Inspection visit
Health inspection
6 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 6 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0656
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Develop and implement a complete care plan that meets all the resident's needs, with timetables and
actions that can be measured.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
medical record review, resident and staff interviews, and policy review, the facility failed to develop a
comprehensive plan of care for Resident #59. This affected one (#59) of three resident reviewed for plan of
cares. The facility census was 66.
Findings include:
Medical record review for Resident #59 revealed an admission on [DATE]. Diagnoses included wedge
compression fracture of thoracic vertebra, hypertension, hypokalemia, fracture of thoracic vertebra 11-12,
blindness, dehydration, fall, and tachycardia. Review of the Minimum Data Set (MDS) assessment dated
[DATE] revealed Resident #59 had intact cognition.
Review of the hospital discharge documentation dated 12/11/22 revealed Resident #59 had difficulty
swallowing foods and weight loss of 15 pounds since 11/04/22.
Review of the facility's speech therapy note dated 12/14/22 revealed Resident #59 was on a regular diet.
Resident #59 reported being on a pureed diet at home and was requesting a dietary downgrade. Resident
#59 reported oral surgery on 10/20/22 to remove an infected tooth. Therapy assessment noted severed
mandibular range of motion deficits. Speech therapist notified the physician's assistant and an order to
follow up with the oral surgeon was ordered.
Review of the nursing progress notes dated 12/14/22 revealed Resident #59 was not able to open her
mouth fully since her tooth extraction in October 2022. The physician assistant was notified and new orders
to follow up with oral surgeon.
Review of the plan of care for Resident #59 revealed it was silent for the inability to open her mouth
adequately to consume a regular diet related to decreased mandibular range of motion.
Interview on 05/07/23 11:00 A.M. with Resident #59 stated she went to a dentist in October 2022 and had a
infected tooth pulled and the jaw just stopped working after that. Resident #59 stated she was no longer
able to open her mouth to eat solid food due to inability to chew it.
Interview with 05/08/23 at 4:20 P.M. with Corporate Registered Nurse (RN) #98 verified Resident #59's care
plan did not include the inability of the resident to open her jaw due to severe mandibular range of motion
resulting in an altered diet. RN #98 verified this should have been included in the care plan.
(continued on next page)
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other
safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the
date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER
REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Facility ID:
If continuation sheet
Page 1 of 8
Event ID:
365377
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
365377
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/10/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Celina Manor
1001 Myers Road
Celina, OH 45822
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0656
Review of the facility policy titled Resident Assessment dated 11/02/16 revealed a comprehensive plan of
care must be developed within seven days after the completion of the comprehensive MDS.
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365377
If continuation sheet
Page 2 of 8
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
365377
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/10/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Celina Manor
1001 Myers Road
Celina, OH 45822
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0677
Provide care and assistance to perform activities of daily living for any resident who is unable.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
medical record review, observation, resident and staff interview, and policy review, the facility failed to
ensure a resident that required assistance from staff with dressing was provided adequate care and
services with changing her clothes routinely. This affected one (#316) of two residents reviewed for activities
of daily living. The facility identified 65 residents who required assistance from staff with dressing. The
facility census was 66.
Residents Affected - Few
Findings include:
Medical record review for Resident #316 revealed an admission on [DATE]. Diagnoses included fracture of
metatarsal bone in left foot, respiratory failure, hemiplegia, and hemiparesis affecting left side,
osteoarthritis, left knee pain, and osteoarthritis.
Review of the plan of care revealed Resident #316 had an activity of daily self-care performance deficit
related to recent hospitalization, need for assistance, and multiple fractures. Interventions include physical
and occupational evaluation and treatment as per physician orders.
Review of the State Tested Nursing Assistants (STNA) documentation dated 05/04/23 through 05/20/23
revealed no documentation was completed for the dressing activities of daily living for Resident #316
Observation and interview on 05/07/23 at 1:35 P.M. revealed Resident #316 was sitting in bed with a light
purple blouse on. The light purple blouse had multiple stains on the upper chest area and food crumbs.
Resident #316 stated she ate her lunch in bed and spilt her coffee and the crumbs were from lunch also.
Resident #316 stated she had been wearing the shirt since Friday and needed to change it.
Subsequent observation and interview on 05/08/23 at 11:45 A.M. revealed Resident #316 was wearing the
same light purple blouse with stains on it. There were additional stains on the bottom front of the shirt.
Resident #316 stated she slept in her shirt because no one asked her to change it. She had pajamas
available to wear, but she was not changed by staff last evening (05/07/23).
Interview on 05/09/23 at 2:13 P.M. with State Tested Nursing Assistant (STNA) #97 stated she worked on
05/07/23 from 2:00 P.M. to 6:00 P.M. after being moved from another unit and again on 05/08/23 from 7:00
A.M. to 7:00 P.M. STNA #97 stated Resident #316 complained that her shirt was not changed since Friday,
and she wanted to have it changed today. STNA #97 verified Resident #313 was wearing the same light
purple shirt on three consecutive days, 05/07/23, 05/08/23, and 05/09/23. STNA #97 stated she gave
Resident #316 a shower on 05/08/23.
Review of the facility policy titled Quality of Care, dated 04/29/16 revealed a resident that is unable to
carryout activities of daily living receives the necessary services to maintain good nutrition, grooming
personal and oral hygiene.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365377
If continuation sheet
Page 3 of 8
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
365377
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/10/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Celina Manor
1001 Myers Road
Celina, OH 45822
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0756
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart,
following irregularity reporting guidelines in developed policies and procedures.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
record review, review of facility policy, and staff interview, the facility failed to respond to the pharmacy's
medication regimen review recommendations in a timely manner. This affected one (Resident #53) of five
residents reviewed for unnecessary medications. The facility census was 66.
Findings include:
Review of the medical record for Resident #53 revealed an admission date 03/28/22. Diagnoses included
dementia, Parkinson's disease, and major depressive disorder. Review of the quarterly Minimum Data Set
(MDS) assessment dated [DATE] revealed Resident #53 had impaired cognition.
Review of the Summary of Monthly Recommendations dated 12/22/22 revealed Resident #53 was
receiving the following medication with psychotropic properties: Depakote Delayed Release (DR) 125
milligram (mg) by mouth twice daily. Please review the resident's medication regimen and indicate your
professional opinion on further use of the medication listed (check all that apply): 1) A dose reduction will
be attempted. See new order below. 2) Medication regimen at this time appears appropriate and consistent
with diagnosis. Resident is at optimal dose and is stable. No need for weaning at this point. 3)
Discontinuation likely will be harmful to resident and/or others or it will disrupt their provision of care. 4)
Resident's target symptoms returned/worsened after the most recent attempt of gradual dose reduction
(GDR). 5) Target symptoms continue to persist in this resident. Reduction is clinically contraindicated as a
result. There was no response from the physician in the medical record or on the Summary of Monthly
Recommendations form.
Interview on 05/09/23 at 2:32 P.M. with the Director of Nursing (DON) verified the physician did not address
Resident #53's pharmacy recommendations timely. The DON verified the physician has not responded to
Resident #53's pharmacy recommendation made on 12/22/22. Subsequent interview on 05/09/23 at 4:10
P.M. with the DON verified the pharmacy recommendation should have been addressed within 30 days.
Review of the facility policy titled Medications Regiment Review and Recommendation, dated 03/20/18,
revealed when a recommendation is made: Non-emergent recommendations are to addressed within the
next 30 days.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365377
If continuation sheet
Page 4 of 8
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
365377
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/10/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Celina Manor
1001 Myers Road
Celina, OH 45822
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0761
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
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.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
record review, observation, staff interview, and policy review, the facility failed to store prescribed
medications appropriately and securely. This affected Resident #36 and had the potential to affect four
residents (#29, #38, #58, and #266) who the facility identified to be confused and independently
ambulatory. The facility census was 66.
Findings include:
1. Medical record review for Resident #36 revealed an admission on [DATE]. Diagnoses included
schizophrenia, psoriasis, anxiety, and psychotic disorder with delusions. Review of the Minimum Data Set
(MDS) assessment dated [DATE] revealed Resident #36 had intact cognition.
Observation on 05/08/23 at 9:19 A.M. of Resident #36's dresser in room revealed a tube of
Nystatin-Triamcinolone Cream (a skin treatment) was unsecured with prescription label on it for Resident
#36.
Interview on 05/08/23 at 9:25 A.M. with Registered Nurse (RN) #102 verified the tube was for Resident #36
and the tube should not have been left in the room unattended. RN #102 stated the treatment was done on
the previous shift and left in the room by mistake.
2. Observation on 05/09/23 at 8:41 A.M. of an unlocked and unsupervised treatment cart located outside of
the restorative nursing office. The treatment cart contained povidone iodine swab sticks and povidone
bottles with warning label to contact poison control if accidental ingestion, tubes of miconazole nitrate
house stock tube if swallowed get medical help and contact poison control and a bottle of peroxide with
label stating chemical danger causes skin irritation and serious eye damage and shortness of breath with
ingestion. Contact poison control if ingested.
Interview with Register Nurse (RN) #161 on 05/09/23 at 8:45 A.M. verified the treatment cart was unlocked
and not under direct supervision of a licensed nurse. RN #161 proceeded to walk away from the unlocked
treatment cart stating the wound nurse was in the facility using it.
Review of the facility's list of residents who were confused and independently ambulatory revealed
Residents #58, #29, #38, and #266) were confused and independently ambulatory around the facility.
Review of the facility policy titled Medication Storage in the Facility, dated 03/1996, stated medications and
biologicals are stored safely and securely following manufactures recommendations. Medication/treatment
carts are to be locked or attended by persons with authorized access.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365377
If continuation sheet
Page 5 of 8
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
365377
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/10/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Celina Manor
1001 Myers Road
Celina, OH 45822
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0773
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the
results.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
medical record review, staff interview, and policy review, the facility failed to promptly notify the physician of
an abnormal urinalysis result which indicated the resident had a urinary tract infection (UTI). This affected
one (Resident #316) of two residents reviewed for laboratory values. The facility census was 66.
Findings include:
Medical record review for Resident #316 revealed an admission on [DATE]. Diagnoses included fracture of
metatarsal bone in left foot, hemiplegia, and hemiparesis affecting left side.
Review of the plan of care revealed Resident #36 had incontinence of bladder related to weakness.
Interventions include encourage fluids, monitor for decline in urine output or signs and symptoms of urinary
tract infections (UTI), monitor lab results as ordered and report any abnormal laboratory results to
physician.
Review of the physician orders for Resident #316 revealed an order dated 05/02/23 for urinalysis with reflex
culture and sensitivity.
Review of the laboratory results dated [DATE] and reported to the facility on [DATE] for Resident #316
revealed a urine culture result indicating a UTI from the bacteria proteus vulgaris. There was nothing in the
medical record to indicate the physician was notified of the urine culture result indicating a UTI.
Interview on 05/09/23 at 1:19 P.M. with Licensed Practical Nurse (LPN) #140 stated she was unable to
locate any communication or documentation that the physician was notified of the abnormal results
indicating Resident #316 had a UTI.
Subsequent interview on 05/09/23 at 4:10 P.M. with LPN #140 verified the physician was not notified on
05/06/23 and LPN #140 notified the physician that day (three days later on 05/09/23) and an antibiotic
(Bactrim double strength tablet 800/160 milligrams (mg) one tablet by mouth for five days) was ordered for
the treatment of a UTI for Resident #316.
Interview on 05/10/23 at 2:10 P.M. with the Director of Nursing (DON) stated the laboratory company
usually sends a fax to the facility and the physician was notified. The DON was unable to determine why the
physician was not notified as he should have been on 05/06/23 further stating the facility was unable to
locate the fax from the laboratory.
Review of the facility policy titled Notification of Changes Policy, dated 11/02/16, revealed the facility must
inform the resident, physician and the resident representative when an change occurs resulting in an
altered treatment plan.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365377
If continuation sheet
Page 6 of 8
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
365377
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/10/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Celina Manor
1001 Myers Road
Celina, OH 45822
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0880
Provide and implement an infection prevention and control program.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
medical record review, observation, review of facility policy, and staff interview, the facility failed to ensure
staff followed physician ordered enhanced barrier precautions (EBP) for high resident care activities. This
affected two (Residents #28 and #36) of six residents reviewed for infection control. The facility census was
66.
Residents Affected - Few
Findings include:
1. Review of Resident #28's medical record revealed an admission date of 01/10/20. Diagnoses included
end stage renal disease, chronic kidney disease, hemiplegia, presence of vascular graft, and dependence
on renal dialysis.
Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #28 was
cognitively intact. Resident #28 was totally dependent on staff for toilet use and transfer. Resident #28
received dialysis services.
Further review of the medical record revealed Resident #28 received peritoneal dialysis through a dialysis
catheter at the facility.
Review of the physician orders dated 08/24/22 revealed an order indicating Resident #28 required the use
of EBP to to an indwelling medical device.
Observation on 05/09/23 at 11:57 A.M. revealed State Tested Nursing Assistant (STNA) #114 and STNA
#103 entering Resident #28's room with a Hoyer (mechanical) lift. STNA #114 and STNA #103 proceeded
to transfer Resident #28 from a recliner into his bed and repositioned him in bed. Neither STNA #114 or
STNA #103 donned any gloves or gown while transferring and caring for Resident #28. A bin with gowns
was present at Resident #28's room entrance and a receptacle for used gowns was present inside
Resident #28's room.
Interview on 05/09/23 at 12:01 P.M. with STNA #114 confirmed STNA #103 and #114 had not donned
gloves and gown while transferring and caring for Resident #28. STNA #114 confirmed a sign posted on
the door read to use EBP for high resident care activities and that transferring was on a list that was
considered a high contact resident care activity.
2. Medical record review for Resident #36 revealed an admission on [DATE]. Diagnoses included
schizophrenia, quadriplegia, bladder dysfunction, and psychotic disorder with delusions.
Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #36 had intact
cognition. Resident #36 required extensive assistance with two staff members for toileting and total
assistance from staff for transfers. Resident #36 had a suprapubic urinary catheter.
Review of the plan of care for Resident #36 reviewed has a suprapubic catheter due to neuromuscular
dysfunction of the bladder secondary to spinal stenosis from quadriplegia. Interventions included catheter
care every shift, change catheter per physician's order, and monitor for signs/symptoms of urinary tract
infection.
Review of the physician orders for Resident #36 revealed an order for the use of EBP due to a
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365377
If continuation sheet
Page 7 of 8
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
365377
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/10/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Celina Manor
1001 Myers Road
Celina, OH 45822
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0880
multi-drug resistant organism (MDRO) and an indwelling medical device.
Level of Harm - Minimal harm
or potential for actual harm
Observation on 05/09/23 09:48 AM with State Tested Nursing Aide (STNA) #120 revealed the STNA
provided morning care (including bathing, incontinent care, and catheter care) for Resident #36. STNA
#120 failed to don a gown while providing care and services for Resident #36. A bin with gowns was
present at the entrance of Resident #36's room entrance and a receptacle for used gowns was present
inside Resident #36's room.
Residents Affected - Few
Interview on 05/09/23 at 12:10 P.M. with STNA #120 confirmed that she had not donned a gown while
providing morning care for Resident #36. STNA #120 confirmed a sign was posted on the door read to use
EBP for high resident care activities and that transferring. bathing, and incontinent care was on a list that
was considered a high contact resident care activity. STNA #120 stated she did not see the sign on the
door and just missed it.
Review of the facility's policy titled Enhance Barrier Precautions dated August 2022 revealed it is the intent
of the facility to use EBP in addition to standard precautions for residents to prevent transmission of
MDROs in their care community. All personnel must wear gloves when high-contact resident care activities
are being performed. All personnel should wear gowns when high-contact resident care activities are being
performed. Shared resident care equipment should be clean and disinfected. High contact resident care
activities listed were dressing, bathing/showering, transferring, providing hygiene, changing linens,
changing attends or assisting with toileting, device care or use: central line, urinary catheter, feeding tube,
tracheostomy/ventilator, wound care: any skin opening requiring a dressing.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365377
If continuation sheet
Page 8 of 8
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Back to topCitations
6 citations recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F656 - Comprehensive Care Plans
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
F677 - A resident who is unable to carry out activities of daily living receives
Provide care and assistance to perform activities of daily living for any resident who is unable.
F756 - Drug Regimen Review
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
F761 - Labeling of Drugs and Biologicals
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.
F773 - The facility must—
Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results.
F880 - Infection Control
Provide and implement an infection prevention and control program.
FAQ · About this visit
Common questions about this visit
What happened during the May 10, 2023 survey of CELINA MANOR?
This was a inspection survey of CELINA MANOR on May 10, 2023. The surveyor cited 6 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at CELINA MANOR on May 10, 2023?
Yes, 6 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be ..."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.
Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.
Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.