Independence Village of Avon Lake — Ohio Facility Report

Inspections on file

Deficiencies cited

Visits with none

Substandard care

Immediate jeopardy

The most recent inspection on file for Independence Village of Avon Lake took place on February 4, 2026. Across the 8 inspections published by the Ohio Department of Health, surveyors cited 10 deficiencies.

A deficiency is a rule the surveyor found the facility was not meeting. Ohio inspects against two rule books at once, so most findings carry a federal code and an Ohio code for the same problem; each is counted once here, the way the state counts it. Correction dates are the state's confirmation that the issue was fixed.

This report reproduces what Ohio publishes and nothing else. Of the 8 inspections listed, the state publishes the surveyor's written findings for 3; for the other 5 it publishes only the date, the type of visit and the number of deficiencies - 5 of which found none.

Facility Details

Ohio license number

#2361R

County

Lorain

Administrator

Alyssa Lepp

Director of nursing

Jennifer Denyer

Phone

(440) 827-2388

Ownership

For Profit - Limited Liability Company

Inspections

8 on file · 10 deficiencies

February 4, 2026Complaint survey · listed in Ohio's index; no findings report publishedNo deficiencies▼

✅

No deficiencies cited

Ohio lists this visit in its inspection index with no deficiencies. The state publishes a findings report only when a visit cites something, so there is no further detail to show.

July 16, 2025Licensure survey3 deficiencies▼

R-0339Administered meds - given only to and as prescribedOhio citation▼

What the surveyor found

Based on family interview, staff interview, review Electronic Medical Record (EMR), review of electronic Medication Administration Records (eMAR), and review of facility policy, the facility failed to ensure resident medications were administered appropriately. This affected one resident (#3) of three residents reviewed for medication administration. The facility census was 82. Findings include: Review of the EMR for Resident #3 revealed an admission date of 11/21/23 with diagnoses including dementia, hypertension (HTN), osteoarthritis, and anemia. Review of the EMR for Resident #3 revealed she was out of the facility from 05/17/25 through 06/09/25 for therapy at a specialty therapy facility. Upon her return to the facility, on 06/09/25, Resident #3 was resumed on 15 milligrams (mg) of Xarelto (a blood thinning medication) taken by mouth once daily. On 06/10/25, a physician order was received to discontinue Resident #3's Xarelto and start 81 mg Aspirin by mouth once daily. Review of the eMAR for Resident #3 revealed the Aspirin was ordered on 06/10/25 and Resident #3 did not receive her ordered dose on 05/11/25 and 05/12/25. Interview on 07/16/25 at 7:47 A.M. with Licensed Practical Nurse (LPN) #227 verified Resident #3's Aspirin was physician ordered to begin on 06/10/25. LPN #227 verified Resident #3 did not receive her ordered dose of 81 mg Aspirin on 05/11/25 or 05/12/25. Review of the facility policy titled, Medication AdministrationBased on family interview, staff interview, review Electronic Medical Record (EMR), review of electronic Medication Administration Records (eMAR), and review of facility policy, the facility failed to ensure resident medications were administered appropriately. This affected one resident (#3) of three residents reviewed for medication administration. The facility census was 82.

Findings include:

Review of the EMR for Resident #3 revealed an admission date of 11/21/23 with diagnoses including dementia, hypertension (HTN), osteoarthritis, and anemia.

Review of the EMR for Resident #3 revealed she was out of the facility from 05/17/25 through 06/09/25 for therapy at a specialty therapy facility. Upon her return to the facility, on 06/09/25, Resident #3 was resumed on 15 milligrams (mg) of Xarelto (a blood thinning medication) taken by mouth once daily. On 06/10/25, a physician order was received to discontinue Resident #3's Xarelto and start 81 mg Aspirin by mouth once daily.

Review of the eMAR for Resident #3 revealed the Aspirin was ordered on 06/10/25 and Resident #3 did not receive her ordered dose on 05/11/25 and 05/12/25.

Interview on 07/16/25 at 7:47 A.M. with Licensed Practical Nurse (LPN) #227 verified Resident #3's Aspirin was physician ordered to begin on 06/10/25. LPN #227 verified Resident #3 did not receive her ordered dose of 81 mg Aspirin on 05/11/25 or 05/12/25.

Review of the facility policy titled, Medication Administration

Rule

Ohio Administrative Code - residential care rules

R-0559Procure, store, prepare, distribute and serve foodsOhio citation▼

What the surveyor found

Based on observation, staff interview, and review of facility policy, the facility failed to ensure a clean and sanitary kitchen and failed to ensure adequate pest control. This had the potential to affect 84 residents who received food from the facility kitchen. The facility census was 84. Findings include: Observation on 07/15/25 at 9:24 A.M. of the facility kitchen revealed water pooled on the floor under the shelving unit used to store clean dishes. This pooled water was observed to be emanating a foul odor. Observation on 07/15/25 at 9:25 A.M. revealed corrosion to the left side of the facility dishwasher as well as on the floor under the dishwasher. Observation on 07/15/25 at 9:26 A.M. revealed numerous flies by the handwashing sink and dishwasher. Observation on 07/15/25 at 9:27 A.M. revealed the scoop for the sugar was stored in the container with the sugar. Observation on 07/15/25 at 9:28 A.M. revealed numerous flies in the dry stock storage room. Observation on 07/15/25 at 9:36 A.M. revealed water pooled on the floor under the shelving unit used to store resident food in the dry stock storage room. This pooled water was observed to be emanating a foul odor. Observation on 07/15/25 at 9:40 A.M. revealed the floor drain under the tilt skillet contained a large amount of food debris. Observation on 07/15/25 at 9:42 A.M. revealed no refuse containers in the facility kitchen contained lids. Interview on 07/15/25 at 9:46 A.M. with Executive Chef #226 verified the above findings. Review of the facility policy titled, Cleaning Log ScheduleBased on observation, staff interview, and review of facility policy, the facility failed to ensure a clean and sanitary kitchen and failed to ensure adequate pest control. This had the potential to affect 84 residents who received food from the facility kitchen. The facility census was 84.

Findings include:

Observation on 07/15/25 at 9:24 A.M. of the facility kitchen revealed water pooled on the floor under the shelving unit used to store clean dishes. This pooled water was observed to be emanating a foul odor.

Observation on 07/15/25 at 9:25 A.M. revealed corrosion to the left side of the facility dishwasher as well as on the floor under the dishwasher.

Observation on 07/15/25 at 9:26 A.M. revealed numerous flies by the handwashing sink and dishwasher.

Observation on 07/15/25 at 9:27 A.M. revealed the scoop for the sugar was stored in the container with the sugar.

Observation on 07/15/25 at 9:28 A.M. revealed numerous flies in the dry stock storage room.

Observation on 07/15/25 at 9:36 A.M. revealed water pooled on the floor under the shelving unit used to store resident food in the dry stock storage room. This pooled water was observed to be emanating a foul odor.

Observation on 07/15/25 at 9:40 A.M. revealed the floor drain under the tilt skillet contained a large amount of food debris.

Observation on 07/15/25 at 9:42 A.M. revealed no refuse containers in the facility kitchen contained lids.

Interview on 07/15/25 at 9:46 A.M. with Executive Chef #226 verified the above findings.

Review of the facility policy titled, Cleaning Log Schedule

Rule

Ohio Administrative Code - residential care rules

R-0680Maintain building and groundsOhio citation▼

What the surveyor found

Based on observation and staff interview, the facility failed to ensure the facility was well-maintained. This had the potential to affect all residents who reside in the facility. The facility census was 84.

Findings include:

Observation on 07/15/25 at 10:20 A.M. revealed peeling wallpaper around the door of Resident #53.

Interview on 07/15/25 at 10:21 with Maintenance Tech #235 verified this finding.

Observation on 07/15/25 at 10:22 A.M. of the wall between the rooms of Resident #54 and Resident #56 revealed multiple scuff marks. Concurrent observation of the door around Resident #55's room revealed peeling wallpaper. Further observation revealed the wall in the common area by the dining room contained two approximately 24-inch long scrapes with missing chunks of paint and exposed drywall. Further observation revealed multiple scuffs in the paint of the dining room.

Interview on 07/15/25 at 10:41 A.M. with Housekeeper #129 verified these findings.

Rule

Ohio Administrative Code - residential care rules

May 9, 2025Complaint survey · listed in Ohio's index; no findings report publishedNo deficiencies▼

✅

No deficiencies cited

Ohio lists this visit in its inspection index with no deficiencies. The state publishes a findings report only when a visit cites something, so there is no further detail to show.

April 23, 2024Licensure survey3 deficiencies▼

R-01312 hours of training within 14 days for RCF with special populationsOhio citation▼

What the surveyor found

Based on record review and staff interview, the facility failed to ensure staff had two hours of specialty training completed within 14 days of hire. This had the potential to affect the 25 residents residing on the memory care unit. The facility census was 69.

Findings include:

Review of the personnel file for Caregiver (CG) #136 revealed a hire date of 09/27/23. CG #135 did not complete her two hours of specialty training and within fourteen days of hire. CG #136 completed 0.50 hours of dementia training on 11/12/23, 0.50 hours of dementia training on 11/12/23, and 0.50 hours of dementia training on 11/27/23.

Interview on 04/22/24 at 2:33 P.M. with Property Administrator (PA) #213 confirmed CG #136 did not complete their two hours of specialty training and within fourteen days of hire. PA #213 reported she doesn't know why they were not completed and within fourteen days.

Rule

Ohio Administrative Code - residential care rules

R-0140Background check requiredOhio citation▼

What the surveyor found

Based on staff interview and review of personnel files, the facility failed to screen all employees against the State of Ohio Nurse Aide Registry to identify if an employee has a finding concerning abuse, neglect, exploitation, mistreatment of residents or misappropriation of resident property. This affected three of three personnel files reviewed for the Nurse Aide Registry. This had the potential to affect all 69 residents residing in the facility.

Findings include:

Review of the personnel files revealed Receptionist #134's first day of work was 03/14/24, Caregiver (CG) #227's first day of work was 12/20/23, and Housekeepers (HK) #152's first day of work was 02/02/24. Receptionist #134, CG #227 and HK #152 were not screened using the State of Ohio Nurse Aide Registry to identify any negative findings.

Interview on 04/22/24 at 2:33 P.M. with Property Administrator (PA) #213 verified Receptionist #134, CG #227 and HK #152 were not checked on the nurse aide registry and she doesn't know why they were not checked.

Rule

Ohio Administrative Code - residential care rules

R-0614Notify director when normal business interruption due to emergency/disasterOhio citation▼

What the surveyor found

Based on record review, policy review, and staff interview, the facility failed to ensure residents were evacuated on all shifts as required for fire drills. This finding had the potential to affect all 69 residents residing in the facility.

Findings include:

Review of the fire drills from 04/28/23 to 03/25/24 revealed residents were not evacuated for first, second and third shift fire drills on 04/28/23, 05/31/23, 06/27/23, 07/31/23, 08/24/23, 09/29/23, 10/30/23, 11/27/23, 12/20/23, 01/11/24, 02/21/24, and 03/25/24.

Interview on 04/22/24 at 10:11 A.M. with Maintenance Director #231 confirmed residents were not evacuated on first, second, and third shift.

Review of the facility's policy titled Fire Drill, revised 01/24/23, revealed the procedure to conduct fire drills and all drills must engage residents along with employees.

Rule

Ohio Administrative Code - residential care rules

December 5, 2023Complaint survey · listed in Ohio's index; no findings report publishedNo deficiencies▼

✅

No deficiencies cited

Ohio lists this visit in its inspection index with no deficiencies. The state publishes a findings report only when a visit cites something, so there is no further detail to show.

January 19, 2023Complaint survey · listed in Ohio's index; no findings report publishedNo deficiencies▼

✅

No deficiencies cited

Ohio lists this visit in its inspection index with no deficiencies. The state publishes a findings report only when a visit cites something, so there is no further detail to show.

December 21, 2022Licensure survey4 deficiencies▼

R-0614Notify director when normal business interruption due to emergency/disasterOhio citation▼

What the surveyor found

Based on the facility fire drill reports and staff interviews, the facility failed to complete a fire drill once a shift per quarter. This could potentially affect all 75 residents residing in the facility at the time of the annual survey completed on 12/21/22.

Findings include:

Review of the facilities fire drills reports revealed no drills were completed for the third quarter of the year (June-August 2022) during the day or evening shifts.

Interview with the facility Administrator on 12/21/22 11:34 A.M. confirmed no fire drills were completed for the third quarter of the year (June-August 2022) during the day or evening shifts. The interview confirmed the facility was between maintenance persons at that time and therefore it was overlooked.

Rule

Ohio Administrative Code - residential care rules

R-0615Fire drill requirementsOhio citation · correction confirmed 04/23/2024▼

What the surveyor found

Based on disaster drill reports and staff interviews, the facility failed to conduct a tornado drill during the months of March through July 2022, as required. This could potentially affect all 75 residents residing in the facility at the time of the annual survey completed on 12/21/22.

Findings include:

Review of the facilities disaster drills conducted for the past 12 months was completed. The facility was noted to have completed one disaster drill; however, no tornado drill was completed from March through June as required.

Interview with the facility Administrator on 12/21/22 11:34 A.M. confirmed the facility did not have any Tornado drills completed from March through in July 2022, as required. The interview confirmed the facility was between maintenance persons at that time and therefore it was overlooked.

Rule

Ohio Administrative Code - residential care rules

R-0624Train all residents in fire drillsOhio citation · correction confirmed 04/23/2024▼

What the surveyor found

Based on the facility monthly self fire inspection form and staff interviews, the facility failed to ensure the self inspection was completed every month. This could potentially affect all 75 residents residing in the facility at the time of the annual survey completed on 12/21/22.

Findings include:

Review of the facilities monthly self inspection form for fire safety was completed on 12/21/22. The inspections were not completed during July and August 2022.

Interview with the facility Administrator on 12/21/22 11:34 A.M. confirmed the facility did not have a maintenance person during that time and therefore it was overlooked.

Rule

Ohio Administrative Code - residential care rules

R-0711Free from abuseOhio citation · correction confirmed 04/23/2024▼

What the surveyor found

Based on medical record reviews, facility social media policies, family and staff interviews, the facility failed to ensure Resident #62 was treated with dignity and respect at all times. This affected one resident (Resident #62) of six residents reviewed for dignity.

Findings include:

Review of Resident #62's medical record identified admission to the facility occurred on 06/29/20 to the facility memory care unit. Resident #62 medical diagnosis included dementia, depression and high blood pressure. The record identified Resident #62 was not cognitively aware.

Interview with the facility Administrator and Care Giver Supervisor (#400) was completed on 12/21/22 at 11:44 A.M. The interviews identified it was reported Care Giver (#350) had made a video-post on instagram that contained Resident #62. The interview identified this incident occurred on the evening shift of 12/20/22 between the hours of 2:00 P.M. to 6:00 P.M. and it had just been reported this morning. The interviews identified the facility was currently in the process of investigating the incident.

On 12/21/22 at 11:48 A.M., Care Giver Supervisor #400 was able to show part of the video to the surveyor. Observation of the video revealed the video clip was approximately 15 seconds and Care Giver Supervisor #400 identified another co-worker had sent her this information and was disturbed by the video. The video showed Care Giver #350 sitting in front of Resident #62, whom was mumbling words that were incoherent, in the background. Care Giver #350 was overheard on the video to say this is what I have to deal with. Resident #62 in the video did not appear to have any reaction to Care Giver #350's statement and continued to ramble incoherent words. Resident #62 appeared fully dressed and sitting in a wheelchair behind Care Giver #350 when the video was posted. Care Giver Supervisor #400 confirmed she spoke with Care Giver #350 whom confirmed she was on Instagram Live and it was her private page. Care giver #350 originally denied posting the video until the supervisor identified she has a clip of the video. The interview confirmed she then confirmed that she had in fact posted the video to instagram, that contained Resident #62. The interview confirmed Care Giver #350 has been suspended pending the facilities investigation.

Interview with Resident #62's family on 12/21/22 at 12:49 P.M. revealed they were sure Resident #62 was not able to understand what was going on and could not provide consent for any videos. Resident #62's daughter identified she was upset that someone would post anything undignified regarding her mother.

Review of the facility social media policies revealed inappropriate postings that may include discriminatory remarks or similar inappropriate conduct will not be tolerated and are ground for termination. The policy identified no employee may record any person without written authorization.

This violation represents non-compliance investigated under Complaint Number OH00137945.

Rule

Ohio Administrative Code - residential care rules

September 7, 2022Complaint survey · listed in Ohio's index; no findings report publishedNo deficiencies▼

✅

No deficiencies cited

Ohio lists this visit in its inspection index with no deficiencies. The state publishes a findings report only when a visit cites something, so there is no further detail to show.