The Gardens of St. Francis
930 South Wynn Road, Oregon, OH 43616
The Gardens of St. Francis is a nursing home in Oregon, Ohio. This page lists the citations, fines and star ratings that CMS publishes for it. Each one has a date and a link to CMS.
At a glance
- CMS overall star rating4 of 5
- Last standard health inspectionMarch 26, 2026 (7 months ago)
- Health citations since September 8, 202140 (Ohio average 31)
- Fines in the past three years1, $45,250 in total
- CMS flagsNone listed by CMS
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One email per CMS update, only when something changed: a new citation, a fine, a star rating change, a new owner. Early access follows one home per address.
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CMS flags
CMS does not list this home as a Special Focus Facility or a candidate. CMS does not show an abuse icon for it. CMS lists no change of ownership in the past 12 months.
Inspections, fines and changes
This list shows every citation and fine in CMS's current data, which covers about the last three years. It also shows changes CMS made to this home's ratings and records.
CMS update of October 28, 2026
Star rating
The CMS overall star rating changed from 3 of 5 to 4 of 5.
Star rating
The CMS staffing star rating changed from 1 of 5 to 2 of 5.
CMS update of July 29, 2026
Star rating
The CMS health inspection star rating changed from 2 of 5 to 3 of 5.
Star rating
The CMS staffing star rating changed from 2 of 5 to 1 of 5.
Staffing
Total nurse staffing reported to CMS went from 3.7 to 1.5 hours per resident per day.
CMS update of April 29, 2026
Staffing
Total nurse staffing reported to CMS went from 4.2 to 3.7 hours per resident per day.
Health inspection on March 26, 2026
6 citationsCMS lists this as a standard inspection.
Show the 6 citations
Citation F0605. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.
CMS lists it as corrected on April 30, 2026.
Citation F0883. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Develop and implement policies and procedures for flu and pneumonia vaccinations.
CMS lists it as corrected on April 30, 2026.
CMS has cited this home for F0883 2 times since 2021.
Citation F0561. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
CMS lists it as corrected on April 30, 2026.
CMS has cited this home for F0561 2 times since 2021.
Citation F0645. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
PASARR screening for Mental disorders or Intellectual Disabilities
CMS lists it as corrected on April 30, 2026.
Citation F0684. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
CMS lists it as corrected on April 30, 2026.
CMS has cited this home for F0684 3 times since 2021.
Citation F0686. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
CMS lists it as corrected on April 30, 2026.
CMS has cited this home for F0686 2 times since 2021.
Fire safety inspection on March 26, 2026
6 citationsCMS lists this as a standard inspection.
Show the 6 citations
Citation K0311. Severity F: potential for more than minimal harm, widespread.
The rule CMS cited:
Have an enclosure around a vertical opening shaft.
CMS lists it as corrected on May 15, 2026.
CMS has cited this home for K0311 2 times since 2024.
Citation K0324. Severity F: potential for more than minimal harm, widespread.
The rule CMS cited:
Provide properly protected cooking facilities.
CMS lists it as corrected on May 15, 2026.
CMS has cited this home for K0324 2 times since 2024.
Citation K0353. Severity F: potential for more than minimal harm, widespread.
The rule CMS cited:
Inspect, test, and maintain automatic sprinkler systems.
CMS lists it as corrected on May 15, 2026.
CMS has cited this home for K0353 2 times since 2021.
Citation K0712. Severity F: potential for more than minimal harm, widespread.
The rule CMS cited:
Have simulated fire drills held at unexpected times.
CMS lists it as corrected on May 15, 2026.
Citation K0751. Severity F: potential for more than minimal harm, widespread.
The rule CMS cited:
Have restrictions on the use of flammable curtains.
CMS lists it as corrected on May 15, 2026.
CMS has cited this home for K0751 2 times since 2021.
Citation K0355. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Properly select, install, inspect, or maintain portable fire extinguishes.
CMS lists it as corrected on May 15, 2026.
CMS update of November 20, 2025
Star rating
The CMS overall star rating changed from 2 of 5 to 3 of 5. CMS changed how it scores this rating for many homes at once.
Star rating
The CMS staffing star rating changed from 1 of 5 to 2 of 5.
CMS update of July 30, 2025
Star rating
The CMS overall star rating changed from 1 of 5 to 2 of 5. CMS changed how it scores this rating for many homes at once.
Star rating
The CMS quality measures star rating changed from 4 of 5 to 5 of 5.
CMS update of April 30, 2025
Ownership
CMS lists this home under a new chain.
CMS update of February 26, 2025
Star rating
The CMS quality measures star rating changed from 3 of 5 to 4 of 5. CMS changed how it scores this rating for many homes at once.
CMS update of October 30, 2024
Staffing
Total nurse staffing reported to CMS went from 3.3 to 1.0 hours per resident per day.
CMS update of September 26, 2024
Fine
CMS changed the fine from February 1, 2024 from $69,615 to $45,250.
CMS update of July 31, 2024
Star rating
The CMS overall star rating changed from 2 of 5 to 1 of 5.
Star rating
The CMS staffing star rating changed from 2 of 5 to 1 of 5. CMS changed how it scores this rating for many homes at once.
Star rating
The CMS quality measures star rating changed from 2 of 5 to 3 of 5.
CMS update of June 26, 2024
Star rating
The CMS overall star rating changed from 1 of 5 to 2 of 5.
Star rating
The CMS health inspection star rating changed from 1 of 5 to 2 of 5.
CMS update of May 29, 2024
Star rating
The CMS overall star rating changed from 2 of 5 to 1 of 5.
Star rating
The CMS health inspection star rating changed from 2 of 5 to 1 of 5.
CMS update of April 25, 2024
Star rating
The CMS overall star rating changed from 1 of 5 to 2 of 5.
Star rating
The CMS staffing star rating changed from 1 of 5 to 2 of 5.
Star rating
The CMS quality measures star rating changed from 3 of 5 to 2 of 5.
Health inspection on March 7, 2024
1 citationCMS lists this as a complaint inspection.
Show the 1 citation
Citation F0755. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
CMS lists it as corrected on March 8, 2024.
CMS has cited this home for F0755 3 times since 2021.
March 1, 2024
Payment stoppedCMS stopped payment for new admissions from March 1, 2024, for 7 days.
Health inspection on February 1, 2024
9 citationsCMS lists this as a standard inspection.
Severity G is the second-highest of CMS's four levels. It means a resident was harmed.
157 of 924 Ohio homes (17%) got a citation at the actual harm level in 2024.
CMS fine of $45,250 on February 1, 2024.
Show the 9 citations
Citation F0689. Severity G: actual harm, isolated.
The rule CMS cited:
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
CMS lists it as corrected on March 8, 2024.
CMS has cited this home for F0689 2 times since 2021.
Citation F0550. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
CMS lists it as corrected on March 8, 2024.
CMS has cited this home for F0550 2 times since 2021.
Citation F0582. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
CMS lists it as corrected on March 8, 2024.
Citation F0684. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
CMS lists it as corrected on March 8, 2024.
Citation F0690. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
CMS lists it as corrected on March 8, 2024.
Citation F0697. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide safe, appropriate pain management for a resident who requires such services.
CMS lists it as corrected on March 8, 2024.
Citation F0755. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
CMS lists it as corrected on March 8, 2024.
Citation F0759. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Ensure medication error rates are not 5 percent or greater.
CMS lists it as corrected on March 8, 2024.
Citation F0761. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
CMS lists it as corrected on March 8, 2024.
Fire safety inspection on February 1, 2024
4 citationsCMS lists this as a standard inspection.
Show the 4 citations
Citation K0311. Severity F: potential for more than minimal harm, widespread.
The rule CMS cited:
Have an enclosure around a vertical opening shaft.
CMS lists it as corrected on May 28, 2024.
Citation K0324. Severity F: potential for more than minimal harm, widespread.
The rule CMS cited:
Provide properly protected cooking facilities.
CMS lists it as corrected on March 8, 2024.
Citation K0741. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
CMS lists it as corrected on March 8, 2024.
Citation K0920. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Ensure proper usage of power strips and extension cords.
CMS lists it as corrected on March 8, 2024.
Health inspection on October 11, 2023
1 citationCMS lists this as a complaint inspection.
Severity G is the second-highest of CMS's four levels. It means a resident was harmed.
85 of 924 Ohio homes (9%) got a citation at the actual harm level in 2023.
Show the 1 citation
Citation F0760. Severity G: actual harm, isolated.
The rule CMS cited:
Ensure that residents are free from significant medication errors.
CMS lists it as corrected on September 30, 2023.
Health inspection on September 8, 2021
23 citationsCMS lists this as a standard inspection.
Show the 23 citations
Citation F0812. Severity F: potential for more than minimal harm, widespread.
The rule CMS cited:
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
CMS lists it as corrected on October 15, 2021.
Citation F0880. Severity F: potential for more than minimal harm, widespread.
The rule CMS cited:
Provide and implement an infection prevention and control program.
CMS lists it as corrected on October 15, 2021.
Citation F0886. Severity F: potential for more than minimal harm, widespread.
The rule CMS cited:
Perform COVID19 testing on residents and staff.
CMS lists it as corrected on October 15, 2021.
Citation F0584. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
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.
CMS lists it as corrected on October 15, 2021.
Citation F0656. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
CMS lists it as corrected on October 15, 2021.
Citation F0684. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
CMS lists it as corrected on October 15, 2021.
Citation F0550. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
CMS lists it as corrected on October 15, 2021.
Citation F0561. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
CMS lists it as corrected on October 15, 2021.
Citation F0580. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
CMS lists it as corrected on October 15, 2021.
Citation F0623. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
CMS lists it as corrected on October 15, 2021.
Citation F0625. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.
CMS lists it as corrected on October 15, 2021.
Citation F0641. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Ensure each resident receives an accurate assessment.
CMS lists it as corrected on October 15, 2021.
Citation F0657. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
CMS lists it as corrected on October 15, 2021.
Citation F0677. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide care and assistance to perform activities of daily living for any resident who is unable.
CMS lists it as corrected on October 15, 2021.
Citation F0685. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Assist a resident in gaining access to vision and hearing services.
CMS lists it as corrected on October 15, 2021.
Citation F0686. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
CMS lists it as corrected on October 15, 2021.
Citation F0689. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
CMS lists it as corrected on October 15, 2021.
Citation F0755. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
CMS lists it as corrected on October 15, 2021.
Citation F0756. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
CMS lists it as corrected on October 15, 2021.
Citation F0758. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
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.
CMS lists it as corrected on October 15, 2021.
Citation F0803. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.
CMS lists it as corrected on October 15, 2021.
Citation F0842. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
CMS lists it as corrected on October 15, 2021.
Citation F0883. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Develop and implement policies and procedures for flu and pneumonia vaccinations.
CMS lists it as corrected on October 15, 2021.
Fire safety inspection on September 8, 2021
3 citationsCMS lists this as a standard inspection.
Show the 3 citations
Citation K0761. Severity F: potential for more than minimal harm, widespread.
The rule CMS cited:
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
CMS lists it as corrected on October 15, 2021.
Citation K0353. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Inspect, test, and maintain automatic sprinkler systems.
CMS lists it as corrected on October 15, 2021.
Citation K0751. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Have restrictions on the use of flammable curtains.
CMS lists it as corrected on October 15, 2021.
CMS star ratings
- 4 of 5CMS overall star rating
- 3 of 5CMS health inspection star rating
- 2 of 5CMS staffing star rating
- 5 of 5CMS quality measures star rating
Facts from CMS
- Phone
- (419) 698-4331
- Last standard health inspection
- March 26, 2026 (7 months ago)
- Certified beds
- 60
- Residents per day, on average
- 54.5
- Ownership type
- Non profit - Corporation
- Legal business name
- Chi Living Communities
- Chain
- Commonspirit Health
- Takes part in
- Medicare and Medicaid
More health citations than the Ohio average (40 vs 31).
Owners and managers
CMS lists these owners and managers for this home. Names are as CMS writes them.
- SYLVANIA FRANCISCAN HEALTH5% or greater direct ownership interest · 100% · since 11/01/2014
- COMMONSPIRIT HEALTH5% or greater indirect ownership interest · 100% · since 11/01/2014
- COMMONSPIRIT HEALTHOperational/managerial control · not applicable · since 11/01/2014
- CONCEPT REHAB, INC.Operational/managerial control · not applicable · since 01/05/2015
- FORVIS MAZARS LLPOperational/managerial control · not applicable · since 08/16/2019
Show 30 more
- ICP INCOperational/managerial control · not applicable · since 02/01/2024
- OHIO NEWSPAPERS, INC.Operational/managerial control · not applicable · since 07/01/2011
- PRELUDE SYSTEMS, INC.Operational/managerial control · not applicable · since 04/01/2017
- ULRICHPINCIOTTI DESIGN GROUP, LLCOperational/managerial control · not applicable · since 07/01/2011
- BOWLES, JAXONOperational/managerial control · not applicable · since 01/10/2022
- CECIL, CAITLINOperational/managerial control · not applicable · since 06/18/2012
- COX, DARLENEOperational/managerial control · not applicable · since 05/09/2013
- DUNAWAY, DEANNAOperational/managerial control · not applicable · since 02/01/2019
- FINN, CHRISTINAOperational/managerial control · not applicable · since 07/01/2017
- GRUBBS, STACEYOperational/managerial control · not applicable · since 03/26/2012
- HAZARD, TEDOperational/managerial control · not applicable · since 11/08/2017
- HOFFMAN, HEIDIOperational/managerial control · not applicable · since 12/13/2021
- HOWARD, CASEYOperational/managerial control · not applicable · since 05/01/2022
- IFFLAND, ALISAOperational/managerial control · not applicable · since 02/01/2019
- KALINOWSKI, ROSANNEOperational/managerial control · not applicable · since 02/01/2019
- KAUR-GREWAL, NAVNEETOperational/managerial control · not applicable · since 11/23/2020
- LONGHIN-HOWARD, JOANOperational/managerial control · not applicable · since 04/16/2007
- MCFARLAND, DIANNEOperational/managerial control · not applicable · since 12/18/2023
- MCKNIGHT, ERINOperational/managerial control · not applicable · since 03/28/2019
- MEACH, DONALDOperational/managerial control · not applicable · since 08/29/2023
- MUNROE, KYLEOperational/managerial control · not applicable · since 09/08/2015
- MURRIEL, SHELLYOperational/managerial control · not applicable · since 09/09/2024
- NAGEL, JENNIFEROperational/managerial control · not applicable · since 11/12/2015
- NARGES, DANIELOperational/managerial control · not applicable · since 11/01/2021
- POLISETTY, SUDHEEROperational/managerial control · not applicable · since 07/01/2024
- REHMER, HEATHEROperational/managerial control · not applicable · since 02/01/2019
- STOINSKI, JENELOperational/managerial control · not applicable · since 04/28/2025
- VOELKER, JENNIFEROperational/managerial control · not applicable · since 02/01/2019
- WINE, MATTHEWOperational/managerial control · not applicable · since 10/01/2018
- WORTKETTER, KRISTYOperational/managerial control · not applicable · since 02/03/2021
Questions
When was The Gardens of St. Francis last inspected?
CMS lists March 26, 2026 as the date of its most recent standard health inspection.
How many citations (violations) does The Gardens of St. Francis have?
CMS lists 40 health citations since September 8, 2021. CMS also calls these deficiencies.
Has The Gardens of St. Francis been fined?
CMS lists 1 fine in the past three years, $45,250 in total.
What is the CMS star rating of The Gardens of St. Francis?
Its CMS overall star rating is 4 of 5.
Is The Gardens of St. Francis a Special Focus Facility?
No. CMS does not list it as a Special Focus Facility or a candidate.