Inspection visit
Health inspection
2 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 2 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0804
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Level of Harm - Minimal harm
or potential for actual harm
Based on review of the facility menu, observation, resident interview, staff interview, and review of the
facility policy, the facility failed to provide palatable food to meet resident nutritional needs. This had the
potential to affect all residents residing in the facility. The facility census was 55 residents.
Residents Affected - Many
Findings include:
Review of the menu for lunch dated 06/27/24 revealed the menu items included the following: creamy
Maryland chicken with mushroom sauce, egg noodles, yellow squash, chilled peach, choice of cold
beverage.
Observation on 06/27/24 at 11:44 A.M. of the test tray revealed the meal included creamy Maryland chicken
with mushroom sauce, penne noodles, yellow squash, and peaches. The squash was sliced and green in
color and was mushy to the touch with no taste or flavoring. The creamy Maryland chicken had pieces of
cut up chicken breast in a crem sauce over noodles. There was a hard substance which appeared to be a
chicken bone mixed in with the sauce and pieces of chicken. The chicken dish was bland and had no flavor.
Observations on 06/27/24 from 11:50 A.M. through 12:24 P.M. of the lunch meal revealed residents
consumed very little of the lunch meal.
Interviews on 06/27/24 from 11:50 A.M. through 12:24 P.M. with Resident #36, #37, #44, #45, #48, and #52
confirmed the vegetables were soggy and distasteful. Further resident interviews confirmed the entree did
not look appealing and they ordered substitute items.
Interview on 06/27/24 at 11:55 A.M. with Dietary Manager (DM) #50 confirmed the squash and zucchini
were mushy, and this happened frequently when they cooked it. DM #50 confirmed he wanted to remove
this item from the menu and give the residents a better option.
Review of a policy titled Food Preparation and Service undated revealed food and nutrition services
employees prepared and serve food in a manner that complied with safe food handling practices.
This deficiency represents noncompliance investigated under Complaint Number OH00155100.
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 3
Event ID:
365476
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
365476
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/01/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Astoria Place of Silverton
6922 Ohio Avenue
Cincinnati, OH 45236
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 0842
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in
accordance with accepted professional standards.
Based on medical record review, staff interview, and review of the facility policy, the facility failed to
accurately and timely document resident wound treatments. This affected one (Resident #48) resident of
three residents reviewed for treatments. The facility census was 55 residents.
Findings include:
Review of the medical record for Resident #48 revealed an admission date of 02/08/24 with diagnoses
including chronic obstructive pulmonary disease (COPD), cellulitis, lymphedema, and type two diabetes
mellitus.
Review of the care plan for Resident #48 dated 02/15/24 revealed the resident had actual impairment to
skin integrity. Interventions included staff were to perform wound treatments with documentation to include
measurements, type of tissue, and any exudate noted.
Review of the Minimum Data Set (MDS) assessment for Resident #48 dated 05/17/24 revealed the resident
had intact cognition and required supervision with bathing.
Review of the physician's orders for Resident #48 revealed an order dated 06/04/24 to cleanse the bilateral
lower extremities (BLE) with normal saline, apply Eucerin ointment to BLE, wrap with kerlix and ACE wraps
in the morning.
Review of the Treatment Administration Record (TAR) for Resident #48 dated June 2024 revealed the
treatment was not documented as completed on the following dates: 06/07/24, 06/08/24, 06/09/24,
06/10/24, 06/11/24, 06/12/24, 06/13/24, 06/14/24, 06/16/24, 06/19/24, 06/21/24, 06/25/24.
Interview on 06/27/24 at 10:23 A.M. with the Director of Nursing (DON) confirmed Resident #48's treatment
to her legs was not signed off as completed in the TAR on multiple dates in June 2024: 06/07/24, 06/08/24,
06/09/24, 06/10/24, 06/11/24, 06/12/24, 06/13/24, 06/14/24, 06/16/24, 06/19/24, 06/21/24, 06/25/24. The
DON further confirmed nurses were required to document completion of treatments in the TAR.
Interview on 06/27/24 at 11:31 A.M. with Licensed Practical Nurse (LPN) #25 confirmed she completed the
treatments for Resident #48 as ordered but did not document completion in the resident's TAR on the
following dates: 06/07/24, 06/08/24, 06/09/24, 06/12/24, 06/13/24, 06/14/24.
Interview on 06/27/24 at 11:36 A.M. with Registered Nurse (RN) #32 confirmed completed the treatments
for Resident #48 as ordered but did not document completion in the resident's TAR on the following dates:
06/10/24, 06/11/24, 06/19/24.
Interview on 06/27/24 at 11:40 A.M. with RN #33 confirmed completed the treatments for Resident #48 as
ordered but did not document completion in the resident's TAR on the following dates: 06/21/24, 06/24/24.
Review of the facility policy titled Charting and Documentation dated 04/01/22 revealed all services
provided to the resident, or any changes in the resident's medical or mental condition, should be
documented in the resident's medical record. Observations, medications administered, services
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365476
If continuation sheet
Page 2 of 3
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
365476
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/01/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Astoria Place of Silverton
6922 Ohio Avenue
Cincinnati, OH 45236
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 0842
performed, etc., would be documented in the resident's clinical records.
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:
365476
If continuation sheet
Page 3 of 3
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Back to topCitations
2 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.
F804 - Food and drink
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
F842 - Resident-identifiable information
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
FAQ · About this visit
Common questions about this visit
What happened during the July 1, 2024 survey of ASTORIA PLACE OF SILVERTON?
This was a inspection survey of ASTORIA PLACE OF SILVERTON on July 1, 2024. The surveyor cited 2 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at ASTORIA PLACE OF SILVERTON on July 1, 2024?
Yes, 2 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature."
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
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Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.