Inspection visit
Health inspection
4 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 4 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 - Some
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
record reviews and interviews, the facility failed to ensure comprehensive care plans were initiated for all
resident care needs. This affected four residents (Resident #7, Resident #11, Resident #25, and Resident
#48's) out of five residents reviewed for comprehensive care plans. The facility census was 56.
Findings included:
1. Review of the medical record for Resident #48 revealed an admission date of 09/12/20. Diagnosis
included but not limited to cerebral infarction, vascular dementia, unspecified severity with other behavioral
disturbance, unspecified psychosis not due to substance or known physiological condition, dementia with
behavioral disturbance, hypertension, and difficulty walking.
Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #48 had
intact cognition and always incontinent of bladder and bowel.
Review of the laboratory results for urinalysis culture and sensitivity dated 08/26/24 revealed Resident #48
was positive for Escherichia Coli of the urine and had a urinary tract infection (UTI).
Review of the physician order dated 08/26/24 revealed an order for Levofloxacin 750 milligram (MG)
(antibiotic for UTI) administer one time a day for five days.
Review of Resident #48's medical record revealed there was not a comprehensive care plan in place for
urinary incontinence or urinary tract infections.
Interview 11/21/24 at 10:59 A.M. with MDS Nurse #147 revealed she didn't know she needed to care plan
for incontinence care.
Interview on 11/26/24 at 8:49 A.M. with Director of Nursing (DON) confirmed care plans were not done
correctly. DON reported QAPI Action Plans were initiated to address these concerns and Resident #48 had
no UTI care plan. DON did not provide evidence of QAPI plans in place at the time of survey.
Interview on 11/26/24 at 12:23 P.M. with Assistant Director of Nursing (ADON) confirmed care plans were
not done correctly, and interventions were not updated on some of the care plans.
2. Review of the medical record for Resident #25 revealed an admission date of 07/26/23. Diagnosis
included but not limited to Hemiplegia and hemiparesis following cerebral infarction affecting right dominant
side, depression, anxiety disorder
(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:
365875
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
365875
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/27/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Crestmont North Nursing Home
13330 Detroit Ave
Lakewood, OH 44107
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
Level of Harm - Minimal harm
or potential for actual harm
Review of the quarterly MDS assessment dated [DATE], revealed Resident #25 was occasionally
incontinent of bladder.
Interview 11/21/24 at 10:59 A.M. with MDS Nurse #147 revealed she didn't know she needed to care plan
for incontinence care.
Residents Affected - Some
Interview on 11/26/24 at 8:49 A.M. with DON confirmed care plans were not done correctly and
interventions were not updated on falls care plan.
Interview on 11/26/24 at 12:23 P.M. with ADON confirmed care plans were not done correctly and
interventions were not updated on some of the care plans.
3. Review of the medical record for Resident #7 revealed an admission date of 10/17/19. Diagnosis
included but not limited to cerebral infarction, unspecified dementia with behavioral disturbance, type two
diabetes mellitus, major depressive disorder, seizures.
Review of the quarterly MDS assessment in progress, dated 11/12/24, revealed Resident #07 was
occasionally incontinent of bladder.
Review of the care plan dated 08/26/19 revealed no care plan for incontinence.
Interview 11/21/24 at 10:59 A.M. with MDS Nurse #147 revealed she didn't know she needed to care plan
for incontinence care.
Interview on 11/26/24 at 8:49 A.M. with DON confirmed care plans were not done correctly, and
interventions were not updated on falls care plan.
Interview on 11/26/24 at 12:23 P.M. with ADON confirmed care plans were not done correctly and
interventions were not updated on some of the care plans.
4. Review of the medical record for Resident #11 revealed an admission date of 01/27/21. Diagnosis
included but not limited to chronic kidney disease, schizoaffective disorder and major depressive disorder.
Review of the quarterly MDS assessment, dated 08/26/24/24, revealed Resident #11 was occasionally
incontinent of bladder and bowel.
Review of the care plan dated 08/26/19 revealed no care plan for incontinence.
Interview 11/21/24 at 10:59 A.M. with MDS Nurse #147 revealed she didn't know she needed to care plan
for incontinence care.
Interview on 11/26/24 at 8:49 A.M. with DON confirmed care plans were not done correctly. DON reported
she didn't realize the large knowledge deficit of the MDS #147 had and education was provided to her.
Interview on 11/26/24 at 12:23 P.M. with ADON confirmed care plans were not done correctly, and
interventions were not updated on some of the care plans.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365875
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
365875
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/27/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Crestmont North Nursing Home
13330 Detroit Ave
Lakewood, OH 44107
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
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Review of facility policy, Charting and Documentation, revised July 2017, revealed documentation in the
medical record will be complete and accurate.
Review of facility policy, Care Plans, Comprehensive Person - Centered, revised December 2016, revealed
a comprehensive, person-centered care plan to meet resident's physical, psychosocial, and functional
needs is developed and implemented for each resident. The care plan interventions are derived from a
thorough analysis of the information gathered as part of the comprehensive assessment. Assessments of
residents are ongoing and care plans are revised as information about the residents and the residents'
condition change.
This deficiency represents non-compliance investigated under Complaint Number OH00159309.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365875
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
365875
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/27/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Crestmont North Nursing Home
13330 Detroit Ave
Lakewood, OH 44107
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 0657
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed,
and revised by a team of health professionals.
Based on record review and interviews, the facility failed to ensure comprehensive care plans were revised
to reflect new fall interventions. This affected three residents (Resident #7, Resident #25, and Resident
#48) out of five residents reviewed for comprehensive care plans.
Findings included:
1. Review of the medical record for Resident #48 revealed an admission date of 09/12/20. Diagnosis
included but not limited to cerebral infarction, vascular dementia, unspecified severity with other behavioral
disturbance, unspecified psychosis not due to substance or known physiological condition, dementia with
behavioral disturbance, hypertension, and difficulty walking.
Review of care plan dated 09/11/20 revealed Resident #48 had a fall on 10/31/24 and the care plan was
not revised to reflect new interventions of non skid socks when out of bed to prevent falls.
Interview on 11/26/24 at 8:49 A.M. with Director of Nursing (DON) confirmed care plans were not done
correctly and fall interventions were not updated on the care plan.
2. Review of the medical record for Resident #25 revealed an admission date of 07/26/23. Diagnosis
included but not limited to Hemiplegia and hemiparesis following cerebral infarction affecting right dominant
side, depression, anxiety disorder
Review of Resident #25's medical record revealed the resident had a fall on 08/06/24 with the intervention
of educate on use of call light to prevent further falls. The care plan dated 07/31/23 was not revised with the
call light education.
Interview on 11/26/24 at 8:49 A.M. with DON confirmed Resident #25's care plan was not revised to reflect
new fall interventions.
3. Review of the medical record for Resident #7 revealed an admission date of 10/17/19. Diagnosis
included but not limited to cerebral infarction, unspecified dementia with behavioral disturbance, type two
diabetes mellitus, major depressive disorder, and seizures.
Review of Resident #7's medical record revealed the resident has a fall on 08/10/24 with a new intervention
of offer assistant with toileting at bed. The care plan dated 08/26/19 revealed the new intervention was not
added to the care plan.
Interview on 11/26/24 at 8:49 A.M. with DON confirmed Resident #7's care plan was not revised to reflect
new fall interventions.
Review of facility policy, Care Plans, Comprehensive Person - Centered, revised December 2016, revealed
a comprehensive, person-centered care plan to meet resident's physical, psychosocial, and functional
needs is developed and implemented for each resident. The care plan interventions are derived from a
thorough analysis of the information gathered as part of the comprehensive assessment. Assessments of
residents are ongoing, and care plans are revised as information about the residents and the residents'
condition change.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365875
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
365875
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/27/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Crestmont North Nursing Home
13330 Detroit Ave
Lakewood, OH 44107
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 0657
This deficiency represents non-compliance investigated under Complaint Number OH00159309.
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:
365875
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
365875
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/27/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Crestmont North Nursing Home
13330 Detroit Ave
Lakewood, OH 44107
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
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to
prevent accidents.
Based on record review and interviews, the facility failed to ensure residents were timely assessed for risk
of falls to ensure appropriate interventions were in place to prevent falls. This affected three residents
(Resident #11, Resident #21, and Resident #48) out of five residents reviewed for accident hazards.
Findings included:
1. Review of the medical record for Resident #48 revealed an admission date of 09/12/20. Diagnosis
included but not limited to cerebral infarction, vascular dementia, unspecified severity with other behavioral
disturbance, unspecified psychosis not due to substance or known physiological condition, dementia with
behavioral disturbance, hypertension, and difficulty walking.
Review of the falls risk assessment revealed Resident #48's latest fall risk assessments were completed on
10/02/24 and 10/31/24. Prior to 10/31/24 the resident was not assessed for falls since 03/08/21.
Interview on 11/26/24 at 8:49 A.M. with Director of Nursing (DON) confirmed falls risk assessments were
not being completed as required.
2. Review of the medical record for Resident #21 revealed an admission date of 07/19/24. Diagnosis
included but not limited major depressive disorder, and chronic viral hepatitis C.
Review of the falls risk assessment revealed Resident #21's fall risk assessment completed on 10/06/24.
There was no evidence the resident's risk of falls were assessed upon admission to ensure appropriate fall
prevention interventions were in place.
Interview on 11/26/24 at 8:49 A.M. with DON confirmed falls risk assessments not being completed as
required.
Interview on 11/26/24 at 12:23 P.M. with Assistant Director of Nursing (ADON) confirmed falls risk
assessments not completed as required.
3. Review of the medical record for Resident #11 revealed an admission date of 01/14/21. Diagnosis
included but not limited to chronic kidney disease, schizoaffective disorder and major depressive disorder.
Review of the falls risk assessment revealed Resident #11's last fall risk assessment was completed
11/17/24. Prior to 11/17/24, the resident's risk of falls was not assessed since 03/10/21.
Interview on 11/26/24 at 8:49 A.M. with DON confirmed falls risk assessments were not being completed as
required.
Interview on 11/26/24 at 12:23 P.M. with ADON confirmed falls risk assessments not completed as
required.
Review of the QAPI Action Plan dated 11/15/24 for Quarterly Assessments timely completion, revealed
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365875
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
365875
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/27/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Crestmont North Nursing Home
13330 Detroit Ave
Lakewood, OH 44107
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
the facility initiated a plan to address timely assessments dated for 11/22/24 which identified need for
additional nursing hours to complete quarterly assessments. ADON/Designee was to complete or delegate
risk assessments.
Review of the facility policy, Fall Risk Assessment revised December 2007, revealed staff will identify and
document resident risk factors for falls and address modifiable fall risk factors and interventions to try to
minimize the consequences of risk factors that are not modifiable.
Review of the facility policy, Falls and Fall Risk Managing revised in December 2007, revealed based on
previous evaluations and current date the staff will identify interventions related to the resident's specific
risks and causes to try to prevent the resident from falling and to try to minimize complications from falling.
This deficiency represents non-compliance investigated under Complaint Number OH00159309.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365875
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
365875
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/27/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Crestmont North Nursing Home
13330 Detroit Ave
Lakewood, OH 44107
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 0755
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a
licensed pharmacist.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interviews and record reviews, the facility failed to ensure residents were administered medication per
physician orders. This affected two residents (#7 and #48) out of three residents reviewed for medication
administration.
Findings included:
1. Review of the medical record revealed Resident ##7 revealed an admission date of 10/17/19. Diagnosis
included but not limited to cerebral infarction, unspecified dementia with behavioral disturbance, type two
diabetes, major depressive disorder, and seizures.
Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #7 had
intact cognition.
Review of the laboratory results for urinalysis culture and sensitivity dated 08/04/24 revealed Resident #7
was positive for Staphylococcus Haemolyticus of the urine and had a urinary tract infection (UTI).
Review of the physician order dated 08/04/24 revealed an order for Macrobid (antibiotic) 100 milligrams
(mg) every twelve (12) hours for five (5) days.
Review of the medication administration records (MAR) dated August 2024 revealed Resident #7 received
Macrobid (antibiotic for UTI) 100 mg on 08/05/24 at 9:00 A.M. but did not receive the evening dose at 9:00
P.M. as ordered per physician. The MAR had a #9 code, indicating other and to see nurses' notes with
initials for Licensed Practical Nurse (LPN_ #106. On 08/06/24 Macrobid 100 mg was administered twice a
day (BID) as ordered. The MARS for 08/07/24, 08/08/24, and 08/09/24 were blank.
Review of the paper MARS dated August 2024 revealed for 08/07/24, 08/08/24, and 08/09/24 Resident #7
reviewed Macrobid 100 mg BID as ordered per physician.
Interview on 11/26/24 at 10:43 A.M. with Director of Nursing (DON) confirmed Resident #7 missed the
evening dose of Macrobid 100 mg on 08/05/24. DON reported she did not know why it wasn't administered.
DON reported there was a starter box in the facility which carries the antibiotic.
Review of facility policy, Medication Utilization and Prescribing - Clinical Protocol, revised July 2016,
revealed staff will ensure medications are given appropriately.
Review of facility policy, Antibiotic Stewardship - Orders for Antibiotics, revised December 2016, revealed
antibiotics will be prescribed and administered under the guidance of the facility's Antibiotic Stewardship
Program and in conjunction with the facility's general policy for Medication Utilization and Prescribing.
2. Review of medical record revealed Resident #48 was admitted to the facility on [DATE]. Diagnosis
included but not limited to cerebral infarction, vascular dementia, unspecified severity with other behavioral
disturbance, unspecified psychosis not due to substance or known physiological condition, dementia with
behavioral disturbance, hypertension, and difficulty walking.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365875
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
365875
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/27/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Crestmont North Nursing Home
13330 Detroit Ave
Lakewood, OH 44107
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 0755
Level of Harm - Minimal harm
or potential for actual harm
Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #48 had
intact cognition.
Review of the laboratory results for urinalysis culture and sensitivity dated 08/26/24 revealed Resident #48
was positive for Escherichia Coli of the urine and had a urinary tract infection (UTI).
Residents Affected - Few
Review of the physician order dated 08/26/24 revealed an order for Levofloxacin 750 milligram (MG)
(antibiotic for UTI) administer one time a day for five days.
Review of the medication administration records (MAR) dated October 2024 revealed Resident #48
received Levofloxacin 750 mg on 08/26/24, 08/27/24 and on 08/29/24. On 08/28/24 it was coded #3, absent
from home as she did not receive any Levofloxacin 750 mg on 08/28/24. Resident #48 missed two doses of
her antibiotic in total.
Interview on 11/26/24 at 10:43 A.M. with DON confirmed the order was entered incorrectly and Resident
#48 missed 3 doses of Levofloxacin 750 mg. DON reported she did not know why it wasn't administered.
DON reported there was a starter box in the facility which carries the antibiotic.
Review of facility policy, Medication Utilization and Prescribing - Clinical Protocol, revised July 2016,
revealed staff will ensure medications are given appropriately.
Review of facility policy, Antibiotic Stewardship - Orders for Antibiotics, revised December 2016, revealed
antibiotics will be prescribed and administered under the guidance of the facility's Antibiotic Stewardship
Program and in conjunction with the facility's general policy for Medication Utilization and Prescribing.
This deficiency represents non-compliance investigated under Complaint Number OH00159309.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365875
If continuation sheet
Page 9 of 9
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Back to topCitations
4 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.
F689 - Accidents
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
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.
F657 - Comprehensive Care Plans
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
F755 - Pharmacy Services
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
FAQ · About this visit
Common questions about this visit
What happened during the November 27, 2024 survey of CRESTMONT NORTH NURSING HOME?
This was a inspection survey of CRESTMONT NORTH NURSING HOME on November 27, 2024. The surveyor cited 4 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at CRESTMONT NORTH NURSING HOME on November 27, 2024?
Yes, 4 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents."
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.