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Complaint Investigation

Andover Village Retirement Community

November 25, 2025 · Andover, OH · 486 S Main St
Citations 3
CMS Rating 5/5
Beds 99
Provider ID 365411
Healthcare Facility
Andover Village Retirement Community
Andover, OH  ·  View full profile →
Inspection Summary

ANDOVER VILLAGE RETIREMENT COMMUNITY in ANDOVER, OH — inspection on November 25, 2025.

Found 3 citations. Severity: Standard violations.

Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.

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Inspection Findings

FF0686
Quality of Life and Care Deficiencies
Potential for More Than Minimal Harm

Review of facility policy labeled, Pressure Ulcer Risk and Skin Assessment dated 12/17/13 revealed it was the facility policy that all residents would receive routine assessments.

The policy revealed if a CNA observes a skin alteration he/ she would inform the nurse and the identified skin change would be addressed by the nurse with an assessment, documentation in the nursing notes and physician/ family notification.

This deficiency represents non-compliance investigated under Complaint Number 2619877, and 2603148.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

11/25/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Andover Village Retirement Community

486 S Main St Andover, OH 44003

SUMMARY STATEMENT OF DEFICIENCIES

any new skin impairment.

She revealed LPN #616 had stated on Resident #64's return from the appointment she had the area to her right heel.

This deficiency represents non-compliance investigated under Complaint Number 2650968.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

11/25/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Andover Village Retirement Community

486 S Main St Andover, OH 44003

SUMMARY STATEMENT OF DEFICIENCIES

Review of facility competency test labeled, Trach Care Competency dated 04/18/25 and completed by RT #600 with the DON overseeing revealed the staff was to wash their hands, don gown, gloves and mask (if applicable).

The staff was to remove and dispose of the trach dressing while observing the condition of the surrounding skin.

The competency revealed the staff was to remove gloves, wash hands and don sterile gloves and proceed to clean the skin under the flange, pat area dry with sterile gauze and replace sterile trach dressing.

The competency revealed the staff was to dispose of inner cannula and replace with another disposable sterile inner cannula.

The policy revealed the staff was to remove their gloves and wash their hands.

This deficiency represents non-compliance investigated under Complaint Number 2650968.

Facility ID:

Frequently Asked Questions

What is an F-tag violation?
F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
Were these violations corrected?
Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
How often do nursing home inspections happen?
CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
What should families do about these violations?
Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in ANDOVER, OH, (5) Report new concerns to state authorities.
Where can I see the full inspection report?
Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from ANDOVER VILLAGE RETIREMENT COMMUNITY or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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