813 1/2 Marion Pike, Coal Grove, OH 45638 · Lawrence County · (740) 532-0449
57 certified beds, about 51 residents a day · For profit - Corporation · Medicare and Medicaid since 2000
CMS Care Compare ratings, data as of September 1, 2026 · CCN 366202 · See it on Medicare.gov · Compare with other homes
At its most recent standard inspection, on September 11, 2025, inspectors cited 5 health deficiencies (the Ohio average is 10.5, the national average 9.2).
Of 25 health citations since December 2021, 1 was rated as actual harm or immediate jeopardy to residents (1 immediate jeopardy).
CMS lists 1 fine totaling $159,708 in the last three years; the largest was $159,708, and the latest is dated March 4, 2024.
Nurses and nurse aides worked 3.16 hours per resident per day, against 3.69 across Ohio and 3.86 nationally. Registered nurses accounted for 0.44 of those hours.
48.8% of nursing staff left within the year CMS measured (Ohio average 48.7%).
CMS links it to Hillstone Healthcare, an affiliated group of 9 nursing homes.
Federal rules call for a standard inspection at least every 15 months, plus a visit whenever a complaint is filed. Each mark below is one citation, colored by how serious inspectors rated it. How to read a citation.
Under each citation, the quoted text is the inspector's own summary from the federal statement of deficiencies (CMS form 2567), word for word apart from a privacy scrub; CMS removes residents' and staff names before it publishes the text. The full notes are on Medicare.gov.
CMS rates every citation by how much harm it caused (rows) and how many residents it touched (columns). The count in each box is this home's, across all 25 health citations on file.
Inspectors wroteBased on record review and staff interview the facility failed to ensure comprehensive care plans to address Post Traumatic Stress Disorder (PTSD) and suicidal ideations were initiated. This affected two Residents (#3 and #4) of 18 resident care plans reviewed. The facility census was 53.
Inspectors wroteBased on resident record review and staff interview the facility failed to ensure there were parameters in place for administration of as needed pain medications and non-pharmacological interventions. This affected one resident (#5) of four residents reviewed for pain management. The facility census was 53.
Inspectors wroteBased on medical record review, resident and staff interviews, and review of facility policy, the facility failed to provide an adequate plan of care for post-traumatic stress disorder and ensure staff were knowledgeable in the plan of care. This affected one (Resident #20) of three residents reviewed for mood and behavior. The facility census was 53.
Inspectors wroteBased on resident record review, staff interview and review of facility policy the facility failed to implement pharmacy recommendations. This affected two Residents (#5 and #42) of five residents reviewed for unnecessary medications. The facility census was 53.
Inspectors wroteBased on record reviews and staff interview, the facility failed to ensure vital signs were monitored as ordered prior to the administration of medication. This affected one resident (#2) out of the five residents reviewed for unnecessary medications. The facility census was 53.
Inspectors wroteBased on record review, staff interview, observation, resident interview, and review of facility policy, the facility failed to ensure dependent residents received assistance with incontinence care and eating. This affected three (Residents #23, #47, #53) of 37 facility-identified incontinent residents and affected one (Resident #53) of five facility-identified residents who required physical assistance with meal consumption. The facility census was 52.
Inspectors wroteBased on record review, staff interview, observation, resident interview, and review of facility policy, the facility failed to ensure there were sufficient staff present to provide care and services to residents. This affected three (Residents #23, #47, #53) of 37 facility-identified incontinent residents and affected one (Resident #53) of five facility-identified residents who required physical assistance with meal consumption. The facility census was 52.
Inspectors wroteBased on closed medical record review, review of the hospital records, review of laboratory test requisitions, review of the facility's laboratory contract, staff interviews, and review of the facility policy, the facility failed to ensure timely and appropriate care and services were provided for Resident #60 following a change in condition. This resulted in Immediate Jeopardy and the potential for serious life-threatening injuries, negative health outcome and/or death on [DATE] at 10:29 A.M. when Resident #60 experienced a decline in condition. Nurse Practitioner (NP) #500 was notified of Resident #60's decline and provided new orders to obtain STAT (urgent) laboratory tests. The ordered laboratory tests were never obtained, and neither the physician nor the NP were notified of the laboratory tests not being obtained. [...]
Inspectors wroteBased on interview, record review and facility policy review the facility failed to ensure target behaviors were identified and appropriate indications for use of antipsychotic medications. This affected six residents (#16, #28, #30, #36, #38 and #43) of seven reviewed for unnecessary medications. The facility census was 41.
Inspectors wroteBased on review of the infection/antibiotic stewardship log, interview, and policy review the facility failed to ensure all prescribed antibiotics were appropriate. This had the potential to affect all 41 residents residing in the facility.
Inspectors wroteBased on interview, record review, and review of the facility policy revealed the facility failed to ensure adequate monitoring, screening and offering of pneumonia vaccine. This affected four residents (#28, #29, #30 and #36) of five reviewed for immunizations. The facility census was 41.
Inspectors wroteBased on observation, interview and record review the facility failed to ensure the comprehensive plan of care was developed and implemented based on the residents preferences and needs and the plan of care was not person centered. This affected three residents (#28, #29 and #32) of 12 residents reviewed for plan of care. The facility census was 41.
Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure monitoring of a resident's skin after post surgical intervention. This affected one resident (#32) of the two residents reviewed for skin conditions during the annual survey. The facility census was 41.
Inspectors wroteBased on observations, interviews, record reviews, and review of facility policy, the facility failed to ensure adequate care and services were provided to identify residents at risk for elopement and prevent elopement. This affected two residents (#4 and #43) out of the five residents residents reviewed for accidents during the annual survey. The facility census was 41.
Inspectors wroteBased on observation, interview, record review and facility policy review revealed the facility failed to implement dietary recommendations timely. This affected one resident (#29) of four residents reviewed for nutrition. The facility census was 41.
Inspectors wroteBased on record reviews, interviews, and review of facility policy, the facility failed to ensure pharmacy recommendations were reviewed and implemented timely. Additionally, the facility failed to ensure the policy for pharmacy recommendations addressed actions to be taken for urgent pharmacy recommendations. This affected three residents (#28, #38, and #43) of the five residents reviewed for unnecessary medications during the annual survey. The facility census was 41.
Inspectors wroteBased on record review and staff interview, the facility failed to ensure adequate instructions and indications for the use of topical medications. This affected one resident (#43) out of the five residents reviewed for unnecessary medications during the annual survey. The facility census was 41.
Inspectors wroteBased on record review, facility policy and procedure review and interview the facility failed provide necessary care and services, including dressing changes and antibiotic administration for Resident #41 who had three Stage IV pressure ulcers to promote wound healing. This affected one resident (#41) of two residents reviewed for pressure ulcers. Findings Include: Review of Resident #41's medical record revealed the resident had medical diagnoses including multiple sclerosis (MS), major depressive disorder, panic disorder, quadriplegia, Type II diabetes mellitus without complications, pressure ulcer of unspecified site (Stage IV), and generalized anxiety disorder. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 11/12/21 revealed the resident had intact cognition with a Brief Interview for Mental Status (BIMS) score of 15. [...]
Inspectors wroteBased on observation, record review and interview the facility failed to ensure fall interventions were in place as care planned for Resident #16 who had a history of falls and was assessed to be at risk for falls. This affected one resident (#16) of one resident reviewed for falls. Findings Include: Review of the medical record for Resident #16 revealed an admission date of 04/17/21 with medical diagnoses including unspecified dementia with behavioral disturbance, generalized anxiety disorder, abnormalities of gait and mobility, muscle weakness and Alzheimer's Disease. Review of the plan of care, dated 04/19/21 revealed Resident #16 was at risk for falls. Interventions included bed in lowest position except when providing direct care. [...]
Inspectors wroteBased on record review and staff interview the facility failed to ensure Resident #1, who was identified as having had a significant weight loss, had documented evidence of substitutes being offered when the resident ate less than 50% of her meal as per her plan of care. This affected one resident (#1) of four residents reviewed for nutrition. Findings Include: A review of Resident #1's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses including Alzheimer's disease, schizophrenia, schizo-affective disorder, unspecified psychosis, major depressive disorder and a malignant carcinoid tumor of the bronchus and lung. A review of Resident #1's quarterly Minimum Data Set (MDS) 3.0 assessment, dated 11/09/21 revealed the resident did not have any communication issues and was cognitively intact. No behaviors or rejection of care was noted. [...]
Inspectors wroteBased on observation, record review, review of pharmacy re-order slips, facility policy review and staff interview the facility failed to ensure medications were available from the contracted pharmacy to be administered to residents as ordered by the physician. This affected two residents (#30 and #31) of two residents reviewed for medication administration. Findings Include: 1. A review of Resident #30's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses including bipolar disorder and generalized anxiety disorder. A review of Resident #30's physician's orders revealed the resident was to receive Citalopram Hydrobromide (Celexa) 10 milligrams (mg) by mouth (po) every morning for bipolar disorder. [...]
Inspectors wroteBased on record review, review of pharmacy recommendations, facility policy and procedure review and staff interview the facility failed to implement pharmacy recommendations timely for Resident #3, Resident #23 and Resident #24. This affected three residents (#3, #23 and #24) of five residents reviewed for unnecessary medication use. Findings Include: 1. Review of the medical record for Resident #3 revealed the resident had medical diagnoses including Alzheimer's Disease, Wernicke's encephalopathy, pseudobulbar affect, dementia in other diseases classified elsewhere with behavioral disturbance, anxiety disorder, altered mental status, major depressive disorder, unspecified mood (affective) disorder and alcohol abuse with alcohol-induced psychotic disorder with hallucinations. [...]
Inspectors wroteBased on observation, record review, review of the facility's contingency medication supply list, review of facility meal times, policy review and staff interview the facility failed to maintain a medication error rate of less than five (5) percent (%). The medication error rate was calculated to be 10% and included three medication errors of 30 medication administration opportunities. This affected one resident (#31) of two residents observed for medication administration. Findings Include: A review of Resident #31's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses including gastro-esophageal reflux disease (GERD) and adult onset diabetes mellitus. A review of Resident #31's physician's orders revealed Resident #31 was to receive Humalog insulin subcutaneously (SQ) before meals (AC) and at bedtime (HS) per sliding scale. [...]
Inspectors wroteBased on record review, review of the facility's menu, meal ticket review and staff interview the facility failed to ensure a resident received the appropriate diet in the form that was required by the resident and ordered by the physician. This affected one (Resident #1) of four residents reviewed for nutrition.
Inspectors wroteBased on record review and interview the facility failed to ensure the daily staffing posted information included hours worked for Registered Nurses (RN), Licensed Practical Nurses (LPN) and State Tested Nursing Assistants (STNA) and the number of RNs working. In addition, the staffing information sheets contained extraneous information that made the posting unclear and hard to understand. This had the potential to affect all 43 residents residing in the facility. Findings Include: Review of the Direct Care Staffing Sheets revealed from 11/16/21 to 11/30/21 there were 12 times when the number of Registered Nurses working only had a checkmark placed in the staffing column area instead of the actual number. The Direct Care Staffing Sheets did not show the actual number of hours worked for RNs, LPNs or STNAs for each date reviewed. [...]
8 fire safety citations on file: 4 on September 11, 2025, 1 on October 19, 2023, 3 on December 7, 2021.
| Date | Penalty | Amount or length |
|---|---|---|
| March 4, 2024 | Fine | $159,708 |
| March 4, 2024 | Payment Denial | 18 days from March 29, 2024 |
A payment denial means Medicare and Medicaid stopped paying for new admissions for that period.
Hours of care per resident per day, from the payroll records every home sends CMS. Higher means more staff time with each resident.
| Measure | This home | Ohio | United States |
|---|---|---|---|
| All nursing staff (RN, LPN and aides) | 3.16 | 3.69 | 3.86 |
| Registered nurses | 0.44 | 0.64 | 0.69 |
| All nursing staff on weekends | 2.87 | 3.28 | 3.42 |
| Nurse aides | 1.87 | ||
| Licensed practical nurses | 0.85 | ||
| Nursing staff turnover (share who left in a year) | 48.8% | 48.7% | 45.8% |
| Registered nurse turnover | not reported | 43.9% | 42.9% |
| Administrators who left | 0 |
CMS expects 4.09 hours a day for residents as sick as this home's (its case-mix figure). The staffing star compares the two.
Every nursing home sends CMS its staff hours for each day (the Payroll Based Journal). Here they are added up by quarter. The latest quarter is the one behind the figures above. In January to March 2026, nursing staff hours per resident were 3.27 on weekdays and 2.87 on weekends, 12% lower on weekends (nationally, weekends ran 15% lower). Contract or agency staff worked 0.0% of nursing hours, against 5.3% nationally. Total nursing hours per resident went from 3.22 in April to June 2025 to 3.16 in January to March 2026.
| Quarter | All nursing staff | Registered nurses | Weekdays | Weekends | Contract staff share | Days with no RN hours | Residents a day |
|---|---|---|---|---|---|---|---|
| Jan to Mar 2026 | 3.16 | 0.44 | 3.27 | 2.87 | 0.0% | 1 of 90 | 51 |
| Oct to Dec 2025 | 3.25 | 0.50 | 3.37 | 2.95 | 0.0% | 3 of 92 | 51 |
| Jul to Sep 2025 | 3.11 | 0.47 | 3.21 | 2.86 | 0.0% | 0 of 92 | 52 |
| Apr to Jun 2025 | 3.22 | 0.45 | 3.38 | 2.83 | 0.0% | 0 of 91 | 53 |
| United States, Jan to Mar 2026 | 3.75 | 0.62 | 3.92 | 3.33 | 5.3% | 0.5% of days | |
| Ohio, Jan to Mar 2026 | 3.64 | 0.60 | 3.80 | 3.24 | 4.6% | 0.4% of days |
Hours per resident per day: staff hours in the quarter divided by resident days (the daily census CMS derives from resident assessments). Registered nurses include the director of nursing and RNs with administrative duties; aides include nurse aides in training and medication aides, as in CMS's own staffing measure. How these are calculated.
Staff pay reports
No staff pay figure for this home has passed review yet. A figure appears only after at least 5 reports from at least 3 different people, sent over at least 60 days, have passed review.
| Job | Median | Middle half | Employed |
|---|---|---|---|
| Ohio, all employers | |||
| CNAs (nursing assistants) | $18.76 | $17.93 to $21.44 | 63,280 |
| LPNs and LVNs | $29.78 | $27.34 to $31.68 | 39,900 |
| Registered nurses | $39.67 | $38.08 to $47.61 | 143,730 |
| United States, nursing care facilities | |||
| CNAs (nursing assistants) | $20.67 | $17.91 to $22.55 | 534,270 |
| LPNs and LVNs | $33.86 | $30.05 to $37.40 | 188,210 |
| Registered nurses | $41.11 | $37.85 to $47.68 | 142,270 |
Hourly wages; the middle half runs from the 25th to the 75th percentile. Source: U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics, May 2025. BLS has no separate estimate for medication aides. These are survey estimates for whole occupations, not figures for any one home.
The measures CMS uses for the quality star. Lower is better for every one of them.
| Measure | This home | Ohio | US |
|---|---|---|---|
| Percentage of long-stay residents whose need for help with daily activities has increased Long Stay residents, 2025Q2-2026Q1 | 8.4 | 5.3 | 13.9 |
| Percentage of long-stay residents with a catheter inserted and left in their bladder Long Stay residents, 2025Q2-2026Q1 | 0.0 | 0.2 | 0.8 |
| Percentage of long-stay residents with a urinary tract infection Long Stay residents, 2025Q2-2026Q1 | 0.0 | 0.5 | 1.6 |
| Percentage of long-stay residents experiencing one or more falls with major injury Long Stay residents, 2025Q2-2026Q1 | 2.0 | 3.2 | 3.2 |
| Percentage of short-stay residents who newly received an antipsychotic medication Short Stay residents, 2025Q2-2026Q1 | 0.0 | 1.2 | 1.6 |
| Percentage of long-stay residents whose ability to walk independently worsened Long Stay residents, 2025Q2-2026Q1 | 4.7 | 6.1 | 14.1 |
| Percentage of long-stay residents with pressure ulcers Long Stay residents, 2025Q2-2026Q1 | 2.1 | 3.4 | 4.6 |
| Percentage of long-stay residents who received an antipsychotic medication Long Stay residents, 2025Q2-2026Q1 | 6.3 | 8.8 | 15.4 |
| Number of hospitalizations per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 1.1 | 1.7 | 1.9 |
| Number of outpatient emergency department visits per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 1.2 | 1.8 | 1.8 |
For a stay to recover after a hospital visit, these are the results CMS publishes for Crystal Care of Coal Grove's Medicare short-stay residents. How to read these, and what Medicare pays for.
Not reported
CMS note: The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
US median of homes 51.5% · Ohio: 147 better, 20 worse
Rate of successful return to home or community from a SNF (risk-standardized discharge to community rate). Higher is better. October 2022 to September 2024. 14 eligible stays.
12.0% this home
No different from the national rate
US median of homes 10.7% · Ohio: 3 better, 7 worse
Rate of potentially preventable hospital readmissions 30 days after discharge from a SNF (risk-standardized rate). Lower is better. October 2022 to September 2024. 32 eligible stays.
Not reported
CMS note: The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
US median of homes 7.1% · Ohio: 1 better, 4 worse
Percentage of infections residents got during their SNF stay that resulted in hospitalization (risk-standardized rate). Lower is better. October 2023 to September 2024. 14 eligible stays.
Not reported
CMS note: The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
Median of homes: Ohio55.6% · US 56.6%
Percentage of residents who are at or above an expected ability to care for themselves and move around at discharge. Higher is better. October 2024 to September 2025. 15 residents counted.
Not reported
CMS note: The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
Median of homes: Ohio0.0% · US 0.0%
Percentage of SNF residents who experience one or more falls with major injury during their SNF stay. Lower is better. October 2024 to September 2025. 16 residents counted.
Not reported
CMS note: The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
Median of homes: Ohio1.4% · US 1.7%
Percentage of residents with pressure ulcers or pressure injuries that are new or worsened (adjusted rate). Lower is better. October 2024 to September 2025. 16 residents counted.
Not reported
CMS note: The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
Median of homes: Ohio100.0% · US 98.7%
Percentage of residents where the SNF provided a current medication list to the resident, family, and/or caregiver at final discharge. Higher is better. October 2024 to September 2025. 2 residents counted.
Source: CMS Skilled Nursing Facility Quality Reporting Program - Provider Data, released 2026-09-30. Better, no different and worse are CMS's own comparisons with the national rate, after adjusting for how sick residents were. Medians of homes and the state counts are worked out by us from the same file.
Legal business name: CRYSTAL CARE OF IRONTON, LLC. CMS links this home to Hillstone Healthcare, a group of 9 nursing homes averaging 4 stars overall.
| Name | Role | Type | Share | Since |
|---|---|---|---|---|
| Detty, Peter | W-2 managing employee | Individual | 03/01/2016 | |
| Ramsey, Tara | W-2 managing employee | Individual | 02/16/2023 | |
| Bergsten, Paul | Corporate officer | Individual | 02/01/2016 | |
| Dapore, Matthew | Corporate officer | Individual | 02/01/2016 | |
| Bergsten, Paul | Operational/managerial control | Individual | 02/01/2016 | |
| Dapore, Matthew | Operational/managerial control | Individual | 02/01/2016 |
As listed in the CMS ownership file, which names owners with a 5% or greater stake and the people and companies with operational or managerial control.
Chosen from this home's own inspection record.
These are the official offices in Ohio. NursingHomeClear cannot take or act on complaints.