01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-06-18 | 7 | 2025-06-18 | 4 |
| Cycle 2 | 2022-11-28 | 14 | 2022-11-28 | 7 |
| Cycle 3 | 2020-01-04 | 6 | 2020-01-04 | 2 |
CMS CCN 3655712026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Otterbein Portage Valley
20311 Pemberville Rd · Pemberville, OH 43450 · Wood County
Certified beds50CMS 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. 6 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2026-04-15 · HEALTHF0580Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Correction field: Deficient, Provider has date of correction · 2026-04-21 · complaint2026-04-15 · HEALTHF0812Severity D · isolated; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Correction field: Deficient, Provider has date of correction · 2026-04-21 · complaint2025-06-18 · HEALTHF0686Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Correction field: Deficient, Provider has date of correction · 2025-07-112025-06-18 · HEALTHF0695Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
Correction field: Deficient, Provider has date of correction · 2025-07-112025-06-18 · HEALTHF0697Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide safe, appropriate pain management for a resident who requires such services.
Correction field: Deficient, Provider has date of correction · 2025-07-11 · complaint2025-06-18 · HEALTHF0755Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Correction field: Deficient, Provider has date of correction · 2025-07-11 · complaint2025-06-18 · 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 · 2025-07-112025-06-18 · FIREK0324Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Provide properly protected cooking facilities.
Correction field: Deficient, Provider has date of correction · 2025-07-112025-06-18 · FIREK0712Severity F · widespread; potential for more than minimal harm
Miscellaneous Deficiencies
Have simulated fire drills held at unexpected times.
Correction field: Deficient, Provider has date of correction · 2025-07-112025-06-18 · FIREK0920Severity E · pattern; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Ensure proper usage of power strips and extension cords.
Correction field: Deficient, Provider has date of correction · 2025-07-112025-06-18 · FIREK0923Severity F · widespread; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Have proper medical gas storage and administration areas.
Correction field: Deficient, Provider has date of correction · 2025-07-112025-03-04 · 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 · 2025-03-21 · complaint2025-03-04 · 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 · 2025-03-21 · complaint2025-03-04 · HEALTHF0842Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Correction field: Deficient, Provider has date of correction · 2025-03-21 · complaint2025-01-23 · HEALTHF0551Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Give the resident's representative the ability to exercise the resident's rights.
Correction field: Deficient, Provider has date of correction · 2025-02-03 · complaint2024-09-10 · 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 · 2024-09-23 · complaint2024-09-10 · HEALTHF0607Severity C · widespread; potential for minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Correction field: Deficient, Provider has plan of correction · 2024-09-23 · complaint2024-07-23 · 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 · 2024-08-04 · complaint2024-05-30 · 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 · 2024-06-10 · complaint2024-05-30 · 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 · 2024-06-10 · complaint2023-08-07 · 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 · 2023-08-25 · complaint2022-11-28 · FIREE0004Severity F · widespread; potential for more than minimal harm
Emergency Preparedness Deficiencies
Develop and maintain an Emergency Preparedness Program (EP).
Correction field: Deficient, Provider has date of correction · 2022-12-222022-11-28 · 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 · 2022-12-222022-11-28 · 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 · 2022-12-2203 / 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
- OTTERBEIN LSC, LLCOrganization · 5% OR GREATER DIRECT OWNERSHIP INTEREST100% · since 01/01/2016
- OTTERBEIN HOMEOrganization · 5% OR GREATER INDIRECT OWNERSHIP INTEREST100% · since 12/01/2021
- BARBEE, DANIELIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 12/01/2021
- BENEDICT, JUDYIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 01/01/2024
- BOWLUS, MARILYNIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 01/01/2014
- GODFREY, MIKEIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 01/01/2024
- HINDS, NORRISIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 04/01/2021
- KYLLO, THOMASIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 01/01/2015
- LOAR, TARAIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 01/01/2025
- MCKIBBIN, KATIEIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 01/01/2023
- POWELL, ANGIEIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 11/24/2014
- STEPHENSON, JOHNIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 08/09/1982
- GREEN, JAMESIndividual · CORPORATE OFFICERNOT APPLICABLE · since 11/21/2005
- HAWKINS, RITAIndividual · CORPORATE OFFICERNOT APPLICABLE · since 01/16/2006
- MILLER, JASONIndividual · CORPORATE OFFICERNOT APPLICABLE · since 08/04/2014
- WILSON, JILLIndividual · CORPORATE OFFICERNOT APPLICABLE · since 05/01/2009
- FUNCTIONAL PATHWAYS OF TENNESSEE LLCOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/01/2018
- OTTERBEIN HOMEOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 12/01/2021
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 hours3.46per resident day
RN hours0.89per resident day
Weekend nurse hours3.09per resident day
Staff turnover64.4%CMS reported field
06 / LOCAL RECORDS
Open the Ohio ledger →Other published facilities nearby
No second facility in the same city met the directory rule.