Lexington Court Care Center

In the surveyor’s words

From the most serious findings on record at Lexington Court Care Center, in the surveyor’s own words.

• Actual harm, isolatedF744Oct 30, 2025

  Based on record review, review of the facility Self-Reported Incident (SRI), facility investigation review, police report review, interviews, review of the facility assessment, training review and policy review, the facility failed to ensure Resident #44 was provided appropriate and dignified dementia care to meet Resident #44's total care needs. This resulted in actual harm on 08/24/25 when Resident #44, who was identified with severe cognitive impairment with a diagnosis of dementia and required one staff assistance with activities of daily living (ADLs), received bruising to her bilateral wrists and lower forearms after her hands and wrists were held while she was combative with personal care provided by Certified Nursing Assistants (CNA) #204, #233 and #251. […]

• No harm, potential for more than minimal, widespreadF812Mar 27, 2025

  Based on observation, interview, and facility policy, the facility failed to ensure a clean and sanitary kitchen as well as hair restraints were worn by kitchen staff while in the kitchen. This had the potential to affect 69 residents out of 69 who received meals from the facility kitchen. The census was 69. Findings include: Observation on 03/25/25 at 10:27 A.M. revealed Interim Dietary Manager (IDM) #300 was not wearing a hair restraint. IDM #300 stated he did not know it was a regulation to wear a hair restraint in Ohio. Further observation of the kitchen revealed there was grease running down the front of the stove. IDM #300 verified the grease and stated that he would get it cleaned up. Observation on 03/26/25 at 11:45 A.M. […]

• No harm, potential for more than minimal, widespreadF803Jun 30, 2022

  Based on observation, record review, resident interview, staff interview, and policy review, the facility failed to ensure the menu was followed and proper portion sizes were served to residents. This had the potential to affect 60 of 60 residents residing in the facility. The facility census was 60. Findings include: Observation of tray line on 06/13/22 at 12:00 P.M., revealed Dietary Cook #558 served chili mac with one number (#) 8 scoop instead of one #5 scoop, served pureed green beans with one #12 scoop instead of one #16 scoop, and served pureed cornbread with one #20 scoop instead of one #10 scoop. […]

• No harm, potential for more than minimal, widespreadF804Jun 30, 2022

  Based on observation, resident interviews, and staff interviews, the facility failed to serve attractive foods at appropriate temperatures. This affected nine (Resident #9, #15, #17, #26, #27, #28, #34, #40, and #47) residents and had the potential to affect all 60 residents residing in the facility. The facility census was 60. Findings include: Interview on 06/07/22 at 1:44 P.M., during the resident meeting portion of the annual survey, with Residents #9, #15, #17, #26, #27, #28, #34, #40, and #47, revealed several concerns being mentioned regarding the lack of flavor and temperature of food and beverages served to residents. […]

• No harm, potential for more than minimal, widespreadF812Jun 30, 2022

  Based on observation, staff interview and policy review, the facility failed to ensure food items were stored properly with a labeled and dated to prevent food borne illness. This had the potential to affect 60 of 60 residents residing in the facility. The facility census was 60. Findings include: Observation on 06/13/22 at 7:58 A.M., during an initial kitchen tour revealed the freezer contained one bag of undated and unlabeled breadsticks, one clear plastic package of undated and unlabeled egg patties, one clear plastic bag of undated and unlabeled cookie dough, and one clear plastic package of undated and unlabeled chicken breasts. Interview on 06/13/22 at 8:12 A.M., with Dietary Cook #569 verified the undated and unlabeled items found during the tour. […]