Inspection visit
Inspection
8 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 8 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0563
Honor the resident's right to receive visitors of his or her choosing, at the time of his or her choosing.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
review of medical record, family and staff interview, review of facility correspondence, and policy review, the
facility failed to allow residents to have visitation by family members at any time. This affected one (#55)
resident who's family was interviewed and had the potential to affect all 81 residents residing in the facility.
Residents Affected - Many
Findings include:
Review of Resident #55's medical record revealed an admission date of 09/18/21. Diagnoses included
cerebral infarction with hemiplegia and hemiparesis, diabetes mellitus, peripheral vascular disease, and
depression.
Review of Resident #55's quarterly Minimum Data Set (MDS) assessment, dated 09/30/21, revealed the
resident had a low cognitive function.
Review of Resident #55's most recent care plan revealed her leisure preferences included having visitors.
Interview with Resident #55's family on 11/01/21 at 3:15 P.M. revealed the facility had restrictive hours for
visitation and refused to allow family members under the age of 16 in to visit. The family stated the facility
had two receptionists and neither would allow Resident #55's grandchildren to visit.
Interview with facility Receptionist #465 on 11/02/21 at 10:07 A.M. revealed visitation was open every
Monday through Friday between 9:00 A.M. and 7:00 P.M. On the weekend's visitation was allowed from
10:00 A.M. to 4:00 P.M. or 5:00 P.M. depending on staffing. Further interview revealed no one under the age
of [AGE] years old was allowed in the facility due to the possibility of carrying a sickness. During a
COVID-19 outbreak no visitors could enter the facility. Compassionate care visits could occur at any time.
Interview with the Administrator on 11/04/21 at 12:34 P.M. revealed visitation was allowed until 5:30 P.M. but
if someone wanted to visit after that time an exception would be made. No children under the age of 12
were allowed in the facility for visitation.
Review of an undated family letter mailed to all resident families by the Administrator revealed visitation
hours would be Monday through Friday from 9:00 A.M. to 5:00 P.M. Weekend visitations would be 9:00 A.M.
to 2:00 P.M. and families must first contact the facility to notify them of the
(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 6
Event ID:
366042
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
366042
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/04/2021
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Spring Meadows Nursing, A Villa Center
1125 Clarion Ave
Holland, OH 43528
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 0563
visitation. Visits were to be no longer than 30 minutes with no more than two people at a time.
Level of Harm - Minimal harm
or potential for actual harm
Review of the facility policy titled Visitations Rights Guidelines, dated 11/28/17, revealed resident visitors
are not subject to visiting hour limitations or other restrictions not imposed by the resident or warranted due
to reasonable clinical and safety restrictions. Facilities must provide 24-hour access to other non-relative
visitors with consent of the resident subject to reasonable restrictions including clinical and safety
restrictions as applicable. The facility will inform the resident and visitors as indicated.
Residents Affected - Many
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366042
If continuation sheet
Page 2 of 6
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
366042
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/04/2021
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Spring Meadows Nursing, A Villa Center
1125 Clarion Ave
Holland, OH 43528
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.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
review of the medical record, resident representative interview, and staff interview, the facility failed to hold
care conferences and failed to invite residents or their representatives to care conferences. This affected
two (#36 and #68) of 20 residents reviewed. The facility census was 81.
Findings include:
1. Review of the medical record review revealed Resident #36 was admitted on [DATE]. Diagnoses included
hypertensive chronic kidney disease, dementia with behavioral disturbance, insomnia, anxiety disorder,
restlessness and agitation, personal history of pulmonary embolism, muscle weakness, extrapyramidal and
movement disorder, and expressive language disorder.
Review of the Minimum Data Set (MDS) assessment, dated 09/03/21, revealed the resident was severely
cognitively impaired.
Review of the medical record was silent for any care conferences being held or any invitations for care
conferences being provided to the resident's representative.
Interview on 11/01/21 at 3:33 P.M. with Resident #36's representative revealed not being invited to any care
conferences.
2. Review of the medical record for Resident #68 revealed an admission date of 10/06/20. Diagnoses
included muscle weakness, type 2 diabetes mellitus with diabetic polyneuropathy, chronic obstructive
pulmonary disease, anxiety disorder, hypothyroidism, schizoaffective disorder, anemia and major
depressive disorder, and bipolar disorder.
Review of the quarterly MDS assessment, dated 10/05/21, revealed Resident #68 was had intact cognition.
Review of the progress notes revealed there was no care conferences held for Resident #68 since
02/11/20.
Interview on 11/02/21 at 11:59 A.M. with Social Services Director #506 verified Resident #36 and #68 have
not been invited to or had care conferences in, at minimum, the last nine months. Social Services Director
#506 revealed she has been working catching up on invitations and holding care conferences.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366042
If continuation sheet
Page 3 of 6
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
366042
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/04/2021
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Spring Meadows Nursing, A Villa Center
1125 Clarion Ave
Holland, OH 43528
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 0679
Provide activities to meet all resident's needs.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
resident record review, observation, staff interview, and review of facility policy, the facility failed to ensure
activity preferences and physician orders were followed for one (#53) out of 20 residents reviewed. The
facility census was 81.
Residents Affected - Few
Findings include:
Review of the medical record revealed Resident #53 was admitted on [DATE]. Diagnosis included heart
failure, hypothyroidism, edema, type two diabetes mellitus without complications, hyperlipidemia,
osteoarthritis, hypertensive heart disease with heart failure, dementia without behavioral disturbance and
chronic kidney disease.
Review of the annual Minimum Data Set (MDS) assessment, dated 6/29/21, the resident was severely
cognitively impaired and listening to music she likes is very important to her.
Review of the care plan, updated 01/17/20, revealed Resident #53 enjoyed Christian and easy listening
music.
Review of the physician order, dated 07/12/20, revealed Resident #53 daughter requested Christian
television channel six be on for the resident to watch daily from 1:00 P.M. to 3:00 P.M.
Observation on 11/01/21 at 1:39 P.M. revealed Resident #53 in bed watching the television with the
Hallmark Channel tuned in.
Observation on 11/02/21 at 1:19 P.M.,1:38 P.M., and 2:03 P.M. revealed Resident #53 in the resident room
with the Hallmark Channel tuned in on the television.
Interview on 11/02/21 at 2:54 P.M. with State Tested Nursing Assistant (STNA) #508 verified the Hallmark
Channel was on the television, not Christian television channel six.
Review of facility policy titled Activities Meets Interest and Needs of Each Resident, dated 05/07/21,
revealed the facility will provide resident center activity designed to meet the interests of and support the
well being of each resident.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366042
If continuation sheet
Page 4 of 6
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
366042
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/04/2021
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Spring Meadows Nursing, A Villa Center
1125 Clarion Ave
Holland, OH 43528
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 0692
Provide enough food/fluids to maintain a resident's health.
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 interview, and staff interview, the facility failed to follow
physician orders for fluid restrictions for one (#18) of one resident reviewed for dialysis. The facility had two
residents receiving dialysis. The facility census was 81.
Residents Affected - Few
Findings include:
Review of the medical record revealed Resident #18 was admitted on [DATE]. Diagnoses included chronic
kidney disease stage four, heart failure, end stage renal disease, dependence on renal dialysis, anemia,
rheumatoid arthritis, type two diabetes mellitus, and urinary calculus.
Review of the Minimum Data Set (MDS) assessment, dated 08/12/21, revealed the resident was
moderately cognitively impaired.
Review of the physician order, dated 08/16/21, revealed the resident had fluids limited to 1800 cubic
centimeter (cc)/per day, fluid intake to be recorded every shift and every meal. No bedside free water due to
fluid restriction.
Observation on 11/02/21 at 8:41 A.M. revealed a 30-ounce tumbler filled with ice and an unidentified clear
liquid on Resident #18's bedside table.
Interview on 11/02/21 at 8:42 A.M. with Resident #18 revealed she is on dialysis and she monitors her fluid
intake. Resident #18 verified she has a tumbler with ice and water on the bedside table.
Observation on 11/02/21 at 11:12 A.M. revealed a 30-ounce tumbler filled with ice and unidentified clear
liquid on Resident #18's bedside table.
Interview on 11/02/21 at 11:18 A.M. with Registered Nurse (RN) #526 verified Resident #18 has a personal
tumbler of water and ice at the bedside table. RN #526 revealed ice can only be retrieved by facility staff.
RN #526 verified this water intake is not tracked. RN #526 stated he/she only records fluid intake provided
during medication administration.
Interview on 11/03/21 at 10:04 A.M. with Licensed Practical Nurse (LPN) #469 verified Resident #18 has a
tumbler of water at the bedside table. LPN #469 verified fluid intake from tumbler is not tracked. LPN #469
stated he/she only records fluid intake provided during medication administration.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366042
If continuation sheet
Page 5 of 6
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
366042
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/04/2021
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Spring Meadows Nursing, A Villa Center
1125 Clarion Ave
Holland, OH 43528
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
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 observation, staff interview, medical record review, and review of a facility policy, the facility failed
to ensure medications were stored and removed from use per manufacturer instructions. This affected one
(#44) of 21 residents with medications stored in the 100 Hall medication cart. The census was 81.
Findings include:
Review of Resident #44's medical record revealed an admission date of 03/11/20. Diagnoses included
cerebral infarction, end stage renal disease, diabetes mellitus type II, hyperkalemia, and unspecified
glaucoma.
Review of a physician order dated 09/23/21 revealed Resident #44 was ordered latanoprost solution 0.005
% eye drops with instructions to instill one drop in both eyes at bedtime for glaucoma.
Observation on 11/04/21 at 10:17 A.M. revealed Resident #44 had two bottles of latanoprost solution
0.005% eye drops in the 100 Hall medication cart. One bottle was not opened and was in a plastic bag
which had a sticker indicating the medication should be refrigerated until opened. The other bottle had a
hand written date on the medication label indicating the medication was opened on 09/14/21.
Interview on 11/04/21 at 10:19 A.M. with Licensed Practical Nurse (LPN) #462 verified one bottle of
Resident #44's latanoprost solution 0.005% eye drops was not opened and should have been refrigerated
instead of being left in the medication cart, and verified the other bottle had an opened date of 09/14/21.
LPN #462 stated the pharmacy told her eye drops could remain in use until the expiration date printed on
the label of the medication.
Review of manufacturer instructions for latanoprost solution 0.005% medication, revised August 2011,
revealed unopened bottles should be stored under refrigeration between two degrees Celsius (C) to eight
degrees C (36 degrees Fahrenheit (F) to 46 degrees F). Once a bottle is opened, it may be stored at room
temperature up to 25 degrees C (77 degrees F) for six weeks.
The manufacturer instructions were reviewed with LPN #462 on 11/04/21 at 10:21 A.M. LPN #462 verified
one of Resident #44's latanoprost solution 0.005% bottles was opened and in use for greater than six
weeks. The bottle indicated the medication was opened on 09/14/21 and should have not have been used
after 10/26/21.
Review of a facility policy titled Medication Storage, dated 11/28/17, revealed the facility shall store all drugs
and biologicals in a safe and secure manner. Medications requiring refrigeration must be stored in a
refrigerator separately from food and must be labeled accordingly.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366042
If continuation sheet
Page 6 of 6
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Back to topCitations
8 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.
F563 - The resident has a right to receive visitors of his or her choosing at the time o
Honor the resident's right to receive visitors of his or her choosing, at the time of his or her choosing.
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.
F679 - Activities
Provide activities to meet all resident's needs.
F692 - Assisted nutrition and hydration
Provide enough food/fluids to maintain a resident's health.
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.
- 0222GeneralS&S Epotential for harm
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
- 0374GeneralS&S Epotential for harm
Install smoke barrier doors that can resist smoke for at least 20 minutes.
F920 - Dining and Resident Activities
Ensure proper usage of power strips and extension cords.
FAQ · About this visit
Common questions about this visit
What happened during the November 4, 2021 survey of SPRING MEADOWS NURSING, A VILLA CENTER?
This was a inspection survey of SPRING MEADOWS NURSING, A VILLA CENTER on November 4, 2021. The surveyor cited 8 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at SPRING MEADOWS NURSING, A VILLA CENTER on November 4, 2021?
Yes, 8 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Honor the resident's right to receive visitors of his or her choosing, at the time of his or her choosing."
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.
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Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.