Above average — CMS composite of the measures below.
A standard survey is most likely before 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 Glendale Place Care Center during CMS and state inspections, most recent first.
Failure to report an allegation of misappropriation: A resident with cerebral infarction, epilepsy, and COPD reported missing $250, but the grievance form had no documented actions or resolution and the allegation was not entered on the SRI log or reported to the state agency. An LPN said she completed the grievance form and gave it to the social worker, and the LSW said he received a voicemail about the missing money but did not document further or notify the Administrator or state agency.
Failure to investigate and report an allegation of misappropriation involving a resident who reported missing money. The grievance form had no documented actions or resolution, the SRI log did not show the allegation was reported, and the LSW confirmed he did not notify the Administrator or state agency despite the facility policy requiring investigation and reporting.
Failure to provide adequate pain management for a resident with dementia-related diagnoses. The resident had an order for PRN Tylenol and was identified in the care plan as at risk for altered comfort, but MAR review showed reported pain levels without documentation of pain medication, other interventions, or a pain reassessment. An LPN stated she used the PAINAD scale, observed pacing and occasional facial grimacing, and could not verify that ordered analgesics or nonpharmacological measures were provided.
Staff failed to follow hand hygiene and sanitary food handling practices during meal service. A Dietary Aide touched his facemask with a gloved hand and then handled bread without washing hands or changing gloves, and an Assistant Dietary Director picked up a lid from the floor, changed gloves without washing hands, used gloves kept in her pockets, and then handled bread. Facility policy required handwashing before glove use and after glove removal, and staff interviews confirmed that gloves should not be stored in pockets and hands should be washed with each glove change.
The facility restricted two residents with intact cognition to withdrawing only $25.00 per day from their personal funds accounts. The handbook and staff statements showed a routine limit of $25.00 per withdrawal, and one resident had only a single $25.00 cash withdrawal while the other had 30 withdrawals of no more than $25.00 each. The DON stated resident funds should be available for withdrawal anytime up to the amount in the account.
A resident who was dependent on staff for bathing due to multiple medical conditions did not consistently receive routine baths, as shown by limited documentation of bathing and unclear records regarding refusals. Staff interviews revealed that baths were sometimes not offered or provided, and documentation practices did not clearly distinguish between missed baths and resident refusals, leading to a deficiency in ADL care.
The facility did not establish or maintain an infection prevention and control program as required, as identified by surveyors through observation and review of facility practices.
A resident with intact cognition and multiple chronic conditions had several routine medication times changed from early morning to later times without being informed. The resident said the new schedule was not preferred and that no explanation was given. Staff acknowledged the resident's concerns, and the DON stated medication times should be resident-centered, but the changes were made to align medication passes and residents were not notified.
Failure to follow provider orders for medication administration and blood sugar management. One resident missed ordered methocarbamol doses when the medication was not available, and staff did not document contacting the pharmacy or provider. Another resident with DM had blood sugars below 70 mg/dL, but staff did not give the ordered glucose solution or complete the required repeat BS checks; an LPN stated she used sugary food or drink instead of the ordered treatment.
A resident approved for unsupervised self-administration of inhalers and nasal spray had medications stored in the room, but two medication vials were observed unsecured on the bedside stand near a nebulizer. The resident said some meds were kept at the bedside, while staff were unaware the resident self-administered meds or had them in the room. The ADON and DON stated safe storage meant a lock box or locked drawer and that meds should remain secured unless being administered.
A resident with hemiplegia, MS, type 2 DM, and moderate cognitive impairment had multiple blank MAR entries for scheduled meds and treatments, including insulin, oral meds, CPAP, pain scale checks, oxygen-related orders, head-of-bed elevation, and WBAT status. LPNs and the DON stated there should not have been blanks and that refusals or inability to administer should still have been documented.
Failure to document vaccine education for resident refusals. A resident with hemiplegia, DM2, CKD stage 3, vascular dementia, and a hx of traumatic subdural hemorrhage declined influenza, pneumococcal, and COVID-19 immunizations, but the record did not show education on the benefits and risks of each vaccine. The immunization audit marked education as not provided, and a nursing note only documented discussion with the family and refusal of influenza and COVID-19 vaccines.
Failure to Report Allegation of Misappropriation
Penalty
Summary
The facility failed to timely report an allegation of misappropriation to the state agency for one resident. The resident’s medical record showed an admission date of 06/21/24 with diagnoses including cerebral infarction, epilepsy, and chronic obstructive pulmonary disease (COPD). A grievance form dated 01/16/26 documented that the resident reported missing $250.00 and stated the money was last seen on 01/11/26, but no actions or resolutions were recorded. Review of the facility’s SRI log from 01/11/26 to 05/19/26 showed the allegation was not reported. An LPN stated she completed the grievance form and gave it to the social worker, and the LSW stated he received a voicemail about the missing money but did not document further, did not report it to the Administrator, and did not report the allegation to the state agency. The facility policy required allegations of misappropriation to be investigated and reported to the state agency.
Failure to Investigate and Report Allegation of Misappropriation
Penalty
Summary
The facility failed to investigate an allegation of misappropriation involving one resident who reported to a nurse that $250.00 was missing and that the money was last seen on 01/11/26. The resident’s medical record showed diagnoses including cerebral infarction, epilepsy, and COPD. Review of the grievance form dated 01/16/26 showed no actions or resolutions documented. Review of the facility SRI log from 01/11/26 to 05/19/26 showed the allegation was not reported. An LPN stated she completed the grievance form and turned it in to the social worker, and the LSW stated he received a voicemail about the missing money but did not document further, did not report the allegation to the Administrator, and did not report it to the state agency. The facility policy stated allegations of misappropriation should be investigated and reported to the state agency.
Failure to Provide Adequate Pain Management
Penalty
Summary
The facility failed to ensure adequate pain management for one resident who had diagnoses including Alzheimer's Disease, dementia with behavioral disturbance, and delusional disorder. The resident had an order for Tylenol 325 mg, two tablets every four hours as needed for pain, and the care plan identified the resident as at risk for alteration in comfort related to functional limitations with an intervention to administer pain medications as ordered. The MDS assessment showed the resident was cognitively impaired and required assistance with ADLs. Review of the MARs for January and February 2026 showed the resident reported pain levels of 5/10 and 6/10 on two separate dates, but there was no documentation that pain medication or other interventions were provided on either occasion. There was also no documentation of a pain reassessment. During interview, an LPN stated she used the PAINAD scale to determine the resident's pain, noted the resident paced and wandered frequently and only occasionally had a facial grimace, and verified she did not give the ordered pain medications and could not recall whether any nonpharmacological interventions were offered. The facility policy stated that if pain was noted, nonpharmacological and pharmacological treatments would be utilized to help control resident pain.
Hand Hygiene and Food Handling Lapses During Meal Service
Penalty
Summary
The facility failed to ensure staff performed hand hygiene and sanitary food handling during meal service. During observation, a Dietary Aide touched his facemask with a gloved hand and then touched a roll of bread without changing gloves or washing hands. In a separate observation, the Assistant Dietary Director picked up a lid that had fallen on the floor, changed gloves without washing hands, used gloves taken from her pockets, and then touched a bread roll with the same gloved hands. Facility policy stated employees should wash hands before putting on gloves and after removing gloves, and that tongs or other serving utensils should be used to serve bread or other items to avoid bare hand contact with food. Staff interviews confirmed expectations that hands should be washed with every glove change and that gloves should not be stored in pockets.
Restriction on Resident Personal Funds Withdrawals
Penalty
Summary
The facility failed to allow residents to withdraw more than $25.00 at a time from their personal funds accounts for 2 residents reviewed for personal funds. The Resident Handbook stated that residents or their authorized representatives had access to personal funds Monday through Friday from 9:00 a.m. to 5:00 p.m., and that advanced arrangements could be made for weekend access through the Gift Shop or Nursing Supervisor, with a maximum of $25.00 available for withdrawal per day. Accounts Receivable staff stated residents could typically only withdraw $25.00 a day and, if more was requested, a paper check might be issued for the resident to cash. Resident #12 was admitted on 02/01/2024 and had a quarterly MDS with a BIMS score of 15, indicating intact cognition. The resident stated they could only withdraw $25.00 a day, and the financial Trust Statement showed one cash withdrawal of $25.00 during the reviewed period. Resident #87 was admitted on 09/29/2023 and had a quarterly MDS with a BIMS score of 14, also indicating intact cognition. The resident stated they were only allowed to withdraw $25.00 per day, and the financial Trust Statement showed 30 cash withdrawals of no more than $25.00 each during the reviewed period. The DON stated she was not very familiar with resident funds but reported that resident funds should be available for withdrawal anytime up to the amount available in a resident's personal funds account.
Failure to Consistently Provide and Document Routine Bathing Assistance
Penalty
Summary
The facility failed to consistently provide routine baths to a resident who was dependent on staff for bathing assistance. The resident, who had a history of hemiplegia, hemiparesis, acquired absence of right foot, adult failure to thrive, and chronic obstructive pulmonary disease, was admitted with an intact cognitive status and required one-person physical assistance with bathing as per the care plan. Documentation revealed that the resident received baths on only a limited number of days over a period of more than a month, with several days marked as 'not applicable' (NA) for bathing, and no documentation of refusals by the resident. Progress notes did not indicate any refusals or reasons for missed baths, and the care plan did not specify the frequency of bathing required. Interviews with State Trained Nursing Assistants (STNAs) confirmed that 'NA' was used to indicate that a bath was not offered or provided, and sometimes also used when a resident refused a bath, without clear differentiation. The Director of Nursing (DON) stated that staff were expected to at least offer baths and document them correctly in the electronic medical record, including proper coding of refusals. The lack of consistent bathing and inadequate documentation practices led to the deficiency cited in the report.
Failure to Implement Infection Prevention and Control Program
Penalty
Summary
The facility failed to provide and implement an infection prevention and control program. This deficiency was identified through surveyor observation and review of facility practices, which revealed that the required infection control measures were not established or maintained as outlined by regulatory standards. The report specifically notes the absence of a comprehensive program designed to prevent and control infections within the facility. No additional details regarding specific residents, staff, or events leading to the deficiency are provided in the report.
Failure to Honor Resident Preference for Medication Administration Times
Penalty
Summary
The facility failed to honor a resident's right to choose a medication administration schedule consistent with the resident's preferences. Resident #97 was admitted with diagnoses including COPD, type 2 diabetes mellitus, and GERD, and had a quarterly MDS BIMS score of 15, indicating intact cognition. The resident's active medication orders included multiple daily medications, including aspirin, dexlansoprazole, escitalopram, insulin glargine, loratadine, metoprolol succinate ER, montelukast, spironolactone, gabapentin, Percocet, and weekly Ozempic. The July 2025 MAR showed that on 07/26/2025, the administration times for several medications were changed from 6:00 AM to 9:00 PM, including aspirin, dexlansoprazole, escitalopram, insulin glargine, loratadine, metoprolol succinate ER, montelukast, and spironolactone. Gabapentin was changed from 6:00 AM and 6:00 PM to 9:00 AM and 9:00 PM, and Percocet was changed from 6:00 AM, 2:00 PM, and 10:00 PM to 9:00 AM, 1:00 PM, and 9:00 PM. Ozempic was changed from 6:00 AM to 9:00 AM on 07/30/2025. The resident stated the medication times were changed from 6 to 9 the previous week and that no explanation was provided, and the resident preferred the previous administration times. Staff interviews showed the resident had raised concerns about the changes. An STNA stated the resident was upset about the medication time changes and that she informed an LPN of the concern. The ADON stated the facility changed medication times to keep them consistent and allow nursing staff more time for direct care, and also stated residents were not informed of the changes. The ADON said the resident wanted the medications switched back because they did not sit well with meals, but the change had not yet been implemented and was pending physician approval. The DON stated medication times should be resident-centered and dependent on resident preference, and that staff should contact the physician as soon as possible when concerns are communicated.
Failure to Follow Medication and Blood Sugar Orders
Penalty
Summary
The facility failed to ensure provider orders were followed for 2 residents reviewed for medication management. Facility policy required staff to follow the 5 rights of medication administration, including the right drug, dose, route, time, and patient. The deficiency involved one resident with a history of muscle spasms and intact cognition, and another resident with hemiplegia and hemiparesis following cerebral infarction, multiple sclerosis, type 2 diabetes mellitus, and moderate cognitive impairment. For the resident with muscle spasms, the order recap showed methocarbamol 500 mg by mouth three times daily. The MAR documented two doses as “Other/See Progress Notes,” and progress notes stated the medication was on order from the pharmacy. The administering LPN stated she did not give the medication because it was not available and did not recall whether she reordered it or contacted the physician to deviate from the order. She also stated the medication arrived at the facility at the end of her shift. The day shift nursing supervisor stated she was not advised the medication was out, and the DON stated the nurse was responsible for ensuring medication orders were carried through by communicating with the pharmacy, provider, and family. For the resident with diabetes, the order recap included sliding scale insulin and an order that if blood sugar was less than 70 mg/dL, glucose solution was to be given by mouth and blood sugar rechecked every 30 minutes for 4 checks. The MAR showed blood sugars of 63 mg/dL and 66 mg/dL on separate occasions, but there was no documented evidence that glucose solution was administered or that repeat blood sugar checks were performed. One LPN stated she usually gave something sugary instead of the ordered glucose solution and only performed 30-minute rechecks if the blood sugar was below 60 mg/dL, although she had not discussed that with the physician. The physician stated staff were expected to follow ordered parameters and that if they disagreed with an order, they should speak with the unit manager so the order could be clarified.
Unsecured Medications Found in Resident Room
Penalty
Summary
The facility failed to ensure drugs and biologicals were stored securely in a resident room for one resident who was approved for unsupervised self-administration of medications. The resident was admitted with a history of chronic obstructive pulmonary disease and had a quarterly MDS showing a BIMS score of 15, indicating intact cognition. The resident’s active orders included albuterol HFA inhalation aerosol, fluticasone nasal spray, Incruse Ellipta, and Symbicort, all ordered for unsupervised self-administration. A self-medication assessment documented that the resident could self-administer medications, had the dexterity to open locks, could track time, read prescription labels, state the proper dose, and administer inhalant medication properly. During observation in the resident’s room, two inhalers were seen on the bedside stand and two medication vials were seen on the nightstand near a nebulizer. The resident stated one inhaler was albuterol, the other was Symbicort, the nebulizer medication was used as needed, and Flonase was kept in a drawer across from the bed. The resident also stated the medications had been kept at the bedside since coming to the facility. Later, the resident showed a plastic lock box in a television stand drawer that contained two inhalers and a container of nasal spray, but two medication vials were still observed sitting unsecured on the bedside stand near the nebulizer. Staff interviews showed multiple nurses and aides were not aware the resident self-administered medications or kept medications in the room. The ADON and DON stated residents who self-administer medications could keep the medication with them after assessment and physician approval, and both later stated safe storage meant the medication should be in a lock box or locked drawer and kept secure unless being administered. The ADON also reviewed the facility policy and stated medications stored in a resident room should be locked in a drawer or lock box and secured whether the resident was inside or outside the room.
Incomplete MAR Documentation for Resident Medication and Treatment Administration
Penalty
Summary
The facility failed to ensure Resident #16’s medical record accurately reflected the resident’s experiences because the Medication Administration Records (MARs) contained multiple blank entries in May and June 2025. The resident was admitted on 09/13/2023 and had diagnoses including hemiplegia and hemiparesis following a cerebral infarction affecting the left non-dominant side, multiple sclerosis, and type 2 diabetes mellitus. The quarterly MDS with an ARD of 05/14/2025 showed a BIMS score of 9, indicating moderate cognitive impairment. Resident #16’s orders included multiple medications and treatments, such as Cymbalta, insulin glargine, insulin aspart, sertraline, carvedilol, trazodone, calcium polycarbophil, sennosides-docusate sodium, pregabalin, pantoprazole, CPAP, pain scale checks, oxygen titration, head-of-bed elevation, oxygen saturation checks, and WBAT status. The MARs had no documentation for several scheduled administrations and treatments, including missing entries for insulin, oral medications, CPAP, pain scale completion, oxygen administration, oxygen saturation checks, head-of-bed elevation, and WBAT checks on multiple dates in May and June 2025. The record also showed missing documentation for whether Cymbalta was administered on 05/31/2025. During interviews, LPNs stated there should not have been blanks in the MAR and that refusals or inability to administer should still have been documented. One LPN stated that if a resident was unavailable, staff could have documented that in the MAR. The DON stated there should never have been blanks in the MAR and that refusals could still have been documented; she also stated that a blank MAR entry made it difficult to determine whether medications had been given and not documented or not administered at all.
Failure to Document Vaccine Education for Resident Refusals
Penalty
Summary
The facility failed to provide documented education regarding the benefits and risks of influenza, pneumococcal, and COVID-19 immunizations for one resident who declined all three vaccines. The resident was admitted with diagnoses including hemiplegia, type 2 diabetes mellitus, stage 3 chronic kidney disease, vascular dementia, and traumatic subdural hemorrhage without loss of consciousness. The resident’s quarterly MDS showed a BIMS score of 14, indicating intact cognition, although the care plan noted fluctuating cognitive function related to traumatic subdural hematoma. Record review showed the resident refused the influenza vaccine, pneumococcal vaccine, and COVID-19 vaccine, and the immunization audit documented that education was not provided for each refusal. A nursing health status note stated the facility spoke with the resident’s family about vaccines offered that year and that the family said it was the resident’s decision; the note documented refusal of influenza and COVID-19 vaccines but did not mention the pneumococcal vaccine. Facility policies stated residents or their representatives were to receive education before pneumococcal and influenza immunizations, but the resident’s record did not show that this education was documented.
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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) |
|---|---|---|---|---|
| Maple Knoll Village | 1.7 mi | ★★★★★ | 2 | 0 |
| Advanced Health Care Of Cincinnati | 1.9 mi | ★★★★★ | 1 | 0 |
| Mount Notre Dame Health Center | 2.8 mi | ★★★★★ | 0 | 0 |
| Daniel Drake Center For Post-acute Care Llc | 3.2 mi | — | 0 | 0 |
| Wellspring Health Center | 3.3 mi | ★★★★★ | 13 | 0 |
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