Inspection visit
Health inspection
9 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 9 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0576
Ensure residents have reasonable access to and privacy in their use of communication methods.
Level of Harm - Minimal harm
or potential for actual harm
Based on medical record review, resident interview, observation, staff interview, review of the facility policy
review, the facility failed to ensure residents were able to have private phone conversations. This affected
two (Residents #5 and #83) of 18 residents sampled for communication. The facility census was 90
residents.
Residents Affected - Few
Findings include:
1. Review of the medical record for Resident # 5 revealed an admission date of 04/19/23 with diagnoses
including heart failure, chronic obstructive pulmonary disease (COPD), morbid obesity, type two diabetes,
and paranoid schizophrenia.
Review of the Minimum Data Set (MDS) assessment for Resident #5 dated 01/03/25 revealed the resident
had moderately impaired cognition.
2. Review of the medical record for Resident # 83 revealed an admission date of 10/03/24 with diagnoses
including quadriplegia, incomplete paraplegia, neuromuscular dysfunction of the bladder, adjustments
disorder with mixed anxiety and depressed mood, and osteomyelitis.
Review of the MDS assessment for Resident #83 dated 11/27/24 revealed the resident was cognitively
intact.
Interview on 03/03/25 at 10:17 A.M. with Resident #83 confirmed he did not have a phone in his room or a
cell phone and had to make all phone calls using the phone at the nurses' station. Resident #83 confirmed
using the phone at the nurses' station made him very uncomfortable because there was no privacy, and
everyone around could hear his conversation.
Interview on 03/03/25 at 2:07 P.M. with Resident #5 confirmed she was unable to have a private
conversation on the phone because she had to use the phone at the nurses' station. Resident #5 stated
she had reported to staff that this made her very uncomfortable, but nurses told the phone at the nurses'
station was the only phone available to the residents.
Observation 03/05/25 at 3:43 P.M. revealed the first-floor nurses' station had one telephone at the corner of
the station sitting on a ledge that was approximately waist high. Licensed Practical Nurses (LPNs) #38 and
#39 were seated behind the nurses' station.
Interview on 03/05/25 at 3:44 P.M. with LPNs #38 and #39 confirmed the phone in the first-floor nurses'
station was the only phone available to staff and residents at the station. LPN #38 and #39 confirmed when
residents were making telephone calls from the phone at the nurses' station, they could
(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 10
Event ID:
366145
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
366145
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/06/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Lakeridge Villa Health Care Center
7220 Pippin Rd
Cincinnati, OH 45239
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 0576
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
hear details of the residents' phone conversations. Further interview confirmed if the situation were
reversed, they would not feel comfortable making personal calls from the phone at the nurses' station. LPNs
#38 and #39 confirmed they had received complaints from multiple residents including Residents #5 and
#83 regarding lack of privacy during telephone conversations.
Observation on 03/06/25 at 11:10 A.M. revealed Resident #5 was sitting in front of the nurses' station
talking on the facility phone with two nurses and multiple residents nearby. Resident #5 was easily
overheard vocalizing her feelings about her day and care received.
Review of policy titled Dignity dated February 2021 revealed staff promoted, maintained, and protected
resident privacy.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366145
If continuation sheet
Page 2 of 10
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
366145
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/06/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Lakeridge Villa Health Care Center
7220 Pippin Rd
Cincinnati, OH 45239
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 0580
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room,
etc.) that affect the resident.
Based on medical record review, staff interview, and review of the facility policy, the facility failed to notify
resident representatives of a change in condition. This affected one (Resident #87) of two residents
reviewed for change in condition. The facility census was 90 residents.
Findings include:
Review of the closed medical record for Resident #87 revealed an admission date of 07/25/11 with
diagnoses including Parkinson's Disease, dementia without behavioral disturbance, and schizoaffective
disorder.
Review of the Minimum Data Set (MDS) assessment for Resident #87 dated 11/07/24 revealed the resident
#87 had severely impaired cognition and required staff assistance with activities of daily living (ADLs.)
Review of the progress note for Resident #87 dated 01/05/25 revealed the resident had remained in bed for
the last two days, refused food, and had minimal fluid intake. The note did not include documentation the
resident's guardian had been informed of the change in condition.
Interview on 03/06/25 at 11:04 A.M. with the Director of Nursing (DON) confirmed the facility staff had
discussed a hospice referral for Resident #87 due to the resident's change in condition, but they did not feel
Resident #87 was appropriate yet. The DON confirmed the facility's plan was to obtain labs, but then the
resident declined rapidly and passed away. The DON confirmed there was no documentation of notification
to Resident #87's guardian regarding the resident's change in condition.
Review of the policy titled Change in a Resident's Condition or Status revised February 2021 revealed the
facility would promptly notify the resident's representative of changes in the resident's medical condition or
status.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366145
If continuation sheet
Page 3 of 10
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
366145
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/06/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Lakeridge Villa Health Care Center
7220 Pippin Rd
Cincinnati, OH 45239
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 0641
Ensure each resident receives an accurate assessment.
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, resident interview, staff interview, and review of the facility policy, the facility staff
failed to ensure the accuracy of comprehensive resident assessments. This affected one (Resident #55) of
four residents reviewed for comprehensive assessments. The facility had a census of 90 residents.
Residents Affected - Few
Findings include:
Review of the medical record for Resident #55 revealed an admission date of 08/10/24 with diagnoses
including end stage renal disease, diabetes, and chronic pulmonary obstructive disease (COPD)
Review of the Minimum Data Set (MDS) assessment for Resident #55 dated 01/23/25 revealed the resident
required substantial to maximum assistance with toileting, bathing, and upper and lower body dressing.
Interview on 03/03/25 at 4:30 P.M. with Resident #55 confirmed he was independent with toileting, bathing,
and dressing. Resident #55 further confirmed he had experienced occasional episodes of weakness and
fatigue following dialysis and the staff monitored showers if taken after dialysis but never provided hands-on
care.
Interview on 03/03/25 at 4:35 P.M with Certified Nursing Assistant (CNA) #16 confirmed Resident #55 was
independent with toileting, bathing, and dressing.
Interview 03/03/25 at 4:52 P.M. with Licensed Practical Nurse (LPN) #38 confirmed Resident #55 was
independent with toileting, bathing and dressing and had been so siince admission on [DATE]. LPN #38
further confirmed Resident #55's MDS dated [DATE] was not accurate regarding the resident's functional
status and abilities.
Review of the facility policy titled Resident Assessments dated March 2022 revealed all persons who had
completed any portion of the MDS must sign a form attesting to the accuracy of the information.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366145
If continuation sheet
Page 4 of 10
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
366145
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/06/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Lakeridge Villa Health Care Center
7220 Pippin Rd
Cincinnati, OH 45239
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 medical record review, observation, resident interview, staff interview, and review of the facility
policy, the facility failed to appropriately revise care plans. This affected one (Resident #85) of three
residents sampled for smoking. The facility census was 90 residents.
Findings include:
Review of the medical record for Resident # 85 revealed an admission date of 01/09/25 with diagnoses
including rheumatoid arthritis, unspecified mental disorder, and cognitive communication deficit.
Review of the smoking safety evaluation for Resident #85 dated 01/09/25 revealed the resident was able to
hold, light, and extinguish a cigarette safely.
Review of care plan for Resident #85 dated 01/15/25 revealed the resident had a potential for injury related
to smoking cigarettes. Interventions included the following: complete smoking assessments quarterly and
with significant change, observe clothing daily for burn holes, secure cigarettes and lighters at the nurses'
station, staff to check room regularly for cigarettes and lighters.
Review of smoking safety evaluation for Resident #85 dated 01/15/25 revealed the resident had balance
problems, had limited range of motion in arms/hands, and followed the facility's smoking policy.
Observation on 03/03/25 at 11:16 A.M. revealed Resident #85 had a box of menthol in the pocket of his
jacket hanging in his room.
Interview on 03/03/25 at 11:17 A.M. with Resident #85 confirmed he was an independent smoker and was
permitted to keep his cigarettes and lighter in his coat pocket and could go out to smoke anytime he wanted
to do so.
Interview on 03/05/25 at 11:19 AM with the Administrator confirmed residents who were deemed safe were
permitted to keep smoking supplies on their person and in their rooms, unless otherwise care planned.
Interview on 03/05/25 at 12:02 P.M. with the Director of Nursing (DON) confirmed the former Administrator
wanted all resident smoking supplies to be kept at the in the nurses' station regardless of the resident's
ability to safely smoke independently. The DON confirmed Resident # 85 was independent with smoking
and was able to keep his smoking supplies in his room. The DON further confirmed Resident #85's care
plan had not been updated to reflect the new policy that independent smokers were able to keep smoking
supplies in their rooms.
Review of the facility policy titled Smoking undated revealed residents who were deemed unsafe were not
permitted to hold smoking materials on their person or in their room.
Review of the facility policy titled Care Plan Revisions Upon Status Change dated 2024 revealed care plans
were modified as needed by the MDS Coordinator or other designated staff member.
.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366145
If continuation sheet
Page 5 of 10
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
366145
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/06/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Lakeridge Villa Health Care Center
7220 Pippin Rd
Cincinnati, OH 45239
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 0760
Ensure that residents are free from significant medication errors.
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 residents were free from significant medication errors. This affected one (Resident #53) of
five residents observed for medication administration. The facility census was 90 residents.
Residents Affected - Few
Findings include:
Review the medical record for Resident #53 revealed an admission date of 10/04/21 with diagnoses
including encephalopathy, depression, anxiety, acute kidney failure, urine retention, and alcohol abuse.
Review of the Minimum Data Set (MDS) assessment for Resident #53 dated 02/07/25 revealed the resident
had no cognitive deficits and required minimal assistance with activities of daily living (ADLs).
Review of the physician's orders for Resident #53 revealed an order dated 08/24/24 for Lexapro 15
milligrams (mg) one time per day.
Observation of medication administration for Resident #53 on 03/05/25 at 8:21 A.M. per Licensed Practical
Nurse (LPN) #38 revealed the nurse administered Lexapro 7.5 mg to the resident.
Interview on 03/05/25 at 11:52 A.M. with LPN #38 confirmed Resident #53's Lexapro order was for 15 mg
daily and she had given the wrong dose on 03/05/25 and every day she had worked in January and
February 2025. LPN #38 confirmed she had made the same medication error with Resident #53's Lexapro
dose on 23 days in January and February 2025.
Review of the staffing schedule dated 01/01/25 to 02/28/25 revealed LPN #38 worked on the following 23
days and administered medications to Resident #53: 01/03/25, 01/06/25, 01/08/25, 01/11/25, 01/12/25,
01/17/25, 01/17/25, 01/20/25, 01/29/25, 01/31/25, 02/03/25, 02/08/25, 02/09/25, 02/10/25, 02/12/23/25,
02/26/25, 02/27/25, 02/28/25.
Review of the facility policy titled Administering Medications dated April 2019 revealed medications should
be administered in a safe and timely manner, and as prescribed.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366145
If continuation sheet
Page 6 of 10
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
366145
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/06/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Lakeridge Villa Health Care Center
7220 Pippin Rd
Cincinnati, OH 45239
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 0800
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional
and special dietary needs.
Based on medical record review, observation, resident interview, and staff interview the facility failed to
provide resident diets in accordance with the physician's orders and resident preference. This affected one
(Resident #192) of five residents reviewed for food. The facility census was 90 residents.
Findings include:
Review of the medical record for Resident #192 revealed an admission date of 02/19/25 with diagnoses
including diabetes, mild intellectual disability, and bilateral below the knee amputations.
Review of the physician's orders for Resident #192 revealed an order dated 02/27/25 for the resident to
receive double portions of food due to weight loss.
Review of meal ticket dated for Resident #192 dated 03/03/25 revealed the resident was to receive double
portions of country chicken and dumplings, peas and carrots, cornbread, and cake.
Interview on 03/03/25 at 10:09 A.M. with Resident #192 confirmed he was supposed to be getting double
portions on his trays, but he only received small portions, and it was not enough food for him.
Observation of Resident #192's dinner tray on 03/03/25 at 4:42 P.M. revealed the tray did not have double
portions of any food item.
Interviews on 03/03/25 at 4:42 P.M. with Certified Nursing Assistants (CNAs) #05 and #11 confirmed
Resident #192 only received single portions at dinner on 03/03/25.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366145
If continuation sheet
Page 7 of 10
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
366145
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/06/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Lakeridge Villa Health Care Center
7220 Pippin Rd
Cincinnati, OH 45239
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 - Few
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve
food in accordance with professional standards.
Based on medical record review, observation, staff interview and review of the facility policy, the facility
failed to ensure staff properly secured their hair while serving resident meals. This affected two (Residents
#70 and #1) of 17 residents observed for meal service. The facility census was 90 residents.
Findings include:
Review of the medical record for Resident #70 revealed an admission date of 11/15/23 with diagnoses
including dementia, congestive heart failure, and chronic kidney disease.
Review of the medical record for Resident #1 revealed an admission date of 02/01/25 with diagnoses
including dementia, diabetes mellitus type two, osteoarthritis, and peripheral vascular disease.
Observation on 03/05/25 at 5:17 P.M. revealed Licensed Practical Nurse (LPN) #30 was serving meal trays
to Residents #70 and #1. LPN #30 had long hair which was unsecured and falling into the residents' meal
trays.
Interview on 03/05/25 at 5:32 P.M. with LPN #30 confirmed her long hair was unsecured and had fallen
onto the plates of Residents #70 and #1.
Review of facility policy titled Preventing Foodborne Illness - Employee Hygiene and Sanitary Practices
undated revealed all employees who served food would be trained in safe food handling practices prior to
serving food to residents. Hair nets or caps must be worn to keep hair from coming in contact with
residents' food.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366145
If continuation sheet
Page 8 of 10
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
366145
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/06/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Lakeridge Villa Health Care Center
7220 Pippin Rd
Cincinnati, OH 45239
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 review, observation, staff interview, and review of the facility policy, the facility failed to
ensure nurses properly documented administration of narcotic medications. This affected three Residents
(#14, #32, and #67) of three residents reviewed for medication reconciliation. The facility census was 90
residents.
Findings include:
1.Review of the medical record for Resident #14 revealed an admission date of 08/12/13 with diagnoses
including right femur fracture, malnutrition, personality disorder, and anxiety.
Review of the controlled substance count sheet for Resident #14 revealed there were three doses of
Tramadol remaining.
Observation on 03/05/25 at 11:04 A.M. with Licensed Practical Nurse (LPN) #30 revealed there were only
two doses of Resident #14's Tramadol in the cart.
Interview on 03/05/25 at 11:04 A.M. with LPN #30 confirmed she had given a dose of Tramadol to Resident
#14 earlier in the day on 03/05/25 but had not documented administration of the medication.
2.Review of the medical record for Resident #32 revealed an admission date of 12/5/23 with diagnoses
including cerebral infarction, aphasia, anxiety, dementia, and depression.
Review of the controlled substance count sheet for Resident #32 revealed there were 12 doses of Ativan
remaining.
Observation on 03/05/25 at 11:05 A.M. with LPN #30 revealed there were only 11 doses of Resident #32's
Ativan in the cart.
Interview on 03/05/25 at 11:05 A.M. with LPN #30 confirmed she had given a dose of Ativan to Resident
#32 earlier in the day on 03/05/25 but had not documented administration of the medication.
3.Review of the medical record for Resident #67 revealed Resident #67 an admission date of 12/02/22 with
diagnoses including cirrhosis, asthma, respiratory disorders, and depression.
Review of the controlled substance count sheet for Resident #67 revealed there were 40 doses of Ativan
remaining.
Observation on 03/05/25 at 11:06 A.M. with LPN #30 revealed there were only 39 doses of Resident #67's
Ativan in the cart.
Interview on 03/05/25 at 11:06 A.M. with LPN #30 confirmed she had given a dose of Ativan to Resident
#67 earlier in the day on 03/05/25 but had not documented administration of the medication.
Review of the facility policy titled Storage of Medications dated November 2020 revealed when the nurse
should document medication administration in the resident's medical record at the time of administration.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366145
If continuation sheet
Page 9 of 10
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
366145
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/06/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Lakeridge Villa Health Care Center
7220 Pippin Rd
Cincinnati, OH 45239
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) when providing direct care
to residents in enhanced barrier precautions (EBP). This affected one (Resident #83) of three residents
observed for EBP. The facility census was 90 residents.
Residents Affected - Few
Findings include:
Review of the medical record for Resident #83 revealed an admission date of on 10/03/24 with diagnoses
including unspecified quadriplegia, incomplete paraplegia, neuromuscular dysfunction of the bladder, and
osteomyelitis.
Review of care plan for Resident #83 dated 10/07/24 revealed the resident was in EBP due to active
wounds, indwelling catheter, and colostomy. Interventions include to educate the resident and family on use
of EBP and proper PPE and to post EBP signage on the resident's door.
Review of the Minimum Data Set (MDS) assessment for Resident #83 dated 11/27/24 revealed the resident
was cognitively intact.
Review of care plan for Resident #83 dated 12/09/24 revealed the resident had an indwelling catheter
related to diagnosis of neurogenic bladder.
Observation on 03/05/25 at 5:04 P.M. of catheter care for Resident #83 per Certified Nursing Assistants
(CNAs) #115 and #20 revealed the aides entered the resident's room wearing face masks and donned
clean gloves. Neither aide donned a gown before transferring the resident from the chair to the bed using a
Hoyer lift, removing the resident's pants, emptying the resident's catheter bag, performing catheter care,
and placing a clean brief on the resident.
Interview on 03/05/25 at 5:20 P.M. with CNA #115 confirmed neither she nor CNA #20 donned a gown prior
to providing direct care to Resident #83 who was on EBP.
Review of the facility policy titled Enhanced Barrier Precautions dated August 2022 revealed employees
should don gowns when providing care to a resident on EBP.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366145
If continuation sheet
Page 10 of 10
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Back to topCitations
9 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.
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.
F760 - Residents are free of any significant medication errors
Ensure that residents are free from significant medication errors.
F800 - Food and nutrition services
Provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs.
F812 - Food safety requirements
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
F842 - Resident-identifiable information
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
F880 - Infection Control
Provide and implement an infection prevention and control program.
F576 - The resident has the right to have reasonable access to the use of a telephone,
Ensure residents have reasonable access to and privacy in their use of communication methods.
F580 - Notification of Changes
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
F641 - Accuracy of Assessments
Ensure each resident receives an accurate assessment.
FAQ · About this visit
Common questions about this visit
What happened during the March 6, 2025 survey of LAKERIDGE VILLA HEALTH CARE CENTER?
This was a inspection survey of LAKERIDGE VILLA HEALTH CARE CENTER on March 6, 2025. The surveyor cited 9 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at LAKERIDGE VILLA HEALTH CARE CENTER on March 6, 2025?
Yes, 9 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a t..."
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.