Maple Knoll Village
Inspection Findings
F-Tag F0677
F 0677
Provide care and assistance to perform activities of daily living for any resident who is unable.
Level of Harm - Minimal harm or potential for actual harm
Based on medical record review, observation, resident interview, staff interview, and review of the facility policy, the facility failed to ensure staff provided timely incontinence care. This affected two (Residents #15 and #16) of three residents reviewed for call light response. The facility census was 66 residents. Findings include: Review of the medical record for Resident #15 revealed an admission date of 02/16/24 with diagnoses including cerebral infarction, diabetes, and depression. Review of the Minimum Data Set (MDS) assessment for Resident #15 dated 08/06/25 revealed the resident had no cognitive impairments and required substantial assistance to total dependence on staff for activities of daily living (ADLs). Review of
the medical record for Resident #16 revealed an admission date of 01/06/23 with diagnoses including dementia, depression, and Barrett's esophagus. Review of the MDS assessment for Resident #16 dated 09/05/25 revealed the resident had no cognitive impairment and was dependent of staff for ADLs.
Observation on 09/22/25 from 3:05 P.M. until 3:25 P.M. revealed Residents #15 and #16's call lights were sounding. Staff did not respond to the call lights. Interview on 09/22/25 at 3:25 P.M. with Resident #15 confirmed he had activated his call light because he needed assistance with being changed. Interview on 09/22/25 at 3:26 P.M with Resident #16 confirmed she had activated her call light because she needed to be changed as she was soiled and had diarrhea. Observation on 09/22/25 at 3:34 P.M. revealed Certified Nursing Assistant (CNA) #25 entered Resident #15's room and turned off his call light without providing care. Interview on 09/22/25 at 3:36 P.M. with CNA #25 confirmed she had been off the unit on a lunch break and had just returned. CNA #25 confirmed she was unaware no one had been available to answer the call lights from 3:05 P.M. to 3:25 P.M. Review of the facility policy titled Supporting Activities of Daily Living undated revealed residents who were unable to carry out ADLs independently would receive the services necessary to maintain good nutrition, grooming, personal and oral hygiene. This deficiency represents noncompliance investigated under Complaint Number 2580344 and and Complaint Number 135097 (OH00161949) and Complaint Number 1395096 (OH00161797) and Complaint Number 1395095 (OH00160987.)
Residents Affected - Few
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99) Previous Versions Obsolete
Facility ID:
If continuation sheet
Event ID:
Printed: 04/13/2026 Form Approved OMB No. 0938-0391
Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
09/25/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Maple Knoll Village
11100 Springfield Pike Cincinnati, OH 45246
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)
F-Tag F0689
Federal health inspectors cited MAPLE KNOLL VILLAGE in CINCINNATI, OH for a deficiency under regulatory tag F-F0689 during a complaint investigation conducted on 2025-09-25.
Category: Quality of Life and Care Deficiencies
The facility was found deficient in the following area: Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 2 deficiencies cited during this inspection of MAPLE KNOLL VILLAGE.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-11-19.
MAPLE KNOLL VILLAGE in CINCINNATI, OH inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
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 CINCINNATI, 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 MAPLE KNOLL VILLAGE or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.