviews and facility policy confirmed these actions were not in line with required infection control practices.
A facility failed to notify a resident's family about a significant change in his care plan. The resident, with severe cognitive impairment and multiple health issues, had his seat belt removed as a fall intervention without family consultation. Interviews confirmed the lack of notification, violating the facility's policy on communicating changes in health status.
Failure to Maintain Accessible Call Lights for Two Residents
Penalty
Summary
Surveyors identified a deficiency in the facility’s failure to ensure that call lights were within reach of residents who were able to use the call light system. For one resident with multiple sclerosis, lack of coordination, and epilepsy, the care plan specified that the resident could use the call light when it was placed in the right hand with a Velcro strap attached to the call light cord and wrapped around the hand, allowing activation with the chin. During observation, this resident was seated upright in a wheelchair with the call light lying on the floor out of reach. A CNA confirmed the call light was out of reach and placed it in the resident’s right hand, but there was no Velcro strap attached. Subsequent observation showed the resident making multiple attempts to press the call light with the chin, but the device fell from the resident’s grasp onto the floor, again without any Velcro strap visible. An RN unit manager and a psychiatric nurse practitioner both verified that the call light had been out of reach on arrival and that the Velcro strap, which was supposed to be in use, could not be located in the room. A second resident, with diagnoses including ALS, respiratory failure with hypercapnia, and Parkinson’s disease, was observed in bed with the call light placed on the bedside nightstand, out of reach. An LPN confirmed that the call light was not within the resident’s reach and then moved it onto the resident’s stomach. In interviews, the DON and the Administrator confirmed that the facility’s expectation was that residents returning to their rooms after care and ADL assistance would be provided with a call light using the tools required per their individual care plans. Review of the facility’s Nurse Call System Policy stated that the facility would provide a means for residents to make staff aware of care needs at all times, including use of modified devices when needed. The observations and interviews showed that, for these two residents, the call light system was not maintained within reach or in the manner required by their care plans and facility policy.
Failure to Report Alleged Staff-to-Resident Abuse to Law Enforcement
Penalty
Summary
The facility failed to report an allegation of staff-to-resident physical abuse to law enforcement as required by policy. A resident with a history of pseudobulbar effect and post-traumatic stress disorder, who communicated primarily via cell phone due to impaired speech, alleged that a CNA was rough during incontinence care, resulting in a small bruise near the resident's eye. The resident was cognitively intact and dependent on staff for toileting hygiene. The facility's investigation included statements from the resident, staff, and the alleged perpetrator, as well as a review of video surveillance, which did not clearly show the incident in question. Despite the allegation and the facility's policy requiring immediate reporting of suspected crimes to law enforcement, the administrator confirmed that the incident was not reported because they did not believe there was reasonable evidence to prove abuse occurred. The facility ultimately unsubstantiated the allegation but did not fulfill the requirement to notify law enforcement of the suspected abuse, as outlined in their own abuse policy.
Inaccurate PASARR Screening for Resident with Mental Illness
Penalty
Summary
The facility failed to ensure that the level one Preadmission Screening and Resident Review (PASARR) accurately reflected a resident's existing mental illness at the time of admission. Specifically, a resident admitted with diagnoses including dementia, post-traumatic stress disorder (PTSD), and epilepsy had a PASARR Identification Screen that did not indicate any of the resident's mental health diagnoses, despite PTSD being documented as an active diagnosis in the resident's Minimum Data Set (MDS) assessment. The PASARR form omitted relevant diagnoses such as mood disorder and other mental disorders, which were present in the resident's medical record. Staff interviews confirmed that the PASARR was not completed accurately and that there was no facility policy in place for PASARRs at the time.
Failure to Follow Physician's Order for Blood Pressure Medication Administration
Penalty
Summary
The facility failed to ensure that a resident was free from significant medication errors by not following a physician's order regarding the administration of Midodrine HCL, a medication prescribed for hypotension. The physician's order specified that the medication should be held if the resident's systolic blood pressure (SBP) was greater than 120. Despite this, staff administered the medication multiple times when the resident's SBP exceeded the specified threshold, as documented in the Medication Administration Record (MAR). Interviews with nursing staff and review of the MAR confirmed that the medication was given outside of the ordered parameters on several occasions, and there was no documentation indicating the medication was held or the reason for holding it when required. The resident involved had diagnoses including cerebral palsy, hyperlipidemia, and acute kidney failure, and was noted to have intact cognition. The care plan directed staff to provide medications and obtain vital signs as ordered. Facility policy required nurses to follow physician orders and check vital signs prior to administering medications with parameters. However, the failure to adhere to these orders and document actions appropriately resulted in significant medication errors, as confirmed by nursing staff and the Director of Nursing during interviews.
Failure to Follow Infection Control Protocols During Wound Care
Penalty
Summary
The facility failed to maintain appropriate infection control practices during wound care for Resident #42, who had a history of ataxia, pneumonia, and acute embolism and thrombosis of the lower extremity, and was being treated for an unstageable pressure ulcer on the sacrum. During an observed wound care procedure, an LPN did not perform hand hygiene prior to donning gloves and gown, and continued to use the same pair of gloves throughout the entire wound care process. The LPN touched multiple surfaces and supplies, cleaned the wound, applied medications, and dressed the wound without changing gloves or performing hand hygiene at any point before, during, or after the procedure. Interviews with staff, including the LPN involved, another LPN, an RN supervisor, the DON, and the Administrator, confirmed that the expected practice was to perform hand hygiene before donning gloves, change gloves and perform hand hygiene between dirty and clean steps of wound care, and after removing gloves and gown. Review of the facility's dressing change policy also outlined these steps, which were not followed during the observed incident. The failure to adhere to these infection control protocols constituted a breach in infection prevention and control during wound care for Resident #42.
Failure to Notify Family of Change in Resident's Care
Penalty
Summary
The facility failed to notify the family of a resident about a significant change in his care and treatment plan. The resident, who had a severe cognitive impairment and multiple diagnoses including Parkinsonism, dementia, and repeated falls, was no longer attempting to get out of his wheelchair independently. As a result, the interdisciplinary team decided to discontinue the use of a seat belt as a fall intervention. However, there was no evidence in the resident's progress notes or medical records that the family was informed or consulted about this change. Interviews with the Director of Nursing and the Administrator confirmed that the family was not notified about the removal of the seat belt. The facility's policy on Change in Health Status requires that the resident's representative be notified of significant changes in the resident's condition or treatment. Despite this policy, the facility did not adhere to the required notification process, resulting in a deficiency related to the failure to communicate changes in the resident's care to the family.
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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 Cincinnati
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Carecore At Margaret Hall | 0.4 mi | ★★★★★ | 12 | 0 |
| Lincoln Crawford Care Center | 1.1 mi | ★★★★★ | 7 | 0 |
| Marjorie P Lee Retirement Community | 1.1 mi | ★★★★★ | 9 | 0 |
| Norwood Towers Post-acute | 1.9 mi | ★★★★★ | 30 | 0 |
| Garden Park Health Care Center | 2 mi | ★★★★★ | 3 | 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.