01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-03-20 | 11 | 2025-03-20 | 2 |
| Cycle 2 | 2023-04-13 | 6 | 2023-04-13 | 3 |
| Cycle 3 | 2020-02-13 | 4 | 2020-02-13 | 2 |
CMS CCN 3656692026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Four Winds Nursing Facility
215 Seth Avenue · Jackson, OH 45640 · Jackson County
Certified beds86CMS provider file
Recent citation rows28current CMS citation release
Penalty rows1current CMS penalties file
Read this record carefully.
The citation files cover the three most recent standard inspections plus qualifying complaint and infection-control inspections in the prior three years. A correction date is a CMS field; this site does not independently verify conditions. Absence from a file is not proof that no issue exists.
02 / CITATION DETAIL
28 rows in the current release
0 rows carry G–L scope/severity codes; 0 carry J–L. 3 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2026-05-18 · HEALTHF0609Severity E · pattern; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Correction field: Deficient, Provider has date of correction · 2026-06-07 · complaint2026-05-18 · HEALTHF0610Severity E · pattern; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Respond appropriately to all alleged violations.
Correction field: Deficient, Provider has date of correction · 2026-06-07 · complaint2025-07-23 · HEALTHF0773Severity D · isolated; potential for more than minimal harm
Administration Deficiencies
Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results.
Correction field: Deficient, Provider has date of correction · 2025-08-08 · complaint2025-03-20 · HEALTHF0569Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Notify each resident of certain balances and convey resident funds upon discharge, eviction, or death.
Correction field: Deficient, Provider has date of correction · 2025-06-302025-03-20 · HEALTHF0610Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Respond appropriately to all alleged violations.
Correction field: Deficient, Provider has date of correction · 2025-06-302025-03-20 · HEALTHF0625Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
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.
Correction field: Deficient, Provider has date of correction · 2025-06-302025-03-20 · HEALTHF0644Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
Correction field: Deficient, Provider has date of correction · 2025-06-302025-03-20 · HEALTHF0657Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Correction field: Deficient, Provider has date of correction · 2025-06-302025-03-20 · HEALTHF0684Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Correction field: Deficient, Provider has date of correction · 2025-06-302025-03-20 · HEALTHF0757Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Correction field: Deficient, Provider has date of correction · 2025-06-302025-03-20 · HEALTHF0880Severity D · isolated; potential for more than minimal harm
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Correction field: Deficient, Provider has date of correction · 2025-06-302025-03-20 · HEALTHF0881Severity E · pattern; potential for more than minimal harm
Infection Control Deficiencies
Implement a program that monitors antibiotic use.
Correction field: Deficient, Provider has date of correction · 2025-06-302025-03-20 · FIREK0374Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Install smoke barrier doors that can resist smoke for at least 20 minutes.
Correction field: Deficient, Provider has date of correction · 2025-06-302025-03-20 · FIREK0741Severity E · pattern; potential for more than minimal harm
Miscellaneous Deficiencies
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
Correction field: Deficient, Provider has date of correction · 2025-06-302023-04-13 · FIREE0037Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Establish staff and initial training requirements.
Correction field: Deficient, Provider has date of correction · 2023-05-152023-04-13 · HEALTHF0582Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
Correction field: Deficient, Provider has date of correction · 2023-05-152023-04-13 · HEALTHF0641Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Ensure each resident receives an accurate assessment.
Correction field: Deficient, Provider has date of correction · 2023-05-152023-04-13 · HEALTHF0677Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide care and assistance to perform activities of daily living for any resident who is unable.
Correction field: Deficient, Provider has date of correction · 2023-05-152023-04-13 · HEALTHF0679Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide activities to meet all resident's needs.
Correction field: Deficient, Provider has date of correction · 2023-05-152023-04-13 · HEALTHF0759Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure medication error rates are not 5 percent or greater.
Correction field: Deficient, Provider has date of correction · 2023-05-152023-04-13 · FIREK0363Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Install corridor and hallway doors that block smoke.
Correction field: Deficient, Provider has date of correction · 2023-05-152023-04-13 · FIREK0521Severity F · widespread; potential for more than minimal harm
Services Deficiencies
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
Correction field: Deficient, Provider has date of correction · 2023-05-152020-02-13 · HEALTHF0561Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
Correction field: Deficient, Provider has date of correction · 2020-03-202020-02-13 · HEALTHF0569Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Notify each resident of certain balances and convey resident funds upon discharge, eviction, or death.
Correction field: Deficient, Provider has date of correction · 2020-03-2003 / ENFORCEMENT FILE
Penalties reported by CMS
Fine amounts and payment-denial days are shown exactly as aggregated from the current penalties file. They do not imply an unpaid balance.
| Date | Type | Fine amount | Payment-denial days |
|---|---|---|---|
| 2025-03-20 | Payment Denial | $0 | 10 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- UNITED CHURCH HOMES, INC.Organization · 5% OR GREATER DIRECT OWNERSHIP INTEREST100% · since 04/01/2000
- BAILEY, PETERIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 06/01/2024
- BATES, TREVORIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 02/01/2017
- BENJAMIN, PAMELAIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 06/01/2021
- BLACK, GEOFFREYIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 06/01/2016
- D'AGOSTINO, JOANNAIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 06/01/2024
- GRAHAM, GEORGEIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 06/01/2025
- GUESS, JAMESIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 06/01/2021
- HAWES-SAUNDERS, RO NITAIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 02/01/2024
- HENRY, JAMESIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 06/01/2019
- JAMES, JILLIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 06/01/2025
- LONG-HIGGINS, DAVIDIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 11/01/2018
- SANDMAN, ROBERTIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 06/01/2025
- ULRICH, KARLIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 06/01/2016
- WILLIAMS, STEPHANIEIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 06/01/2024
- WINFREY, LAPEARLIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 06/01/2020
- NADERHOFF, JUDITHIndividual · CORPORATE OFFICERNOT APPLICABLE · since 01/01/2026
- YOUNG, KENNETHIndividual · CORPORATE OFFICERNOT APPLICABLE · since 02/07/2025
Names and roles are self-reported CMS disclosure fields. Exact-name pages do not prove that similarly named people or organizations are the same entity.
05 / CMS STAFFING FIELDS
Reported hours and turnover
Staffing fields are provider-reported and case-mix context matters. CMS applies footnotes and exclusions not reproduced as a new score here.
Total nurse hours3.18per resident day
RN hours0.51per resident day
Weekend nurse hours2.89per resident day
Staff turnover42.2%CMS reported field
06 / LOCAL RECORDS
Open the Jackson ledger →