01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-05-08 | 3 | 2025-05-08 | 1 |
| Cycle 2 | 2022-12-07 | 4 | 2022-12-07 | 4 |
| Cycle 3 | 2019-08-01 | 2 | 2019-08-01 | 1 |
CMS CCN 3652462026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Van Wert Manor
160 Fox Rd · Van Wert, OH 45891 · Van Wert County
Certified beds62CMS provider file
Recent citation rows15current 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
15 rows in the current release
1 rows carry G–L scope/severity codes; 0 carry J–L. 1 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2025-05-08 · HEALTHF0686Severity G · isolated actual 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 · 2025-05-282025-05-08 · 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 · 2025-05-282025-05-08 · HEALTHF0727Severity F · widespread; potential for more than minimal harm
Nursing and Physician Services Deficiencies
Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.
Correction field: Deficient, Provider has date of correction · 2025-05-282025-05-08 · 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 · 2025-05-282022-12-07 · HEALTHF0655Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
Correction field: Deficient, Provider has date of correction · 2023-01-052022-12-07 · 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 · 2023-01-052022-12-07 · 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 · 2023-01-052022-12-07 · 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 · 2023-01-052022-12-07 · 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 · 2023-01-052022-12-07 · FIREK0222Severity E · pattern; 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 · 2023-01-052022-12-07 · FIREK0293Severity F · widespread; potential for more than minimal harm
Egress Deficiencies
Have properly located and lighted "Exit" signs.
Correction field: Deficient, Provider has date of correction · 2023-01-052022-12-07 · FIREK0918Severity F · widespread; 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 · 2023-01-052019-08-01 · 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 · 2019-09-092019-08-01 · 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 · 2019-09-092019-08-01 · FIREK0511Severity E · pattern; potential for more than minimal harm
Services Deficiencies
Have properly installed electrical wiring and gas equipment.
Correction field: Deficient, Provider has date of correction · 2019-09-0903 / 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 |
|---|---|---|---|
| 2025-05-08 | Fine | $25,490 | 0 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- CHAD M. UNVERFERTH 12-14-11 IRRV GRANTOR TROrganization · 5% OR GREATER INDIRECT OWNERSHIP INTEREST6% · since 12/13/2021
- DAVID V. UNVERFERTH 12-14-11 IRRV GRANTOR TROrganization · 5% OR GREATER INDIRECT OWNERSHIP INTEREST6% · since 12/13/2021
- JEFFREY L. UNVERFERTH 12-14-11 IRRV GRANTOR TROrganization · 5% OR GREATER INDIRECT OWNERSHIP INTEREST6% · since 12/13/2021
- JOANN C. UNVERFERTH 12-29-04 REVOCABLE TRUSTOrganization · 5% OR GREATER INDIRECT OWNERSHIP INTEREST5% · since 12/13/2021
- JOANN C. UNVERFERTH 12-31-12 IRREVOCABLE GRANTOR TRUST FBO KENDRA M. UOrganization · 5% OR GREATER INDIRECT OWNERSHIP INTEREST7% · since 12/13/2021
- JOANN C. UNVERFERTH 12-31-12 IRREVOCABLE GRANTOR TRUST FBO KERRI A. ROOrganization · 5% OR GREATER INDIRECT OWNERSHIP INTEREST7% · since 12/13/2021
- JOANN C. UNVERFERTH 12-31-12 IRREVOCABLE GRANTOR TRUST FBO KEVAN R. UNOrganization · 5% OR GREATER INDIRECT OWNERSHIP INTEREST7% · since 12/13/2021
- JOANN C. UNVERFERTH 12-31-12 IRREVOCABLE GRANTOR TRUST FBO KRISTEN S.Organization · 5% OR GREATER INDIRECT OWNERSHIP INTEREST7% · since 12/13/2021
- JOANN C. UNVERFERTH 12-31-12 IRREVOCABLE GRANTOR TRUST FBO KYLE J. UNVOrganization · 5% OR GREATER INDIRECT OWNERSHIP INTEREST7% · since 12/13/2021
- JOSEPH L. UNVERFERTH 12-15-11 IRRV GRANTOR TROrganization · 5% OR GREATER INDIRECT OWNERSHIP INTEREST6% · since 12/13/2021
- LAWRENCE G. UNVERFERTH 12-13-11 IRRV GRANTOR TROrganization · 5% OR GREATER INDIRECT OWNERSHIP INTEREST6% · since 12/13/2021
- R. STEVEN UNVERFERTH 12-14-11 IRRV GRANTOR TROrganization · 5% OR GREATER INDIRECT OWNERSHIP INTEREST6% · since 12/13/2021
- KLAY, CELESTEIndividual · W-2 MANAGING EMPLOYEENOT APPLICABLE · since 08/01/2011
- ROMES, KERRIIndividual · W-2 MANAGING EMPLOYEENOT APPLICABLE · since 04/01/2013
- SHAW, ANTHONYIndividual · W-2 MANAGING EMPLOYEENOT APPLICABLE · since 08/29/1994
- UNVERFERTH, CHADIndividual · W-2 MANAGING EMPLOYEENOT APPLICABLE · since 03/17/2003
- WILLAIMS, COURTNEYIndividual · W-2 MANAGING EMPLOYEENOT APPLICABLE · since 12/13/2022
- KLAY, CELESTEIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 01/01/2016
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 hours3.77per resident day
RN hours0.69per resident day
Weekend nurse hours3.31per resident day
Staff turnover34.5%CMS reported field
06 / LOCAL RECORDS
Open the Van Wert ledger →