01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-03-13 | 11 | 2025-03-13 | 9 |
| Cycle 2 | 2023-11-30 | 7 | 2023-11-30 | 10 |
| Cycle 3 | 2021-06-04 | 9 | 2021-06-04 | 19 |
CMS CCN 3663352026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Snf-The Villa At Marymount
5200 Marymount Village Drive · Garfield Heights, OH 44125 · Cuyahoga County
Certified beds130CMS provider file
Recent citation rows65current CMS citation release
Penalty rows3current 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
65 rows in the current release
4 rows carry G–L scope/severity codes; 1 carry J–L. 15 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2026-06-11 · HEALTHF0584Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
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.
Correction field: Deficient, Provider has date of correction · 2026-07-20 · complaint · under IDR/IIDR2025-03-13 · 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 · 2025-04-05 · complaint2025-03-13 · 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 · 2025-04-05 · complaint2025-03-13 · HEALTHF0689Severity G · isolated actual 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 · 2025-04-05 · complaint2025-03-13 · HEALTHF0692Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide enough food/fluids to maintain a resident's health.
Correction field: Deficient, Provider has date of correction · 2025-04-05 · complaint2025-03-13 · 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 · 2025-04-052025-03-13 · HEALTHF0804Severity F · widespread; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Correction field: Deficient, Provider has date of correction · 2025-04-052025-03-13 · HEALTHF0812Severity F · widespread; 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 · 2025-04-052025-03-13 · HEALTHF0868Severity F · widespread; potential for more than minimal harm
Administration Deficiencies
Have the Quality Assessment and Assurance group have the required members and meet at least quarterly
Correction field: Deficient, Provider has date of correction · 2025-04-052025-03-13 · 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 · 2025-04-05 · complaint2025-03-13 · HEALTHF0883Severity E · pattern; potential for more than minimal harm
Infection Control Deficiencies
Develop and implement policies and procedures for flu and pneumonia vaccinations.
Correction field: Deficient, Provider has date of correction · 2025-04-052025-03-13 · FIREK0161Severity E · pattern; potential for more than minimal harm
Construction Deficiencies
Use approved construction type or materials.
Correction field: Deficient, Provider has date of correction · 2025-04-052025-03-13 · FIREK0211Severity E · pattern; potential for more than minimal harm
Egress Deficiencies
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Correction field: Deficient, Provider has date of correction · 2025-04-052025-03-13 · FIREK0311Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Have an enclosure around a vertical opening shaft.
Correction field: Deficient, Provider has date of correction · 2025-04-052025-03-13 · FIREK0351Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Install an approved automatic sprinkler system.
Correction field: Waiver has been granted · 2025-04-052025-03-13 · FIREK0712Severity E · pattern; potential for more than minimal harm
Miscellaneous Deficiencies
Have simulated fire drills held at unexpected times.
Correction field: Deficient, Provider has date of correction · 2025-04-052025-03-13 · FIREK0761Severity E · pattern; potential for more than minimal harm
Miscellaneous Deficiencies
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
Correction field: Deficient, Provider has date of correction · 2025-04-052025-03-13 · FIREK0914Severity E · pattern; 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 · 2025-04-052025-03-13 · FIREK0918Severity E · pattern; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Have generator or other power source capable of supplying service within 10 seconds.
Correction field: Deficient, Provider has date of correction · 2025-04-052025-03-13 · 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 · 2025-04-052024-12-16 · HEALTHF0600Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Correction field: Past Non-Compliance · 2024-11-19 · complaint2024-12-16 · 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 · 2025-01-10 · complaint2024-12-16 · HEALTHF0761Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
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.
Correction field: Deficient, Provider has date of correction · 2025-01-10 · complaint2024-12-16 · 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 · 2025-01-10 · complaint03 / 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 |
|---|---|---|---|
| 2025-03-13 | Fine | $29,601 | 0 |
| 2024-02-20 | Payment Denial | $0 | 5 |
| 2023-11-08 | Fine | $54,002 | 0 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- MARYMOUNT HEALTHCARE HOLDCO LLCOrganization · 5% OR GREATER DIRECT OWNERSHIP INTEREST100% · since 06/30/2023
- CTH IRREVOCABLE TRUSTOrganization · 5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 06/30/2023
- CTH NIGHTINGALE LLCOrganization · 5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 06/30/2023
- CUTLASS OP FAMILY TRUST IIOrganization · 5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 06/30/2023
- CUTLASS OP HOLDINGS LLCOrganization · 5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 06/30/2023
- SRI FAMILY IRREVOCABLE TRUSTOrganization · 5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 06/30/2023
- SRI NIGHTINGALE LLCOrganization · 5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 06/30/2023
- WELLSPRING AT MARYMOUNT LLCOrganization · 5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 06/30/2023
- BRAUN, DOVIndividual · 5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 06/30/2023
- GOTTESMAN, DANIELIndividual · 5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 06/30/2023
- GUTMAN, ISAACIndividual · 5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 06/30/2023
- TAUB, JACOBIndividual · 5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 06/30/2023
- JAKOBOWITCH, DAVIDIndividual · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 06/30/2023
- BRAUN, DOVIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 06/30/2023
- BRAUN, DOVIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 06/30/2023
- CORRIGAN, KIMBERLYIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 05/12/2025
- RASTOGI, VIJAYIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 11/01/2023
- BRAUN, DOVIndividual · ADP OF THE SNFNOT APPLICABLE · since 06/30/2023
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 hours4.03per resident day
RN hours0.46per resident day
Weekend nurse hours3.39per resident day
Staff turnover63.1%CMS reported field
06 / LOCAL RECORDS
Open the Garfield Heights ledger →