Not rated by CMS — ratings are suppressed for new or low-volume facilities.
A standard survey is most likely before around November 2026
Estimate from public CMS data, current as of June 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Astoria Place Of Waterville during CMS and state inspections, most recent first.
A resident with bipolar disorder, schizoaffective disorder, major depressive disorder, epilepsy, and other comorbidities experienced a gradual dose reduction of Abilify without timely psychiatric reassessment and with inconsistent behavior documentation. In the weeks before the incident, staff and psychology notes described depression, low energy, poor concentration, anhedonia, and later increased aggression, arguing, medication refusal, and throwing objects, but these behaviors were not consistently charted, and no medication changes were implemented. On an overnight shift, a CNA observed the resident talking to himself, shouting profanities, and becoming highly agitated and unapproachable, while an LPN documented verbal aggression, threatening gestures, and lack of sleep, but hospice was not notified as directed and no effective interventions were implemented. The next morning, the resident was found outside on a snowy hillside about 100 feet from his window, lightly clothed, combative, stating he wanted to die, and showing signs of hypothermia and injury; EMS and hospital records documented altered mental status, psychosis, delusions, hypothermia, frostbite, and placement on an Emergency Application for a suspected suicide attempt. The facility lacked a policy for behavioral or psychological needs and did not follow its change-in-condition policy requiring physician consultation for significant mental or psychosocial changes.
A resident with multiple chronic conditions and moderate cognitive impairment exited the building through a window and was later found outside, prompting staff to call 911 and remain with the resident until EMS arrived. Although internal notifications were documented, review of the state CALS system showed no report of the elopement to the Ohio Department of Health. In an interview, the Administrator confirmed the elopement and acknowledged that ODH was not notified, stating unawareness of the reporting requirement despite a facility policy directing that such incidents be reported to the Administrator and, when applicable, to ODH within required time frames.
A resident with a history of schizophrenia and moderate cognitive impairment, who had no prior documented aggressive behaviors, was found in a room with another resident who was discovered deceased with ligatures tightly wrapped around her neck. Staff had last seen both residents in the hallway earlier in the evening. The facility failed to prevent resident-to-resident abuse, resulting in the death of a resident by strangulation, as confirmed by coroner and police reports.
The facility did not provide food prepared in a form tailored to meet the individual needs of residents, resulting in meals that were not consistently modified for specific dietary or physical requirements.
The facility did not ensure staff consistently followed dietary restrictions and supervision requirements, resulting in a resident's death from choking after receiving unapproved food, and additional incidents where residents with special dietary needs were left unsupervised or accessed inappropriate food items.
Surveyors identified multiple environmental deficiencies, including holes in drywall, water accumulation under sinks, missing or broken light cords and covers, and stained ceilings in several resident rooms. The Regional Director of Maintenance confirmed these issues, which affected eight residents and indicated a failure to maintain a homelike environment.
Two residents with self-care deficits did not receive adequate nail care as required by their care plans. One resident was repeatedly observed with dirty fingernails containing a dark brown substance, despite staff awareness of her behaviors and care needs. Another resident had long fingernails and expressed a desire for them to be trimmed, but staff were unclear about responsibility for this task. Facility policy required staff to follow ADL care plans, including nail care, but this was not consistently done.
Two residents experienced deficiencies in supervision and safety: one was not properly assessed after an unwitnessed fall, and another, with a history of taking food from others, was able to access and consume food not permitted in her prescribed pureed diet. Staff were aware of these behaviors but did not implement additional interventions to prevent recurrence.
The facility did not ensure an RN was present for the required eight hours on a specific day, as confirmed by schedule and timesheet reviews and staff interview. This lapse affected all 68 residents, as there was no RN available to provide necessary nursing care and oversight.
A housekeeper used personally purchased household cleaning products instead of facility-approved agents to clean resident rooms and common areas on one unit, with the knowledge and approval of her supervisor. The cleaning products were not intended for industrial or sanitizing use, and the facility lacked a policy specifying required cleaning agents.
A resident with severe cognitive impairment and high fall risk was assisted to the bathroom without his walker by two CNAs, resulting in a fall and a fractured femur. The incident was not reported to the nurse, and the facility's investigation was incomplete, lacking documentation of the resident's use of a walker and environmental conditions. The care plan did not include the use of a walker, and the facility's fall policy was not adequately followed.
A resident with a history of aggressive behavior physically abused two other residents, causing significant injuries. The facility's interventions, such as 15-minute checks and psychological evaluations, were insufficient, and the investigation lacked comprehensive assessments. The facility's policy on abuse prevention was not effectively implemented, contributing to repeated incidents of abuse.
The facility failed to timely report resident-to-resident abuse incidents involving a resident with dementia who caused injuries to two other residents. The incidents were not promptly filed in the Self-Reported Incident (SRI) database, and local law enforcement was not notified as required by the facility's policy. This resulted in non-compliance with state regulations.
Failure to Assess and Respond to Resident’s Acute Mental Health Decline Leading to Harm
Penalty
Summary
The deficiency involves the facility’s failure to adequately assess, monitor, document, and address a resident’s mental health decline and behavioral changes, despite the resident’s significant psychiatric history and hospice status. The resident had diagnoses including bipolar disorder, schizoaffective disorder, major depressive disorder, epilepsy, COPD, and CKD, and was receiving hospice services. Antipsychotic medication (Abilify) had been gradually reduced from 10 mg to 5 mg on 11/11/25 and then to 2.5 mg on 12/11/25 as a gradual dose reduction. Psychology notes from 12/10/25 and 12/24/25 documented depression, low energy, poor concentration, and lack of motivation, but no psychosis, hallucinations, or suicidal ideation at those times. Behavior documentation from 12/07/25 through 01/02/26 showed no recorded behaviors, despite later staff reports of aggression and mood changes. On 12/22/25, nursing documentation noted low energy, inability to sleep, quiet and flat affect, and a behavior note described anhedonia and sadness. A PHQ-9 interview on 12/23/25 recorded no mood symptoms and indicated no need for a staff mood interview. On 12/24/25, psychology documented depressed affect, low energy, poor concentration, lack of interest, and sadness, but still no psychosis or suicidal ideation. On 12/30/25, a nursing progress note stated hospice was advised of increased aggression and that a PNP would adjust medications; however, there was no corresponding documentation of the resident’s aggression in the behavior charting, no record that the PNP actually saw the resident that day, and no evidence of any medication changes. A later interview with an RN clarified that the resident had been arguing with a roommate, refusing medications, and throwing things in his room, but these behaviors were not captured in the behavior documentation. During the night shift of 01/01/26–01/02/26, a CNA reported that the resident was “not right” and “actually scary,” lying in bed talking quietly to himself, shouting profanities when staff walked by, and becoming more agitated when approached, acting as if he would get out of bed. The CNA, who had cared for the resident for two to three years, stated this behavior was very out of character and reported her concerns to the LPN. The LPN attempted to give evening medications around 7:30 P.M., which the resident refused, and stated the door was kept open to observe him. The LPN later sent a text to the physician at 6:07 A.M. about the behaviors and lack of sleep but did not contact hospice as instructed by the DON and did not receive a response before leaving at 6:36 A.M. Behavior charting for 01/02/26 at 5:59 A.M. documented that the resident was verbally aggressive, yelling profanities, making threatening gestures, unapproachable, highly agitated, awake all night, and talking loudly with aggressive, profane language to himself; it also stated that the physician and on-call provider were notified, but there was no evidence of interventions implemented throughout the night. On the morning of 01/02/26, the DON reported receiving a call around 6:00 A.M. from the hall nurse about the resident talking to himself and to people who were not there and instructed the nurse to call hospice. The DON arrived at approximately 7:00 A.M., was told the resident was sleeping, and did not check on him. Hospice later confirmed the facility did not contact them about the change in mental status and that hospice only became aware when their nurse arrived for a routine visit and saw EMS assisting the resident. Around 7:50 A.M., a transportation driver arriving at the facility saw something in the snow and discovered the resident outside approximately 100 feet from his window, on his knees in the snow, agitated, stating he wanted to die, with abrasions, bright red skin, and wearing only light clothing. Facility staff and EMS reports indicated the resident was combative, aggressive, and psychotic, with altered mental status, injuries, and signs of hypothermia in temperatures around 21°F. EMS and hospital records documented that the resident was found kneeling in the snow with a cold wet blanket, with drag marks suggesting he had rolled down a hill from a first-floor window approximately 77 inches above the ground. The resident was pale with purple extremities, abrasions, and nonblanchable skin over heels and knees, and required soft restraints and sedative medication due to combative behavior. At the hospital, he was described as cold to the touch, with a core temperature of 95.6°F, delusions (including stating he was pregnant), and paranoia. He was admitted with hypothermia due to exposure, stage one frostbite to the heels, and delusions, and was placed on an Emergency Application for suspected suicide attempt after reportedly jumping from his window and remaining in the snow. Interviews with the PNP and hospice staff revealed discrepancies in Abilify dosing between hospice and facility records, lack of timely psychiatric reassessment after the GDR, and inconsistent or missing documentation of behavioral concerns. The facility’s Administrator and Vice President of Clinical Operations confirmed there was no facility policy related to meeting residents’ behavioral or psychological needs, and the facility’s change-in-condition policy required physician consultation for significant changes in mental or psychosocial status, which was not consistently followed in this case.
Failure to Report Resident Elopement to State Agency
Penalty
Summary
The facility failed to notify the Ohio Department of Health (ODH) of a resident elopement as required. Medical record review showed that Resident #09, who had multiple diagnoses including localization-related symptomatic epilepsy with simple partial seizures, COPD, chronic kidney disease, bipolar disorder, schizoaffective disorder, morbid obesity, and major depressive disorder, was admitted on an identified date and later transferred to the hospital. An MDS assessment indicated the resident was moderately cognitively impaired without documented mood concerns or behaviors. A nursing progress note documented that on a specific date the nurse was notified the resident was outside, 911 was called, and the nurse remained with the resident until emergency services arrived, stating that all parties were notified. Review of the Certification, Licensure, and Survey (CALS) system for the relevant time period revealed no evidence that the facility reported the resident’s elopement to ODH. During an interview, the Administrator confirmed that the resident had exited the building through his window and was found outside the facility, and acknowledged that ODH had not been notified. The Administrator stated that hospice had informed her they were required to report the incident to ODH, but she was not aware that she was also required to do so. Review of the facility’s Abuse, Mistreatment, Neglect, Exploitation, and Misappropriation of Resident Property policy showed that all incidents and allegations of abuse, neglect, exploitation, mistreatment, misappropriation, and all injuries of unknown source must be reported immediately to the Administrator or designee, and that if abuse was alleged or serious bodily injury identified, the Administrator/designee would notify ODH immediately but not later than two hours after the allegation or identification of serious bodily injury.
Failure to Prevent Resident-to-Resident Abuse Resulting in Homicide
Penalty
Summary
A deficiency occurred when the facility failed to prevent resident-to-resident abuse, resulting in the death of one resident. The incident involved a resident with a history of schizophrenia, chronic obstructive pulmonary disease, hypertension, and brief psychotic disorder, who was initially admitted to a secured dementia unit, later moved to a behavior unit, and then returned to the dementia unit. This resident had no documented history of aggressive behaviors toward staff or other residents during their stay, and their care plan included interventions for cognitive loss and impaired judgment. Another resident, with diagnoses including major depression, bipolar disorder, severe cognitive impairment, and other medical conditions, resided on the secured dementia unit and was independently ambulatory with severe cognitive impairment noted on assessment. On the evening of the incident, staff were unable to locate the resident with schizophrenia for medication administration. After searching, staff found the resident in a room with the door closed, standing inside and perspiring. Behind a privacy curtain, another resident was found lying supine on the floor with towels and a pillowcase tightly wrapped around her neck, her face purple, and blood in her mouth. The staff immediately called for help, assessed the unresponsive resident, and contacted emergency services and law enforcement. The resident was pronounced deceased at the scene, and the cause of death was determined to be homicide by strangulation, as confirmed by the county coroner and autopsy findings. Interviews and documentation revealed that staff had last seen both residents in the hallway earlier that evening, and there was no indication of prior aggressive behavior from the resident who committed the act. The facility's policy on abuse, mistreatment, and neglect was reviewed, which defines abuse as the willful infliction of injury resulting in physical harm. The incident was investigated by police, and the resident responsible was taken into custody. The deficiency was cited for the facility's failure to protect residents from abuse, resulting in actual harm and death.
Failure to Provide Food in Appropriate Form for Individual Needs
Penalty
Summary
The facility failed to ensure that each resident received food prepared in a form designed to meet their individual needs. This deficiency indicates that meals were not consistently modified or adapted to accommodate the specific dietary requirements or physical abilities of residents, such as those needing pureed, chopped, or otherwise altered food textures. The report does not provide further details about the residents involved or their medical conditions at the time of the deficiency.
Failure to Enforce Dietary Restrictions and Supervision Leading to Choking Incidents
Penalty
Summary
The facility failed to provide adequate administrative oversight, resulting in a resident's death due to choking after being given food items that were not approved for their diet. Despite a requirement for staff to use diet order cards on snack trays to ensure residents received appropriate food, observations revealed that staff were not consistently utilizing these cards during snack distribution. Additionally, a resident who required supervision while eating was observed eating alone and subsequently began choking, with staff intervention needed to resolve the incident. Another resident on a pureed diet was seen taking bacon from another resident's meal tray left unattended in the hallway, despite staff being aware of this resident's tendency to take food from others and the need for close monitoring. Medical record reviews confirmed that the residents involved had specific dietary restrictions and supervision requirements that were not followed. Staff interviews corroborated that the required practices, such as using diet order cards and supervising residents during meals, were not consistently implemented. The facility's policies and job descriptions outlined the responsibility of administration to ensure proper procedures and quality of care, but these were not effectively enforced, leading to multiple incidents where residents received inappropriate food or were left unsupervised during meals.
Environmental Deficiencies and Lack of Homelike Environment
Penalty
Summary
Surveyors observed multiple environmental deficiencies affecting eight residents in the facility. In one resident's bedroom, there was a large hole in the drywall at door handle height and a smaller hole near the ceiling behind the door. The shared bathroom for two residents had a waste basket under the sink that was approximately one-quarter full of water. In another resident's bedroom, the light above the bed was missing a cord to turn it on, and the same shared bathroom had the water-filled waste basket. Two residents' room ceilings had large brown-colored areas of an unidentified substance throughout, and another resident's bedroom had a light above the bed with no pull cord. Additionally, another room's ceiling had similar brown-colored areas, and a different resident's light had a broken cover hanging from it. The Regional Director of Maintenance confirmed these findings during an interview and stated that the water under the sink was due to a part needed for repair. The director also confirmed the absence of pull cords for the lights above the beds and acknowledged that while water pipes had burst and been fixed in some rooms, the brown-colored spots on the ceilings had not been addressed. The broken light cover was also confirmed. These observations and confirmations indicate the facility failed to maintain a homelike environment as required.
Failure to Provide Adequate Nail Care for Dependent Residents
Penalty
Summary
The facility failed to provide adequate nail care for dependent residents, as evidenced by observations and interviews involving two residents with self-care deficits. One resident with dementia, Alzheimer's disease, and behavioral issues, including playing in her own feces, was observed on multiple occasions with dirty fingernails containing a dark brown substance. Despite care plan interventions specifying that nail length should be checked, trimmed, and cleaned on bath days and as necessary, the resident's nails remained soiled over several days, even while eating meals with her hands. Staff interviews confirmed the resident's behaviors and the ongoing issue with dirty nails. Another resident with multiple chronic conditions, including bipolar disorder and diabetes, was found to have long fingernails on repeated observations, although the nails were clean and not jagged. The resident expressed dissatisfaction with the length of his nails and requested they be trimmed, but staff were unaware of who was responsible for this task. The facility's policy required staff to follow the ADL care plan, which included nail care, but this was not consistently implemented for the residents reviewed.
Failure to Prevent Accidents and Ensure Dietary Supervision
Penalty
Summary
The facility failed to adequately assess a resident following an unwitnessed fall and did not provide sufficient supervision to prevent another resident from consuming food not included in their prescribed diet. In the first incident, a resident with diagnoses including paranoid schizophrenia, major depressive disorder, and pseudobulbar affect, who was cognitively intact and required supervision for ADLs, was found lying on the ground near the nurse’s station with her walker beside her. A housekeeper assisted the resident off the floor without notifying nursing staff, and the LPN on duty was unaware of the incident until informed by the surveyor. The required post-fall assessment and reporting procedures were not initiated immediately following the event. In the second incident, a resident with Alzheimer’s disease, dementia, oropharyngeal dysphagia, and schizoaffective disorder, who was on a pureed diet, was observed taking and consuming regular texture food from other residents’ trays on multiple occasions. Despite documentation of repeated incidents where the resident took food from trays or the trash and consumed it, staff interventions were limited to verbal redirection and education. During an observation, the resident was able to access the tray cart, remove bacon from another resident’s tray, and begin eating it before being stopped by a staff member. Interviews confirmed that staff were aware of the resident’s behavior but had not implemented additional interventions to prevent access to inappropriate foods. Both incidents demonstrate a lack of adequate supervision and failure to follow established protocols for resident safety and dietary management. The facility did not ensure that staff were consistently monitoring residents at risk for falls or for consuming foods not aligned with their prescribed diets, resulting in deficiencies affecting two residents reviewed for accidents.
Failure to Provide Required RN Coverage
Penalty
Summary
The facility failed to ensure that a Registered Nurse (RN) was on duty for eight hours daily, as required. Review of staff schedules and timesheets for May 2015 showed there was no RN coverage on one specific day. This was confirmed during an interview with Regional Clinical Support, who acknowledged the absence of documentation indicating an RN worked in the facility on that day. This deficiency affected all 68 residents in the facility, as there was no RN present to provide required nursing oversight and care during the identified period.
Inappropriate Use of Non-Approved Cleaning Agents in Resident Areas
Penalty
Summary
The facility failed to ensure that appropriate cleaning agents were used for cleaning resident rooms and common areas, affecting 32 residents on the upstairs unit. Housekeeper #302, assigned to the second floor, used cleaning products she personally purchased rather than facility-approved chemicals. She did this for convenience, as the facility's chemical supplies were located on the first floor. The housekeeper used two Pinalen brand products, one for floors and one for surfaces and toilets, and did not measure the cleaning solution, instead estimating the amount used. Her supervisor was aware of and approved the use of these products. The facility did not have a policy regarding the types of cleaning products required to meet its cleaning needs. Review of the Safety Data Sheet for Pinalen revealed it is a household multipurpose cleaner not intended for industrial use or as a sanitizing agent. The deficiency was identified through staff interviews, observation, and review of product instructions and documentation, and was confirmed by the facility administrator.
Failure to Ensure Safe Ambulation and Report Fall
Penalty
Summary
The facility failed to ensure the safety and proper supervision of a resident, leading to a fall and subsequent injury. The resident, who had severe cognitive impairment and was at high risk for falls, was assisted to the bathroom by two CNAs without the use of his prescribed walker. During this process, the resident's legs buckled, and he was lowered to the floor by the CNAs. The CNAs then assisted the resident onto the toilet and back to bed without reporting the incident to the nurse, as they did not recognize it as a fall. The resident was later found by the oncoming shift with bruising and swelling, and an x-ray revealed a displaced intertrochanteric fracture of the left femur. The resident required surgical repair and hospitalization. The facility's investigation into the incident was incomplete, lacking documentation of the resident's use of a walker, footwear, and environmental conditions at the time of the fall. Additionally, there was no evidence of a thorough investigation or assessment of the resident's injuries prior to moving him after the fall. The facility's care plan for the resident did not include the use of a walker, despite recommendations from physical therapy. The CNAs involved were unaware that lowering a resident to the floor constituted a fall and did not report the incident. The facility's fall policy was not adequately followed, as the incident was not documented or reported in a timely manner, and the care plan was not updated with appropriate interventions to prevent future falls.
Failure to Prevent Resident-to-Resident Abuse
Penalty
Summary
The facility failed to prevent resident-to-resident physical abuse, resulting in actual harm to residents. Resident #01, with a known history of aggressive behavior, struck Resident #02 in the face, causing a hematoma and a closed fracture of the right orbital floor. Despite Resident #01's history of aggression, the facility's interventions, such as 15-minute checks and psychological evaluations, were insufficient to prevent the incident. The facility's investigation lacked comprehensive interviews and assessments to understand the factors leading to the incident. In another incident, Resident #01 struck Resident #03 multiple times in the back while Resident #03 was asleep. The facility's response included separating the residents and placing Resident #01 on one-to-one monitoring, but the monitoring was not documented. The facility's investigation into this incident also lacked thorough assessments and documentation of Resident #01's behaviors prior to the incident. The facility's policy on abuse prevention was not effectively implemented, as ongoing assessments and appropriate interventions were not adequately documented or executed. Resident #01's medical records revealed a history of physical aggression, yet there was a delay in psychiatric evaluation and insufficient documentation of behavior assessments. The facility's failure to implement effective monitoring and intervention strategies contributed to the repeated incidents of resident-to-resident abuse. The Director of Nursing acknowledged the lack of documentation and assessments, indicating a gap in the facility's approach to managing residents with aggressive behaviors.
Failure to Timely Report Resident-to-Resident Abuse
Penalty
Summary
The facility failed to timely report allegations of resident-to-resident abuse, affecting three residents. On 08/09/24, Resident #01 was observed grabbing Resident #02's hair and punching her in the face, resulting in facial swelling and an orbital fracture. Although the incident was reported to the Director of Nursing (DON) on the same day, there was no evidence that it was filed in the Self-Reported Incident (SRI) database until 08/14/24. The facility's investigation lacked interviews with other staff or residents and did not include any resident interviews. The police were notified, but no report was made due to Resident #01's dementia diagnosis. Another incident occurred on 08/13/24, where Resident #01 struck Resident #03 multiple times in the back, causing a bruise. This incident was not reported to the SRI database until 08/14/24, and local law enforcement was not notified. The facility's policy requires that all allegations of abuse involving bodily injury be reported to the Ohio Department of Health (ODH) database immediately or within two hours. The facility's failure to adhere to this policy resulted in non-compliance with control numbers OH00156980 and OH0015690.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Waterville
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Ayden Healthcare Of Waterville | 1.6 mi | — | 31 | 0 |
| Otterbein Monclova | 4 mi | — | 4 | 0 |
| Whitehouse Country Manor | 4.7 mi | — | 0 | 0 |
| St Clare Commons | 4.9 mi | — | 13 | 0 |
| Lakes Of Monclova Health Campus The | 5 mi | — | 1 | 0 |
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