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Complaint Investigation

Carriage Inn Of Steubenville

October 23, 2025 · Steubenville, OH · 3102 St Charles Drive
Citations 4
CMS Rating 3/5
Beds 120
Provider ID 365271
Healthcare Facility
Carriage Inn Of Steubenville
Steubenville, OH  ·  View full profile →
Inspection Summary

CARRIAGE INN OF STEUBENVILLE in STEUBENVILLE, OH — inspection on October 23, 2025.

Found 4 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

FF0689
Quality of Life and Care Deficiencies
Actual Harm

sitting up in her wheelchair. CNA #104 was asked to take the resident back to her room so she could be assisted into a standing position out of her wheelchair, to see if fall prevention interventions, including the use of Dycem to her wheelchair were in place. CNA #104 received assistance from the facility's Director of Nursing (DON) to stand the resident up from a seated position in her wheelchair. A gait belt and the assistance of the CNA and DON were used to have the resident stand from her wheelchair.

The resident was observed to only have a cushion in the seat of her wheelchair with no evidence of Dycem being above or below her cushion.

There was a piece of Dycem draped over the armrest of a stationary chair in her room.

Findings were verified by the DON.On 10/14/25 at 2:40 P.M., an interview with CNA #104 revealed the resident was assisted up into her wheelchair by the night shift staff, as the resident was already up when she came on duty at 6:00 A.M.

She had not known the resident to fall in the month or so that she had been there, but did feel the resident was at risk for falls.

She acknowledged the resident's plan of care for fall prevention included the use of Dycem when she was up in her wheelchair and was not sure why it was not in place.

This deficiency demonstrates non-compliance investigated under Complaint Number 2630029.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

10/23/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Carriage Inn of Steubenville

3102 St Charles Drive Steubenville, OH 43952

SUMMARY STATEMENT OF DEFICIENCIES

Review of Resident #7's annual Minimum Data Set (MDS) assessment dated [DATE] revealed the resident did not have any communication issues and her cognition was severely impaired.

She was not indicated to have displayed any behaviors and was not known to reject care.

She required a partial to moderate assist with transfers and ambulation.

The resident was coded as having received a diuretic medication during the seven day assessment period.

Review of Resident #7's care plans revealed the resident had the potential for fluid imbalance related to kidney disease and diuretic use.

The goal was for the resident to demonstrate adequate hydration as evidenced by laboratory values within normal range for the resident.

The interventions included the need to maintain water at the resident's bedside.On 10/14/25 at 2:31 P.M., an observation of Resident #7 noted her to not have any water made available to her in her room as per her plan of care.

There was no evidence of her being provided a Styrofoam cup, with a lid and straw, as was noted in other residents' rooms providing them with ice water.

Her room was absent of any cups or other sources of a beverage for her to drink to help keep her hydrated per her plan of care.

Findings were verified by Certified Nursing Assistant (CNA) #104.

On 10/14/25 at 2:40 P.M., an interview with CNA #104 revealed she had provided Resident #7 with ice water earlier that morning, when they were getting residents up for the day.

She denied she had assisted Resident #7 with getting up that morning, as she was already up when she came on duty at 6:00 A.M.

She reported night shift got Resident #7 up that morning.

She was not able to locate a Styrofoam cup for the resident in her room or any other beverage for the resident to drink when she wanted.

She suspected that maybe housekeeping had thrown it away when they were in the resident's room cleaning it earlier.

She acknowledged housekeepers were in other residents' rooms cleaning their rooms without throwing their Styrofoam cups away.

She further acknowledged Resident #7's plan of care indicated the staff were to maintain water at her bedside at all times. On 10/15/25 at 8:40 A.M., further observations of Resident #7 noted her to be lying in bed in her room.

She was noted to have a Styrofoam cup dated 10/15/25 that had water in it, but the Styrofoam cup was sitting on the overbed table that was placed near the entry door to the room and out of the resident's reach. On 10/15/25 at 8:43 A.M., an interview with CNA #26 confirmed Resident #7's water that was in a Styrofoam cup on her overbed table was not left in the resident's reach.

She further confirmed with the placement of the overbed table away from the resident's bed, the resident would not be able to reach her Styrofoam cup if she wanted or needed a drink.

This deficiency demonstrates non-compliance investigated under Complaint Number 2630029.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

10/23/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Carriage Inn of Steubenville

3102 St Charles Drive Steubenville, OH 43952

SUMMARY STATEMENT OF DEFICIENCIES

Review of the facility's Antibiotic Stewardship Program policy revised 05/30/23 revealed it was the policy of the facility to implement an Antibiotic Stewardship program as part of the facility's overall infection prevention and control program.

The purpose of the program was to optimize the treatment of infections while reducing the adverse events associated with antibiotic use.

The Medical Director and the facility's Director of Nursing (DON) was to serve as leaders of the Antibiotic Stewardship program.

The Medical Director was to set the standards for antibiotic prescribing practices for all healthcare providers prescribing antibiotics, overseeing adherence to antibiotic prescribing practices, and was to review antibiotic use data and ensure best practices were followed.

The IP was to utilize expertise and data to inform strategies to improve antibiotic use to include tracking of antibiotic starts, monitoring adherence to evidence-based published criteria during the evaluation and management of treated infections.

Monitoring of the antibiotic was to include monitoring the response to antibiotics, and laboratory results, when available, to determine if the antibiotic was still indicated or adjustments should be made.

Antibiotics orders obtained from emergency providers should be reviewed for appropriateness.

This is an incidental finding discovered during the complaint investigation.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

10/23/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Carriage Inn of Steubenville

3102 St Charles Drive Steubenville, OH 43952

SUMMARY STATEMENT OF DEFICIENCIES

Based on observation, interview, and review of maintenance work orders the facility failed to maintain a safe and comfortable home like environment.

This had the potential to affect one (Resident #07) of five residents rooms observed. the census was 78.

Observation on 10/15/25 at 10:02 A.M. revealed a hole in the wall behind the head of Resident #7's bed.

The hole was observed to be located behind the head of the resident's bed, near the baseboard.

The hole was approximately eight inches by eight inches.Review of facility maintenance work orders for the past six months revealed no documentation of an order to repair the hole in the wall of Resident #7's room.Interview on 10/15/25 at 10:48 A.M. with Certified Nurses Assistant (CNA) #42 and Licensed Practical Nurse (LPN) #18 confirmed there was a larger hole in the wall of Resident #7's room.

The hole was located behind the head board near the bottom of the wall. CNA #42 and LPN #18 stated they had not noticed the hole in the wall prior to it being pointed out.

This deficiency demonstrates non-compliance investigated under Complaint Number 2630029.

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 STEUBENVILLE, 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 CARRIAGE INN OF STEUBENVILLE or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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