Highland Square Nursing: Vision Care Failures - OH
The Social Services Director personally delivered the glasses to Resident 65 in early 2025. Initially, the resident had no complaints about his new eyewear.
But his family later contacted the facility. The glasses didn't work. The resident couldn't see through them.
The Social Services Director, identified as SSD 369, told federal inspectors she contacted the optometry service to add the resident back to the appointment list for their next facility visit. Then she stopped tracking the case entirely.
"SSD 369 stated she did not follow-up with the resident and was unsure if he was seen by the contracted optometry services the next time they were in the facility," inspectors wrote in their August 20 report.
She never documented any of this in the resident's medical record. Not the initial glasses delivery. Not the family's complaint about vision problems. Not her call to schedule a follow-up appointment.
Nothing.
When inspectors reviewed Resident 65's complete medical file, they found zero documentation related to vision or optometry services during his entire stay. The resident lived at Highland Square from February 20 through July 14, nearly five months.
His medical conditions were serious. Congestive heart failure. Ischemic cardiomyopathy. Atherosclerotic heart disease. History of sudden cardiac arrest. He had coronary angioplasty implants and grafts.
For someone managing multiple cardiovascular conditions, clear vision becomes critical for reading medication labels, navigating safely, and maintaining quality of life. The resident needed glasses that actually worked.
The Social Services Director had been employed at Highland Square since late March 2025. During her entire tenure, she told inspectors, she never received visit reports from the contracted optometry service. She had no system for tracking which residents received eye care, when they were seen, or what treatments were provided.
This information gap extended beyond just one resident's glasses. Without optometry visit reports, the facility couldn't verify that any resident was receiving appropriate vision care follow-up.
Federal regulations require nursing homes to assist residents in gaining access to vision and hearing services. This means more than just scheduling initial appointments. Facilities must ensure residents actually receive the care they need and that the services are effective.
Highland Square failed on both counts with Resident 65.
The facility operates with 64 beds and was responding to a formal complaint when inspectors discovered this violation. The complaint investigation, numbered 2575188, revealed the vision care breakdown as part of a broader review of ancillary services.
Inspectors examined three residents' records for ancillary service compliance. Only one resident, number 65, experienced problems with vision care access and follow-up.
But that single case revealed systemic gaps in the facility's oversight of contracted services. No documentation protocols. No follow-up procedures. No communication system with outside providers.
The Social Services Director's admission that she was "unsure" whether the resident ever received corrective care highlights the facility's fundamental failure to track resident outcomes. In a nursing home setting, uncertainty about whether a resident received needed medical care represents a serious oversight failure.
For Resident 65, the consequences were concrete. He spent months at Highland Square unable to see clearly through glasses that didn't work. His family had to advocate for basic vision care that should have been automatically monitored by facility staff.
The resident was discharged in July, but inspectors couldn't determine from facility records whether his vision problems were ever resolved. The Social Services Director's lack of follow-up meant no one at Highland Square knew if the optometry service ever saw him again or provided corrected lenses.
This case demonstrates how administrative failures can directly impact resident care. A simple documentation and follow-up system could have prevented months of inadequate vision correction for a resident managing serious heart conditions.
Instead, Highland Square's Social Services Director delivered glasses, took a family complaint, made one phone call, and then lost track of whether the resident ever received the vision care he needed.
Federal inspectors classified this as minimal harm, but for Resident 65, the months of impaired vision represented a significant quality of life issue that went unresolved due to the facility's inadequate tracking systems.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Highland Square Nursing and Rehabilitation from 2025-08-20 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: Official federal inspection data from the Centers for Medicare & Medicaid Services (CMS).
Editorial process: AI-synthesized regulatory data, reviewed for accuracy by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: June 21, 2026 · Our methodology
HIGHLAND SQUARE NURSING AND REHABILITATION in AKRON, OH was cited for violations during a health inspection on August 20, 2025.
The Social Services Director personally delivered the glasses to Resident 65 in early 2025.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.