Inspection visit
Inspection
15 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 15 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0578
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to
participate in experimental research, and to formulate an advance directive.
Based on medical record review, staff interview, and review of the facility policy, the facility failed to ensure
resident code status was correctly noted in the medical record This affected three (Residents #9, #28, and
#31) of 16 residents reviewed for advance directives. The facility census was 42 residents. Findings include:
1.Review of the medical record for Resident #28 revealed an admission date of 12/08/24 with diagnoses
including atherosclerotic heart disease, hypertension, major depressive disorder, anxiety disorder, and
cardiomyopathy.
Review of the paper chart for Resident #28 revealed a signed Do Not Resuscitate (DNR) form dated
12/18/24 indicating the resident's code status was DNR Comfort Care.
Review of the Minimum Data Set (MDS) assessment for Resident #28 dated 06/17/25 revealed the resident
was cognitively intact and required staff assistance with activities of daily living (ADLs.)
Review of the active physician orders for Resident #28 in the electronic health record revealed an order
dated 08/18/25 for the resident to be a full code status.
Interview on 09/03/25 at 10:45 A.M. with Licensed Practical Nurse (LPN) #38 confirmed Resident #28 had
a current order for a code status of full code and had a signed DNR form in his paper chart.
2. Review of the medical record for Resident #31 revealed an admission date of 10/24/24 with diagnoses
including unspecified dementia, type two diabetes mellitus, and hypertension.
Review of the paper chart for Resident #31 revealed there was a sticker on the outside of the chart which
indicated the resident's code status was DNRCC-A. The chart included a DNRCC form signed by the
physician dated 09/01/24.
Review of the MDS assessment for Resident #31 dated 05/21/25 revealed the resident required staff
assistance with ADLs.
Interview on 09/03/25 at 10:15 A.M. with Certified Nursing Assistant (CNA) #90 confirmed she would check
the resident's chart if she needed to determine the resident's code status.
Interview on 09/03/25 at 10:23 A.M with the DON confirmed the nurse labeled resident charts on admission
to reflect the resident's code status. The DON verified Resident #31's chart had a sticker indicating the
resident's code status was DNRCC-A, but the resident's correct code status was DNRCC.
Review of the facility policy titled Advance Directives dated 04/22/25 revealed upon admission
(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 9
Event ID:
365798
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
365798
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/04/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Courtyard at Seasons
7100 Dearwester Drive
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 0578
staff would verify resident advanced directives and ensure a signed copy of advanced directive was be kept
in resident's chart.
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:
365798
If continuation sheet
Page 2 of 9
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
365798
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/04/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Courtyard at Seasons
7100 Dearwester Drive
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 0584
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
FORM CMS-2567 (02/99)
Previous Versions Obsolete
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.
Based on observation, staff interview, and review of the facility policy, the facility failed to provide a
comfortable homelike atmosphere for residents dining in the skilled nursing dining room. This affected six
(Residents #3, #12, #15, #21, #27, #38) and had the potential to affect all of the residents residing in the
facility with the exception of one facility-identified resident (#36) who did not receive nutrition by mouth. The
facility census was 42 residents. Findings include:Observation on 09/02/25 at 4:53 P.M. of dinner in the
skilled nursing dining room revealed staff served residents on trays directly from the serving cart. The staff
did not remove the plates from the meal trays. Interview on 09/02/25 at 4:55 P.M. with Certified Nursing
Assistant (CNA) #104 confirmed resident meals were served on trays and staff did not remove the plates of
food, utensils, and beverages from the tray. Observation on 09/03/25 at 12:34 P.M. of lunch in the skilled
dining room revealed staff served residents on trays directly from the serving cart. The staff did not remove
the plates from the meal trays. Interview on 09/03/25 at 12:35 P.M. with Food Service Manager (FSM) #157
confirmed resident meals were served on trays and staff did not remove the plates of food, utensils, and
beverages from the tray. Interview on 09/03/25 at 12:47 P.M. with FSM #157 confirmed the facility policy
indicated resident food should be taken off the tray and placed on the table in front of each resident to be
served in a homelike style. Review of the facility policy titled Meal Service - Hospitality and Customer
Service Standard revealed table settings should include tablecloths or place mats, center pieces, presetting
of glassware, china plates and tableware without the tray.
Event ID:
Facility ID:
365798
If continuation sheet
Page 3 of 9
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
365798
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/04/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Courtyard at Seasons
7100 Dearwester Drive
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 0689
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to
prevent accidents.
Based on medical record review, observation and staff interview, facility failed to ensure staff provided the
appropriate level of supervision during mealtime. This affected one (Resident #38) of six facility-identified
residents who required supervision with meals. The facility census was 45. Findings include: Review of the
medical record for Resident #38 revealed an admission date of 08/28/24 with diagnoses including cerebral
atherosclerosis, dysphagia, and depression. Review of the physician's orders for Resident #38 revealed an
order dated 11/01/24 for a regular diet, pureed texture and nectar fluids consistency.Review of the Minimum
Data Set (MDS) assessment for Resident #38 dated 06/05/25 revealed the resident had severe cognitive
impairment and required supervision from staff with eating.Review of care plan for Resident #38 dated
06/09/25 revealed the resident was at severe nutritional and hydration risk. The goal of the care plan was
for resident to be able to safely and effectively chew and swallow a pureed diet with nectar thick
liquidsReview of the physician's orders for Resident #38 dated 06/17/25 revealed the resident's diet was
liberalized to include mechanical soft foods for pleasure.Review of the physician's orders for Resident #38
dated an order dated 06/24/25 for staff to provide the resident with assistance with feeding at breakfast
daily.Observation on 09/02/25 at 5:03 P.M. revealed Resident #38 was sitting in the dining room at a table
by herself facing the wall and exhibited episodes of coughing while eating which grew worse as the meal
continued. The Surveyor asked Certified Nursing Assistant (CNA) #104 to check on the resident. CNA #104
sat down and faced the Resident #38 and encouraged the resident to slow down in eating. CNA #104 then
assisted Resident #38 to take smaller bites at a slower pace. Interview on 09/02/25 at 5:28 P.M. with CNA
#104 confirmed Resident #38 had been sitting where staff could not easily see her and the resident had
been coughing while eating. CNA #104 confirmed when she provided supervision to Resident #38 at the
Surveyor's request. CNA #104 confirmed staff need to intervene immediately to assist any resident who is
coughing while eating. Interview on 09/03/25 at 10:20 A.M. with the Director of Nursing (DON) confirmed
Resident #38 had an order for staff to assist the resident with eating for breakfast as resident had greatest
difficulty eating on her own soon after waking up. The DON confirmed Resident #38 needed supervision at
all meals and the expectation was for aides to be stationed in the dining room during all meals and to
monitor all residents eating in the dining room.
Event ID:
Facility ID:
365798
If continuation sheet
Page 4 of 9
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
365798
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/04/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Courtyard at Seasons
7100 Dearwester Drive
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 0761
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
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.
Based on medical record review, observation, staff interview, and review of the facility policy, the facility
failed to ensure insulin was dated upon opening. This affected one (Resident #31) of six residents who had
orders for insulin. The facility failed to ensure expired medications were discarded. This affected one
(Resident #54) of 42 residents reviewed for medication storage. The facility census was 42
residents.Findings include:1. Review of the medical record for Resident #31 revealed an admission date of
11/11/24 with diagnoses including dementia, type two diabetes, and hyperlipidemia. Observation on
09/03/25 at 3:54 P.M of medication storage with Registered Nurse (RN) #76 revealed the Lantus insulin pen
for Resident #31 had not been dated upon opening. Interview on 09/03/25 at 3:55 P.M. with RN #76
confirmed Resident #31's Lantus insulin pen had not been dated upon opening. 2. Review of the medical
record for Resident #54, revealed an admission date of 08/26/25 with diagnoses including myoneural
disorder, rhabdomyolysis, and type two diabetes.Review of the active physician's orders for Resident #54
revealed an order for oyster shell calcium 500 milligrams (mg) twice dailyObservation on 09/03/25 at 4:01
P.M. of the medication cart with RN #76 revealed the oyster shell calcium for Resident #54 had an
expiration date of July 2025.Interview on 09/03/25 at 4:02 P.M. with RN #76 confirmed the oyster shell
calcium for Resident #54 was expired and should have been discarded.Review of facility policy titled
Medication Storage Standard dated on 12/12/24 revealed the facility will follow state regulations regarding
medication storage.
Event ID:
Facility ID:
365798
If continuation sheet
Page 5 of 9
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
365798
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/04/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Courtyard at Seasons
7100 Dearwester Drive
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 0790
Provide routine and 24-hour emergency dental care for each resident.
Level of Harm - Minimal harm
or potential for actual harm
Based on medical record review, resident interview, staff interview, and review of the facility policy, the
facility failed to ensure residents received dental services. This affected one (Resident #43) of three
residents reviewed for dental services. The facility census was 42 residents. Findings include: Review of the
medical record for Resident #43 revealed an admission date of 09/15/23 with diagnoses which included
hereditary idiopathic neuropathy, peripheral venous insufficiency, arthritis, and depressionReview of the
admission packet for Resident #43 dated 07/19/23 revealed the resident signed the admission packet which
noted the facility would arrange for physician visits as authorized under the agreement for ancillary services
prescribed by a physician. Review of the physician's orders for Resident #43 revealed an order dated
08/22/23 for resident to receive ancillary services as needed including dental services.Review of the
Minimum Data Set (MDS) for Resident #43 dated 05/20/25 revealed the resident was cognitively intact and
required staff assistance with activities of daily living (ADLs.)Interview on 09/03/25 at 3:37 P.M. with
Resident #43 confirmed she had never been offered the opportunity to see a dentist since her admission to
the facility. Resident #43 confirmed she had no emergent need for a dentist but felt she needed to have her
teeth cleaned and evaluated. Interview on 09/03/25 at 5:11 P.M. with the Administrator confirmed Resident
#43 had not been seen by a dentist since her admission to the facility.
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365798
If continuation sheet
Page 6 of 9
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
365798
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/04/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Courtyard at Seasons
7100 Dearwester Drive
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 0812
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Many
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve
food in accordance with professional standards.
Based on observation, staff interview and review of the facility policy, the facility failed to safely serve food
in a manner to avoid possible contamination and food borne illnesses. This had the potential to affect all of
the residents residing in the facility who received food from the facility kitchen. The facility identified one
(Resident #36) who received no nutrition by mouth. The facility census was 42 residents.Findings
include:Observation on 09/03/25 at 12:05 P.M of trays being assembled revealed Dietary Aide (DA) #10
donned gloves, grabbed a tray off the cart, reviewed the tray ticket, and picked up a sandwich off the steam
table. DA #10 placed food on the plate using serving utensils and removed and replaced the lid to the
heated serving compartment with gloved hands. DA #10 then picked up the next tray, reviewed the ticket,
picked up a chicken breast with gloved hands and placed it on a plate. Interview on 09/03/25 at 12:10 P.M.
with DA #10 at 12:10 P.M. confirmed he had donned gloves and residents' food (sandwich and chicken
breast) directly with his gloved hands after touching multiple surfaces and items in the environment.
Observation on 09/03/25 at 12:17 P.M. revealed DA #10 picked up a tray, reviewed a tray ticket, and used
tongs to put a sandwich on the counter to cut it in half. DA #10 picked up a knife and held the sandwich with
his gloved hand to cut it in half. DA #10 then picked up each half of the sandwich with tongs and placed it
on the plate. DA #10 then removed his gloves, washed his hands and applied new gloves. DA #10 pulled
the next tray, reviewed the ticket, and put a piece of chicken breast on the counter using tongs. DA #10 then
cut the chicken breast using his gloved hand to hold the chicken breast as he sliced it. Interview on
09/03/25 at 12:20 P.M. with DA #10 confirmed he touched the sandwich and the chicken breast directly with
his gloved hands while slicing the items. DA #10 confirmed he touched other surfaces in the kitchen before
and after touching the residents' food. Interview on 09/03/25 at 12:28 P.M. with Food Service Manager
(FSM) #157 confirmed gloves should be changed and proper hand hygiene performed prior to touching any
food items during tray line. Review of the facility policy titled Hand Hygiene versus Alcohol Based Hand Rub
dated 06/15/16 revealed staff should practice hand hygiene at key points in time to disrupt the transmission
of microorganisms to residents after contact with contaminated surfaces even if gloves are worn and after
removing gloves. Wearing gloves did not relace hand hygiene).
Event ID:
Facility ID:
365798
If continuation sheet
Page 7 of 9
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
365798
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/04/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Courtyard at Seasons
7100 Dearwester Drive
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 0880
Provide and implement an infection prevention and control program.
Level of Harm - Minimal harm
or potential for actual harm
Based on medical record review, observation, staff interview, and review of the facility policy, the facility
failed to ensure staff donned appropriate personal protective equipment (PPE) during direct care for
residents with orders for enhanced barrier precautions (EBP). This affected one (Resident #50) of three
residents reviewed for EBP. The facility also failed to take preventative measures to minimize the risk of
legionella per the facility's water management plan. This had the potential to affect all of the residents
residing in the facility. The facility census was 42 residents.Findings include: 1.Review of the medical record
for Resident #50 revealed an admission date of 08/26/25 with diagnoses including but perforation of
intestine, colostomy status, and hypertension.Review of the physician's orders for Resident #50 revealed an
order dated 08/26/25 for the resident to be on enhanced barrier precautions related to presence of an
ostomy. Observation on 09/03/25 at 8:21 A.M. of colostomy care for Resident #50 per Licensed Practical
Nurse (LPN) #30 and Certified Nursing Assistant (CNA) #110 revealed the staff donned gloves prior to care
but did not don gowns.Interview on 09/03/25 at 8:30 A.M with LPN #30 confirmed Resident #50 had an
order for EBP due to the colostomy. LPN #50 confirmed staff should don a gown and gloves prior to
providing direct care to a resident on EBP. LPN #30 confirmed staff had not donned gowns prior to
colostomy care for Resident #50.Interview on 09/03/25 at 8:34 A.M with CNA #110 confirmed the aide had
not donned a gown prior to assisting with colostomy care for Resident #50.Review of the facility policy titled
Enhanced Barrier Precautions-Skilled dated 04/09/24 revealed staff members should wear a gown and
gloves when participating in high contact resident care including touching indwelling medical devices for
residents with physician's orders for EBP.2. Review of the facility water management program dated
12/29/17 revealed the facility should conduct regular water testing including visual inspections, checking
levels, and checking temperatures to minimize the risk of legionella.Interview on 09/03/25 at 4:00 P.M with
Maintenance Assistant (MA) #48 and the Administrator confirmed the facility had no recent concerns with
legionella, but the facility had no evidence of recent water testing including checking water
temperatures.Review of the facility policy titled Health and Wellness Legionella Disease dated 04/22/25
revealed the facility should use preventative maintenance to quickly identify a potential risk of legionella.
Residents Affected - Many
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365798
If continuation sheet
Page 8 of 9
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
365798
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/04/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Courtyard at Seasons
7100 Dearwester Drive
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 0883
Develop and implement policies and procedures for flu and pneumonia vaccinations.
Level of Harm - Minimal harm
or potential for actual harm
Based on medical record review, staff interview, and review of the facility policy, the facility failed to ensure
residents were offered appropriate pneumococcal immunizations. This affected one (Resident #42) of eight
residents reviewed for immunizations. The facility census was 42 residents.Findings include: Review of the
medical record for Resident #42 revealed an admission date of 11/09/22 with diagnoses including chronic
atrial fibrillation, gastrointestinal hemorrhage, and hyperlipidemia.Review of the immunization record for
Resident #42 revealed the resident received Pneumovax 23 (PPSV23) on 11/10/22.Review of the Minimum
Data Set (MDS) assessment for Resident #42 dated 08/15/25 revealed the resident was cognitively intact
and the resident's pneumococcal immunizations were completed.Interview on 09/04/25 at 12:20 P.M with
the Director of Nursing (DON) confirmed the facility did not offer Pneumococcal Conjugate Vaccine
(PCV)15, PCV20, or PCV21 vaccines to Resident #42 due to accidentally marking his pneumococcal
immunizations as complete.Review of the facility policy titled Offering Pneumococcal Vaccine dated
03/06/25 revealed upon admission residents will be assessed for eligibility to receive the pneumococcal
vaccines (PCV15, PCV23, and PPSV20) and will be offered within 5 days of admission.
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365798
If continuation sheet
Page 9 of 9
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Back to topCitations
15 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.
- 0345GeneralS&S Fpotential for harm
Have approved installation, maintenance and testing program for fire alarm systems.
- 0353GeneralS&S Fpotential for harm
Inspect, test, and maintain automatic sprinkler systems.
- 0363GeneralS&S Fpotential for harm
Install corridor and hallway doors that block smoke.
- 0521GeneralS&S Fpotential for harm
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
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.
F914 - Be designed or equipped to assure full visual privacy for each
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.
F918 - Bathroom Facilities
Have generator or other power source capable of supplying service within 10 seconds.
F920 - Dining and Resident Activities
Ensure proper usage of power strips and extension cords.
F578 - The right to request, refuse, and/or discontinue treatment, to participate in or
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
F584 - Safe Environment
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.
F689 - Accidents
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
F790 - Dental services
Provide routine and 24-hour emergency dental care for each resident.
F812 - Food safety requirements
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
F880 - Infection Control
Provide and implement an infection prevention and control program.
F883 - Influenza and pneumococcal immunizations
Develop and implement policies and procedures for flu and pneumonia vaccinations.
FAQ · About this visit
Common questions about this visit
What happened during the September 4, 2025 survey of COURTYARD AT SEASONS?
This was a inspection survey of COURTYARD AT SEASONS on September 4, 2025. The surveyor cited 15 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at COURTYARD AT SEASONS on September 4, 2025?
Yes, 15 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Have approved installation, maintenance and testing program for fire alarm systems."
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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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.