Below average — CMS composite of the measures below.
The next survey window likely opens around January 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 Lincoln Knolls Health & Rehab Llc during CMS and state inspections, most recent first.
A resident with multiple chronic conditions and intact cognition was found living in a room that was not maintained in a clean, sanitary, or homelike condition, despite facility policies and expectations for daily thorough cleaning. Surveyors observed stained walls, a pile resembling drywall dust behind the bed, trash and items such as a plastic pitcher, pill cup, and used plastic wrap on the floor, and dried food-like debris on the bed frame and oxygen concentrator. An LPN confirmed these conditions, and the resident reported not knowing when the room was last cleaned and expressed dissatisfaction with living in that environment. The Administrator stated housekeeping was expected to clean resident rooms daily, and this issue represented continued noncompliance from a prior survey.
The facility failed to secure resident personal funds with a surety bond large enough to cover the total amount managed for 27 residents. Records showed resident account balances totaled far more than the bond limit, and the Corporate Director of Operations confirmed the bond was below the amount needed when the accounts were reviewed.
Medication storage was not maintained appropriately when surveyors found expired and improperly stored items in the med room and on med carts. An RN verified a frozen dinner in the med freezer, expired liquid meds and IV antibiotics, and an incomplete biohazard fridge temp log, while an LPN verified loose pills, expired glucometer control solutions, expired COVID-19 tests, expired Folic Acid and nicotine patches, and full sharps containers on two med carts.
Unlabeled and undated food items were found in the kitchen and walk-in cooler. A plastic container of dry cereal, an unsealed bag of sliced white cheese, and a box of nutritional supplements including health shakes and ice cream products were observed without labels or open dates, and the DM could not state when the items had been placed or removed from the freezer.
Infection control protocols were not followed during wound care, blood glucose testing, insulin administration, medication preparation, and droplet precautions. An ADON performed wound care without changing gloves between tasks and touched contaminated surfaces, an RN failed to use hand hygiene, barriers, and cleaning practices during glucose checks and insulin administration, another RN handled medications with bare hands without hand hygiene, and a CNA transported a resident on droplet precautions without PPE and without a mask on the resident.
Unsafe environment, broken showers, and cigarette litter: A resident room was observed dirty with stained surfaces, no sheets on the bed, and spilled supplement on a pillowcase, while dryer sheets were found in P-Tac vents in multiple rooms and were identified by the DON and Maintenance Director as a fire hazard. A resident also reported no cold water in his shower and a broken valve, and the Maintenance Director verified multiple showers were not working properly. In the designated smoking courtyard, more than 100 cigarettes were found on the ground and used cigarettes were also discarded in a trash can; RN and the Administrator confirmed the condition.
Failure to Notify Residents of Medicaid Spend Down Balances: The facility did not notify Medicaid recipients when their resources were within $200 of the Medicaid limit. Several residents had account balances at or above the allowable amount, and only a few spend down notices had been issued, with no further notices provided to residents after the initial batch. One resident also lost Medicaid benefits after the BOM failed to complete renewal paperwork timely.
Failure to Accommodate Resident’s Wheelchair Request: A resident with no cognitive impairment and significant lower-extremity limitations requested a new motorized wheelchair because his current chair was too small and he wanted to get out of bed more. The DOR confirmed the request was approved by insurance, but the resident was placed on a therapy wait list and the DOR said management told her not to order power wheelchairs due to concerns about residents leaving the facility in them.
Water Leaks and Ceiling Damage in Resident Rooms: Two residents had rooms with large brown water stains on the ceiling, and one room had an active leak with a bucket collecting water. One resident said the stain had been present for over a week and was directly above the bed, while the other resident, who was bedbound, said the stains had been visible for about a week and she saw them all day. The MD said the roof was leaking due to ice damming and freeze/thaw conditions.
A resident with quadriplegia, spinal stenosis, and an in-house acquired stage IV pressure ulcer to both buttocks had wound care treatments that were not documented as completed on multiple days each month over an extended period. Review of the physician orders and TARs showed repeated missing signatures, and the DON and ADON confirmed that if the treatment was not signed, it was not done. The ADON also stated she reviewed TARs daily later on but did not verify that the ordered treatments were actually completed.
Unsafe Smoking Supervision: Three residents who smoked were not properly supervised or managed according to their care plans. Two residents were observed smoking in the courtyard without staff present, and another resident was smoking without the required apron until a housekeeper intervened. The residents had diagnoses including dementia, COPD, and major depressive disorder, and facility records stated they required supervision while smoking.
The facility failed to provide consistent dialysis care for multiple residents with ESRD and DM2. Records showed missed or incomplete pre- and post-dialysis assessments, missing dialysis communication sheets, and cancelled transportation that caused missed dialysis treatments; one resident was sent to the ER/hospital for dialysis after missed trips. Interviews with the DON, Administrator, LPN, Ombudsman, dialysis social worker, and resident confirmed the transportation and communication problems.
A resident with significant mobility limitations and a power wheelchair requested to get out of bed and begin therapy, but PT/OT services were delayed and no assessment was completed in a timely manner. The DOR confirmed the resident had not been evaluated for PT or OT, had not been assessed for proper wheelchair fit, and the facility had no set timeline for handling therapy requests; management also directed rehab staff not to order power wheelchairs because of concerns about residents leaving the building in them.
The facility failed to help a resident maintain Medicaid coverage, and the lapse caused dialysis transportation to be cancelled. The resident, who had ESRD, DM2, dementia, CVA, PVD, and CHF, missed multiple dialysis appointments because the transportation company was no longer a covered provider after the Medicaid benefits ended. Interviews confirmed the missed treatments were due to the coverage lapse and that the former BOM failed to complete the renewal paperwork.
A resident with multiple comorbidities and full dependence on staff for mobility experienced a fall during a transfer with a Hoyer lift when the device tilted and fell, resulting in the resident landing on the floor in the sling. Two CNAs were assisting at the time, and it was later determined that the lift's legs were only partially open, contrary to facility policy requiring stability and locking before use. The resident reported pain and was subsequently sent to the ER and admitted.
The facility failed to maintain a safe sidewalk for residents using wheelchairs, with large cracks and divots causing wheelchairs to get stuck. Residents and staff confirmed the difficulty in navigating the area, although no injuries were reported. Previous repair attempts were ineffective.
Failure to Maintain Clean and Homelike Resident Room Environment
Penalty
Summary
Surveyors identified a deficiency related to the facility’s failure to provide a safe, clean, comfortable, and homelike environment for a resident. The resident had multiple medical conditions including COPD, type II diabetes, morbid obesity, major depressive disorder, cirrhosis, anxiety disorder, ADHD, chronic pain syndrome, muscle wasting, venous insufficiency, an acquired absence of the left foot, and alcohol abuse. The resident’s MDS showed intact cognition with a BIMS score of 15, required set-up and clean-up assistance for eating and oral hygiene, moderate assistance with bed mobility, and often refused showers and shower transfers, preferring to remain in bed. Despite the facility’s policies requiring routine cleaning and disinfection of visibly soiled surfaces and high-touch areas, and maintaining a sanitary, orderly, and comfortable environment, the resident’s room was not maintained accordingly. During observation of the resident’s room, surveyors noted multiple dark-colored stains on the wall under the television, yellow streaks on the wall next to the bed, and a large pile resembling drywall dust on the floor behind the head of the bed. Additional items found on the floor included a clear plastic pitcher under the bed, an empty pill cup near the head of the bed, and a balled-up, used piece of clear plastic wrap under the bed. There were also multiple spots resembling dried food debris on the bed frame and oxygen concentrator. An LPN confirmed these findings during interview. The resident reported not knowing when the room was last cleaned and stated he should not have to live in that condition. The Administrator stated that housekeeping was expected to thoroughly clean each resident’s room daily. This deficiency was cited as continued noncompliance from a prior annual survey.
Insufficient Surety Bond for Resident Funds
Penalty
Summary
The facility failed to assure the security of resident personal funds deposited with the facility because it did not have a surety bond covering the total amount of resident funds it managed. Review of the facility’s surety bond showed coverage up to $35,000, while review of the resident accounts listing showed the facility managed funds for 27 residents, with a total balance of $83,396.36. The amount of resident funds exceeded the bond coverage by $48,396.36. During interview, the Corporate Director of Operations confirmed that the facility realized the bond was insufficient when it ran the resident accounts report and that the surety bond limit increase from $35,000 to $100,000 was completed on 02/18/26.
Medication Storage and Expired Supply Issues
Penalty
Summary
The facility failed to ensure medications and biologicals were stored appropriately. During observation of the medication storage room with an RN present, surveyors found a frozen dinner in the medication storage freezer, a full bottle of liquid Levothyroxine 37.5 mg/ml with a use-by date of 12/25/25, a full bottle of liquid Vancomycin 50 mg/ml with a use-by date of 11/07/25, 5 bags of Micafungin 100 mg/100 ml ordered on 09/26/25 with a use-by date of 10/23/25, and 1 bag of Cefepime 2 grams/100 ml ordered in December 2025 with a use-by date of 01/13/26. The biohazard refrigerator temperature log had not been filled out since January 2025, with only 8 of 31 days completed, and the freezer needed defrosted; these observations were verified by the RN. Additional observations of the 300 hall med cart with an LPN present revealed loose medications in the drawers, including one white oblong pill, one white round pill, and one round yellow pill, along with three boxes of expired glucometer control solutions and one box of expired COVID-19 tests. Observation of the 400 hall med cart with the same LPN present revealed one bottle of expired Folic Acid 400 mg tabs, one box of expired Nicotine Patches 21 mg, and one loose peach oblong pill. The 400 hall med cart sharps container was full, and the 100 hall med cart sharps container was also full. The DON and ADON later confirmed the expired medications, loose pills, and the incomplete biohazard refrigerator temperature log.
Unlabeled and Undated Food Items Stored Improperly
Penalty
Summary
Food was not stored in a safe and sanitary manner in the kitchen and walk-in cooler. During observation on 02/10/26 at 8:00 A.M., a plastic container of dry cereal on the main kitchen cereal shelf had no label and no open date, and Dietary Manager #746 verified the container was unlabeled and undated and could not state when the corn flakes were placed into it. In the walk-in cooler, an unsealed plastic bag containing sliced white cheese had no label and no open date, and Dietary Manager #746 verified the cheese was unlabeled and undated and could not state when it had been placed in the bag. Also in the walk-in cooler, a large cardboard box containing multiple nutritional supplement products, including health shakes and ice cream products, was sitting on a shelf with no indication of how long the items had been out of the freezer; Dietary Manager #746 confirmed this and stated there should have been a date on the box indicating when the items were removed from the freezer, but could not state when they had been moved to the cooler.
Infection Control Failures During Wound Care, Medication Administration, and Droplet Precautions
Penalty
Summary
The facility failed to implement appropriate infection control protocols during wound care for a resident with in-house acquired stage IV pressure ulcers to the right and left buttock. During observation, the ADON performed wound care while using a dirty tray table covered with a barrier and surrounded by personal items, cleansed hands and applied gloves, but did not change gloves between tasks, touched the trash can with gloved hands, and continued wound care without removing gloves. The ADON also repeated the same practice while treating the resident’s left buttock wound. The ADON later confirmed she did not follow proper infection control procedure during the wound care. The facility also failed to follow infection control practices during blood glucose testing and insulin administration for a resident with anemia, CAD, diabetes, CHF, and hypertension who required staff assistance with ADLs and medication administration. An RN placed the glucometer on the resident’s tray table without a barrier, did not perform hand hygiene before gloving for the blood glucose check, did not clean the glucometer after use, and did not clean the insulin pen before administration. The RN also did not perform hand hygiene after insulin administration and confirmed she should have used a barrier, performed hand hygiene, cleaned the glucometer, and cleaned the insulin pen. In addition, the facility failed to maintain infection control during medication preparation for a cognitively impaired resident with COPD, schizophrenia, epilepsy, vascular dementia, hepatitis C, and prostate cancer. An RN removed two medications from the medication cup with bare hands, placed them on top of the medication cart, then picked them up again with bare hands and opened the capsules without wearing gloves or performing hand hygiene. The RN confirmed she should have worn gloves, should not have placed the medications on the cart, and should have performed hand hygiene before and after touching the medications. The facility also failed to follow ordered droplet precautions for a resident diagnosed with Human Metapneumovirus, as a CNA transported the resident without PPE and without a mask on the resident while moving him through the hallway and into the dining room, despite posted droplet precaution signage and PPE supplies outside the room.
Unsafe environment, broken showers, and improper cigarette disposal
Penalty
Summary
The facility failed to maintain a safe, sanitary, and homelike environment when Resident #22’s room was observed to be dirty, with stains on the curtain between the beds, a dirty wall with what appeared to be a tan liquid spill, no sheets on the bed, and a pillowcase with Boost spilled on it while the resident was lying in the bed. In the same observation, dryer sheets were found tucked into the top vents of the P-Tac units in occupied resident rooms 103, 107, 108, 109, 302, and an unoccupied resident room, while the units were on and blowing heat. The DON verified the dryer sheets in the units and stated they were a fire hazard, and the Maintenance Director stated staff should not be putting dryer sheets in the vents of the P-Tac units because it was a fire hazard. The facility also failed to maintain resident showers in proper working order. Resident #12 stated there was no cold water in the shower in his room and that the valve on the shower had broken off and needed replacement, which was confirmed by observation. The Maintenance Director verified the showers in the building were not working properly and stated there was only one working shower when he took over the role, with three working showers currently but multiple valves and pipes still needing replacement and repair. In addition, the designated smoking courtyard was observed to have more than 100 cigarettes littered on the ground and several used cigarettes discarded in a trash can with a plastic liner bag. RN #757 verified the cigarettes were littered throughout the courtyard and in the trash can, and the Administrator confirmed the courtyard needed to be cleaned up.
Failure to Notify Residents of Medicaid Spend Down Balances
Penalty
Summary
The facility failed to notify Medicaid recipients when their total resources were within $200 of the maximum limit for maintaining Medicaid eligibility. This deficiency affected 15 residents whose funds were managed by the facility, including residents with account balances ranging from $1,812.44 to $7,876.25. Review of the most recent spend down notices showed that only five residents were issued notices on 02/07/25, and no additional spend down notices were provided to any resident after that date. Record review showed that 38 of 39 residents were Medicaid recipients, and one resident had previously been a Medicaid recipient until his benefits lapsed after the former BOM failed to complete renewal paperwork timely. The Ohio Department of Medicaid guidance reviewed by surveyors stated that the Medicaid resource limit for a single person was $2,000 and $3,000 for couples. Residents #18, #31, and #36 had balances within $200 of the $2,000 limit, while other affected residents had balances above the allowable limit and had not received updated spend down notices.
Failure to Accommodate Resident’s Wheelchair Request
Penalty
Summary
The facility failed to accommodate Resident #1’s request for a new motorized wheelchair. Resident #1 was admitted with diagnoses including acute respiratory failure with hypoxia, unspecified abnormalities of gait and mobility, hereditary and idiopathic neuropathy, major depression, muscle weakness, and localized edema. The annual MDS showed a BIMS score of 15 with no cognitive impairment and functional limitations affecting both lower extremities. An annual therapy screen documented that the resident wanted to start getting out of bed. During interview, Resident #1 stated that in December 2025 he discussed with the DOR wanting to get out of bed into a wheelchair and requested a new motorized wheelchair because his current one was too small. The resident reported that insurance approval for the new motorized wheelchair was relayed to him in December 2025, but he was told he would be on a wait list for therapy until March 2026 before therapy services and the wheelchair request would be addressed. The DOR confirmed the resident wanted to get out of bed more and into his wheelchair, that the request was submitted to insurance and the resident qualified for a motorized wheelchair, and also stated she had been told by facility management not to order power wheelchairs for residents because of issues with residents leaving the facility in their power chairs and riding on the street.
Water Leaks and Ceiling Damage in Resident Rooms
Penalty
Summary
The facility failed to maintain a clean, safe, sanitary environment in good repair for two residents. In one room, observation revealed a large brown water stain on the ceiling measuring approximately six feet by one and a half feet directly above one resident’s bed. The resident stated the stain had been there for over a week, was directly above the bed, and was worried it might drip on him or collapse. The resident also said he did not want to move his belongings, though he would move if the stain or wetness worsened. The Administrator confirmed the stain and stated it could not be painted over because it was still partially wet. In another room, observation showed large brown water stains on the ceiling immediately to the left of a bed along the outside wall, with a blue bucket actively collecting leaking water beneath the discolored ceiling. The resident, who had a speech impairment and was bedbound, indicated the ceiling had been an issue for about one week and that she saw the stains all day and did not want to look at them any longer. A CNA confirmed the brown water stains had been visible for about one week and stated maintenance was aware of the leak because a bucket had been placed under the stained area. The Maintenance Director stated the roof was leaking due to extreme cold, freezing, ice damming, and freeze/thaw cycles affecting several sections of the roof.
Missed Documentation of Ordered Wound Care
Penalty
Summary
The facility failed to ensure wound care treatments were completed on time per physician orders for one resident with an in-house acquired stage IV pressure ulcer to the right and left buttock. The resident was admitted on 10/21/13 with diagnoses including spondylosis with myelopathy of the cervical region, quadriplegia, and spinal stenosis. Review of the resident’s physician wound treatment orders and TARs from March 2024 through January 2026 showed missing documentation of wound care completion on multiple days each month until August 2025. During observation on 02/18/26, the resident was noted to have wounds to both buttocks. The DON and ADON later confirmed that the missing TAR signatures from March 2024 through August 2025 meant the treatments were not done, and the ADON stated she began daily TAR reviews in September 2025 but did not verify whether the treatments were actually completed.
Unsafe Smoking Supervision
Penalty
Summary
The facility failed to provide appropriate supervision and safe smoking interventions for residents who smoked. Resident #6 had diagnoses including muscle weakness, muscle wasting and atrophy, adjustment disorder with anxiety, and major depressive disorder, and the smoking evaluation dated 01/23/26 stated the resident must be supervised at all times while smoking. On 02/11/26 at 10:28 A.M., Residents #6 and #26 were observed smoking in the courtyard without staff present to supervise them, and an LPN at the nurse’s station verified they were smoking without supervision. The facility’s smoking list identified 19 residents who smoked, all of whom required supervision. Resident #26 had diagnoses including COPD, vascular dementia, major depressive disorder, and nicotine dependence, and the smoking evaluation dated 11/07/25 stated the resident must be supervised at all times while smoking. Resident #34 had diagnoses including major depressive disorder, dementia, schizoaffective disorder bipolar type, intermittent explosive disorder, and muscle weakness, and the smoking evaluation dated 11/13/25 stated the resident must be supervised at all times while smoking and must wear a smoking apron. On 02/12/26 at 2:02 P.M., Resident #34 was observed smoking in the courtyard without a smoking apron, and at 2:04 P.M. a housekeeper supervising the smokers retrieved an apron and instructed another staff member to put it on the resident. The facility policy stated residents who smoked would be assessed for supervision needs and follow their care plans.
Dialysis care failures: missed transportation, incomplete assessments, and poor communication
Penalty
Summary
The facility failed to provide safe, appropriate dialysis care and services for residents who required dialysis. The report states that the facility did not ensure reliable transportation to and from dialysis, did not maintain adequate communication with dialysis providers, and did not complete required pre- and post-dialysis assessments. These failures affected all three residents identified by the facility as receiving dialysis treatments, and the facility census was 39. Resident #3 had diagnoses including end stage renal disease, dependence on renal dialysis, and type 2 diabetes mellitus. The resident’s care plan called for dialysis three times weekly with facility transport, no blood pressures on the fistula arm, and pre- and post-dialysis assessments per facility policy. The record showed multiple missed or incomplete dialysis assessments, including missing pre-dialysis and post-dialysis documentation on several treatment dates. During interview, the DON verified that the dialysis assessments were not completed as they should have been for this resident. Resident #11 also had end stage renal disease, dependence on renal dialysis, and type 2 diabetes mellitus, with orders for dialysis three times weekly and a care plan calling for transportation and pre- and post-dialysis assessments. The dialysis communication folder lacked multiple communication sheets, and the record showed missing pre- and post-dialysis assessments on some treatment dates. The resident missed dialysis when transportation was cancelled, and progress notes showed the resident was sent to the ER and hospital for dialysis after missing treatments. Interviews with nursing staff, the Ombudsman, the Administrator, the DON, the ADON, the dialysis social worker, and the resident confirmed missed dialysis appointments were related to transportation problems and lack of communication, and that the resident did not refuse dialysis. Resident #20 had end stage renal disease, dependence on renal dialysis, and type 2 diabetes mellitus, with dialysis ordered three times weekly and a care plan requiring pre- and post-dialysis assessments and monitoring of the dialysis port. The record showed multiple missing pre- and post-dialysis assessments, and one pre-dialysis assessment contained vitals timestamped after the resident had already returned from dialysis and identical to the post-dialysis vitals. The DON verified that dialysis assessments were not completed as they should have been for this resident. The facility policy titled Hemodialysis stated that the facility would assure safe transportation, complete assessments before and after dialysis, and maintain ongoing communication and collaboration with the dialysis facility.
Delayed Therapy Services and Wheelchair Assessment
Penalty
Summary
The facility failed to provide therapy services in a timely manner for one resident who had diagnoses including acute respiratory failure with hypoxia, gait and mobility abnormalities, hereditary and idiopathic neuropathy, major depression, muscle weakness, and localized edema. The resident’s annual MDS showed a BIMS score of 15 and functional limitations including impairment of both lower extremities, partial/moderate assistance for rolling in bed, and lying to sitting not attempted due to medical condition or safety concerns. An annual therapy screen completed on 01/08/26 documented that the resident wanted to start getting out of bed and that therapy would be determined after consultation with the durable medical equipment provider; the screen also noted the resident had a power wheelchair and OT was recommended for positioning, upper body strength, core strength, and simple hygiene and grooming. During interview, the resident stated that in December 2025 he discussed with the DOR wanting to get out of bed into his wheelchair and requested a new motorized wheelchair because his current one was too small. The DOR confirmed the request was submitted to insurance and that the resident qualified for a motorized wheelchair, but the resident was told he would not start therapy for another two weeks because no therapy staff were available. The DOR also stated the resident had not been assessed for PT or OT, had not been assessed with his current wheelchair to determine fit, and that facility management had told rehab staff not to order power wheelchairs for residents due to issues with residents leaving the facility in their power chairs and riding on the street. The Administrator and ADON stated the facility had no policy for processing therapy requests and no set timeline for completing the process, and a review of residents who started PT or OT since December 2025 showed 27 residents had started services while this resident had not.
Failure to Maintain Medicaid Coverage for Dialysis Transportation
Penalty
Summary
The facility failed to provide assistance to Resident #11 to maintain the Medicaid benefits for which he was eligible. Resident #11 was admitted on 10/29/19 with diagnoses including end stage renal disease, dependence on renal dialysis, type two diabetes mellitus, cerebral infarction, peripheral vascular disease, dementia, and congestive heart failure. The quarterly MDS dated 12/04/25 indicated he had no cognitive impairment, and the payer source information listed Medicaid as the primary payer. The Medicaid Benefits and Assignment Plan showed his Medicaid benefits ended on 01/31/26. Progress notes showed Resident #11’s dialysis transportation was cancelled, resulting in missed dialysis treatments on 01/12/26, 02/04/26, 02/06/26, and 02/09/26. Interviews confirmed the missed appointments were due to transportation being cancelled because his Medicaid coverage had lapsed, and the transportation company was no longer a covered provider. The Administrator stated the Medicaid renewal paperwork was completed on 02/09/26 and confirmed it was the Business Office Manager’s responsibility to complete insurance renewal paperwork, but the former BOM had failed to do so for Resident #11.
Failure to Ensure Safe Mechanical Lift Transfer
Penalty
Summary
The facility failed to ensure a safe transfer for a resident requiring a mechanical lift (Hoyer) for mobility. The resident, who had multiple diagnoses including type 2 diabetes, CHF, COPD, anxiety disorder, failure to thrive, morbid obesity, and CKD, was cognitively intact but fully dependent on staff for mobility and activities of daily living. The resident was at moderate risk for falls, completely incontinent, chair-bound, and unable to stand independently. During a transfer to bed using the Hoyer lift, two CNAs were assisting when the lift tilted sideways and fell, causing the resident to fall to the ground while still in the sling. The nurse arrived to find the resident sitting upright on the floor in the sling, and upon assessment, the resident reported pain in the buttocks. Further review revealed that one CNA could not recall whether the legs of the Hoyer lift were open or closed at the time of the incident, and the Administrator later stated the legs were only partially open. Facility policy required staff to ensure the lift was stable and locked before use. The resident was subsequently assessed, medicated for pain, and sent to the emergency room for evaluation after x-rays, where she was admitted to the hospital. The incident was documented and investigated by facility leadership.
Unsafe Sidewalk Conditions for Wheelchair Users
Penalty
Summary
The facility failed to maintain a safe and accessible sidewalk for residents, particularly those using wheelchairs, which posed a potential risk to all residents. During an interview and observation, several residents reported that their wheelchairs frequently got stuck in large cracks and divots on the sidewalk leading to the smoking area. These cracks measured six inches wide and two to three inches deep, while the divots in the grass adjacent to the sidewalk were four to twelve inches deep, with visible wheelchair marks indicating where residents had become stuck. The Director of Nursing and the Maintenance Supervisor confirmed the presence of these hazards, acknowledging the difficulty they posed for residents and staff. The Maintenance Supervisor noted that previous attempts to fill the divots with hay and quick concrete were ineffective, as the repairs did not last. Despite the challenges, no injuries had been reported at the time of the survey. A State Tested Nursing Assistant also confirmed the difficulty in safely maneuvering wheelchairs over the cracked sidewalk, further emphasizing the safety concerns.
What surveyors are citing around you — mapped
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Illustrative
What surveyors actually found near you
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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.
Illustrative
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Illustrative
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Nursing homes near Youngstown
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Maplecrest Nursing And Hta | 3 mi | ★★★★★ | 0 | 0 |
| Park Vista Nursing And Rehab | 3.6 mi | ★★★★★ | 5 | 0 |
| Windsor Health Care Center | 4.3 mi | ★★★★★ | 1 | 0 |
| Park Center Healthcare And Rehabilitation | 4.5 mi | ★★★★★ | 18 | 0 |
| Oasis Center For Rehabilitation And Healing | 4.5 mi | ★★★★★ | 16 | 0 |
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