Inspection visit
Health inspection
3 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 3 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0773
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the
results.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
record review and staff interviews, the facility did not ensure timely notification to the physician or nurse
practitioner (NP) of abnormal laboratory values for Resident #68. This affected one resident (Resident #68)
of three reviewed for laboratory tests. The facility census was 77.
Findings include:
Review of the medical record revealed Resident #68 was admitted to the facility on [DATE] with diagnoses
including anemia (a condition in which the blood does not have enough healthy red blood cells and
hemoglobin) osteomyelitis to the right ankle and foot, thrombus (blood clot) and embolism (blockage
caused by a blood clot) in the right lower extremity, crest syndrome (a type of collagen vascular disease),
asthma, systemic sclerosis (chronic hardening and tightening of the skin and connective tissues), chronic
obstructive pulmonary disease, amputation, Raynaud's syndrome (condition of decrease blood flow to the
fingers), Buerger's disease (blood vessels swell which can prevent blood flow), atrial fibrillation, aortic
aneurysm, hypertension, congestive heart failure, and cellulitis.
Review of the Five-Day Medicare Minimum Data Set 3.0 assessment dated [DATE] revealed Resident #68
had intact cognition.
Review of the physician order dated 10/09/23 revealed Resident #68 had an order for a complete blood
count (a test measuring the concentration of hemoglobin, a protein contained in red blood cells that is
responsible for carrying oxygen to the tissues) every Monday. On 10/31/23 the order was revised to repeat
the complete blood count (CBC) in one month.
Review of the laboratory tests for November 2023 revealed Resident #68's hemoglobin levels were
between 7.6 to 7.9 (normal hemoglobin is between 12.0 to 16.0).
Review of progress notes and physician notes for November 2023 revealed the hemoglobin levels were
being reviewed by the physician or NP and no new orders were given. On 11/21/23 a physician progress
note indicated Resident #68 was being seen for management of chronic conditions after a hospital stay in
June 2023 for hip surgery complicated by anemia for which she had received blood transfusions. The plan
was to monitor the anemia and related lab tests.
Review of the laboratory test dated 12/05/23 revealed Resident #68's hemoglobin was 6.3 which was
flagged on the test as being a critical lab. On 12/07/23 NP #201 hand wrote on the test to give two units of
packed red blood cells.
(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 4
Event ID:
366463
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
366463
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/14/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Avenue at Wooster
1700 East Smithville Western Road
Wooster, OH 44691
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 0773
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Review of the physician order dated 12/08/23 revealed Resident #68 had an order to type and crossmatch
to be done today and then she was to be transfused on 12/09/23.
On 03/12/24 at 2:20 P.M. an interview with Nurse Practitioner (NP) # 201 revealed there were some issues
with the facility not notifying her promptly of laboratory results. NP #201 said the staff would place the
laboratory results into a folder for her, she visited the facility three days a week, and would review and sign
the laboratory results during visits. When asked why the 12/05/23 laboratory results for Resident #68 were
not signed by her until 12/07/23, NP #201 indicated she would do some research and get back to the
surveyor with an answer.
On 03/12/24 at 2:30 P.M. an interview with Registered Nurse (RN) #104 revealed she placed laboratory
results for Resident #68 in the folder for NP #201 but did not notify the NP immediately of the results. RN
#104 said the physician or NP should have been notified immediately of the laboratory results for Resident
#68.
On 03/13/24 at 9:20 A.M. a follow-up interview with NP #201 revealed she remembered finding Resident
#68's lab results from 12/05/23 in her folder when she showed up at the facility to do rounds on 12/07/23.
NP #201 stated she had notified the DON they were in her folder but she should have been notified
immediately considering those lab results were considered critical. NP #201 stated because Resident #68
was not showing any symptoms related to the low hemoglobin of 6.3, she would not have sent her out to
the hospital so scheduling Resident #68 for an outpatient transfusion appointment on 12/09/23 was
appropriate and treatment had not been delayed. NP #201 said she still should be notified immediately of
any abnormal laboratory tests for any resident instead of the staff just putting the results in her folder for her
next visit.
This deficiency represents non-compliance investigated under Complaint Number OH000151433.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366463
If continuation sheet
Page 2 of 4
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
366463
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/14/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Avenue at Wooster
1700 East Smithville Western Road
Wooster, OH 44691
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 0803
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be
updated, be reviewed by dietician, and meet the needs of the resident.
Based on observation, record review, interviews with staff and review of facility policy, the facility failed to
ensure appropriate meal substitutions were given to residents ordered pureed and mechanical soft diets.
This affected 11 residents (Resident #2, #5, #10, #13, #19, #23, #26, #43, #50, #54, #63) the facility
identified as requiring a pureed or mechanical soft diet of 76 residents receiving meals from the kitchen.
The facility identified Resident #37 as receiving nothing by mouth (NPO) The facility census was 77.
Findings included:
Observation of meal service on 03/12/24 from 10:40 A.M. to 12:10 P.M. revealed the meal prepared was
cheese tortellini, Italian green beans, garlic bread and mandarin oranges. Dietary Manager (DM) #105
indicated they did not have mandarin oranges, so they were substituting with fruit cocktail and all
mechanical soft and pureed diets were getting vanilla pudding.
Review of the facility meal spreadsheet for 03/12/24 revealed mechanical soft and pureed diets were to get
mandarin oranges (fruit cocktail) not vanilla pudding.
On 03/12/24 at 12:16 P.M. an interview with DM #105 confirmed vanilla pudding was not an appropriate
substitution for fruit for the residents who received pureed and mechanical soft diets.
On 03/12/24 at 12:28 P.M. an interview with Corporate Dietitian #200 verified vanilla pudding was not an
appropriate substitution for fruit with the residents who received pureed and mechanical soft diet unless it
was a resident's preference.
Review of the undated facility policy titled, Meal Substitutions, revealed menu substitutions would be made
after discussion with the director of food and nutritional services whenever possible. Substitutions may need
to be made for uncontrollable situations. Staff must choose any food on the Menu Substitution list within the
same list to substitute for the unavailable item.
Review of the Menu Substitution list revealed for canned fruit a suitable substitution would be fruit drink,
fresh fruit, or dried fruit. Vanilla pudding was not on the list of items to be used for a substitution.
This deficiency represents non-compliance investigated under Complaint Number OH00151601.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366463
If continuation sheet
Page 3 of 4
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
366463
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/14/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Avenue at Wooster
1700 East Smithville Western Road
Wooster, OH 44691
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
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve
food in accordance with professional standards.
Based on observation, interview with staff, and review of facility policy, the facility failed to ensure the
kitchen staff wore beard nets and hair nets appropriately to prevent contamination of food. This affected all
76 residents in the facility who ate meals from the kitchen except Resident #37 who the facility identified as
receiving nothing by mouth (NPO). The facility census was 77.
Findings included:
Observation during meal preparation on 03/12/24 at 10:40 A.M. revealed [NAME] #400 and Dietary Aide
(DA) #401 were not wearing a beard net on their beard while preparing food. Also, Dietary Aide #402 did
not have her front bangs under her hair net while preparing drinks.
On 03/12/24 at 11:00 A.M. an interview with Dietary Mangers # 105 confirmed [NAME] #400, DA #401 and
DA #402 did not have on beard nets or have all hair appropriately covered while preparing food in the
kitchen.
Review of the undated facility policy titled, Employee Sanitation Practices, revealed all employees would
wear hair restraints including hairnets, hat and/or beard covers to prevent hair from contacting exposed
food.
This deficiency represents non-compliance investigated under Complaint Number OH00151601.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366463
If continuation sheet
Page 4 of 4
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Back to topCitations
3 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.
F773 - The facility must—
Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results.
F803 - Menus and nutritional adequacy
Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the 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.
FAQ · About this visit
Common questions about this visit
What happened during the March 14, 2024 survey of AVENUE AT WOOSTER?
This was a inspection survey of AVENUE AT WOOSTER on March 14, 2024. The surveyor cited 3 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at AVENUE AT WOOSTER on March 14, 2024?
Yes, 3 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
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Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.