01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-02-27 | 7 | 2025-02-27 | 2 |
| Cycle 2 | 2023-02-13 | 10 | 2023-02-13 | 3 |
| Cycle 3 | 2020-01-04 | 16 | 2020-01-04 | 2 |
CMS CCN 3658092026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Grande Lake Healthcare Center
1209 Indiana Avenue · St Marys, OH 45885 · Auglaize County
Certified beds45CMS provider file
Recent citation rows40current CMS citation release
Penalty rows0current 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
40 rows in the current release
1 rows carry G–L scope/severity codes; 0 carry J–L. 7 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2025-02-27 · HEALTHF0550Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Correction field: Deficient, Provider has date of correction · 2025-03-21 · complaint2025-02-27 · HEALTHF0554Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Allow residents to self-administer drugs if determined clinically appropriate.
Correction field: Deficient, Provider has date of correction · 2025-03-212025-02-27 · HEALTHF0583Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Keep residents' personal and medical records private and confidential.
Correction field: Deficient, Provider has date of correction · 2025-03-212025-02-27 · HEALTHF0760Severity G · isolated actual harm
Pharmacy Service Deficiencies
Ensure that residents are free from significant medication errors.
Correction field: Deficient, Provider has date of correction · 2025-03-21 · complaint2025-02-27 · HEALTHF0810Severity D · isolated; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Provide special eating equipment and utensils for residents who need them and appropriate assistance.
Correction field: Deficient, Provider has date of correction · 2025-03-212025-02-27 · HEALTHF0847Severity D · isolated; potential for more than minimal harm
Administration Deficiencies
Inform resident or representatives choice to enter into binding arbitration agreement and right to refuse.
Correction field: Deficient, Provider has date of correction · 2025-03-212025-02-27 · HEALTHF0880Severity F · widespread; 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 · 2025-03-212025-02-27 · FIREK0353Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Correction field: Deficient, Provider has date of correction · 2025-03-212025-02-27 · 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 · 2025-03-212024-06-27 · 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 · 2024-07-03 · complaint2023-02-13 · HEALTHF0641Severity E · pattern; 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 · 2023-03-062023-02-13 · 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 · 2023-03-062023-02-13 · HEALTHF0679Severity F · widespread; 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 · 2023-03-062023-02-13 · HEALTHF0680Severity F · widespread; potential for more than minimal harm
Quality of Life and Care Deficiencies
Ensure the activities program is directed by a qualified professional.
Correction field: Deficient, Provider has date of correction · 2023-03-062023-02-13 · 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 · 2023-03-062023-02-13 · HEALTHF0689Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Correction field: Deficient, Provider has date of correction · 2023-03-062023-02-13 · HEALTHF0693Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.
Correction field: Deficient, Provider has date of correction · 2023-03-062023-02-13 · HEALTHF0756Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Correction field: Deficient, Provider has date of correction · 2023-03-062023-02-13 · HEALTHF0760Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure that residents are free from significant medication errors.
Correction field: Deficient, Provider has date of correction · 2023-03-062023-02-13 · HEALTHF0791Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide or obtain dental services for each resident.
Correction field: Deficient, Provider has date of correction · 2023-03-062023-02-13 · FIREK0222Severity F · widespread; potential for more than minimal harm
Egress Deficiencies
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.
Correction field: Deficient, Provider has date of correction · 2023-03-062023-02-13 · FIREK0353Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Correction field: Deficient, Provider has date of correction · 2023-03-062023-02-13 · FIREK0914Severity F · widespread; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.
Correction field: Deficient, Provider has date of correction · 2023-03-062020-01-04 · HEALTHF0558Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Reasonably accommodate the needs and preferences of each resident.
Correction field: Deficient, Provider has date of correction · 2020-02-0403 / 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 |
|---|---|---|---|
| No penalty row appeared in the August 2026 penalties file. | |||
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- SXCY MSTR LSCO, LLCOrganization · 5% OR GREATER DIRECT OWNERSHIP INTEREST100% · since 01/01/2022
- HEALTH CARE LEASE FACILITIES, LLCOrganization · 5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 03/01/2018
- SXCY HOLDINGS, LLCOrganization · 5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 01/01/2022
- ROMEO, DOMINICIndividual · CORPORATE OFFICERNOT APPLICABLE · since 04/01/2023
- STOLTZ, CHARLESIndividual · CORPORATE OFFICERNOT APPLICABLE · since 03/01/2018
- WILHEIM, RONALDIndividual · CORPORATE OFFICERNOT APPLICABLE · since 03/01/2018
- INDIANA MGT CO., LLCOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 03/01/2018
- GROVES, DONNAIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 04/14/2023
- PEYTON, JOSEPHIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 09/28/2022
- ROMEO, DOMINICIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 04/01/2023
- TAYLOR, JANEIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 03/01/2021
- C.R. STOLTZ FAMILY INVESTMENT COMPANY INCOrganization · ADP OF THE SNFNOT APPLICABLE · since 03/01/2018
- C.R. STOLTZ IRREVOCABLE TRUSTOrganization · ADP OF THE SNFNOT APPLICABLE · since 03/01/2018
- HEALTH CARE LEASE FACILITIES, LLCOrganization · ADP OF THE SNFNOT APPLICABLE · since 03/01/2018
- I. ROSEDALE IRREVOCABLE TRUSTOrganization · ADP OF THE SNFNOT APPLICABLE · since 03/01/2018
- INDIANA MGT CO., LLCOrganization · ADP OF THE SNFNOT APPLICABLE · since 05/16/2025
- R.S. WILHEIM IRREVOCABLE TRUSTOrganization · ADP OF THE SNFNOT APPLICABLE · since 03/01/2018
- RONALD S WILHEIM 2012 SPOUSAL TRUSTOrganization · ADP OF THE SNFNOT APPLICABLE · since 03/01/2018
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 hours3.22per resident day
RN hours0.39per resident day
Weekend nurse hours2.89per resident day
Staff turnover43.2%CMS reported field
06 / LOCAL RECORDS
Open the St Marys ledger →