11 health deficiencies
Top issue: Quality of Life and Care (6 deficiencies)
3 fire-safety deficiencies
Top issue: Smoke (2 deficiencies)
Somerset, OH
2-star overall rating with 3-star inspections with 11 recent health deficiencies with 3 fire-safety deficiencies in the latest cycle
411 South Columbus Street, Somerset, OH
(740) 743-2924
Overall
2 / 5
CMS overall stars
Health inspections
3 / 5
Survey and complaint cycles
Staffing
1 / 5
RN + nurse staffing
Quality measures
4 / 5
Resident outcomes and process measures
Quick facts
Beds
79
Certified beds
Average residents
69
Average occupied residents
Ownership
For-Profit
Publicly displayed owner type
Chain
Altercare
Operator or chain grouping
Approved since
1989-10-17
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Chain footprint
22 facilities
Chain averages 3 overall / 3 health / 2 staffing / 5 quality stars
Changed ownership
No
Within the last 12 months
Family council
Yes
Resident and family council reported
Sprinklers
Yes
Automatic sprinklers in all required areas
Staffing
RN hours / resident day
0.38
Registered nurse staffing · state 0.63 · national 0.68
LPN hours / resident day
0.74
Licensed practical nurse staffing · state 0.96 · national 0.87
Aide hours / resident day
2.11
Nurse aide staffing · state 2.14 · national 2.35
Total nurse hours
3.23
All reported nurse hours · state 3.72 · national 3.89
Licensed hours
1.12
RN + LPN hours · state 1.59 · national 1.54
Weekend hours
2.55
Weekend nurse staffing · state 3.29 · national 3.43
Weekend RN hours
0.25
Weekend registered nurse coverage · state 0.41 · national 0.47
Physical therapist
0.03
Reported PT staffing · state 0.05 · national 0.07
Adjusted RN hours
0.33
CMS adjusted RN staffing hours
Adjusted total hours
2.78
CMS adjusted total nurse staffing hours
Case-mix index
1.59
Higher values indicate more complex resident acuity
RN turnover
50%
Annual RN turnover · state 47% · national 45%
Total nurse turnover
59%
Annual nurse turnover · state 50% · national 46%
SNF VBP
Program rank
9,416
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
23.72
Composite VBP score used to determine payment impact.
Payment multiplier
0.9832
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
Readmission
0
Baseline 17.59% · Performance 21.47% · Measure score 0 · Achievement 0 · Improvement 0
Healthcare-associated infections
6.22
Baseline 6.19% · Performance 5.97% · Measure score 6.22 · Achievement 6.22 · Improvement 1.31
Total nurse turnover
2.43
Baseline 48.44% · Performance 53.73% · Measure score 2.43 · Achievement 2.43 · Improvement 0
Adjusted total nurse staffing
0.83
Baseline 2.89 hours · Performance 3.27 hours · Measure score 0.83 · Achievement 0.68 · Improvement 0.83
SNF QRP
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 11.38% |
10.72%
0.7 pts worse
|
No Different than the National Rate · Eligible stays 55 · Observed rate 14.55% · Lower 95% interval 7.91% |
| Discharge to community | 58.32% |
50.57%
7.8 pts better
|
No Different than the National Rate · Eligible stays 53 · Observed rate 56.6% · Lower 95% interval 48.93% |
| Medicare spending per beneficiary | 0.83 |
1.02
0.2 pts better
|
|
| Drug regimen review with follow-up | 100% |
95.27%
4.7 pts better
|
Numerator 56 · Denominator 56 |
| Falls with major injury | 3.57% |
0.77%
2.8 pts worse
|
Numerator 2 · Denominator 56 |
| Discharge self-care score | 33.33% |
53.69%
20.4 pts worse
|
Numerator 12 · Denominator 36 |
| Discharge mobility score | 25% |
50.94%
25.9 pts worse
|
Numerator 9 · Denominator 36 |
| Pressure ulcers or injuries, new or worsened | 0% |
2.29%
2.3 pts better
|
Numerator 0 · Denominator 56 · Adjusted rate 0% |
| Healthcare-associated infections requiring hospitalization | 5.98% |
7.12%
1.1 pts better
|
No Different than the National Rate · Eligible stays 39 · Observed rate 0% · Lower 95% interval 2.74% |
| Staff COVID-19 vaccination coverage | 4.29% |
8.2%
3.9 pts worse
|
Numerator 3 · Denominator 70 |
| Staff flu vaccination coverage | 53.66% |
42%
11.7 pts better
|
Numerator 44 · Denominator 82 |
| Discharge function score | 22.22% |
56.45%
34.2 pts worse
|
Numerator 8 · Denominator 36 |
| Transfer of health information to provider | 100% |
95.95%
4 pts better
|
Numerator 20 · Denominator 20 |
| Transfer of health information to patient | 100% |
96.28%
3.7 pts better
|
Numerator 21 · Denominator 21 |
| Resident COVID-19 vaccinations up to date | 8.33% |
25.2%
16.9 pts worse
|
Numerator 3 · Denominator 36 |
Quality measures
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 96.5% |
92.4%
4.1 pts better
|
93.4%
3.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 100.0% · Q2 100.0% · Q3 93.4% · Q4 93.1% · 4Q avg 96.5% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 94.6% |
94.5%
0.1 pts better
|
95.5%
0.9 pts worse
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 94.6% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 7.0% |
3.3%
3.7 pts worse
|
3.3%
3.7 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 9.1% · Q2 7.5% · Q3 8.2% · Q4 3.4% · 4Q avg 7.0% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 28.8% |
26.1%
2.7 pts worse
|
11.4%
17.4 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 39.6% · Q2 31.9% · Q3 22.0% · Q4 24.1% · 4Q avg 28.8% |
| Percentage of long-stay residents who lose too much weight | 11.6% |
6.2%
5.4 pts worse
|
5.4%
6.2 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 12.8% · Q2 18.6% · Q3 11.8% · Q4 4.2% · 4Q avg 11.6% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 28.6% |
25.4%
3.2 pts worse
|
19.6%
9 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 31.9% · Q2 31.1% · Q3 29.4% · Q4 22.4% · 4Q avg 28.6% |
| Percentage of long-stay residents who received an antipsychotic medication | 16.7% |
11.5%
5.2 pts worse
|
16.7%
About the same
|
Long Stay · 2024Q4-2025Q3 · Q1 8.6% · Q2 10.8% · Q3 24.4% · Q4 21.6% · 4Q avg 16.7% · Used in QM five-star |
| Percentage of long-stay residents who were physically restrained | 0.0% |
0.1%
0.1 pts better
|
0.1%
0.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% |
| Percentage of long-stay residents whose ability to walk independently worsened | 5.2% |
7.7%
2.5 pts better
|
16.3%
11.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q2 10.7% · Q3 0.0% · Q4 9.2% · 4Q avg 5.2% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 10.4% |
6.2%
4.2 pts worse
|
14.9%
4.5 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 11.9% · Q2 17.9% · Q3 7.3% · Q4 4.9% · 4Q avg 10.4% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 0.0% |
0.2%
0.2 pts better
|
1.0%
1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 0.4% |
0.5%
0.1 pts better
|
1.7%
1.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 1.7% · 4Q avg 0.4% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 22.0% |
21.7%
0.3 pts worse
|
19.8%
2.2 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 12.3% · Q2 24.5% · Q3 17.3% · Q4 34.3% · 4Q avg 22.0% |
| Percentage of long-stay residents with pressure ulcers | 1.7% |
3.7%
2 pts better
|
5.1%
3.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 1.8% · Q3 3.3% · Q4 1.4% · 4Q avg 1.7% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 65.6% |
78.1%
12.5 pts worse
|
81.7%
16.1 pts worse
|
Short Stay · 2024Q4-2025Q3 · Q1 57.5% · Q2 69.0% · Q3 67.1% · Q4 68.0% · 4Q avg 65.6% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 12.2% |
12.5%
0.3 pts better
|
12.0%
0.2 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 12.2% · Observed 12.2% · Expected 11.1% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 0.6% |
1.2%
0.6 pts better
|
1.6%
1 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 2.2% · 4Q avg 0.6% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 69.8% |
75.6%
5.8 pts worse
|
79.7%
9.9 pts worse
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 69.8% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 26.1% |
25.1%
1 pts worse
|
23.9%
2.2 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 26.1% · Observed 26.8% · Expected 24.5% · Used in QM five-star |
Survey summary
Top issue: Quality of Life and Care (6 deficiencies)
3 fire-safety deficiencies
Top issue: Smoke (2 deficiencies)
Top issue: Quality of Life and Care (3 deficiencies)
1 fire-safety deficiencies
Top issue: Gas and Vacuum and Electrical Systems (1 deficiency)
Top issue: Freedom from Abuse and Neglect and Exploitation (3 deficiencies)
1 fire-safety deficiencies
Top issue: Egress (1 deficiency)
Fire safety
Fire Safety
Have approved installation, maintenance and testing program for fire alarm systems.
Corrected 2024-08-13
Fire Safety
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Corrected 2024-08-13
Fire Safety
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
Corrected 2024-08-13
Fire Safety
Have proper medical gas storage and administration areas.
Corrected 2022-12-05
Fire Safety
Have exits that are accessible at all times.
Corrected 2020-01-31
Inspection history
Health
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected 2025-04-22
Health
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Corrected 2025-04-22
Health
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected 2025-01-07
Health
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
Corrected 2024-11-12
Health
Protect each resident from the wrongful use of the resident's belongings or money.
Corrected 2024-11-12
Health
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected 2024-11-12
Health
Provide enough food/fluids to maintain a resident's health.
Corrected 2024-11-12
Health
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Corrected 2024-11-12
Health
Provide enough food/fluids to maintain a resident's health.
Corrected 2024-08-13
Health
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected 2024-08-13
Health
Notify each resident of certain balances and convey resident funds upon discharge, eviction, or death.
Corrected 2024-08-13
Health
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected 2024-08-13
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2024-08-13
Health
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Corrected 2024-08-13
Health
Provide appropriate colostomy, urostomy, or ileostomy care/services for a resident who requires such services.
Corrected 2024-08-13
Health
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
Corrected 2024-08-13
Health
Provide timely, quality laboratory services/tests to meet the needs of residents.
Corrected 2024-08-13
Health
Provide and implement an infection prevention and control program.
Corrected 2023-10-31
Health
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected 2020-01-31
Health
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Corrected 2020-01-31
Health
Respond appropriately to all alleged violations.
Corrected 2020-01-31
Health
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected 2020-01-31
Health
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Corrected 2020-01-31
Health
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected 2020-01-31
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2020-01-31
Health
Provide safe, appropriate dialysis care/services for a resident who requires such services.
Corrected 2020-01-31
Health
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Corrected 2020-01-31
Health
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
Corrected 2020-01-31
Penalties and ownership
5% Or Greater Direct Ownership Interest · Organization
Operational/Managerial Control · Organization
Corporate Officer · Individual
5% Or Greater Indirect Ownership Interest · Organization
5% Or Greater Indirect Ownership Interest · Organization
5% Or Greater Indirect Ownership Interest · Organization
5% Or Greater Indirect Ownership Interest · Organization
Corporate Officer · Individual
Corporate Officer · Individual
Corporate Officer · Individual
W-2 Managing Employee · Individual
Corporate Officer · Individual
5% Or Greater Indirect Ownership Interest · Organization
5% Or Greater Indirect Ownership Interest · Organization
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