Based on resident interviews, staff interviews, an Ombudsman interview, police interviews, medical record review, and policy review, the facility failed to provide a safe discharge for Resident #19. This resulted in Immediate Jeopardy on 04/10/25 when Resident #19 was placed at risk for potential serious life-threatening harm, injuries, negative health outcomes and/or death when the facility discharged Resident #19 without providing a safe discharge location or provisions for a wound treatment. This affected one (Resident #19) of three residents reviewed for discharge. The facility census was 69. On 04/23/25 at 1:07 P.M., the Administrator, Director of Nursing (DON), and Regional Director of Operations (RDO) #200 were notified that Immediate Jeopardy began on 04/10/25 at 3:00 P.M. …
F624 citations in Ohio
Resident Rights Deficiencies
Prepare residents for a safe transfer or discharge from the nursing home.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
Ohio cites F624 more often than its own record predicts
1.59 times the share F624 takes of citations nationally.
Of every deficiency written in Ohio in 2025, this is the portion that was F624.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Ohio surveyors wrote
F624 findings written in Ohio, one from each severity band recorded here, most serious first.
Severity is as the surveyor wrote it. Some findings had already been corrected before the survey.
Based on observations, medical record review, policy review, resident interview, Insurance Provider Representative interview and staff interviews, the facility failed to ensure a resident was provided an orderly discharge to meet the mental health and safety of the resident. This resulted in actual psychosocial harm of the resident as evidence by the resident displaying physical signs of red face, being out of breath, crying and verbally stating she was being kicked out. This affected one (#10) of three residents reviewed for discharge planning. The current census is 59. Findings include: Review of Resident #10's medical record revealed the resident was admitted to the facility on [DATE]. diagnoses [MEDICAL RECORD OR PHYSICIAN ORDER] . …
Based on medical record review, interview, policy review, the facility failed to ensure home health services were arranged prior to resident discharge from the facility. This affected one resident (#139) of three resident records reviewed. The census was 136. Findings include: Review of Resident #139's medical record revealed he was admitted to the facility on [DATE] and discharged on 03/20/25. Diagnoses included cerebral infarction, hemiplegia and hemiparesis, vascular dementia, dysphagia, impulse disorder, major depression, and intermittent explosive disorder. Review of the annual minimum data set (MDS) assessment dated [DATE] revealed his cognition was intact. …
The short window
Recent years
| Year | Share of Ohio citations | vs expected |
|---|---|---|
| 2023 | 0.22% | 2.06× |
| 2024 | 0.32% | 2.72× |
| 2025 | 0.08% | 1.59× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Ohio surveyors cite →
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