Crestline Nursing Center

MEDICARE CERTIFIED

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Crestline Nursing Center was recognized and ceritified in 1995 by Centers for Medicare & Medicaid Services as one of model nursing home providers promoting health and improving quality of life. Crestline Nursing Center which is located in 327 West Main Street Crestline, is scientifically measured and assessed by Centers for Medicare & Medicaid Services and is shown to provide good nursing home services or products under the Medicare program. Crestline Nursing Center is being offered ceritified services and products in Ohio.

  327 West Main Street
       Crestline, OH 44827

  (419) 683-3255

County: Crawford
Federal Provider Number: 366002

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Participates in: Medicare And Medicaid
Certified Date: Thursday, June 8, 1995 (29 years certified)
Certified Agency: Centers for Medicare & Medicaid Services
Legal Business Name: Crestline Facilty Operations, Llc
Ownership Type: For Profit - Corporation
Provider Changed Ownership in Last 12 Months: No

Type	Name	Role Description
Organization	Lv Operations Ii, Llc	5% Or More Ownership Interest
Organization	Lv Operations I, Llc	5% Or More Ownership Interest
Organization	Lv Investment, Llc	5% Or More Ownership Interest
Organization	Lv Chc Holdings I Llc	5% Or More Ownership Interest
Organization	Lavie Care Centers, Llc	5% Or More Ownership Interest
Organization	Fc Lv Holdco Llc	5% Or More Ownership Interest
Organization	Fc Investors Xxi, Llc	5% Or More Ownership Interest
Organization	Columbia Pacific Opportunity Fund L.p.	5% Or More Ownership Interest
Organization	Cmc Ii Llc	Operational/managerial Control
Organization	Cmc Ii Investors Llc	5% Or More Ownership Interest
Organization	Alg Lavie, Llc	5% Or More Ownership Interest
Organization	Mcp Lavie, Llc	5% Or More Ownership Interest
Organization	Midcap Funding Iv, Llc	5% Or Greater Security Interest
Organization	Midcap Funding V Llc	5% Or Greater Security Interest
Organization	Say La Vie, Llc	5% Or More Ownership Interest
Organization	Senior Care Lavie, Llc	5% Or More Ownership Interest
Organization	The 1995 David Reis Family Trust	5% Or More Ownership Interest
Person	Zvi Tress	Director/officer
Person	John Sword	Director/officer
Person	Harold Sussman	Director/officer
Person	David Reis	Director/officer
Person	Isaac Neuberger	Director/officer
Person	Isaac Neuberger	5% Or More Ownership Interest
Person	Asher Low	Director/officer
Person	Asher Low	5% Or More Ownership Interest
Person	Jeffrey Jellerson	Director/officer
Person	Robert Hartman	Director/officer
Person	Robert Hartman	5% Or More Ownership Interest
Person	Steven Fishman	Director/officer
Person	Christina Firth	Director/officer
Person	Phillip Critcher	W-2 Managing Employee
Person	Joseph Conte	Director/officer
Person	Joseph Conte	5% Or More Ownership Interest
Person	Troy Antonik	Director/officer
Person	Joe Alesantrino	Director/officer

Provider Resides in Hospital: No
Number of Federally Certified Beds: 30
Number of Residents in Federally Certified Beds: 27 (90% occupied)
Continuing Care Retirement Community: No
Special Focus Facility: No
With a Resident and Family Council: Resident
Automatic Sprinkler Systems in All Required Areas: Yes

Survey Date: Thursday, March 6, 2014
Survey Type: Health
Deficiency: F0161 (Provide proof that residents' personal money that is deposited with the nursing home is secure.)
Scope Severity Code: C
Deficiency Corrected: Deficient, Provider Has Plan Of Correction
Date the deficiency was corrected: Friday, April 18, 2014
The inspection cycle of deficiency: 1 (the deficiency was found on a standard inspection)

Survey Date: Thursday, March 6, 2014
Survey Type: Health
Deficiency: F0315 (Ensure that each resident who enters the nursing home without a catheter is not given a catheter, un)
Scope Severity Code: D
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Friday, April 18, 2014
The inspection cycle of deficiency: 1 (the deficiency was found on a standard inspection)

Survey Date: Thursday, March 6, 2014
Survey Type: Health
Deficiency: F0278 (Ensure each resident receives an accurate assessment by a qualified health professional.)
Scope Severity Code: E
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Friday, April 18, 2014
The inspection cycle of deficiency: 1 (the deficiency was found on a standard inspection)

Survey Date: Thursday, March 6, 2014
Survey Type: Health
Deficiency: F0226 (Develop and implement policies for 1) screening and training employees; and the 2) prevention, ident)
Scope Severity Code: D
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Friday, April 18, 2014
The inspection cycle of deficiency: 1 (the deficiency was found on a standard inspection)

Survey Date: Thursday, March 6, 2014
Survey Type: Health
Deficiency: F0246 (Reasonably accommodate the needs and preferences of each resident.)
Scope Severity Code: D
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Friday, April 18, 2014
The inspection cycle of deficiency: 1 (the deficiency was found on a standard inspection)

Survey Date: Thursday, March 6, 2014
Survey Type: Health
Deficiency: F0225 (1) Hire only people with no legal history of abusing, neglecting or mistreating residents; or 2) rep)
Scope Severity Code: D
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Friday, April 18, 2014
The inspection cycle of deficiency: 1 (the deficiency was found on a standard inspection)

Survey Date: Tuesday, March 4, 2014
Survey Type: Fire Safety
Deficiency: K0018 (Corridor and hallway doors that block smoke.)
Scope Severity Code: E
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Friday, April 18, 2014
The inspection cycle of deficiency: 1 (the deficiency was found on a standard inspection)

Survey Date: Tuesday, March 4, 2014
Survey Type: Fire Safety
Deficiency: K0062 (Automatic sprinkler systems that have been maintained in working order.)
Scope Severity Code: F
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Friday, April 18, 2014
The inspection cycle of deficiency: 1 (the deficiency was found on a standard inspection)

Survey Date: Tuesday, January 29, 2013
Survey Type: Fire Safety
Deficiency: K0144 (Weekly inspections and monthly testing of generators.)
Scope Severity Code: F
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Friday, February 22, 2013
The inspection cycle of deficiency: 2 (the deficiency was found on a standard inspection)

Survey Date: Tuesday, January 29, 2013
Survey Type: Fire Safety
Deficiency: K0050 (Record of quarterly fire drills for each shift under varying conditions.)
Scope Severity Code: F
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Friday, February 22, 2013
The inspection cycle of deficiency: 2 (the deficiency was found on a standard inspection)

Survey Date: Tuesday, January 29, 2013
Survey Type: Fire Safety
Deficiency: K0062 (Automatic sprinkler systems that have been maintained in working order.)
Scope Severity Code: F
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Friday, February 22, 2013
The inspection cycle of deficiency: 2 (the deficiency was found on a standard inspection)

Survey Date: Thursday, January 17, 2013
Survey Type: Health
Deficiency: F0315 (Ensure that each resident who enters the nursing home without a catheter is not given a catheter, un)
Scope Severity Code: D
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Friday, February 22, 2013
The inspection cycle of deficiency: 2 (the deficiency was found on a standard inspection)

Survey Date: Thursday, September 22, 2011
Survey Type: Health
Deficiency: F0332 (Keep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5%.)
Scope Severity Code: D
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Tuesday, November 1, 2011
The inspection cycle of deficiency: 3 (the deficiency was found on a standard inspection)

Number of Facility Reported Incidents: 0
Number of Substantiated Complaints: 0
Number of Fines: 0
Number of Payment Denials: 0
Total Number of Penalties: 0
Total Amount of Fines in Dollars: USD 0

This data allows consumers to compare information about nursing homes. Information here is not an endorsement or advertisement for any nursing home and should be considered carefully. Use it with other information you gather about nursing homes facilities. Talk to your doctor or other health care provider about this.

This data was updated by using data source from Centers for Medicare and Medicaid Services (CMS) which is publicized on Wednesday, October 1, 2014. If you found out that something incorrect and want to change it, please follow this Update Data guide.

The Five Star Quality Rating System is not a substitute for visiting the nursing home. This system can give you important information, help you compare nursing homes by topics you consider most important, and help you think of questions to ask when you visit the nursing home. Use the Five-Star ratings together with other sources of information.

items	rating
Health Inspection Rating	(4 out of 5 stars)
Quality Rating	(4 out of 5 stars)
Staffing Rating	(1 out of 5 stars)
RN Staffing Rating	(1 out of 5 stars)
Overall Rating	(3 out of 5 stars)

Nursing homes vary in the quality of care and services they provide to their residents. Reviewing health inspection results, staffing data, and quality measure data are three important ways to measure nursing home quality. This information gives you a "snap shot" of the care individual nursing home give.

Patients experiences	Provider	State	Nation
Percent of High Risk Long Stay Residents With Pressure Ulcers	N/A	6%	6%
Percent of Long Stay Residents Experiencing One or More Falls with Major Injury	N/A	4%	3%
Percent of Long Stay Residents Who Self Report Moderate to Severe Pain	N/A	8%	8%
Percent of Long Stay Residents Who Were Physically Restrained	N/A	1%	1%
Percent of Long Stay Residents Whose Need for Help with ADLs has Increased	N/A	15%	16%
Percent of Long Stay Residents with a Catheter Inserted and Left in Their Bladder	N/A	3%	3%
Percent of Long Stay Residents With a Urinary Tract Infection	N/A	6%	6%
Percent of Short Stay Residents Who Self Report Moderate to Severe Pain	N/A	21%	19%
Percent of Short Stay Residents With Pressure Ulcers That Are New or Worsened	N/A	1%	1%
Percent of Long Stay Residents Assessed and Appropriately Given the Pneumococcal Vaccine	N/A	95%	94%
Percent of Long Stay Residents Assessed and Appropriately Given the Seasonal Influenza Vaccine	N/A	94%	94%
Percent of Long Stay Residents Who Have Depressive Symptoms	N/A	14%	6%
Percent of Long Stay Residents Who Lose Too Much Weight	N/A	8%	7%
Percent of Long Stay Residents Who Received an Antipsychotic Medication	N/A	22%	20%
Percent of Low Risk Long Stay Residents Who Lose Control of Their Bowel or Bladder	N/A	40%	44%
Percent of Short Stay Residents Assessed and Appropriately Given the Pneumococcal Vaccine	N/A	86%	83%
Percent of Short Stay Residents Who Newly Received an Antipsychotic Medication	N/A	2%	2%
Percent of Short Stay Residents Who Were Assessed and Appropriately Given the Seasonal Influenza Vaccine	N/A	87%	84%

N/A

Data not available.

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