Average — CMS composite of the measures below.
The next survey window likely opens around April 2027
Estimate from public CMS data, current as of October 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Gem City Healthcare And Rehabilitation Center during CMS and state inspections, most recent first.
A CNA provided incontinence care to a resident on EBP without wearing PPE, and an LPN verified the improper PPE use while the CNA stated she did not know PPE was required. The resident had multiple diagnoses, received enteral nutrition, and was dependent on staff for ADLs. The facility also stored dirty laundry and trash in the clean linen room, with clean linen boxes placed on a dirty floor, contrary to the laundry policy requiring soiled and clean laundry to be kept separate.
Kitchen sanitation and food storage were not maintained in a clean, sanitary manner: staff lacked hair nets, floors in food prep and storage areas were dirty, expired and opened foods were found in active use, eggs with cracked shells were leaking onto items below, and food was stored on the freezer floor with ice buildup and condensation in the cooler. The facility also used an incorrect scoop size for carrots, substituted salad when carrots ran out, served a meal that did not match the menu because items were unavailable, and staff had no menu substitution log; food temp logs were also missing for multiple meal-service periods.
The facility failed to keep kitchen garbage cans covered when not in active use. Surveyors observed two uncovered trash cans in the food prep area and one uncovered trash can in the dish room, and the Acting Kitchen Manager confirmed lids could not be located for any of the three cans. The facility policy stated that all trash must be contained in covered, leak-proof containers that prevent cross contamination.
Improper Storage of Opened Aplisol Vials: An opened vial of Aplisol was found undated in the medication room, and a second opened vial was also undated while another vial was dated. An LPN verified the findings during observation. The facility policy required medications to be stored per manufacturer recommendations, and the Aplisol insert stated vials in use more than 30 days should be discarded.
Kitchen Steam Table Not Working: The facility failed to ensure the steam table used to keep food at safe serving temperatures was functioning. An AKM reported the unit would not turn on while preparing for lunch service, and later observation confirmed it was still not in working order. The facility policy required kitchen equipment to be properly maintained and issues to be promptly reported and recorded.
A resident’s sink was found filled with brown water, with a dripping, discolored pipe, standing water on the floor, and a strong foul odor extending into the hallway. Staff and the resident reported the sink had been clogging on and off for months, and the MD confirmed repeated snaking had occurred but no plumber had inspected or repaired it; the Administrator also confirmed the recurring issue.
The facility failed to ensure comprehensive care plans reflected the needs of three residents. One resident with chronic respiratory failure and corrective lens use had no vision needs or interventions in the care plan despite requesting an eye doctor for months. Another resident with chronic pain and heel skin integrity orders had no pain or skin integrity care plan. A third resident with depression and antidepressant orders had no care plan for depression or antidepressant use, and the DON confirmed the omissions.
A resident who was dependent for bathing and other ADLs was scheduled for showers twice weekly, but facility documentation showed multiple missed showers over several weeks. The resident reported not receiving showers as scheduled, and the DON confirmed the shower schedule and the missed documentation on the STNA skin condition report sheet.
Missed Ordered Wound Care for Stage IV Pressure Ulcer: A resident with a stage IV pressure ulcer and multiple serious diagnoses, including DM2 and respiratory failure, had an order for daily wound care to the sacrococcyx and bilateral buttocks. The TAR showed no documentation that the ordered treatment was provided on several days, and the DON confirmed there were no progress notes explaining why the wound care was not done. The facility policy required wound treatments to be provided per physician orders and documented on the TAR.
G-tube Not Properly Maintained: A resident with a G-tube and multiple medical diagnoses had visible yellow debris, black particles, and orange gastric drainage in the tubing on observation. The resident said staff stopped flushing the tube after the NPO order was discontinued, though dressing changes continued, and the DON confirmed the debris and stated the tube needed to be changed. The resident did not want the material flushed into the intestines.
A resident with cognitive intactness and diagnoses including acute kidney failure and a coagulation defect missed multiple ordered heparin injections because the medication was reportedly awaiting pharmacy delivery. The MAR and nursing notes showed several omitted doses, the DON could not explain why doses were still missed after the medication had been delivered, and the prescriber was not notified until much later. The physician confirmed the missed doses were not known until then and stated there were no negative outcomes reported.
A completed Discharge Return not Anticipated MDS for a resident with diagnoses including cardiac arrest, hypothermia, schizophrenia, epilepsy, and anxiety was not transmitted to CMS for acceptance. The MDS was documented as completed, and the MDS Nurse confirmed that a completed assessment had not been submitted. The MDS Coordinator job description stated assessments are to be transmitted in accordance with current regulations and as frequently as necessary for timely validation in the QIES ASAP database.
Failure to provide access to vision services. A resident with chronic respiratory failure, dependence on a respirator, and documented vision impairment reported requesting an eye doctor for months without being seen. The SSD stated the facility had not been able to offer vision services since the prior eye provider stopped bedside visits, and the Administrator acknowledged the delay was too long. The facility policy states all residents should have access to vision services.
A resident with hemiplegia, multiple contractures, aphasia, and total dependence for many ADLs did not have an ordered left palm protector applied as directed. Staff observed the resident’s contracted left hand without the device on multiple occasions, and an LPN could not locate the palm protector in the room. TARs showed repeated missed applications, and the DON confirmed there were no nursing notes explaining the omissions.
Inaccurate MAR documentation for diabetes medication: A resident with Type II DM, CKD III, and respiratory failure had orders for daily Victoza, but the MAR showed multiple blank administration entries for the medication. The resident said she received the medication as ordered, and the DON stated the missing entries were believed to be a documentation error rather than a medication administration error.
Failure to Post Daily Nurse Staffing Information: The facility did not have nurse staffing posted for resident care on floors one, two, and three. The DON confirmed the omission during observation and interview, and the facility census was 33. The facility policy required daily posting of staffing information in a prominent location accessible to residents and visitors.
Improper PPE Use and Poor Linen Storage
Penalty
Summary
The facility failed to provide proper infection prevention and control practices when a CNA provided incontinence care to a resident without wearing PPE. The resident had diagnoses including hemiplegia/hemiparesis, dysphagia, diabetes, and depression, and the quarterly MDS showed the resident received nutrition through an enteral method and was dependent on staff for activities of daily living. A physician order dated 05/28/25 required Enhanced Barrier Precautions due to a gastronomy tube. During observation on 05/20/26 at 10:18 A.M., the CNA was seen providing incontinence care without PPE, and the LPN present verified the CNA was not wearing the proper PPE. The CNA stated she was unaware that she was supposed to wear PPE while providing care to the resident. The facility also failed to ensure clean linens were stored appropriately. During observation and interview on 05/19/26, a large 30-gallon trash can filled to the top with dirty clothes and trash was seen in the clean linen room next to the clean exit door, and the Administrator stated it should not have been there. Clean linen was also observed in six large boxes on the floor, and the floor of the clean linen room was observed to be covered with a black and brown substance and appeared very dirty. The Maintenance Director confirmed the dirty floor and the trash can full of dirty clothes. The facility policy titled Laundry, dated 12/2024, stated soiled laundry shall be kept separate from clean laundry at all times.
Kitchen sanitation, portion control, and menu substitution tracking failures
Penalty
Summary
Food was not stored and prepared under sanitary conditions in the kitchen, dry storage, walk-in refrigerator, and walk-in freezer. During observation, there were no hair nets available at the kitchen entrance, the kitchen and dry storage floors were dirty with crumbs, food pieces, sugar packets, syrup packets, and empty boxes, and three bags of Tostitos chips with a use-by date of 03/24/26 were still on an active storage shelf. In the walk-in refrigerator, a box of eggs with cracked shells had egg yolk dripping onto an opened box of individual coffee creamers below it, several opened condiments and foods were dated well past their open dates, three gallons of whole milk with expiration dates of 04/26/26 remained in active use, and condensation from the ceiling was dripping onto the floor and forming a puddle. In the walk-in freezer, pieces of french fries were on the floor, unopened food items were stored on the floor, and there was approximately one-inch-thick ice buildup on the floor under the compressor. The Acting Kitchen Manager confirmed the lack of hair nets, the dirty floors, the expired chips in active use, the cracked eggs with yolk dripping onto the creamers, the opened condiments with dates of 02/16/26, 12/21/25, 02/25/26, and 02/23/26, the milk still on the shelf, the condensation puddle, the food stored on the freezer floor, and the ice buildup. The Director of Maintenance also confirmed the ice buildup in the freezer and the condensation dripping in the refrigerator. Facility policy stated that the kitchen and equipment were to be properly maintained, all foods were to be stored wrapped or in covered containers, labeled and dated, and arranged to prevent cross contamination, and that the Dining Services Director would ensure the kitchen was maintained in a clean and sanitary manner. The facility also failed to ensure portion sizes were accurate according to the approved recipe and failed to maintain a substitution log. During lunch tray line service, the Acting Kitchen Manager used a six-ounce scoop for carrots when a three-ounce scoop should have been used, and he estimated a three-ounce portion because the correct scoops were still dirty from the prior dinner service. When carrots ran out for the last five resident meals, salad was substituted. On another meal service, lunch was served as an open-faced turkey sandwich with mashed potatoes and gravy, brussel sprouts, and pudding instead of the menu items listed for that day because the items were not in stock. Staff stated they did not have a method or log for documenting and tracking menu substitutions, despite facility policy requiring a menu substitution log. Food temperature logs were also missing for multiple date ranges, and the Acting Kitchen Manager confirmed the logs were expected to be completed at every meal but could not locate documentation showing that occurred.
Uncovered Garbage Cans in Kitchen Areas
Penalty
Summary
The facility failed to ensure that garbage cans in the kitchen were properly covered when not in active use. Observation on 05/18/26 at 9:45 A.M. revealed two garbage cans in the kitchen food prep area and one garbage can in the dish room, and all three cans were without lids and not in active use. During interview on 05/18/26 at 10:23 A.M., the Acting Kitchen Manager confirmed there were two garbage cans in the kitchen food preparation area and one in the dish room, all without lids, and stated he was unable to locate lids for any of the three cans or cover them when not in active use. Review of the facility policy titled Hearthstone Hospitality Management Dining [NAME] Policy and Procedure Manual, effective 01/01/25, stated that all trash will be contained in covered, leak-proof containers that prevent cross contamination.
Improper Storage of Opened Aplisol Vials
Penalty
Summary
The facility failed to properly store medications in the second floor medication room. During observation, an opened vial of Aplisol 5 ml/mg was found not dated, and a second vial of Aplisol 5 ml/mg was also observed open and not dated, while another vial was dated 11/06/25. The LPNs present verified the condition of the vials during the observations. Review of the FDA information identified Aplisol/Tuberculin, Purified Protein Derivative as a biologic used to aid in the detection of infection with Mycobacterium tuberculosis, and the manufacturer package insert stated that vials in use more than 30 days should be discarded due to possible oxidation and degradation that may affect potency. The facility’s Medication Storage Policy stated that medications must be stored according to the manufacturer’s recommendations.
Kitchen Steam Table Not Working
Penalty
Summary
The facility failed to ensure the steam table in the kitchen was functioning properly. On 05/18/26 at 12:00 P.M., observation showed the steam table used to maintain food at safe serving temperatures would not turn on. During interview at that time, the Acting Kitchen Manager stated the steam table did not turn on while preparing for lunch service and that maintenance had been informed. On 05/20/26 at 3:25 P.M., the steam table was again observed not to be in working order, and the Acting Kitchen Manager confirmed it was still not working and that maintenance was aware. Review of the facility policy stated kitchen and associated equipment are to be properly maintained and that kitchen equipment issues are to be promptly reported and recorded according to facility protocol.
Recurring Sink Clog and Unsanitary Conditions
Penalty
Summary
The facility failed to provide a functional and sanitary environment for Resident #32, who was admitted with diagnoses including morbid obesity with alveolar hypoventilation, major depressive disorder, and generalized anxiety disorder. The most recent MDS assessment identified the resident as cognitively intact. During observation and interview, the resident’s sink was found completely filled with brown water, with a discolored pipe under the sink that was dripping, a puddle of water and stain on the floor, and a strong foul smell extending into the hallway. A confidential employee stated the sink had been clogged on and off for months, and Resident #32 reported the problem first occurred in February and that the sink had been snaked multiple times but continued to clog and smell bad. The Maintenance Director confirmed awareness of the recurring clogging and stated he had snaked the sink, but no plumber had come to inspect or repair it. The Administrator also confirmed the sink had clogged multiple times. Facility policy required regular monitoring of environmental services to ensure the facility was maintained in a safe and sanitary manner.
Incomplete Care Plans for Multiple Residents
Penalty
Summary
The facility failed to ensure that three of 19 residents reviewed had comprehensive care plans that reflected their identified care needs. Resident #22 was admitted with chronic respiratory failure, dependence on a respirator, neuralgia, and neuritis. The most recent MDS showed the resident was cognitively intact, required set up for eating, was dependent for toileting, bathing, and personal hygiene, had adequate vision, and used corrective lenses. Although the provider orders included that the resident may receive vision consults as needed per the personal plan of care, the care plan dated 08/17/22 did not include vision needs or interventions. During interview, the resident stated she had requested to see an eye doctor for months and had not yet seen one, and the DON confirmed the care plan did not address vision needs. Resident #04 was admitted with insomnia, obesity, anxiety, schizoaffective disorder, chronic pain, and depression. The quarterly MDS showed no cognitive deficits and that the resident required substantial to dependent assistance with ADLs. Physician orders included oxycodone 5 mg every six hours as needed for right leg pain and skin prep to bilateral heels daily for skin integrity, but the care plan did not include a pain care plan or a skin integrity care plan. Resident #13 was admitted with depression, adjustment disorder, and diabetes, and had orders for sertraline 50 mg and Lexapro 5 mg. The care plans for this resident did not include depression or antidepressant medication use, and the DON verified these omissions. The facility policy stated that each resident should have a comprehensive person-centered care plan with measurable objectives and timeframes based on the comprehensive assessment.
Missed Scheduled Showers for Dependent Resident
Penalty
Summary
The facility failed to provide showers to a resident as scheduled. Resident #10 was admitted with diagnoses including neoplasm of unspecified behavior of brain, Type II Diabetes Mellitus, pulmonary embolism without acute cor pulmonale, torsade's de pointes, and presence of other vascular implants and grafts. The most recent MDS showed the resident was dependent on assistance for oral hygiene, toileting hygiene, bathing, dressing, personal hygiene, bed mobility, and transfers, and the resident reported being scheduled for showers every Tuesday and Friday. Review of the facility shower schedule confirmed the resident was assigned showers on Tuesdays and Fridays, but the STNA Skin Condition Report Sheet showed multiple missed showers, including on 03/16/26, 03/23/26, 03/31/26, 04/03/26, 04/06/26, 04/21/26, 04/28/26, 05/01/26, and 05/08/26. The DON confirmed that the resident was scheduled for showers twice weekly and that the documentation indicated the showers were not provided on those dates. The facility policy stated residents would be provided showers as per request or facility schedule protocols.
Missed Ordered Wound Care for Stage IV Pressure Ulcer
Penalty
Summary
The facility failed to ensure wound care was provided as ordered for a resident with a stage IV pressure ulcer to the bilateral buttocks. The resident was admitted with multiple diagnoses including acute and chronic respiratory failure, sepsis due to Escherichia coli, acute kidney failure, Type II Diabetes Mellitus, dysphagia, and a sacral pressure ulcer. The medical record showed an order to cleanse the sacrococcyx and bilateral buttocks with wound cleanser, pat dry, apply Dakin's solution-soaked gauze roll pack lightly to the wound bed, and cover with a border foam dressing every day shift for wound healing, starting on 05/08/26. Review of the TAR showed no documentation that the ordered wound care was provided on 05/14/26, 05/15/26, and 05/16/26. The DON confirmed the missing documentation and stated there were no progress notes in the electronic medical record explaining why the wound care was not provided on those dates. The facility policy stated wound treatments are to be provided in accordance with physician orders and documented on the TAR.
G-tube Not Properly Maintained
Penalty
Summary
The facility failed to ensure ongoing care of a gastrostomy (G) tube for one resident with diagnoses including neoplasm of unspecified behavior of the brain, type II diabetes mellitus, pulmonary embolism without acute cor pulmonale, torsade's de pointes, and presence of other vascular implants and grafts. The resident was dependent on assistance for oral hygiene, toileting hygiene, bathing, dressing, personal hygiene, bed mobility, and transfers. On observation, the resident's G-tube contained numerous yellow-colored debris and black spots between the access port and a lock placed on the tubing, and there was orange-colored liquid and material in the tubing between the lock and the external retention disk that did not move when the resident repositioned the tubing. The resident stated staff stopped flushing the G-tube when the NPO order was discontinued and a regular diet was started, although staff continued changing the dressing around the tube. The resident said she wanted the material in the tube addressed but did not want it flushed into her intestines. On a later observation, the same debris and orange material remained in the G-tube. The DON confirmed the orange fluid appeared to be gastric drainage and confirmed the debris and black particles in the tubing, stating the G-tube needed to be changed and that G-tubes are changed as needed. The facility policy stated balloon-type G-tubes are typically changed every three months and should be replaced immediately when there are visible cracks, leaks, or clogging.
Missed Heparin Doses Not Administered as Ordered
Penalty
Summary
The facility failed to ensure that anticoagulant medication was administered as ordered for one resident who was cognitively intact and admitted with diagnoses including acute kidney failure, coagulation defect, depression, major depressive disorder, and generalized anxiety disorder. The resident had a physician order for heparin sodium 5,000 units subcutaneously three times daily, but the Medication Administration Record showed multiple missed doses, including doses on the evening of 05/01/26 and several doses on 05/02/26, 05/03/26, and 05/04/26. Nursing progress notes stated staff were unable to give the medication because they were waiting for pharmacy delivery. The record and interviews showed the missed doses were not communicated to the prescriber until 05/20/26. The DON confirmed the MAR reflected the missed heparin doses and that a pharmacy packing slip showed the medication was delivered on 05/03/26 at 11:19 A.M., but the DON could not explain why doses were still not administered after delivery. The DON also stated the heparin should have been ordered as a stat drop from the pharmacy, and the physician confirmed being unaware of the missed doses until 05/20/26. The physician reported no significant concerns and no negative outcomes related to the missed doses.
Failure to Transmit Completed Discharge MDS
Penalty
Summary
The facility failed to submit a Discharge Return not Anticipated MDS for Resident #31 within the required timeframe. Record review showed the resident was admitted with diagnoses including cardiac arrest, hypothermia, schizophrenia, epilepsy, and anxiety. The Discharge Return not Anticipated MDS dated [DATE] indicated the resident had no cognitive deficits and was independent with activities of daily living, and another MDS dated [DATE] was completed but was never submitted to CMS for acceptance. During a telephone interview on 05/21/26 at 12:30 P.M., the MDS Nurse verified that if an MDS assessment shows completed, it has not been submitted or transmitted to CMS for acceptance. The MDS Coordinator job description stated that assessments are to be transmitted in accordance with current regulations and as frequently as necessary to obtain timely validation of MDS acceptance into the QIES ASAP database.
Failure to Provide Access to Vision Services
Penalty
Summary
The facility failed to ensure residents were provided vision services. Resident #22 was admitted with diagnoses including chronic respiratory failure, dependence on respirator, neuralgia, and neuritis. The most recent MDS 3.0 assessment showed the resident was cognitively intact, required set-up assistance for eating, was dependent for toileting, bathing, and personal hygiene, had adequate vision, and used corrective lenses. Provider orders dated 05/13/25 indicated the resident may receive vision consults as needed per the personal plan of care, and a quarterly nursing assessment documented a general impairment of vision. During interview on 05/18/2026, Resident #22 stated she had requested to see an eye doctor for months, had not yet seen one, and wanted to be checked because it had been a long time since she had been seen by an eye provider. The Social Service Director stated the facility had an eye care provider until 10/2025, but that provider refused to see patients at bedside, and the facility had not been able to offer vision services since then. The Administrator confirmed the delay in obtaining vision services was too long and stated he was working on a contract with another provider. The facility policy titled Hearing and Vision Services stated it is the facility's policy to ensure all residents have access to vision services.
Failure to Apply Ordered Palm Protector
Penalty
Summary
The facility failed to apply a left palm protector as ordered for a resident with multiple contractures and significant functional dependence. The resident was admitted with diagnoses including hemiplegia and hemiparesis following cerebral infarction affecting the right dominant side, gastrostomy status, dysphagia, aphasia following cerebral infarction, Type II diabetes mellitus, contracture of the right hip, left ankle, right knee, and left knee, major depressive disorder, pneumonia, and encephalopathy. The resident did not reject care and did not wander. The most recent quarterly MDS showed the resident was rarely/never understood, received nutrition by enteral method, and was dependent for oral hygiene, toileting hygiene, bathing, dressing, personal hygiene, rolling, transfers, and wheelchair mobility. Medical orders directed that a left palm protector be worn at all times except for hygiene and skin checks to decrease contractures and improve skin integrity. Observations showed the resident’s left hand fingers were contracted and the palm protector was not in place on two separate occasions. During an observation with an LPN, the palm protector could not be located in the resident’s room, and the LPN stated she had been unable to locate it for a while and had not contacted therapy for a replacement. The TARs showed multiple dates in April and May when the palm protector was not applied as ordered, and the DON confirmed there were no nursing progress notes explaining why it was not in place on those dates.
Inaccurate MAR Documentation for Diabetes Medication
Penalty
Summary
The facility failed to maintain an accurate medical record regarding administration of diabetes-related medication for one resident. Resident #15 was admitted with diagnoses including Type II Diabetes Mellitus, acute and chronic respiratory failure, dependence on a ventilator, tracheostomy status, chronic kidney disease stage III, and muscle weakness. The resident’s quarterly MDS indicated she was cognitively intact and required varying levels of assistance with activities of daily living, including supervision for eating and oral hygiene and maximal to dependent assistance for several other tasks. Record review showed physician orders for Victoza subcutaneous solution pen-injector, first at 1.2 mg daily and later at 1.8 mg daily. Review of the MAR showed no documentation that Victoza was administered on several dates, including 03/04/26, 03/10/26, 03/13/26, 03/17/26, 04/11/26, 04/20/26, and 04/28/26. The resident stated she consistently received her diabetes medication on time and as prescribed. The DON confirmed the MAR reflected no documentation for those dates and stated she believed the blank administration blocks were due to a documentation error rather than a medication administration error. The facility policy stated the medical record must contain an accurate representation of the resident’s actual experiences and be completed at the time of service, but no later than the shift in which the care occurred.
Failure to Post Daily Nurse Staffing Information
Penalty
Summary
The facility failed to ensure that daily nurse staffing information was posted. During an interview and observation on 05/21/26 at 9:10 A.M. with the DON, it was confirmed that staffing was not posted for resident care on floors one, two, and three. The facility census was 33. Review of the policy titled, Nurse Staffing Posting Information, dated 2024, stated that the nurse staffing sheet is to be posted daily and include the facility name, current date, current resident census, and the total number and actual hours worked by RN, LPN, and CNA staff directly responsible for resident care per shift, in a prominent place readily accessible to residents and visitors.
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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 Dayton
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Grafton Oaks Nursing Center | 0.3 mi | ★★★★★ | 14 | 0 |
| Dunbar Health & Rehab Center | 1.6 mi | ★★★★★ | 0 | 0 |
| Carecore At Mary Scott | 2 mi | ★★★★★ | 22 | 0 |
| Widows Home Of Dayton | 2.4 mi | ★★★★★ | 6 | 0 |
| Riverside Nursing And Rehabilitation Center | 2.7 mi | ★★★★★ | 0 | 0 |
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