Above average — CMS composite of the measures below.
The next survey window likely opens around April 2027
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 Kingston Of Miamisburg during CMS and state inspections, most recent first.
Unsafe Food Storage and Unsanitary Kitchen Conditions: Food in the main kitchen was found unlabeled, undated, and in some cases uncovered or exposed to air, including items in the walk-in refrigerator and freezer. The kitchen and kitchenette areas also had a leaking sink with standing water, heavily soiled dishwasher surfaces, dirt and debris under the sink, food splatter on walls, and debris on a fan and ceiling tile; the DM verified these conditions.
A resident receiving Eliquis had a visible bruise on the right hand, but the chart lacked a skin assessment and physician notification for the bruise. Although anticoagulant bleeding precautions were documented as completed each shift, the ADON verified there was no documentation of the current bruise being assessed or reported, despite the resident stating it occurred after hitting the bedside table.
Medication storage was unsafe when an LPN left one resident’s morning meds on another resident’s dresser while answering a call light. The cup contained ten pills labeled for the other resident, and the DON and LPN confirmed the meds were repulled and administered after the nurse thought the first set had been discarded. One resident had impaired cognition and both residents depended on staff for med administration.
A resident discharged home after a short-term rehab stay did not receive an adequate supply of medications, as the facility failed to send prescriptions to the pharmacy and only provided the remaining medications on hand, contrary to the physician's order for a two-week supply. Staff were unaware of the discharge until it was demanded by the resident's spouse, and the facility's discharge planning policy did not specify medication supply requirements.
A resident with chronic kidney disease and heart failure did not have physician-ordered bilateral leg wraps completed and documented as required. Review of the TAR showed multiple missed or unsigned treatments, and the DON was unable to confirm if the treatments were performed.
A resident with severe cognitive impairment and multiple diagnoses did not receive physician-ordered wound care for pressure ulcers over a three-day period, as documented treatments were not signed off and the DON could not verify completion.
Two residents did not receive medications as ordered due to inaccurate transcription of physician orders and failure to ensure medication availability. One resident received continuous lidocaine patch application instead of the prescribed schedule, while another missed multiple doses of an ophthalmic solution because prior authorization was not obtained and staff did not follow up with the pharmacy or provider.
A narcotic medication prescribed for a resident with severe cognitive impairment was found stored outside the required double-locked compartment, contrary to facility policy. Staff confirmed the medication was not properly secured due to lack of access to the narcotic compartment keys, resulting in a failure to meet controlled substance storage requirements.
A resident with multiple chronic conditions had a stat chest x-ray ordered due to abnormal lung sounds, but the x-ray was delayed because the lab service could not initially locate the order. The x-ray was not completed until the next day, despite facility policy requiring timely diagnostic services, as confirmed by the DON.
Unsafe Food Storage and Unsanitary Kitchen Conditions
Penalty
Summary
Food was not stored and prepared in a safe and sanitary manner in the main kitchen and kitchenette areas. During the initial tour of the main kitchen, the walk-in refrigerator contained 80 slices of cake on dessert plates with no label or date, three large clear bags of waffles with no label or date, nine individual dessert cups with yogurt, two very large containers of pork loin with no label or date, sixty individual fruit cups with no label or date, and 20 orange slices in dessert cups with no label or date. The walk-in freezer contained a large box of frozen hamburger patties that was open and exposed to air with no label or date, and a large gallon bag of premade sandwich-style eggs with no label or date. A large puddle of water was observed under the sink, and the Dietary Manager verified the sink had a leak causing the puddle on the floor. The main kitchen also had a heavily soiled dishwasher with dried food splatter running down the front and sides, food crumbs piled high on top of the dishwasher, a heavily soiled area under the sink with dirt and debris, and large strands of fuzzy material hanging from the ceiling tile over the dishwasher cycle. In kitchen number two, the window was heavily soiled, the walls around the dishwasher had dirt, debris, and food splatter, dried food splatter was running down the sides of the dishwasher, brown items that appeared to be bugs were observed in the light over the food preparation area, a large blackened area was seen behind the toaster on the wall, and a large fan aimed at the food preparation area was heavily soiled with fuzzy strips of debris hanging from it. The Dietary Manager verified these conditions during interview, and the facility policy stated food and supplies shall be properly stored and that food is covered, dated, and stored loosely to permit air circulation.
Failure to Document and Report Bruising in a Resident on Anticoagulant Therapy
Penalty
Summary
The facility failed to ensure physician-ordered monitoring was followed for the side effects of anticoagulant use for one resident. Resident #11 was admitted with diagnoses including Alzheimer's disease, COPD, diabetes mellitus type 2, vascular dementia, myocardial infarction, and depression. The resident had a care plan for risk for injury related to anticoagulant use, with interventions to assess for signs and symptoms of active bleeding and notify the physician if observed. The physician orders included Eliquis 2.5 mg daily and anticoagulant bleeding precautions requiring assessment for bruising and bleeding with physician notification if observed. On observation, Resident #11 had a bruise on the right hand, and the resident stated it occurred after hitting the hand on the underside of the bedside table. Review of the electronic charting showed no skin assessment documenting the bruise and no physician notification for the current bruise. Although the May TAR documented the anticoagulant assessment as completed each shift, the ADON verified there was no documentation of a skin assessment or physician notification for the bruise and stated the expectation was that a nurse would document the skin assessment and update the physician when a bruise was observed. The facility policy for wound and skin management stated that if a bruise was identified, an initial assessment should be completed, an order obtained to monitor the bruise every shift until resolved, and abnormalities documented in the medical record.
Medication Left on Another Resident’s Dresser
Penalty
Summary
Medication was not stored in a safe manner when a medication cup containing another resident’s morning medications was left on the dresser of a different resident. Resident #07 was admitted with diagnoses including polyarthritis, scoliosis, hyperglyceridemia, essential primary hypertension, mixed hyperlipidemia, dysphagia, and constipation, and her MDS showed impaired cognition and dependence on staff for medication administration and other ADLs. During observation, Resident #07 was seated in her wheelchair with an overbed table in front of her, and a medication cup with ten pills and a plastic strip labeled with Resident #14’s name was seen on her dresser. LPN #96 verified the cup contained Resident #14’s medications and that the strip documented the medications were for the morning of 05/03/26. The DON confirmed that Resident #14’s morning medications had been left on Resident #07’s dresser and that both residents required staff to administer medications. The DON reported that LPN #109 had pulled Resident #14’s pills, stopped to answer Resident #07’s call light, placed the medication cup on Resident #07’s dresser, and later thought the pills had been discarded, so she pulled a second set of the same medications and administered them. LPN #109 later verified she had placed Resident #14’s medications in a cup, set them on Resident #07’s dresser while answering the bathroom call light, and then repulled the medications after believing she had thrown them away. Resident #14’s record showed she was cognitively intact and dependent on staff for medication administration, toileting, showers, lower body dressing, putting on shoes, and personal hygiene.
Failure to Provide Adequate Medication Supply at Discharge
Penalty
Summary
The facility failed to ensure that a resident received an adequate supply of medications upon discharge to home. The resident, who was cognitively intact and admitted for a short-term rehabilitation stay with diagnoses including epilepsy, was discharged following a planned process that included care conferences and discharge planning interventions. Despite these preparations, there was no documentation that prescriptions were sent to the pharmacy upon discharge, and the resident was only sent home with the remaining medications available at the facility, rather than a two-week supply as ordered. Staff interviews revealed that the registered nurse responsible for the discharge was not aware of the discharge until the resident's spouse arrived and demanded it. The nurse obtained a telephone order from the physician to discharge the resident and to send the remaining medications, but was unsure of the exact quantity provided. The facility's typical process of sending electronic prescriptions to the pharmacy was not followed, and there was no evidence that prescriptions were sent for the resident to obtain additional medication after discharge. The Director of Nursing confirmed that the facility did not have documentation of electronic prescriptions being sent and that the resident was only discharged with the remaining medications on hand. The facility's discharge planning policy did not specify the amount of medication to be sent with residents upon discharge. There was no indication in the record that the resident or their representative reported issues obtaining medications after discharge, but the lack of proper documentation and follow-through on medication supply constituted the deficiency.
Failure to Complete and Document Physician-Ordered Skin Treatments
Penalty
Summary
Staff failed to complete and document physician-ordered skin treatments for a resident with chronic kidney disease and acute on chronic diastolic heart failure, who was admitted with orders to wrap both legs with Kerlix and compression wraps every shift due to swelling, mass, and lumps in the lower limbs. Medical record review showed that the Treatment Administration Record (TAR) lacked documentation of treatment completion on several specified days and shifts. During an interview, the DON confirmed that the treatments were not signed off as completed on those dates and could not verify whether the treatments had actually been performed.
Failure to Provide Physician-Ordered Pressure Ulcer Care
Penalty
Summary
Staff failed to provide wound care for pressure ulcers as ordered by the physician for a resident with severe cognitive impairment and multiple diagnoses, including Alzheimer's disease and fibromyalgia. The resident was dependent for activities of daily living and had two pressure ulcers requiring specific daily treatments as per physician orders. Review of the Treatment Administration Record for February 2025 showed that the required pressure ulcer treatments were not signed off as completed for three consecutive days. The Director of Nursing confirmed that there was no verification that the treatments had been completed on those dates.
Failure to Administer Medications as Ordered and Ensure Medication Availability
Penalty
Summary
The facility failed to ensure medications were administered as ordered for two residents. For one resident with Alzheimer's disease, heart failure, and generalized anxiety disorder, physician orders specified the application of a lidocaine 4% topical patch to the left hip for 12 hours on and 12 hours off. However, medical record review and staff interview revealed that from August 2024 to March 2025, the resident was signed off for the application of two lidocaine patches daily, resulting in an external patch being on at all times, contrary to the intended order. The DON confirmed that the physician's orders were not transcribed accurately, leading to continuous patch application. For another resident with cerebrovascular disease, narcolepsy, chronic kidney disease, dementia, and dry eye syndrome, there was a physician's order for Rocklatan ophthalmic solution to be administered at bedtime. Review of medication administration records showed that the medication was not administered on multiple occasions due to it not being available. Further investigation revealed that the required prior authorization for the medication had never been sent to the pharmacy. Nursing staff failed to follow up with the pharmacy or notify the provider regarding the unavailability of the medication, as confirmed by the DON. Facility policy required medications to be administered as prescribed and for staff to contact the Medical Director if there were concerns, but this was not followed.
Improper Storage of Narcotic Medication
Penalty
Summary
A deficiency was identified when a narcotic medication, specifically oxycodone 5 mg prescribed for pain management, was not stored according to facility policy and regulatory requirements. The medication, intended for a resident with severe cognitive impairment and multiple diagnoses including acute lymphadenitis, cerebral infarction, and dementia, was found in a medication cart drawer adjacent to the locked narcotic compartment rather than inside the double-locked compartment designated for controlled substances. The narcotic card contained 42 tablets and was secured only with a requisition sheet and rubber band. Staff interviews confirmed that the medication was not properly stored. One LPN acknowledged the improper storage and stated that narcotics must be kept under double lock. Another LPN reported that the ADON had delivered the medication earlier but she did not have the keys to the narcotic compartment, preventing her from storing the medication appropriately. Review of the facility's policy confirmed that all schedule II-V medications are required to be stored in a permanently affixed, double-locked compartment, separate from other medications.
Delay in Stat Chest X-ray for Resident
Penalty
Summary
The facility failed to provide laboratory services in a timely manner for one resident who was admitted with multiple diagnoses, including peripheral vascular disease, major depressive disorder, chronic kidney disease, and dry eye syndrome. A physician ordered a stat chest x-ray for this resident due to rales in the left lower lobe of the lungs. However, a review of the medical record and staff interviews revealed that the x-ray order was not promptly processed; the lab service was initially unable to locate the order, and the x-ray was not completed until the following day. The facility's policy required timely provision of lab and diagnostic services, but this was not met in this instance, as confirmed by the Director of Nursing.
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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 Miamisburg
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Sycamore Trails Post Acute | 2.5 mi | ★★★★★ | 0 | 0 |
| Sycamorespring Of Miamisburg | 2.6 mi | ★★★★★ | 3 | 0 |
| Laurels Of West Carrollton The | 3.2 mi | ★★★★★ | 18 | 0 |
| Wood Glen Alzheimer's Community | 3.6 mi | ★★★★★ | 16 | 0 |
| Carlisle Manor Health Care Inc | 3.7 mi | ★★★★★ | 1 | 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.