Complaint Investigation

Oakwood Heights Village

October 22, 2025 · Oil City, PA · 10 Vo Tech Drive

Citations 2

CMS Rating 2/5

Beds 106

Provider ID 395502

Healthcare Facility

Oakwood Heights Village

Oil City, PA · 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

OAKWOOD HEIGHTS VILLAGE in OIL CITY, PA — inspection on October 22, 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

FF0600

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Actual Harm

During interviews on 10/21/25, with RN Employees E2 and E9, LPN Employees E3, E5, and E6, and CNA Employees E7 and E8, all confirmed that Resident R1 was always an assist of two for transfers/bed mobility rolling side to side and the information could be found under the task orders.

The facility failed to ensure that Resident R1 was free from neglect resulting in actual harm of a laceration to the right forehead and an intraventricular hemorrhage.

During an interview on 10/21/25, at approximately 9:30 a.m. the DON confirmed that the agency CNA Employee E1 did not ask for assistance, did not follow the task orders, and did not follow the care plan which indicated Resident R1 required two staff for bed mobility/rolling side to side and attempted to roll Resident R1 independently causing harm to Resident R1. 28 Pa.

Code 201.14(a) Responsibility of licensee 28 Pa.

Code 201.18(b)(1)(e)(1) Management 28 Pa.

Code 211.12(c) Nursing services 28 Pa.

Code 211.12(d)(1)(3)(5) Nursing services

Facility ID:

IDENTIFICATION NUMBER:

Building

COMPLETED

10/22/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Oakwood Heights Village

10 Vo Tech Drive Oil City, PA 16301

SUMMARY STATEMENT OF DEFICIENCIES

FF0689

Quality of Life and Care Deficiencies

Actual Harm

During an interview with the NHA and the DON on 10/22/25, at approximately 2:30 p.m. and review of the facility's immediate actions, education, competencies, and audits, it was verified that the facility had implemented a plan of correction to ensure residents are free from harm/injury regarding transfer status/bed mobility rolling side to side of residents and had achieved substantial compliance. 28 Pa.

Code 201.14(a) Responsibility of licensee 28 Pa.

Code 201.18(b)(1)(e)(1) Management 28 Pa.

Code 211.12(c) Nursing services 28 Pa.

Code 211.12(d)(1)(3)(5) Nursing services

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 OIL CITY, PA, (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 OAKWOOD HEIGHTS VILLAGE or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.

More Reports

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.