Cycle 1
Health 2024-03-13 · Fire 2024-03-13
5 health deficiencies
Top issue: Administration (1 deficiency)
6 fire-safety deficiencies
Top issue: Smoke (3 deficiencies)
Northfield, OH
Northfield Village Retirement Community
4-star overall rating with 4-star inspections with 5 recent health deficiencies with 6 fire-safety deficiencies in the latest cycle
10267 Northfield Road, Northfield, OH
(330) 468-1800
Overall
4 / 5
CMS overall stars
Health inspections
4 / 5
Survey and complaint cycles
Staffing
3 / 5
RN + nurse staffing
Quality measures
4 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
70
Certified beds
Average residents
50
Average occupied residents
Ownership
For-Profit
Publicly displayed owner type
Chain
Vrc Management
Operator or chain grouping
Approved since
2003-07-03
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Chain footprint
5 facilities
Chain averages 4 overall / 4 health / 3 staffing / 4 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
Hours and turnover
RN hours / resident day
0.69
Registered nurse staffing · state 0.63 · national 0.68
LPN hours / resident day
1.06
Licensed practical nurse staffing · state 0.96 · national 0.87
Aide hours / resident day
2.17
Nurse aide staffing · state 2.14 · national 2.35
Total nurse hours
3.91
All reported nurse hours · state 3.72 · national 3.89
Licensed hours
1.75
RN + LPN hours · state 1.59 · national 1.54
Weekend hours
3.27
Weekend nurse staffing · state 3.29 · national 3.43
Weekend RN hours
0.28
Weekend registered nurse coverage · state 0.41 · national 0.47
Physical therapist
0.09
Reported PT staffing · state 0.05 · national 0.07
Adjusted RN hours
0.66
CMS adjusted RN staffing hours
Adjusted total hours
3.75
CMS adjusted total nurse staffing hours
Case-mix index
1.43
Higher values indicate more complex resident acuity
RN turnover
54%
Annual RN turnover · state 47% · national 45%
Total nurse turnover
64%
Annual nurse turnover · state 50% · national 46%
SNF VBP
Value-based purchasing
Program rank
6,505
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
32.63
Composite VBP score used to determine payment impact.
Payment multiplier
0.9872
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
3.15
Baseline 19.49% · Performance 19.97% · Measure score 3.15 · Achievement 3.15 · Improvement 0
Healthcare-associated infections
7.73
Baseline 5.73% · Performance 5.53% · Measure score 7.73 · Achievement 7.73 · Improvement 2.24
Total nurse turnover
1.42
Baseline 45.24% · Performance 57.89% · Measure score 1.42 · Achievement 1.42 · Improvement 0
Adjusted total nurse staffing
0.77
Baseline 3.38 hours · Performance 3.30 hours · Measure score 0.77 · Achievement 0.77 · Improvement 0
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 11.9% |
10.72%
1.2 pts worse
|
No Different than the National Rate · Eligible stays 90 · Observed rate 17.78% · Lower 95% interval 9.23% |
| Discharge to community | 56.89% |
50.57%
6.3 pts better
|
No Different than the National Rate · Eligible stays 101 · Observed rate 45.54% · Lower 95% interval 46.4% |
| Medicare spending per beneficiary | 0.97 |
1.02
0.1 pts better
|
|
| Drug regimen review with follow-up | 88.51% |
95.27%
6.8 pts worse
|
Numerator 77 · Denominator 87 |
| Falls with major injury | 0% |
0.77%
0.8 pts better
|
Numerator 0 · Denominator 87 |
| Discharge self-care score | 60% |
53.69%
6.3 pts better
|
Numerator 36 · Denominator 60 |
| Discharge mobility score | 45% |
50.94%
5.9 pts worse
|
Numerator 27 · Denominator 60 |
| Pressure ulcers or injuries, new or worsened | 0% |
2.29%
2.3 pts better
|
Numerator 0 · Denominator 87 · Adjusted rate 0% |
| Healthcare-associated infections requiring hospitalization | 5.53% |
7.12%
1.6 pts better
|
No Different than the National Rate · Eligible stays 74 · Observed rate 2.7% · Lower 95% interval 2.81% |
| Staff COVID-19 vaccination coverage | 11.46% |
8.2%
3.3 pts better
|
Numerator 11 · Denominator 96 |
| Staff flu vaccination coverage | 20% |
42%
22 pts worse
|
Numerator 19 · Denominator 95 |
| Discharge function score | 56.67% |
56.45%
0.2 pts better
|
Numerator 34 · Denominator 60 |
| Transfer of health information to provider | 100% |
95.95%
4 pts better
|
Numerator 31 · Denominator 31 |
| Transfer of health information to patient | 97.67% |
96.28%
1.4 pts better
|
Numerator 42 · Denominator 43 |
| Resident COVID-19 vaccinations up to date | 12.82% |
25.2%
12.4 pts worse
|
Numerator 5 · Denominator 39 |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 97.3% |
92.4%
4.9 pts better
|
93.4%
3.9 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 90.0% · Q2 100.0% · Q3 100.0% · Q4 100.0% · 4Q avg 97.3% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 100.0% |
94.5%
5.5 pts better
|
95.5%
4.5 pts better
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 100.0% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 4.7% |
3.3%
1.4 pts worse
|
3.3%
1.4 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 2.5% · Q2 5.6% · Q3 5.4% · Q4 5.7% · 4Q avg 4.7% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 3.0% |
26.1%
23.1 pts better
|
11.4%
8.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 5.4% · Q2 0.0% · Q3 3.1% · Q4 3.1% · 4Q avg 3.0% |
| Percentage of long-stay residents who lose too much weight | 3.8% |
6.2%
2.4 pts better
|
5.4%
1.6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 2.9% · Q2 3.0% · Q3 5.7% · Q4 3.2% · 4Q avg 3.8% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 19.3% |
25.4%
6.1 pts better
|
19.6%
0.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 14.3% · Q2 20.6% · Q3 22.9% · Q4 19.4% · 4Q avg 19.3% |
| Percentage of long-stay residents who received an antipsychotic medication | 3.6% |
11.5%
7.9 pts better
|
16.7%
13.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 6.5% · Q2 3.4% · Q3 3.8% · Q4 0.0% · 4Q avg 3.6% · 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 | 31.0% |
7.7%
23.3 pts worse
|
16.3%
14.7 pts worse
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 31.0% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 11.6% |
6.2%
5.4 pts worse
|
14.9%
3.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 21.9% · Q2 9.4% · Q3 13.8% · Q4 0.0% · 4Q avg 11.6% · 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 | 0.0% |
0.5%
0.5 pts better
|
1.7%
1.7 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 new or worsened bowel or bladder incontinence | 27.3% |
21.7%
5.6 pts worse
|
19.8%
7.5 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 33.4% · Q2 40.2% · Q3 16.3% · Q4 18.3% · 4Q avg 27.3% |
| Percentage of long-stay residents with pressure ulcers | 5.6% |
3.7%
1.9 pts worse
|
5.1%
0.5 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 6.2% · Q2 7.2% · Q3 4.7% · Q4 4.3% · 4Q avg 5.6% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 86.6% |
78.1%
8.5 pts better
|
81.7%
4.9 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 73.6% · Q2 79.7% · Q3 94.3% · Q4 97.8% · 4Q avg 86.6% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 12.0% |
12.5%
0.5 pts better
|
12.0%
About the same
|
Short Stay · 20240701-20250630 · Adjusted 12.0% · Observed 14.1% · Expected 13.1% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 0.3% |
1.2%
0.9 pts better
|
1.6%
1.3 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 1.1% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.3% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 85.8% |
75.6%
10.2 pts better
|
79.7%
6.1 pts better
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 85.8% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 30.2% |
25.1%
5.1 pts worse
|
23.9%
6.3 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 30.2% · Observed 39.1% · Expected 30.8% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2022-02-17 · Fire 2022-02-17
8 health deficiencies
Top issue: Resident Assessment and Care Planning (3 deficiencies)
17 fire-safety deficiencies
Top issue: Smoke (5 deficiencies)
Cycle 3
Health 2019-07-11 · Fire 2019-07-11
5 health deficiencies
Top issue: Resident Rights (2 deficiencies)
5 fire-safety deficiencies
Top issue: Smoke (3 deficiencies)
Fire safety
Fire-safety citations
F · Potential for more than minimal harm
2024-03-13
K311 · Smoke Deficiencies
Fire Safety
Have an enclosure around a vertical opening shaft.
Corrected 2024-04-02
E · Potential for more than minimal harm
2024-03-13
K222 · Egress Deficiencies
Fire Safety
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
Corrected 2024-04-02
E · Potential for more than minimal harm
2024-03-13
K321 · Smoke Deficiencies
Fire Safety
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Corrected 2024-04-02
E · Potential for more than minimal harm
2024-03-13
K353 · Smoke Deficiencies
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2024-04-02
E · Potential for more than minimal harm
2024-03-13
K741 · Miscellaneous Deficiencies
Fire Safety
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
Corrected 2024-04-02
E · Potential for more than minimal harm
2024-03-13
K920 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Ensure proper usage of power strips and extension cords.
Corrected 2024-04-02
F · Potential for more than minimal harm
2022-02-17
K161 · Construction Deficiencies
Fire Safety
Use approved construction type or materials.
Corrected 2022-04-06
F · Potential for more than minimal harm
2022-02-17
K211 · Egress Deficiencies
Fire Safety
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Corrected 2022-04-06
F · Potential for more than minimal harm
2022-02-17
K300 · Egress Deficiencies
Fire Safety
Meet other general requirements that are deficient.
Corrected 2022-04-06
F · Potential for more than minimal harm
2022-02-17
K324 · Smoke Deficiencies
Fire Safety
Provide properly protected cooking facilities.
Corrected 2022-04-06
F · Potential for more than minimal harm
2022-02-17
K345 · Smoke Deficiencies
Fire Safety
Have approved installation, maintenance and testing program for fire alarm systems.
Corrected 2022-04-06
F · Potential for more than minimal harm
2022-02-17
K353 · Smoke Deficiencies
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2022-04-06
F · Potential for more than minimal harm
2022-02-17
K363 · Smoke Deficiencies
Fire Safety
Install corridor and hallway doors that block smoke.
Corrected 2022-04-06
F · Potential for more than minimal harm
2022-02-17
K511 · Services Deficiencies
Fire Safety
Have properly installed electrical wiring and gas equipment.
Corrected 2022-04-06
F · Potential for more than minimal harm
2022-02-17
K712 · Miscellaneous Deficiencies
Fire Safety
Have simulated fire drills held at unexpected times.
Corrected 2022-04-06
F · Potential for more than minimal harm
2022-02-17
K741 · Miscellaneous Deficiencies
Fire Safety
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
Corrected 2022-04-06
F · Potential for more than minimal harm
2022-02-17
K761 · Miscellaneous Deficiencies
Fire Safety
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
Corrected 2022-04-06
F · Potential for more than minimal harm
2022-02-17
K914 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.
Corrected 2022-04-06
F · Potential for more than minimal harm
2022-02-17
K918 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have generator or other power source capable of supplying service within 10 seconds.
Corrected 2022-04-06
E · Potential for more than minimal harm
2022-02-17
K222 · Egress Deficiencies
Fire Safety
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
Corrected 2022-04-06
E · Potential for more than minimal harm
2022-02-17
K355 · Smoke Deficiencies
Fire Safety
Properly select, install, inspect, or maintain portable fire extinguishes.
Corrected 2022-04-06
E · Potential for more than minimal harm
2022-02-17
K911 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Meet requirements for the installation and maintenance of electrical systems.
Corrected 2022-04-06
E · Potential for more than minimal harm
2022-02-17
K926 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Ensure that personnel concerned with handling of medical gases and cylinders are trained on the risk.
Corrected 2022-04-06
F · Potential for more than minimal harm
2019-07-11
K712 · Miscellaneous Deficiencies
Fire Safety
Have simulated fire drills held at unexpected times.
Corrected 2019-08-24
F · Potential for more than minimal harm
2019-07-11
K918 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have generator or other power source capable of supplying service within 10 seconds.
Corrected 2019-08-24
E · Potential for more than minimal harm
2019-07-11
K321 · Smoke Deficiencies
Fire Safety
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Corrected 2019-08-24
E · Potential for more than minimal harm
2019-07-11
K362 · Smoke Deficiencies
Fire Safety
Ensure that corridors are separated from use areas by walls constructed to limit the passage of smoke.
Corrected 2019-08-24
E · Potential for more than minimal harm
2019-07-11
K374 · Smoke Deficiencies
Fire Safety
Install smoke barrier doors that can resist smoke for at least 20 minutes.
Corrected 2019-08-24
Inspection history
Recent health citations
D · Potential for more than minimal harm
2024-12-30
F842 · Resident Assessment and Care Planning Deficiencies
Health
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Corrected 2025-01-15
F · Potential for more than minimal harm
2024-03-13
F812 · Nutrition and Dietary Deficiencies
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2024-04-02
D · Potential for more than minimal harm
2024-03-13
F645 · Resident Assessment and Care Planning Deficiencies
Health
PASARR screening for Mental disorders or Intellectual Disabilities
Corrected 2024-04-02
D · Potential for more than minimal harm
2024-03-13
F686 · Quality of Life and Care Deficiencies
Health
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected 2024-04-02
D · Potential for more than minimal harm
2024-03-13
F758 · Pharmacy Service Deficiencies
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 2024-04-02
D · Potential for more than minimal harm
2024-03-13
F772 · Administration Deficiencies
Health
Have an agreement with an approved laboratory to obtain services, if on-site laboratory services aren't provided.
Corrected 2024-04-02
D · Potential for more than minimal harm
2024-02-21
F842 · Resident Assessment and Care Planning Deficiencies
Health
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Corrected 2024-03-13
D · Potential for more than minimal harm
2023-11-16
F573 · Resident Rights Deficiencies
Health
Let each resident or the resident's legal representative access or purchase copies of all the resident's records.
Corrected 2023-12-08
E · Potential for more than minimal harm
2022-02-17
F584 · Resident Rights Deficiencies
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 2022-04-06
E · Potential for more than minimal harm
2022-02-17
F805 · Nutrition and Dietary Deficiencies
Health
Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.
Corrected 2022-04-06
E · Potential for more than minimal harm
2022-02-17
F842 · Resident Assessment and Care Planning Deficiencies
Health
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Corrected 2022-04-06
D · Potential for more than minimal harm
2022-02-17
F558 · Resident Rights Deficiencies
Health
Reasonably accommodate the needs and preferences of each resident.
Corrected 2022-04-06
D · Potential for more than minimal harm
2022-02-17
F641 · Resident Assessment and Care Planning Deficiencies
Health
Ensure each resident receives an accurate assessment.
Corrected 2022-04-06
D · Potential for more than minimal harm
2022-02-17
F689 · Quality of Life and Care Deficiencies
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2022-04-06
D · Potential for more than minimal harm
2022-02-17
F919 · Environmental Deficiencies
Health
Make sure that a working call system is available in each resident's bathroom and bathing area.
Corrected 2022-04-06
F · Potential for more than minimal harm
2019-07-11
F812 · Nutrition and Dietary Deficiencies
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2019-08-24
E · Potential for more than minimal harm
2019-07-11
F584 · Resident Rights Deficiencies
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 2019-08-24
D · Potential for more than minimal harm
2019-07-11
F759 · Pharmacy Service Deficiencies
Health
Ensure medication error rates are not 5 percent or greater.
Corrected 2019-08-24
Penalties and ownership
What sits behind the stars
Ownership
Francus, Michael
5% Or Greater Direct Ownership Interest · Individual
Joseph B. Francus Revocable Trust
5% Or Greater Direct Ownership Interest · Organization
Kraus, Andrea
5% Or Greater Direct Ownership Interest · Individual
Francus, Michael
Operational/Managerial Control · Individual
Gerbasich, Holly
Operational/Managerial Control · Individual
Vrc Management, Inc.
Operational/Managerial Control · Organization
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#2
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2-star overall rating with 2-star inspections with $23,140 in total fines with 10 recent health deficiencies with 7 fire-safety deficiencies in the latest cycle
#3
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2-star overall rating with 2-star inspections with 9 recent health deficiencies with 10 fire-safety deficiencies in the latest cycle
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