Average — CMS composite of the measures below.
The next survey window likely opens around February 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 Wright Rehabilitation And Healthcare Center during CMS and state inspections, most recent first.
Food and food prep services were not protected from contamination. Surveyors observed sanitizer and detergent buckets with washcloths stored on the kitchen floor near the prep area, raw chicken thawing in the rinse compartment of a 3-compartment sink while utensils soaked in sanitizer in another compartment, and a visibly dirty ice machine in the activities room that held ice used for residents. The Dietary Manager said staff used the 3-compartment sink to thaw food, and an LPN confirmed the ice machine was used for residents.
Pureed food was not prepared to the required texture when a cook made pureed ham with diced ham, broth, and thickening additive, then returned it to hot holding even though small pieces were still felt during tasting. The FSD expected it to thicken later, and residents with pureed diets were served the item despite the puree not being smooth and lump free as the recipe and SLP described.
A resident with aphasia, vascular dementia, hallucinations, altered mental status, and a feeding tube was moved to the MCU due to wandering. The DON, Administrator, and SS stated the family was notified by phone, but the resident’s daughter said she did not receive written notice of the room change before leaving the facility.
Failure to maintain a clean resident room: A resident with impaired cognition and multiple diagnoses had soil, dust, and debris found under the bed and near the wall heater. The family said housekeeping had been asked three times to sweep the floor since admission and it was never done, while two housekeepers confirmed the room needed to be swept despite the facility's daily cleaning expectations.
Failure to Monitor a Resident After Positive COVID-19 Test: A resident with encephalopathy, vascular dementia, COPD, and bronchitis tested positive for COVID-19 and was placed in droplet isolation. Although the care plan included monitoring for fever, dehydration, and respiratory symptoms, the record showed no daily or shift-by-shift symptom monitoring, and the Administrator and DON verified that no symptom management was completed.
A resident with Alzheimer’s disease, CKD, anxiety, and depression received Augmentin for diverticulitis despite no documented history or diagnosis of diverticulitis or diverticulosis. Nursing notes showed severe abdominal pain, the MD ordered the antibiotic based on symptoms, later x-rays were negative for diverticulitis, and the guardian confirmed the resident had never had that diagnosis. The LPN/IP confirmed the antibiotic was continued without proper testing to support the diagnosis, and the DON stated there was no policy for stopping meds without a proper diagnosis.
A resident with aphasia, vascular dementia, hallucinations, altered mental status, and a feeding tube had documented cognitive impairment and a care plan for mood, psychotic disturbance, and anxiety, but the chart lacked documentation of wandering and other behaviors. Staff reported the resident was moved to memory care after wandering into other residents’ rooms and exhibiting kicking, punching, slapping, and attempts to get out of the wheelchair, and multiple staff confirmed these behaviors were not documented in the medical record.
Improper Bed Rail Assessment and Consent: A resident with dementia, a recent femur fracture, and a compression fracture had 1/2 siderail use included in the care plan, but the facility did not complete a proper bed rail assessment, including air mattress measurements, and obtained consent from the resident despite severe cognitive impairment. The resident was later found lying against the siderail with bruising and rib pain, and x-rays showed age-indeterminate right rib fractures.
A resident with cognitive and physical impairments was sexually abused by another resident with a history of dementia and behavioral issues after the latter was left unsupervised during a smoke break. The lack of required supervision allowed the resident to leave the Memory Support Unit and enter another resident's room, resulting in inappropriate contact that was witnessed by staff. Facility policy required continuous supervision of such residents, but this was not followed, leading to the incident.
A resident with dementia and a history of aggressive behaviors was left unsupervised after being allowed to leave a supervised smoke break early. The resident entered another resident's room and engaged in inappropriate physical contact, despite the other resident's objections, until staff intervened. Staff interviews confirmed that supervision protocols were not followed, resulting in the incident.
A resident experienced a delay in receiving a stat X-ray after a fall, resulting in a fractured femur being diagnosed the following day. Another resident received improper incontinent care when a CNA did not follow the correct procedure for perineal care. These deficiencies highlight the facility's failure to provide timely medical care and adhere to proper care procedures.
A facility failed to ensure a Stat X-ray was ordered and completed in a timely manner for a resident with multiple fractures and other health conditions. Despite a physician's order for a Stat X-ray, there was a delay in contacting the X-ray company, and the procedure was not completed within the expected four-hour timeframe, resulting in non-compliance with the facility's policy.
A CNA failed to change gloves between cleaning and applying lotion during incontinence care for a cognitively impaired resident, breaching infection control protocols. The facility's policy requires glove changes between dirty and clean tasks, which was not followed.
A resident with a fracture and risk for skin breakdown had physician orders for ace wraps to remain on until a follow-up. However, an STNA removed the wraps during a shower, against orders, after being told by a nurse they could be removed. The ADON later clarified the wraps should remain until the follow-up, confirming the deficiency.
Food Safety Lapses in Kitchen and Resident Ice Machine
Penalty
Summary
Food and food preparation services were not protected from potential contamination. On 03/02/26, surveyors observed one red bucket and one green bucket stored on the kitchen floor at the end of the food service line, next to the prep sink and juice machine, with washcloths sitting in detergent and sanitizer solutions. The Dietary Manager stated the buckets were used for washcloths to wipe down kitchen equipment such as food prep counters and acknowledged that storing them on the floor was likely not the best location, but said they were usually kept there because of limited kitchen space. On 03/03/26, surveyors observed a large bag of partially thawed raw chicken thighs sitting in the rinse compartment of the three-compartment sink with no water running, while utensils were soaking in sanitizer solution in the sanitize compartment. The Dietary Manager stated staff regularly used the three-compartment sink to thaw foods because the prep sink nearest the food service line had a spray nozzle that did not allow a continuous flow of water. The facility policy listed acceptable thawing methods as refrigeration at 41 degrees Fahrenheit or lower, microwave thawing, thawing under running potable water at 70 degrees Fahrenheit or lower, or thawing during cooking. On 03/05/26, surveyors observed the inside of the ice machine in the activities room was visibly dirty with brown debris accumulating inside while it held ice used for residents; an LPN confirmed the ice was used for residents and that the machine appeared visibly dirty despite monthly cleanings.
Pureed Food Served With Undesired Texture
Penalty
Summary
The facility failed to ensure pureed food was prepared in a form designed to meet individual resident needs when it served pureed ham that still contained small pieces. During lunch preparation, a cook placed diced ham and an unidentified amount of chicken broth into a food processor and added powdered thickening additive using a spoon that was not a true measuring teaspoon. The cook stated they were unsure of the exact amount of broth used and were trying to achieve an applesauce-like smooth texture. When the pureed ham was tasted, small pieces of ham were felt on the palate and with swallowing, and the cook acknowledged sensing small pieces remaining in the mixture. The Food Service Director stated the puree appeared somewhat soupy and expected it to thicken in the hot holding unit before service, but the food was returned to hot holding without confirming it was free of small pieces. At lunch, three residents were served pureed ham, and the facility identified seven residents with pureed texture dietary orders. The Speech Language Pathologist stated pureed food should not have any pieces left to chew and should not leave pieces in the mouth after dissolving. The facility recipe for pureed baked ham stated the consistency should be checked until the food is smooth, lump free, and extremely thick.
Failure to Provide Written Notice Before Room Change
Penalty
Summary
The facility failed to provide written notification before changing a resident’s room. Resident #95 was admitted with aphasia, vascular dementia, hallucinations, altered mental status, and esophageal obstruction, and the admission MDS showed impaired cognition with a BIMS score of 07 and dependence with all care; the resident also had a feeding tube. The care plan documented vascular dementia with mood disturbance, psychotic disturbance, and anxiety. Review of the resident’s progress notes showed no documentation that the resident was moved to another room, no family notification, and no written notice of the room change. During interviews, the DON and Administrator stated the facility decided to move the resident to the Memory Care Unit due to wandering, Social Services stated the family was notified by phone early in the morning, and the resident’s daughter stated she was notified by phone that the resident was moving to the MCU but had not received written notification before leaving the facility.
Failure to Maintain Clean Resident Room
Penalty
Summary
The facility failed to maintain a clean and home-like environment for Resident #93. Resident #93 was admitted with diagnoses including calculus of the bile duct with cholangitis or cholecystitis without obstruction, COPD, sepsis, and Alzheimer's disease, and the admission MDS showed impaired cognition with a BIMS score of 07 while the admission assessment was still in progress. During observation on 03/02/26 at 12:06 P.M., a two-inch round pile of flower potted soil substance about one inch high was found under the middle of the bed toward the head of the bed, three small spots were located under the bed in line with the larger spot, and one round dust ball was found on the floor under the wall heating system beside the bed. The resident's family stated they had requested housekeeping three times since admission to have the floor swept and that it had never been swept, adding that housekeeping only came in to take out trash and clean the toilet. Housekeeper #284 and Housekeeper #292 each stated rooms are to be cleaned daily by sweeping, taking trash out, and cleaning the bathroom, and both confirmed Resident #93's room needed to be swept. The facility's housekeeping/environmental services policy stated cleaning schedules are developed and implemented to assure each area is maintained in a safe, clean, and comfortable manner.
Failure to Monitor a Resident After Positive COVID-19 Test
Penalty
Summary
The facility failed to provide assessments and monitoring for a resident who tested positive for COVID-19. Resident #92 was admitted with diagnoses including encephalopathy, vascular dementia, chronic obstructive pulmonary disease, and bronchitis. The resident’s MDS admission assessment showed impaired cognition with a BIMS score of 99 and bladder incontinence. The care plan identified COVID-19 interventions including lab/culture/diagnostic testing as ordered, education on handwashing, encouragement of fluids unless contraindicated, monitoring and reporting signs and symptoms of dehydration, monitoring for elevated temperature, and droplet isolation with full PPE during direct care. Progress notes showed the resident tested positive for COVID-19 and was placed in droplet isolation, and the care plan was updated to monitor for elevated temperature. However, the medical record did not show daily or shift-by-shift monitoring for symptoms of dehydration, elevated temperature, or respiratory symptoms. The Administrator and DON both verified that no symptom management was completed for the resident after the positive COVID-19 test.
Unnecessary antibiotic given without adequate indication
Penalty
Summary
The facility failed to ensure a resident’s drug regimen was free from unnecessary drugs when Resident #10 received Augmentin 875/125 mg every 12 hours for seven days for diverticulitis without an adequate indication for use. The resident was admitted with diagnoses including Alzheimer’s disease with late onset, chronic kidney disease stage 3, essential hypertension, anxiety disorder, and major depressive disorder with psychotic symptoms. Review of the record showed no diagnosis or history of diverticulitis or diverticulosis, and the annual MDS indicated moderate cognitive impairment and no antibiotic use at that time. On 02/28/26, nursing documentation noted the resident complained of severe left abdominal pain during the night, and the physician was contacted and ordered Augmentin for diverticulitis. The physician order reflected the same antibiotic regimen for diverticulitis. A later physician note stated abdominal x-rays were reviewed and were negative for diverticulitis. The care plan later identified the resident as having an infection and being on an antibiotic for diverticulitis. The resident’s guardian confirmed the resident had never had a diagnosis of diverticulitis or diverticulosis, and the LPN/IP confirmed the antibiotic was ordered based on symptoms rather than testing results and had not been discontinued despite the lack of proper testing for the diagnosis. The DON stated there was no policy for discontinuing medications that do not have a proper diagnosis for use.
Failure to Document Resident Behaviors in Medical Record
Penalty
Summary
The facility failed to ensure that resident behaviors were documented in the medical record for Resident #95. The resident was admitted with aphasia, vascular dementia, hallucinations, altered mental status, and esophageal obstruction, and the MDS admission assessment showed impaired cognition with a BIMS score of 07. The resident was also assessed as dependent with all care and had a feeding tube. The care plan identified vascular dementia with mood disturbance, psychotic disturbance, and anxiety, but the progress notes contained no documentation of wandering events or behaviors. Staff interviews confirmed that Resident #95 exhibited behaviors that led to placement in the memory care unit. A CNA stated the resident was brought from the west hall to memory care on the day of admission because of behaviors and needed one-on-one supervision, describing kicking, punching, slapping, and trying to get out of the wheelchair. The DON and Administrator stated the resident was moved to the memory care unit because of wandering into multiple female rooms and scaring female residents, and they confirmed there was no documentation of wandering in the medical record. Social Services also confirmed the resident’s behavior was not documented, and an LPN reported the resident wandered around the east unit, got out of the wheelchair, and touched a Hoyer lift, while confirming this was not documented.
Improper Bed Rail Assessment and Consent
Penalty
Summary
The facility failed to complete a proper bed rail assessment for Resident #96, including measurements of the air mattress and obtaining proper consent. Resident #96 was admitted with multiple diagnoses including a right femur fracture, L5 compression fracture, dysphagia, and unspecified dementia, and the care plan identified 1/2 siderail use for repositioning and bed mobility. The record showed an admission bed rail evaluation dated 01/20/26 stating informed consent was obtained, but the Director of Nursing later confirmed the resident had severe cognitive impairment with a BIMS score of 07 and should not have signed consent. On 02/04/26, the resident was found lying up against the right siderail with light bruising to the right side of the neck and guarding with tenderness in the right rib area. The siderails were removed, the physician ordered stat x-rays, and the x-rays completed on 02/05/26 showed age indeterminate right rib fractures. Staff interviews confirmed the resident was unable to describe what happened because of dementia, and the DON confirmed the facility did not complete proper measurements on the air mattress.
Failure to Prevent Sexual Abuse Due to Inadequate Supervision
Penalty
Summary
The facility failed to prevent sexual abuse involving a resident with a history of aphasia, paraplegia, anxiety, and neuromuscular dysfunction, who was cognitively intact and dependent on staff for bed mobility, transfers, and toileting. During a staff member's rounds, another resident with diagnoses including alcohol-induced persisting dementia, stroke, aphasia, schizophrenia, and Wernicke's encephalopathy, and also with intact cognition, was observed in the first resident's room engaging in inappropriate sexual contact. The incident occurred after the second resident, who resided in a locked Memory Support Unit (MSU) and was considered an elopement risk with aggressive behaviors, was allowed to re-enter the facility unsupervised during a smoke break, contrary to the expectation that MSU residents be observed at all times outside the unit. Staff interviews and documentation revealed that the inappropriate contact was witnessed by a CNA, who immediately intervened and separated the residents. The resident who was touched reported being awoken by the incident and stated he did not consent to the contact. The staff member who allowed the second resident to return inside unsupervised assumed she had gone back to the unit after the smoke break, but she instead entered the other resident's room. The facility's policy required residents to be free from abuse and neglect, and staff were expected to supervise MSU residents at all times when outside the unit. The incident was reported to the nursing leadership, and an internal investigation confirmed that the lack of supervision during the smoke break allowed the resident from the MSU to access another resident's room and commit the act of sexual abuse. The failure to maintain required supervision directly led to the opportunity for the abuse to occur, in violation of facility policy and resident rights.
Failure to Supervise Memory Care Resident Leads to Inappropriate Contact
Penalty
Summary
Staff failed to provide adequate supervision for a resident with a history of alcohol dependence, alcohol-induced persisting dementia, stroke, aphasia, schizophrenia, and Wernicke's encephalopathy, who resided in a secure memory care unit due to elopement risk and aggressive behaviors. The resident, who was assessed as having intact cognition and required set-up assistance for daily activities, was allowed to leave a supervised smoke break early and return to the facility unsupervised after reporting feeling cold. Staff permitted the resident to wait alone in the activity room, and when the smoke break concluded, it was assumed the resident had returned to the unit without verification. As a result of this lapse in supervision, the resident entered another resident's room and was observed engaging in inappropriate physical contact with that resident, who requested the behavior stop but was ignored until staff intervened. Multiple staff interviews confirmed that the expectation was for memory care unit residents to be observed at all times when outside the unit, and the failure to do so directly led to the incident.
Delayed Medical Intervention and Improper Incontinent Care
Penalty
Summary
The facility failed to ensure timely medical intervention for a resident who experienced a fall resulting in a fracture. Resident #90, who was moderately cognitively impaired and had a history of falls, fell in her room and complained of pain in her left leg. Despite a physician's order for a stat X-ray, there was a significant delay in obtaining the X-ray, which was not completed until the following day, revealing a fractured femur. The delay in treatment was confirmed by the Director of Nursing, who noted that the X-ray should have been completed within four hours of the order. Additionally, the facility did not provide proper incontinent care for Resident #38, who was severely cognitively impaired and always incontinent for bowel and bladder. During an observation, a CNA was seen improperly performing perineal care by wiping up in the labia area instead of following the correct procedure of wiping from front to back. This improper technique was confirmed by the CNA, who stated he was trained to wipe up in the labia area, contrary to the facility's policy. These deficiencies were identified during a survey, highlighting the facility's failure to provide timely medical care and adhere to proper incontinent care procedures. The deficiencies affected the residents involved and had the potential to impact other residents in the facility.
Failure to Timely Implement Stat X-ray Order
Penalty
Summary
The facility failed to ensure a Stat X-ray was ordered and implemented in a timely manner for Resident #90, who was admitted with multiple fractures of ribs, ulcerative colitis, non-Alzheimer's dementia, anxiety, and depression. The resident was moderately cognitively impaired and required partial/moderate assistance for daily activities. On 01/17/25, a physician ordered a Stat X-ray for the resident's left knee, left femur, left hip, and pelvis. However, there was no evidence that the X-ray company was contacted about the order until 5:50 P.M., and the X-ray was not completed until 01/18/25 at 11:48 A.M., well beyond the four-hour window expected for Stat orders. The Director of Nursing confirmed that the X-ray should have been completed within four hours of the order, but it was not completed until the following day. The facility's policy on Request for Diagnostic Services states that orders for diagnostic services should be carried out as instructed by the physician's order. This deficiency was identified during an investigation under Complaint Number OH 00160894, indicating non-compliance with the facility's policy and the timely provision of necessary diagnostic services.
Infection Control Breach During Incontinence Care
Penalty
Summary
The facility failed to maintain proper infection control during incontinence care for a resident who was severely cognitively impaired and dependent on assistance for toileting. The resident, who had medical diagnoses including diabetes, renal insufficiency, and seizure disorder, was always incontinent for bowel and bladder. During an observation, a Certified Nursing Aide (CNA) provided incontinence care without changing gloves between cleaning the anal area and applying lotion to the resident's skin, which is a breach of infection control protocols. The CNA confirmed during an interview that he did not change gloves before applying lotion and stated he was not instructed to do so. The facility's policy on perineal care, dated 09/01/21, outlines the proper procedure for perineal care, including changing gloves between dirty and clean tasks. This incident highlights a failure to adhere to the facility's infection control policy, potentially affecting the health and safety of residents.
Failure to Follow Physician Orders for Wound Care
Penalty
Summary
The facility failed to adhere to physician orders for wound care dressing for a resident, leading to a deficiency. Resident #85, who was admitted with multiple diagnoses including a fracture of the left lower leg and was at risk for skin breakdown, had a physician's order for ace wraps to remain on the bilateral lower extremities until a follow-up appointment. However, on 08/01/24, a State tested Nursing Assistant (STNA) removed the ace wraps during a shower, contrary to the physician's orders. The Assistant Director of Nursing (ADON) was called to assist in removing xeroform that was stuck to the resident's left ankle, and upon inquiry, it was revealed that the STNA had been told by a nurse that the wraps could be removed for the shower. The ADON clarified that the wraps were to remain in place until the follow-up with the surgeon. This incident was verified during an interview with the ADON, confirming the removal of the ace wraps against physician orders, which was investigated under Complaint Number OH00156618.
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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 Fairborn
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Trinity Community At Fairborn | 1.5 mi | ★★★★★ | 0 | 0 |
| Dayspring Of Miami Valley Hlth Care Center & Rehab | 3 mi | ★★★★★ | 0 | 0 |
| Friends Extended Care Center | 6.1 mi | ★★★★★ | 10 | 0 |
| Beavercreek Post Acute | 6.2 mi | ★★★★★ | 0 | 0 |
| Beavercreek Health And Rehab | 7.5 mi | ★★★★★ | 7 | 0 |
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