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The Laurels of Gahanna

5151 North Hamilton Road, Columbus, OH 43230 · Franklin County · (614) 337-1066

112 certified beds, about 103 residents a day · For profit - Corporation · Medicare and Medicaid since 2017

Last standard inspection more than 2 years ago Certified for Medicaid Certified for Medicare
Overall
2 of 5
Health inspections
1 of 5
Staffing
4 of 5
Quality measures
5 of 5

CMS Care Compare ratings, data as of September 1, 2026 · CCN 366457 · See it on Medicare.gov · Compare with other homes

The record in brief

At its most recent standard inspection, on June 3, 2024, inspectors cited 9 health deficiencies (the Ohio average is 10.5, the national average 9.2).

Of 84 health citations since January 2020, 7 were rated as actual harm or immediate jeopardy to residents.

CMS lists 3 fines totaling $394,237 in the last three years; the largest was $229,620, and the latest is dated January 15, 2026.

Nurses and nurse aides worked 3.93 hours per resident per day, against 3.69 across Ohio and 3.86 nationally. Registered nurses accounted for 0.99 of those hours.

52.0% of nursing staff left within the year CMS measured (Ohio average 48.7%).

CMS links it to Ciena Healthcare/Laurel Health Care, an affiliated group of 81 nursing homes.

Health inspections

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.

Potential for minimal harm Potential for more than minimal harm Actual harm Immediate jeopardy Found on a complaint visit

Where its citations fall on CMS's grid

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 84 health citations on file.

Severity
Isolated
Pattern
Widespread
Immediate jeopardy
0J
0K
0L
Actual harm
7G
0H
0I
Potential for more than minimal harm
56D
14E
5F
Potential for minimal harm
0A
0B
2C
June 22, 2026Complaint inspection · 2 citations
  1. D
    Develop and implement policies and procedures to prevent abuse, neglect, and theft.
    F607 · Freedom from Abuse, Neglect, and Exploitation · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) July 8, 2026
    Inspectors wroteBased on medical record review, staff interview, facility policy review, and Elder Abuse Act regulation review, the facility failed to report allegations of misappropriation to law enforcement in a timely manner. This affected two (Residents #85 and #101) of three resident investigations reviewed. The census was 98. Findings Include:1. Resident #85 was admitted to the facility on [DATE]. Her diagnoses were urinary tract infection, klebsiella pneumoniae, bacteremia, muscle wasting, muscle weakness, hypertensive heart and chronic kidney disease, congestive heart failure, sciatica, atherosclerotic heart disease, chronic kidney disease, polyneuropathy, hyperlipidemia, vitamin D deficiency, major depressive disorder, insomnia, arthritis, anemia, polyarthritis, and retention of urine. Review of her minimum data set (MDS) assessment, dated 05/20/26, revealed she was cognitively intact. [...]
  2. D
    Respond appropriately to all alleged violations.
    F610 · Freedom from Abuse, Neglect, and Exploitation · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) July 8, 2026
    Inspectors wroteBased on medical record review, facility investigative document review, staff interview and facility policy review, the facility failed to complete a thorough investigation regarding an allegation of misappropriation. This affected one (Resident #101) of three residents reviewed for misappropriation allegations. The census was 98. Findings Include:Resident #101 was admitted to the facility on [DATE]. His diagnoses were pleural effusion, congestive heart failure, acute and chronic respiratory failure, muscle weakness, lack of coordination, cognitive communication deficit, atherosclerotic heart disease, atrioventricular block, chronic kidney disease, atrial fibrillation, chronic obstructive pulmonary disease, hypertensive heart and chronic kidney disease, Type II Diabetes, major depressive disorder, hyperlipidemia, ischemic cardiomyopathy, and dependence on supplemental oxygen. [...]
April 15, 2026Complaint inspection · 2 citations
  1. D
    Give the resident's representative the ability to exercise the resident's rights.
    F551 · Resident Rights · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) May 4, 2026
    Inspectors wroteBased on record review, staff interview, resident and power of attorney (POA) interview, contractor interview, review of POA document, and facility contract review, the facility failed to ensure the decisions of the resident representative (POA) were given the same consideration as if the resident made the decision themselves. This affected one (Resident #95) of three residents reviewed for resident representative involvement in facility appointed contracted services. The facility census was 95.
  2. D
    Keep residents' personal and medical records private and confidential.
    F583 · Resident Rights · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) May 4, 2026
    Inspectors wroteBased on record review, resident and Power of Attorney (POA) interview, staff interview, contractor interview, admission documentation review, contractor documents, and facility policy review, the facility failed to ensure a resident had the right to personal privacy and confidentiality of his or her personal and medical records. This affected one (Resident #95) of three residents reviewed for HIPAA. The facility census was 95.
January 15, 2026Complaint inspection · 4 citations
  1. G
    Provide appropriate treatment and care according to orders, resident’s preferences and goals.
    F684 · Quality of Life and Care · Actual harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) March 4, 2026
    Inspectors wroteBased on record review, resident, family, and staff interviews, and policy review, the facility failed to implement an individualized skin program to ensure necessary care and services were provided to timely identify the resident's skin breakdown, including diabetic ulcers and failed to provide necessary and care services to a resident who was not to receive food by mouth due to an esophageal repair. In addition, the facility failed to provide timely care and services to a resident's chest tube drain. Actual harm occurred to Resident #37, who had a history of amputation, required substantial/maximal assistance with lower body dressing, and had a diagnosis of diabetic polyneuropathy when the facility failed to identify four arterial wounds the hospital had identified prior to admission. [...]
  2. G
    Provide appropriate pressure ulcer care and prevent new ulcers from developing.
    F686 · Quality of Life and Care · Actual harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) March 4, 2026
    Inspectors wroteBased on observations, record review, resident and staff interviews, review of the guidelines from the National Pressure Ulcer Advisory Panel (NPUAP), and policy review, the facility failed to accurately assess and provide timely interventions to prevent the development of pressure ulcers or healing of existing pressure ulcers; and failed to timely identify the resident's pressure ulcers until it reached an advanced stage. This resulted in Actual Harm to Residents #37 and #117 who were at risk for pressure ulcers and dependent on staff for toileting. Resident #37 developed three unstageable pressure ulcers (Slough and/or eschar: known but not stageable due to coverage of wound bed by slough and/or eschar). Resident #117 developed one pressure ulcer as a stage III pressure ulcer (Full thickness tissue loss. Subcutaneous fat may be visible, but bone, tendon or muscle is not exposed). [...]
  3. E
    Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
    F657 · Resident Assessment and Care Planning · No actual harm, potential for more than minimal harm, pattern · found on a complaint visit · Corrected (the home has a date of correction) March 4, 2026
    Inspectors wroteBased on medical record reviews, resident and staff interviews, and review of facility policy, the facility failed to conduct admission and quarterly care conferences in a timely manner. This affected five (Residents #8, #34, #45, #48, and #75) of five residents reviewed for care planning. The facility census was 111 residents.
  4. D
    Provide care and assistance to perform activities of daily living for any resident who is unable.
    F677 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) March 4, 2026
    Inspectors wroteBased on medical record review, observations, resident representative and staff interviews and review of facility policy, the facility failed to provide a resident who was dependent on staff assistance with personal hygiene received adequate and timely assistance with nail care. This affected one (Resident #75) of three residents reviewed for activities of daily living (ADL). The facility census was 111 residents.
August 20, 2025Complaint inspection · 21 citations
  1. E
    Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
    F584 · Resident Rights · No actual harm, potential for more than minimal harm, pattern · found on a complaint visit · Corrected (the home has a date of correction) September 26, 2025
    Inspectors wroteBased on observation, interview, medical record review, and review of facility policy, the facility failed to ensure resident rooms were maintained in a clean and sanitary manner. This affected four residents (#10, #11, #12, #67) of 107 residents. The facility census was 107.
  2. E
    Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
    F656 · Resident Assessment and Care Planning · No actual harm, potential for more than minimal harm, pattern · found on a complaint visit · Corrected (the home has a date of correction) September 26, 2025
    Inspectors wroteBased on observation, interview, medical record review, and review of facility policy, the facility failed to develop a detailed and comprehensive care plan for Resident #19, #26, #27, #34, #79, and #108. This affected six residents (#19, #26, #27, #34, #79, and #108) of 19 resident records reviewed. The facility census was 107.
  3. E
    Provide appropriate treatment and care according to orders, resident’s preferences and goals.
    F684 · Quality of Life and Care · No actual harm, potential for more than minimal harm, pattern · found on a complaint visit · Corrected (the home has a date of correction) September 26, 2025
    Inspectors wroteBased on observation, open and closed medical record review, interviews, hospital summary review and facility policy review, the facility failed to provide medical treatment with a change in condition, monitor, assess and ensure treatment was provided for skin conditions for one resident (#108). Additionally, the facility failed to report concerns with a transfer and monitor a bruise for Resident #109 who was on an anticoagulant (a medication that thins the blood) therapy. The facility also failed to monitor and assess a skin tear and bruise for Resident #106. Further review revealed the facility failed to ensure hospice information was available for review for Resident #79. This affected three residents ( #106,#108 and #109) of three residents reviewed for skin conditions and one resident (#79) of one resident reviewed for hospice. The facility census was 107. Findings Include:1. [...]
  4. E
    Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
    F690 · Quality of Life and Care · No actual harm, potential for more than minimal harm, pattern · found on a complaint visit · Corrected (the home has a date of correction) September 26, 2025
    Inspectors wroteBased on open and closed record review and interviews, the facility failed to ensure bowel and bladder tracking to reflect an accurate reflection of the resident's bowel and bladder function. This affected three residents (#19, #59 and #108) of three residents reviewed for decline in bowel and bladder function. Additionally, the facility failed to timely assess and treat a urinary tract infection (UTI) for Resident #38. This affected one resident (#38) of three residents reviewed for UTI's. The facility census was 107. Findings Include:1. [...]
  5. E
    Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician.
    F801 · Nutrition and Dietary · No actual harm, potential for more than minimal harm, pattern · found on a complaint visit · Corrected (the home has a date of correction) September 26, 2025
    Inspectors wroteBased on observation, interview, and review of dishwasher sanitation logs, the facility failed to ensure the dietary manager was competent to ensure the kitchen was maintained in a clean and sanitary manner. This had the potential to affect 104 of 107 residents who consumed food from the kitchen the facility identified three residents (#2, #84, and #92) who ate nothing by mouth. The facility census was 107.
  6. E
    Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service.
    F802 · Nutrition and Dietary · No actual harm, potential for more than minimal harm, pattern · found on a complaint visit · Corrected (the home has a date of correction) September 26, 2025
    Inspectors wroteBased on observation, interview, review of kitchen staffing schedule, review of dishwasher sanitation log,and review of staff personnel file revealed the facility failed to employ sufficient staff to maintain a clean kitchen. Additionally, they failed to ensure staff were competent to ensure the dishwasher was running appropriately and qualified to be a cook. This had the potential to affect 104 residents who consumed food from the kitchen. The facility identified three residents (#2, #84, and #92) who ate nothing by mouth. The facility census was 107.
  7. E
    Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
    F804 · Nutrition and Dietary · No actual harm, potential for more than minimal harm, pattern · found on a complaint visit · Corrected (the home has a date of correction) September 26, 2025
    Inspectors wroteBased on observation and interview the facility failed to ensure food was served at a palatable temperature. This had the potential to affect 104 residents who consumed food from the kitchen the facility identified three residents (#2, #84, and #92) who ate nothing by mouth.
  8. E
    Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
    F812 · Nutrition and Dietary · No actual harm, potential for more than minimal harm, pattern · found on a complaint visit · Corrected (the home has a date of correction) September 26, 2025
    Inspectors wroteBased on observation, interview, review of dishwasher manual, review of sanitation instructions, and facility policy review, the facility failed to maintain a clean and sanitary kitchen and sanitize dishes in an appropriate manner. This had the potential to affect 104 residents who consumed food from the kitchen. The facility identified three residents (#2, #84, and #92) who ate nothing by mouth. The facility census was 107.
  9. E
    Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
    F921 · Environmental · No actual harm, potential for more than minimal harm, pattern · found on a complaint visit · Corrected (the home has a date of correction) September 26, 2025
    Inspectors wroteBased on observation, interview, record review, and review of facility policy, the facility failed to ensure kitchen equipment was in working order and a system was in place to track maintenance requests. This had the potential to affect 104 residents who consumed food from the kitchen the facility identified three residents (#2, #84, and #92) who ate nothing by mouth. The facility also failed to ensure a safe and clean environment when 35 resident rooms had missing transition strips from residents to hallways. This affected 48 residents (#1, #3, #4, #6, #7, #10, #11, #12, #13, #19, #20, #26, #27, #31, #33, #36, #39, #42, #43, #44, #45, #46, #47, #53, #54, #55, #56, #57, #58, #77, #78, #85, #88, #89, #90, #91, #93, #95, #96, #97, #98, #99, #100, #103, #104, #105, #106, and #107) of 107 residents residing in the facility.
  10. D
    Reasonably accommodate the needs and preferences of each resident.
    F558 · Resident Rights · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) September 26, 2025
    Inspectors wroteBased on observation, record review, interview and facility policy review, the facility failed to ensure call lights were accessible for use. This affected two residents (#32 and #79) of 14 sampled residents. The facility census was 107. Findings Include:1. Review of the medical record for Resident #79 revealed an initial admission date of 12/17/20 with the diagnoses including but not limited to multiple sclerosis, diabetes mellitus, vitamin D deficiency, anxiety disorder, encounter for palliative care, opioid use, pain, cerebellar ataxia, history of falling, severe protein malnutrition, hypertension, chronic pain syndrome and adult failure to thrive. Review of the resident's comprehensive Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had a severe cognitive deficit. [...]
  11. D
    Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
    F580 · Resident Rights · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) September 26, 2025
    Inspectors wroteBased on medical record review, interview and facility policy review, the facility failed to notify the physician and the resident's family of a new skin impairment. This affected one resident (#79) of three residents reviewed for pressure ulcers. The facility census was 107. Findings Include:Review of the medical record for Resident #79 revealed an initial admission date of 12/17/20 with the diagnoses including but not limited to multiple sclerosis, diabetes mellitus, vitamin D deficiency, anxiety disorder, encounter for palliative care, opioid use, pain, cerebellar ataxia, history of falling, severe protein malnutrition, hypertension, chronic pain syndrome and adult failure to thrive. Review of the resident's comprehensive Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had a severe cognitive deficit. [...]
  12. D
    Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
    F600 · Freedom from Abuse, Neglect, and Exploitation · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) September 26, 2025
    Inspectors wroteBased on interview, medical record review, review of facility investigation and self-reported incidents (SRI), and facility policy review, the facility failed to ensure Resident #112 was free from verbal abuse. This affected one resident (#112) of one resident reviewed for verbal abuse. The facility also failed to prevent an injury of unknown origin for Resident #79. This affected one resident (#79) of three residents reviewed for injuries. The facility census was 107.
  13. D
    Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
    F609 · Freedom from Abuse, Neglect, and Exploitation · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) September 26, 2025
    Inspectors wroteBased on medical record review, interview and facility policy review, the facility failed to ensure an injury of unknown origin was reported to the required state agency. This affected one resident (#79) of three residents reviewed for pressure ulcers. The facility census was 107. Findings Include:Review of the medical record for Resident #79 revealed an initial admission date of 12/17/20 with the diagnoses including but not limited to multiple sclerosis, diabetes mellitus, vitamin D deficiency, anxiety disorder, encounter for palliative care, opioid use, pain, cerebellar ataxia, history of falling, severe protein malnutrition, hypertension, chronic pain syndrome and adult failure to thrive. Review of the resident's comprehensive Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had a severe cognitive deficit. [...]
  14. D
    Respond appropriately to all alleged violations.
    F610 · Freedom from Abuse, Neglect, and Exploitation · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) September 26, 2025
    Inspectors wroteBased on medical record review, interview and facility policy review, the facility failed to ensure an injury of unknown origin was investigated. This affected one resident (#79) of three residents reviewed for pressure ulcers. The facility census was 107. Findings Include:Review of the medical record for Resident #79 revealed an initial admission date of 12/17/20 with the diagnoses including but not limited to multiple sclerosis, diabetes mellitus, vitamin D deficiency, anxiety disorder, encounter for palliative care, opioid use, pain, cerebellar ataxia, history of falling, severe protein malnutrition, hypertension, chronic pain syndrome and adult failure to thrive. Review of the resident's comprehensive Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had a severe cognitive deficit. [...]
  15. D
    Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
    F628 · Resident Rights · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) September 26, 2025
    Inspectors wroteBased on interview, record review, and review of facility policy, the facility failed to appropriately document a transfer and discharge and provide a transfer notice for Resident #108 and #109. This affected two residents (#108 and #109) of five discharge records reviewed. The facility census was 107.
  16. D
    Ensure each resident receives an accurate assessment.
    F641 · Resident Assessment and Care Planning · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) September 26, 2025
    Inspectors wroteBased on medical record review and interview, the facility failed to ensure Minimum Data Set (MDS) 3.0 assessments were completed accurately for Resident #108 and Resident #109. This affected two residents (#108 and #109) of 19 medical records reviewed. The facility census was 107.
  17. D
    Provide appropriate pressure ulcer care and prevent new ulcers from developing.
    F686 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) September 26, 2025
    Inspectors wroteBased on observations, open and closed medical record review, interviews and facility policy review, the facility failed to ensure timely accurate comprehensive assessment of pressure ulcers/injury. Additionally, the facility failed to ensure skin interventions were implemented as physician ordered. This affected three residents (#32, #79 and #108) of three residents reviewed for pressure ulcers. The facility census was 107. Findings Include:1. [...]
  18. D
    Provide safe and appropriate respiratory care for a resident when needed.
    F695 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) September 26, 2025
    Inspectors wroteBased on interview, medical record review, the facility failed to have orders in place for continuous oxygen use for Resident #26. This affected one resident (#26) of three residents reviewed for oxygen use. The facility census was 107.
  19. D
    Provide safe, appropriate pain management for a resident who requires such services.
    F697 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) September 26, 2025
    Inspectors wroteBased on medical record review, interview, and policy review, the facility failed to assess Resident #26's pain, document location of pain with administration of 'as needed' pain medications, and administering pain medications according to orders. This affected one resident (#26) of three residents reviewed for pain. The facility census was 107.
  20. D
    Provide safe, appropriate dialysis care/services for a resident who requires such services.
    F698 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) September 26, 2025
    Inspectors wroteBased on interview and medical record review, the facility failed to educate Resident #108 upon refusal of dialysis and notify Resident #102's family of his refusal to attend dialysis. This affected two residents (#102 and #108) of three residents reviewed for dialysis. The facility census was 107.
  21. D
    Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
    F755 · Pharmacy Service · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) September 26, 2025
    Inspectors wroteBased on closed record review, interview and facility policy review, the facility failed to ensure medication was available for administration as physician ordered. This affected one resident (#108) of three residents reviewed for medication availability. The facility census was 107. [...]
January 7, 2025Complaint inspection · 1 citation
  1. D
    Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
    F689 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) January 9, 2025
    Inspectors wroteBased on medical record review, observations, resident and staff interview, and review of the facility policy, the facility failed to provide a care planned fall intervention for Resident #63. This affected one resident (#63) out of four residents reviewed for accidents. The facility census was 102 residents.
October 22, 2024Complaint inspection · 1 citation
  1. D
    Respond appropriately to all alleged violations.
    F610 · Freedom from Abuse, Neglect, and Exploitation · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) October 24, 2024
    Inspectors wroteBased on closed medical record review, review of the facility investigation, resident and staff interviews, and facility policy review, the facility failed to conduct a thorough investigation of an allegation of sexual abuse reported by one resident (Resident #105). This affected one resident (#105) of three residents reviewed for abuse. The facility census was 105. Findings Include: Review of the closed medical record for Resident #105 revealed the resident was admitted on [DATE], a readmission date on 06/20/24, and a discharge date on 10/11/24. Medical diagnoses included end stage renal disease, bipolar disorder, schizophrenia, dependence on renal dialysis, chronic obstructive pulmonary disease (COPD), and cognitive communication deficit. Review of Resident #105's census revealed she was admitted to a semi-private room. [...]
September 30, 2024Complaint inspection · 7 citations
  1. G
    Provide safe, appropriate dialysis care/services for a resident who requires such services.
    F698 · Quality of Life and Care · Actual harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) October 24, 2024
    Inspectors wroteBased on closed record review, interview, and policy review the facility failed to ensure Resident #100, a newly admitted resident received hemodialysis services timely and as recommended by the hospital at the time of the resident's hospital discharge and failed to ensure timely and ongoing monitoring of the resident's hemodialysis access site for patency and/or signs of infection. This affected one resident (#100) of three residents reviewed for dialysis services. The facility census was 96. Actual harm occurred on 08/14/24 when the facility failed to ensure Resident #100 received hemodialysis treatments as ordered (between 08/10/24 and 08/14/24) resulting in an acute change in the resident's condition, including a swollen abdomen, generalized edema throughout the resident's body and presence of excessive fluid requiring transfer to the hospital for hemodialysis. [...]
  2. D
    Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
    F550 · Resident Rights · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) October 24, 2024
    Inspectors wroteBased on record review, review of a facility abuse investigation, staff and resident interviews, and facility policy review, the facility failed to ensure one resident (Resident #26) was treated with dignity and respect. The deficient practice affected one resident (Resident #26) of three reviewed for dignity. The facility census was 96. Findings Include: Review of the medical record for Resident #26 revealed an admission date on 04/04/18. Medical diagnoses included paraplegia, chronic pain syndrome, need for assistance with personal care, and atherosclerotic heart disease of native coronary artery without chest pain. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #26 had intact cognition and scored 15 out of 15 on the Brief Interview for Mental Status (BIMS) assessment. [...]
  3. D
    Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
    F609 · Freedom from Abuse, Neglect, and Exploitation · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) October 24, 2024
    Inspectors wroteBased on record review, review of a facility abuse investigation, resident and staff interviews, and facility policy review, the facility failed to report former Licensed Practical Nurse (LPN) #115 to the state Nursing Board for an inappropriate relationship with one resident (Resident #26). The deficient practice affected one resident (Resident #26) of three reviewed for abuse. The facility census was 96. Findings Include: Review of the medical record for Resident #26 revealed an admission date on 04/04/18. Medical diagnoses included paraplegia, chronic pain syndrome, need for assistance with personal care, and atherosclerotic heart disease of native coronary artery without chest pain. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #26 had intact cognition and scored 15 out of 15 on the Brief Interview for Mental Status (BIMS) assessment. [...]
  4. D
    Respond appropriately to all alleged violations.
    F610 · Freedom from Abuse, Neglect, and Exploitation · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) October 24, 2024
    Inspectors wroteBased on record review, review of a facility abuse investigation, resident and staff interviews, and facility policy review, the facility failed to complete a thorough investigation of an inappropriate relationship between former Licensed Practical Nurse (LPN) # 115 and one resident (Resident #26). The deficient practice affected one resident (Resident #26) of three reviewed for abuse. The facility census was 96. Findings Include: Review of the medical record for Resident #26 revealed an admission date on 04/04/18. Medical diagnoses included paraplegia, chronic pain syndrome, need for assistance with personal care, and atherosclerotic heart disease of native coronary artery without chest pain. [...]
  5. D
    Provide care and assistance to perform activities of daily living for any resident who is unable.
    F677 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) October 24, 2024
    Inspectors wroteBased on record review, review of shower documentation, review of the shower schedule, resident and staff interviews, and facility policy review, the facility failed to ensure showers were completed as scheduled and per resident preference for two residents (Residents #69 and #79). The deficient practice affected two residents (Residents #69 and #79) of three residents reviewed for showers. The facility census was 96. Findings Include: Review of the medical record for Resident #69 revealed an admission date 10/29/20. Medical diagnoses included cerebral infarction (stroke), multiple sclerosis, and muscle weakness. Review of the annual Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #69 had intact cognition and scored 14 out of 15 on the Brief Interview for Mental Status (BIMS) assessment. Resident #69 required substantial/maximal assistance with bathing or showering. [...]
  6. D
    Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
    F755 · Pharmacy Service · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) October 24, 2024
    Inspectors wroteBased on record review, interview, and policy review the facility failed to administer all medications to Resident #100 the evening of admission. This affected one (Resident #100) out of three residents reviewed for medication administration upon admission. Facility census was 98.
  7. D
    Ensure that residents are free from significant medication errors.
    F760 · Pharmacy Service · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) October 24, 2024
    Inspectors wroteBased on interview and record review the facility failed to ensure residents were free from significant medications errors. This affected one (Resident #100) out of three residents reviewed for insulin administration. The facility census was 96.
July 11, 2024Complaint inspection · 1 citation
  1. D
    Ensure that residents are free from significant medication errors.
    F760 · Pharmacy Service · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) July 27, 2024
    Inspectors wroteBased on observation, record review, policy review, review of manufacturer instructions, review of Medscape guidance on intermittent insulin injections, and pharmacy and staff interviews, the facility failed to prime an insulin pen per manufacturer instructions prior to administration, resulting in a significant medication error. This affected one (Resident #75) of one resident observed for insulin administration. The facility identified 19 residents who receive insulin. The facility census was 98.
June 3, 2024Standard inspection, Complaint inspection · 9 citations
  1. G
    Provide appropriate treatment and care according to orders, resident’s preferences and goals.
    F684 · Quality of Life and Care · Actual harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) July 11, 2024
    Inspectors wroteBased on medical record review, review of hospital medical records, observations, resident and staff interviews, and facility policy review, the facility failed to provide timely treatment and care in response to resident's change in condition resulting in hospitalizations. This resulted in actual harm for Resident #37, who was admitted to the facility on [DATE], was sent to the hospital from an outside appointment on 07/18/23 due to abdominal distention and a concern for a bowel obstruction related to multiple days of having no bowel movements and no treatment. Resident #37 received a computed topography (CT) scan of her abdomen in the emergency department which revealed a bowel obstruction. A gastrointestinal (GI) consult was completed, and Resident #37 received surgery for a loop colostomy to be placed. [...]
  2. F
    Dispose of garbage and refuse properly.
    F814 · Nutrition and Dietary · No actual harm, potential for more than minimal harm, widespread · Corrected (the home has a date of correction) July 11, 2024
    Inspectors wroteBased on observations and staff interview, the facility failed to ensure garbage and refuse is disposed of properly. This had the potential to affect all 101 residents residing in the facility. The census was 101.
  3. E
    Provide and implement an infection prevention and control program.
    F880 · Infection Control · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) July 11, 2024
    Inspectors wroteBased on record review, observations, staff interviews, and policy review, the facility failed to follow infection control protocols during glucose testing for Resident #35. This affected one (#35) out of three residents observed for glucometer checks and had the potential to affect 10 (#15, #24, #33, #35, #77, #38, #71, #69, #35 and #7) residents that receive blood glucose monitoring (BGM) using a shared glucometer. Additionally, the facility failed to ensure infection control practices were followed during catheter care for Resident #85. This affected one (#85) of one resident observed for catheter care. The facility census was 101.
  4. D
    Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
    F656 · Resident Assessment and Care Planning · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) July 11, 2024
    Inspectors wroteBased on record review, review of care plan, and staff interviews, the facility failed to properly develop comprehensive care plans. This affected two residents (#33 and #6) of two residents reviewed for care plans. The facility census was 101.
  5. D
    Provide appropriate foot care.
    F687 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) July 11, 2024
    Inspectors wroteBased on record review, interviews, observations, and policy review, the facility failed to ensure residents were seen by a podiatrist when needed. This affected three residents (#41, #75 and #89) of three residents reviewed for foot care. The census was 101.
  6. D
    Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
    F690 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) July 11, 2024
    Inspectors wroteBased on medical record review and resident and staff interviews, the facility failed to ensure staff consistently implemented a resident's indwelling urinary catheter care. This affected one (#85) out of one residents reviewed for indwelling catheter care. Facility census was 101.
  7. D
    Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
    F755 · Pharmacy Service · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) July 11, 2024
    Inspectors wroteBased on medical record review, staff interview and facility policy review, the facility failed to ensure a residents pain medication was available and administered as physician ordered. This affected one (#85) out of three residents reviewed for medication administration. Facility census was 101.
  8. D
    Ensure medication error rates are not 5 percent or greater.
    F759 · Pharmacy Service · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) July 11, 2024
    Inspectors wroteBased on observations, medical chart review, policy review, and staff interviews, the facility failed to ensure a medication error rate of less than 5%. Four medication errors out 33 medication administration observations resulted in an error rate of 12%. This affected two residents (#35,and #159) of four residents (#35, #71, #159, and #73) observed for medication administration. The facility census was 101.
  9. D
    Ensure that residents are free from significant medication errors.
    F760 · Pharmacy Service · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) July 27, 2024
    Inspectors wroteBased on observation, medical records review, policy review, and staff interview, the facility failed to prime an insulin pen prior to administration, resulting in a significant medication error. This affected one (Resident #35) of four residents observed for medication administration.
February 5, 2024Complaint inspection · 1 citation
  1. D
    Provide and implement an infection prevention and control program.
    F880 · Infection Control · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) March 1, 2024
    Inspectors wroteBased on medical record review, observation, staff interview, and policy review, the facility failed to maintain appropriate infection control procedures during medication administration for Resident #10. This affected one (Resident #10) of three residents reviewed for medication administration. The facility census was 111.
October 6, 2023Complaint inspection · 4 citations
  1. F
    Provide and implement an infection prevention and control program.
    F880 · Infection Control · No actual harm, potential for more than minimal harm, widespread · found on a complaint visit · Corrected (the home has a date of correction) November 20, 2023
    Inspectors wroteBased on observation, interview, and facility policy review the facility failed to ensure staff wore Personal Protective Equipment (PPE) appropriately while the facility was in a COVID-19 outbreak and failed to ensure appropriate PPE was available outside of Resident #64's room who was on isolation for COVID-19. This had the potential to affect all 97 residents who did not have an active diagnosis of COVID (Resident #64 had an active diagnosis of COVID-19). The facility census was 98.
  2. D
    Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
    F656 · Resident Assessment and Care Planning · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) November 20, 2023
    Inspectors wroteBased on interview, resident record review, and facility policy review the facility failed to update care plans to meet resident needs. This affected three residents (#29, #79, and #83) of three residents reviewed for pressure ulcers. The facility census was 98.
  3. D
    Provide appropriate pressure ulcer care and prevent new ulcers from developing.
    F686 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) November 20, 2023
    Inspectors wroteBased on observation, interview, resident record review and facility policy review the facility failed to ensure a resident who had a Stage 3 (involving full-thickness skin loss potentially extending into the subcutaneous tissue layer) coccyx pressure ulcer was turned regularly and the treatment order was followed. This affected one resident (#29) of three residents reviewed for pressure ulcers.
  4. D
    Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
    F842 · Resident Assessment and Care Planning · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) November 20, 2023
    Inspectors wroteBased on interview and resident record review the facility failed to ensure resident records were complete and accurate. This affected two residents (#29 and #83) of three residents reviewed for pressure ulcers. The facility census was 98.
January 20, 2023Standard inspection · 17 citations
  1. G
    Provide appropriate pressure ulcer care and prevent new ulcers from developing.
    F686 · Quality of Life and Care · Actual harm, isolated · Corrected (the home has a date of correction) February 15, 2023
    Inspectors wroteBased on observation, medical record review, staff interview, policy review and review of the National Pressure Injury Advisory Panel (NPIAP) guidelines, the facility failed to implement an effective pressure ulcer prevention and treatment program for Resident #47 and Resident #63. Actual harm occurred on 01/02/23 when Resident #47, who was mildly cognitively impaired and dependent on staff for turning and repositioning, was identified to have an open area to the buttocks. The area was not staged, and no treatment orders were implemented. On 01/05/23 the resident was assessed to have a Stage III (full-thickness loss of skin, in which adipose (fat) is visible in the ulcer and granulation tissue and epiboly (rolled wound edges) are often present) pressure ulcer to the buttocks. [...]
  2. G
    Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
    F689 · Quality of Life and Care · Actual harm, isolated · Corrected (the home has a date of correction) February 15, 2023
    Inspectors wroteBased on observation, medical record review, staff and family interview, and policy review, the facility failed to implement timely interventions to decrease the risk for falls for Resident #256 who was a new admission and identified to have a history of falls and cognitive impairment. Actual harm occurred to Resident #256 when there was not a baseline care plan with fall interventions implemented, resulting in an unwitnessed fall on 12/31/22 and hospitalization where she was found to have a right fibular fracture. This affected one resident (Resident #256) of four residents reviewed for falls. The census was 106.
  3. G
    Provide safe, appropriate pain management for a resident who requires such services.
    F697 · Quality of Life and Care · Actual harm, isolated · Corrected (the home has a date of correction) February 15, 2023
    Inspectors wroteBased on record review, observation, staff interview, review of facility policy, review of guidelines from the National Pressure Ulcer Advisory Panel (NPUAP), and review of an online resources regarding pain in dementia residents, the facility failed to ensure Resident #15's pain was managed during a dressing change to a Stage III pressure ulcer. Actual Harm occurred on 01/09/23 when Resident #15 was not medicated for pain prior to wound care which resulted in the resident exhibiting signs (yelling out, moaning and grimacing) of severe pain. This affected one resident (#15) of one resident reviewed for pain management.
  4. F
    Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
    F725 · Nursing and Physician Services · No actual harm, potential for more than minimal harm, widespread · Corrected (the home has a date of correction) February 15, 2023
    Inspectors wroteBased on record review, staff and resident interviews, and policy review, the facility failed to ensure there was enough staff to provide showers and turning and repositioning for residents. This affected three (#15, #61, #207) of three residents reviewed for showers and one (#47) of four residents reviewed for pressure ulcers, with the potential to affect all 106 residents.
  5. E
    Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
    F550 · Resident Rights · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) February 15, 2023
    Inspectors wroteBased on observation, staff and resident interview, and policy review, the facility failed to ensure the dining room stayed open even when there was an outbreak of COVID-19. This had the potential to affect all 98 residents who consumed food from the kitchen. The facility identified there were eight residents who could not eat anything by mouth.
  6. E
    Honor the resident's right to organize and participate in resident/family groups in the facility.
    F565 · Resident Rights · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) February 15, 2023
    Inspectors wroteBased on observation, staff and resident interviews, resident council minutes, and policy review, the facility failed to ensure Resident Council Concerns were addressed in a timely manner. This affected seven (#5, #33, #41, #42, #53, #69, and #207) of seven residents reviewed for resident council.
  7. E
    Provide care and assistance to perform activities of daily living for any resident who is unable.
    F677 · Quality of Life and Care · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) February 15, 2023
    Inspectors wroteBased on observations, family and staff interviews, medical record review and policy review, the facility failed to ensure residents were dressed in personal clothes and received showers as scheduled. This affected four (#5, #41, #63, and #207) residents out of the five residents reviewed for activities of daily Living (ADL). This had the potential to affect all the residents. The facility census was 106.
  8. D
    Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
    F656 · Resident Assessment and Care Planning · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) February 15, 2023
    Inspectors wroteBased on medical record review, staff interview and policy review, the facility failed to ensure a individualized care plan was initiated for residents who used psychotropic medications. This affected two residents (#15 and #75) of five residents reviewed for unnecessary medications. The census was 106.
  9. D
    Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
    F688 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) February 15, 2023
    Inspectors wroteBased on observations, staff and family interviews, medical record review and policy review, the facility failed to apply Resident #63's splints to maintain range of motion as ordered. This affected one resident (#63) out of two residents reviewed for range of motion.
  10. D
    Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.
    F693 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) February 15, 2023
    Inspectors wroteBased on observation, medical record review, and staff interview, the facility failed to ensure Resident #15's enteral feed and flush was was dated and failed to position Resident #15 properly in bed to prevent aspiration. This affected one resident (Resident #15) out of eight residents on enteral feedings.
  11. D
    Provide safe and appropriate respiratory care for a resident when needed.
    F695 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) February 15, 2023
    Inspectors wroteBased on observation and staff interview, the facility failed to ensure a Artificial Manual Breathing Unit (AMBU) bag was in the room for a resident who had a tracheostomy. This affected one (#70) of one resident resident reviewed for tracheostomy. The census was 106.
  12. D
    Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.
    F700 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) February 15, 2023
    Inspectors wroteBased on medical record review, staff interview, and policy review, the facility failed to assess a resident for risk of entrapment. This affected one (#63) resident of one resident reviewed for side rails.
  13. D
    Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
    F761 · Pharmacy Service · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) February 15, 2023
    Inspectors wroteBased on observation, staff and resident interview, and policy review, the facility failed to ensure medications were not left at the bedside. This affected one (#27) of one resident reviewed for medications left at the bedside.
  14. D
    Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
    F804 · Nutrition and Dietary · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) February 15, 2023
    Inspectors wroteBased on resident and staff interviews, record review, and policy review, the facility failed to provide meals at an appetizing temperature. This affected two (#42 and #53) residents out of the three residents sampled for meals. This had the potential to affect 98 residents who received meal trays, as the facility identified eight residents (#3, #7, #15, #63, #67, #70, #76, #258) received nothing by mouth.
  15. D
    Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times.
    F809 · Nutrition and Dietary · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) February 15, 2023
    Inspectors wroteBased on resident and staff interviews, observations, and record review, the facility failed to deliver meal trays timely. This affected two (#42 and #53) residents out of the three residents sampled for meals. This had the potential to affect 98 residents who received meal trays, as the facility identified eight residents (#3, #7, #15, #63, #67, #70, #76, #258) received nothing by mouth.
  16. D
    Provide and implement an infection prevention and control program.
    F880 · Infection Control · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) February 15, 2023
    Inspectors wroteBased on record review, observation, and interview, the facility failed to maintain appropriate infection control procedures during the treatment of Resident #22's wound. This affected one resident (Resident #22) out of four reviewed for wound care.
  17. C
    Develop and implement policies and procedures to prevent abuse, neglect, and theft.
    F607 · Freedom from Abuse, Neglect, and Exploitation · No actual harm, potential for minimal harm, widespread · deficient, provider has February 15, 2023
    Inspectors wroteBased on review of personnel files, staff interview, and policy review, the facility failed to implement their abuse policy. This had the potential to affect all 106 residents in the facility.
January 30, 2020Standard inspection · 14 citations
  1. F
    Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
    F761 · Pharmacy Service · No actual harm, potential for more than minimal harm, widespread · Corrected (the home has a date of correction) February 21, 2020
    Inspectors wroteBased on observation, record review and interview the facility failed to ensure medications were properly stored and dated when opened to prevent use after expiration. This had the potential to affect all 93 residents residing in the facility.
  2. F
    Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
    F812 · Nutrition and Dietary · No actual harm, potential for more than minimal harm, widespread · Corrected (the home has a date of correction) February 21, 2020
    Inspectors wroteBased on observation, record review and staff interview the facility failed to store, label, and date food properly to prevent contamination and food borne illness. This had potential to affect 90 of 90 residents residing in the facility who received meal trays from the kitchen, with the exception of Resident #53, #287, and #337 who received nothing by mouth. The facility census was 93.
  3. D
    Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
    F550 · Resident Rights · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) February 21, 2020
    Inspectors wroteBased on observation, medical record review and interview the facility failed to ensure Resident #75 was provided dignity related to the use of an indwelling urinary catheter. This affected one resident (#75) of two residents reviewed for catheters.
  4. D
    Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
    F561 · Resident Rights · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) February 21, 2020
    Inspectors wroteBased on record review and interview the facility failed to honor Resident #13's right to change rooms. This affected one resident (#13) of one resident reviewed who requested a room change.
  5. D
    Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
    F584 · Resident Rights · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) February 21, 2020
    Inspectors wroteBased on observation, record review and interview the facility failed to ensure Resident #74 received clean bed linens and was provided with pillow cases. This affected one resident (#74) of 26 residents reviewed for homelike environment and dignity.
  6. D
    Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
    F655 · Resident Assessment and Care Planning · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) February 21, 2020
    Inspectors wroteBased on observation, medical record review and staff interview the facility failed to include the use of oxygen for Resident #137 in a baseline care plan. This affected one resident (#137) of two residents reviewed for oxygen use.
  7. D
    Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
    F657 · Resident Assessment and Care Planning · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) February 21, 2020
    Inspectors wroteBased on observation, record review and interview the facility failed to ensure quarterly care conferences were conducted for Resident #63 and failed to ensure Resident #73's care plan was revised related to hemodialysis. This affected one resident (#63) of one resident reviewed for care conferences and one resident (#73) of three residents specifically reviewed for care plan revisions. Findings Include: 1. Record review revealed Resident #63 was admitted to the facility on [DATE] with diagnoses including hypothyroidism, dysphagia, muscle weakness, unspecified convulsions, hypertension, congestive heart failure, major depressive disorder, hemiplegia and hemiparesis, nontoxic multinodular goiter, personal history of traumatic brain injury, morbid obesity, hyperlipidemia and anemia. [...]
  8. D
    Provide activities to meet all resident's needs.
    F679 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) February 21, 2020
    Inspectors wroteBased on observation, record review and interview the facility failed to develop and implement a comprehensive and individualized activity program to meet the total care needs of Resident #8. This affected one resident (#8) of one resident reviewed for activities.
  9. D
    Provide appropriate treatment and care according to orders, resident’s preferences and goals.
    F684 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) February 21, 2020
    Inspectors wroteBased on observation, medical record review and interview the facility failed to ensure physician ordered heel (protectors) boots were provided as ordered for Resident #52. This affected one resident (#52) of six residents assessed for skin alterations.
  10. D
    Assist a resident in gaining access to vision and hearing services.
    F685 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) February 21, 2020
    Inspectors wroteBased on record review and interview the facility failed to ensure Resident #63 was offered vision appointments. This affected one resident (#63) of two residents reviewed for sensory appointments. Findings Include: Record review revealed Resident #63 was admitted to the facility on [DATE] with diagnoses including hypothyroidism, dysphagia, muscle weakness, unspecified convulsions, hypertension, congestive heart failure, major depressive disorder, hemiplegia and hemiparesis, nontoxic multinodular goiter, personal history of traumatic brain injury, morbid obesity, hyperlipidemia and anemia. Review of the Minimum Data Set (MDS) 3.0 assessment, dated 01/12/20 revealed a Brief Interview for Mental Status (BIMS) score of 12, which indicated she was cognitively intact. Review of Resident #63's medical records revealed she did not have a document which indicated her wishes for vision care. [...]
  11. D
    Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
    F690 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) February 21, 2020
    Inspectors wroteBased on observation, medical record review and interview the facility failed to provide an appropriate justification and assessment for the ongoing use of a urinary (Foley) catheter for Resident #75. This affected one resident (#75) of two residents reviewed for catheters.
  12. D
    Provide safe and appropriate respiratory care for a resident when needed.
    F695 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) February 21, 2020
    Inspectors wroteBased on observation, medical record review and staff interview the facility failed to ensure Resident #137's oxygen tubing and humidified water bottle was dated. This affected one resident (#137) of two resident reviewed for oxygen use.
  13. D
    Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
    F755 · Pharmacy Service · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) February 21, 2020
    Inspectors wroteBased on record review and interview the facility failed to maintain a system of records and disposition to ensure all controlled drugs were accurately accounted for and reconciled. This affected one resident (#5) randomly reviewed for narcotic medication reconciliation. The facility census was 93.
  14. C
    Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
    F623 · Resident Rights · No actual harm, potential for minimal harm, widespread · deficient, provider has February 21, 2020
    Inspectors wroteBased on medical record review and staff interview the facility failed to notify the State Ombudsman regarding resident discharges in a timely manner. This affected two residents (#86 and #87) and had the potential to affect all 93 residents residing in the facility.

Fire safety inspections

10 fire safety citations on file: 6 on June 3, 2024, 4 on January 20, 2023.

Every fire safety citation10 citations
  1. F
    Have approved installation, maintenance and testing program for fire alarm systems.
    K 345 · June 3, 2024 · Corrected (the home has a date of correction)
  2. F
    Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
    K 521 · June 3, 2024 · Corrected (the home has a date of correction)
  3. F
    Have simulated fire drills held at unexpected times.
    K 712 · June 3, 2024 · Corrected (the home has a date of correction)
  4. F
    Have generator or other power source capable of supplying service within 10 seconds.
    K 918 · June 3, 2024 · Corrected (the home has a date of correction)
  5. E
    Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
    K 222 · June 3, 2024 · Corrected (the home has a date of correction)
  6. E
    Install corridor and hallway doors that block smoke.
    K 363 · June 3, 2024 · Corrected (the home has a date of correction)
  7. F
    Have approved installation, maintenance and testing program for fire alarm systems.
    K 345 · January 20, 2023 · Corrected (the home has a date of correction)
  8. F
    Inspect, test, and maintain automatic sprinkler systems.
    K 353 · January 20, 2023 · Corrected (the home has a date of correction)
  9. F
    Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
    K 521 · January 20, 2023 · Corrected (the home has a date of correction)
  10. E
    Have proper medical gas storage and administration areas.
    K 923 · January 20, 2023 · Corrected (the home has a date of correction)

Fines and payment denials

DatePenaltyAmount or length
January 15, 2026Fine $229,620
January 15, 2026Payment Denial 47 days from February 13, 2026
September 30, 2024Fine $62,221
June 3, 2024Fine $102,396
June 3, 2024Payment Denial 28 days from June 29, 2024

A payment denial means Medicare and Medicaid stopped paying for new admissions for that period.

Staffing

Hours of care per resident per day, from the payroll records every home sends CMS. Higher means more staff time with each resident.

MeasureThis homeOhioUnited States
All nursing staff (RN, LPN and aides)3.933.693.86
Registered nurses0.990.640.69
All nursing staff on weekends3.463.283.42
Nurse aides2.07
Licensed practical nurses0.87
Nursing staff turnover (share who left in a year)52.0%48.7%45.8%
Registered nurse turnover45.8%43.9%42.9%
Administrators who left0

CMS expects 4.07 hours a day for residents as sick as this home's (its case-mix figure). The staffing star compares the two.

Staffing by quarter, from daily payroll records

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 4.12 on weekdays and 3.46 on weekends, 16% lower on weekends (nationally, weekends ran 15% lower). Contract or agency staff worked 3.3% of nursing hours, against 5.3% nationally. Total nursing hours per resident went from 3.71 in April to June 2025 to 3.93 in January to March 2026.

QuarterAll nursing staffRegistered nursesWeekdaysWeekendsContract staff shareDays with no RN hoursResidents a day
Jan to Mar 20263.930.994.123.46 3.3%0 of 90103
Oct to Dec 20253.761.013.913.38 3.4%0 of 92105
Jul to Sep 20253.771.043.923.40 4.2%0 of 92104
Apr to Jun 20253.710.973.883.27 3.0%0 of 91103
United States, Jan to Mar 20263.750.623.923.335.3%0.5% of days
Ohio, Jan to Mar 20263.640.603.803.244.6%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

Staff pay at this home

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. If you work here, your report helps start one.

Official wage estimates for Ohio

JobMedianMiddle halfEmployed
Ohio, all employers
CNAs (nursing assistants)$18.76$17.93 to $21.4463,280
LPNs and LVNs$29.78$27.34 to $31.6839,900
Registered nurses$39.67$38.08 to $47.61143,730
United States, nursing care facilities
CNAs (nursing assistants)$20.67$17.91 to $22.55534,270
LPNs and LVNs$33.86$30.05 to $37.40188,210
Registered nurses$41.11$37.85 to $47.68142,270

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.

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For The Laurels of Gahanna. No name, email or phone, and nothing you could type about a resident: every answer is a number or a choice.

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Every report is reviewed before it counts; what it says about the home never decides whether it counts. How pay reports are handled.

How staff pay reports work · CNA pay by state

Quality measures

The measures CMS uses for the quality star. Lower is better for every one of them.

MeasureThis homeOhioUS
Percentage of long-stay residents whose need for help with daily activities has increased
Long Stay residents, 2025Q2-2026Q1
4.35.313.9
Percentage of long-stay residents with a catheter inserted and left in their bladder
Long Stay residents, 2025Q2-2026Q1
0.00.20.8
Percentage of long-stay residents with a urinary tract infection
Long Stay residents, 2025Q2-2026Q1
0.30.51.6
Percentage of long-stay residents experiencing one or more falls with major injury
Long Stay residents, 2025Q2-2026Q1
2.53.23.2
Percentage of short-stay residents who newly received an antipsychotic medication
Short Stay residents, 2025Q2-2026Q1
1.41.21.6
Percentage of long-stay residents whose ability to walk independently worsened
Long Stay residents, 2025Q2-2026Q1
6.66.114.1
Percentage of long-stay residents with pressure ulcers
Long Stay residents, 2025Q2-2026Q1
4.63.44.6
Percentage of long-stay residents who received an antipsychotic medication
Long Stay residents, 2025Q2-2026Q1
5.98.815.4
Percentage of short-stay residents who were rehospitalized after a nursing home admission
Short Stay residents, 20250101-20251231
24.624.923.8
Percentage of short-stay residents who had an outpatient emergency department visit
Short Stay residents, 20250101-20251231
7.312.912.0

Short-term rehab results

For a stay to recover after a hospital visit, these are the results CMS publishes for The Laurels of Gahanna's Medicare short-stay residents. On returning residents home or to the community, CMS rates it no different from the national rate (51.7% of residents, after adjusting for how sick they were). How to read these, and what Medicare pays for.

Went home or back to the community

51.7% this home

No different from the national rate

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. 76 eligible stays.

Potentially preventable readmissions

9.7% 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. 70 eligible stays.

Infections that led to a hospital stay

8.0% this home

No different from the national rate

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. 55 eligible stays.

Self-care and mobility at discharge

58.5% this home

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. 41 residents counted.

Falls with major injury

1.3% this home

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. 76 residents counted.

New or worsened pressure ulcers

3.1% this home

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. 74 residents counted.

Medication list given at discharge

100.0% this home

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. 21 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.

Owners and operators

Legal business name: THE LAURELS OF GAHANNA, LLC. CMS links this home to Ciena Healthcare/Laurel Health Care, a group of 81 nursing homes averaging 2.8 stars overall.

NameRoleTypeShareSince
Laurel Ohio Operations Group, LLC5% or greater direct ownership interestOrganization100%06/30/2018
Laurel Health Care Holdings, Inc.5% or greater indirect ownership interestOrganization100%06/30/2018
Laurel Acquisition Holding CorporationIndirect ownership interestOrganization06/30/2018
Khan, AnisManaging control - governing bodyIndividual06/30/2018
Qazi, MohammadManaging control - governing bodyIndividual06/30/2018
Laurel Health Care CompanyOperational/managerial controlOrganization06/30/2018
Adkins, FrankOperational/managerial controlIndividual12/18/2014
Khan, AnisOperational/managerial controlIndividual06/30/2018
Qazi, MohammadOperational/managerial controlIndividual06/30/2018
Slaybaugh, RandallOperational/managerial controlIndividual01/01/2025
Laurel Health Care CompanyAdp of the SNFOrganization04/04/2025
Adkins, FrankAdp of the SNFIndividual12/18/2024
Khan, AnisAdp of the SNFIndividual06/30/2018
Slaybaugh, RandallAdp of the SNFIndividual01/01/2025
Stobb, DavidAdp of the SNFIndividual06/30/2018

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.

Questions to ask on a visit

Chosen from this home's own inspection record.

  1. How do you prevent falls and pressure injuries, and how are families told when one happens?Inspectors cited 29 problems in this area, most recently on January 15, 2026: "Provide appropriate treatment and care according to orders, resident’s preferences and goals."
  2. How do residents and families raise a complaint or grievance, and how fast is it answered?Inspectors cited 13 problems in this area, most recently on April 15, 2026: "Give the resident's representative the ability to exercise the resident's rights."
  3. How are medications reviewed, and how often are antipsychotic or sedating drugs used?Inspectors cited 10 problems in this area, most recently on August 20, 2025: "Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist."
  4. How are allegations of abuse or neglect reported and investigated, and who tells the family?Inspectors cited 9 problems in this area, most recently on June 22, 2026: "Develop and implement policies and procedures to prevent abuse, neglect, and theft."

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Common questions

What is The Laurels of Gahanna's Medicare star rating?
CMS rates The Laurels of Gahanna 2 out of 5 stars overall, with 1 for health inspections, 4 for staffing and 5 for quality measures (CMS data as of September 1, 2026).
How many deficiencies did The Laurels of Gahanna get at its last inspection?
9 health deficiencies at the standard inspection on June 3, 2024. The Ohio average is 10.5.
Has The Laurels of Gahanna been fined?
Yes. CMS lists 3 fines totaling $394,237 in the last three years.
Does The Laurels of Gahanna accept Medicaid?
It is certified to take Medicaid (CMS lists it as "Medicare and Medicaid"). Certification does not mean a Medicaid bed is open: ask the admissions office.
Who owns The Laurels of Gahanna?
CMS lists 15 owners and managers, and links the home to Ciena Healthcare/Laurel Health Care. Legal business name: THE LAURELS OF GAHANNA, LLC.

Sources

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