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Complaint Investigation

Country Lane Gardens Rehab & Nursing Ctr

August 15, 2025 · Pleasantville, OH · 7820 Pleasantville Road
Citations 2
CMS Rating 2/5
Beds 99
Provider ID 366199
Healthcare Facility
Country Lane Gardens Rehab & Nursing Ctr
Pleasantville, OH  ·  View full profile →
Source Document
Official CMS Inspection Report (Medicare.gov)
Downloaded from CMS/Medicare.gov. Reflects what state inspectors documented and does not include the facility's plan of correction, which is submitted separately. Facilities may have taken corrective actions since this report was released.
Inspection Summary

COUNTRY LANE GARDENS REHAB & NURSING CTR in PLEASANTVILLE, OH — inspection on August 15, 2025.

Found 2 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.

Inspection Findings

FF0580
Resident Rights Deficiencies

psychosocial status.This deficiency represents non-compliance investigated under Complaint Number

366199 08/15/2025

Country Lane Gardens Rehab & Nursing Ctr 7820 Pleasantville Road Pleasantville, OH 43148

stated Resident #14 told her she had multiple falls, and her foot and ankle were hurting. CNA #130

#130 stated she reported to LPN #107 who stated she was aware, and the dayshift nurse would have

on 08/13/25 at 1:27 P.M. with CNA #133 revealed he recalled Resident #14 had been lowered to the floor by her spouse around 6:30-7:00 P.M. on either Friday (07/25/25) or Saturday (07/26/25) and he let the nurse know. CNA #133 stated he assisted in getting Resident #14 up prior to the nurse coming since her husband had already started to pick her up. CNA #133 stated Resident #14 did not complain of pain until later in the night. Resident #14 had a scrape to one of her legs below the knee from her wheelchair and complained of pain in the ankle. CNA #133 stated he told LPN #105 about the incident who went to Resident #14's room immediately.Interview on 08/13/25 at 2:03 P.M. with the Administrator confirmed there were no nursing notes (from 07/25/27- 07/27/25) related to falls or pain for Resident #14 until the x-ray was ordered (07/28/25).

The x-ray note only indicated it was due to pain and no information about why the new onset of pain was occurring.

The Administrator confirmed a late-entry note dated 07/29/25 for the date of 07/26/25 entered by LPN #105 revealed Resident #14 had a fall 07/26/25, after the note regarding the x-ray was entered.

The Administrator confirmed the x-ray results were not in the nursing notes.Interview on 08/14/25 at 6:32 A.M. with CNA #140 revealed she was aware of several falls occurring for Resident #14. CNA #140 stated upon the beginning of their shift Saturday night (07/26/25) CNA #133 told her Resident #14 had a fall with her husband. CNA #140 stated when she saw Resident #14, she had complained of pain in her left foot. CNA #140 stated Resident #14 had another fall around 3:00 A.M. and when asked for assistance, CNA #133 came in to help her and they just lifted Resident #14 off the ground prior to any vitals or assessment being completed. CNA #140 stated this was confusing to her because other facilities she worked at followed protocol, like waiting for the nurse to assess the resident and take vitals. CNA #140 stated there was also a third fall later in the morning. CNA #140 stated Resident #14 was complaining of pain throughout the night. CNA #140 stated she wrote a statement and took a picture of it because she was told they (staff statements) usually go missing. CNA #140 stated her statement did not have many details because she was afraid of retaliation and her coworkers treating her poorly.Review of a policy titled Change in Condition dated 12/2016 revealed the nurse would notify the physician when there has been an accident or incident involving the resident, discovery of injuries of an unknown source, or other change in condition.

Prior to notifying the physician, the nurse would make detailed observations and gather relevant information and pertinent information for the provider.This deficiency represents non-compliance investigated under Complaint Number 2583218

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 PLEASANTVILLE, 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 COUNTRY LANE GARDENS REHAB & NURSING CTR or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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About This Inspection Report

Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.

Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.

Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.