Federal inspectors discovered the violation during a September 19 complaint investigation, finding that all 71 residents in the facility were potentially affected by the arrangement that began in June.
The director of nursing herself confirmed during an 11:56 a.m. interview that she has worked full-time managing both the skilled nursing facility and assisted living facility since June 2025. When asked how much time she devotes to each unit weekly, she told inspectors she didn't know.
"She addresses concerns on the SNF and the AL as they arise," according to the inspection report.
Licensed Practical Nurse #448 confirmed during interviews that the director of nursing oversees both skilled nursing and assisted living residents, an arrangement that has been in place for the past two years. The scope expanded to a formal dual role this summer.
The facility's own policies contradict the current staffing arrangement. The Nursing Services policy, dated April 2025, explicitly states that "the facility will designate a Registered Nurse to serve as the Director of Nursing on a full time basis." The director of nursing job description specifies that the position "assumes authority, responsibility, and accountability for the delivery of nursing services in the facility."
Licensed Nursing Home Administrator confirmed the problematic arrangement during a 12:35 p.m. interview, telling inspectors that the director of nursing manages both the skilled nursing facility and assisted living "for the community full time." She acknowledged that nobody had ever informed her that the director of nursing couldn't cover both buildings.
Human Resources Director #314 provided documentation showing the formal change occurred on June 12, 2025. A Change of Status form revealed that date as when the director of nursing officially assumed responsibility for both facilities.
The violation represents a fundamental misunderstanding of federal nursing home requirements. Skilled nursing facilities must employ a registered nurse as director of nursing on a full-time basis specifically for the skilled nursing operation. The regulation exists to ensure that the complex medical needs of skilled nursing residents receive dedicated professional oversight.
Assisted living facilities operate under different regulatory frameworks and have distinct care requirements from skilled nursing facilities. Skilled nursing residents typically require more intensive medical supervision, wound care, medication management, and coordination with physicians. The federal requirement for a full-time director of nursing reflects these heightened care needs.
The arrangement at Brethren Retirement Community effectively dilutes the director of nursing's attention across two different types of care facilities with different regulatory requirements and resident populations. While the administrator claimed the director works "full time" for the community, federal regulations specify full-time dedication to the skilled nursing facility alone.
The facility's violation affects program participation requirements. Nursing homes must maintain compliance with federal staffing requirements to continue receiving Medicare and Medicaid payments. The inspection report notes that "an approved plan of correction is requisite to continued program participation."
Inspectors classified the violation as having "minimal harm or potential for actual harm" but affecting "many" residents. In this case, the potential impact extends to all residents in the 71-bed facility, as inadequate nursing supervision can compromise care quality, medication safety, and emergency response capabilities.
The timeline reveals the facility operated with this improper arrangement for at least three months before the September inspection. The director of nursing began her expanded dual role in June, suggesting the facility either misunderstood federal requirements or chose to operate with insufficient nursing leadership for the skilled nursing unit.
Federal regulations require nursing homes to have adequate nursing supervision to ensure resident safety and proper care delivery. The director of nursing position carries responsibility for nursing staff oversight, care plan development, medication administration supervision, and coordination with physicians and other healthcare providers.
The facility now faces the requirement to submit a plan of correction addressing how it will ensure full-time director of nursing coverage specifically for the skilled nursing facility. The correction must separate the roles or hire additional nursing leadership to meet federal requirements.
For families with relatives at Brethren Retirement Community, the violation raises questions about the adequacy of nursing supervision their loved ones have received since June. The arrangement suggests that neither the skilled nursing facility nor the assisted living facility received the full attention of dedicated nursing leadership during this period.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Brethren Retirement Community from 2025-09-19 including all violations, facility responses, and corrective action plans.
Additional Resources
- View all inspection reports for Brethren Retirement Community
- Browse all OH nursing home inspections