Federal nursing home survey record · CMS-certified nursing home· Not a state assisted-living licensing record
TRIPLE CREEK RETIREMENT COMMUNITY
CINCINNATI, OH · 56 certified beds · Last Life Safety survey July 11, 2025
CMS Certification Number 366364 · first certified September 2008
Ownership
Operated by TRILOGY HEALTH SERVICES · For profit - Corporation
No change of ownership on CMS record since January 1, 2016, when the records begin.
Position within OH
13 citations — more than 36% of the 922 certified nursing homes in OH. Compared within OH rather than nationally because which state a facility is in explains about 30% of the variation in citation counts between facilities, while bed count explains under 1%. State survey agencies differ far more than the buildings do. How this is calculated
The latest survey found 2 citations; the earlier surveys in the window averaged 5.5. With 3 surveys on file this is a direction of travel, not a conclusion.
When is the next survey likely?
The window opens March 2027 — about 5 months from now. This facility’s last Life Safety survey was July 2025. Facilities in OH are typically surveyed 20–32 months after the last one (median 26), measured over 889 consecutive surveys in the last two years of CMS records.
A range the record supports, not a prediction of a date. State agencies vary widely — from about 11 months in Pennsylvania to three years in Maryland. How the window is measured
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Emergency preparedness
2 of the 13 citations on file are Emergency Preparedness E-tags. E-tags are cited under 42 CFR §483.73 and concern the emergency plan, training, drills, communications and supplies. Nationally about half of certified facilities have at least one. The Emergency Preparedness Index
Physical environment (health survey)
5 physical-environment citations on the health survey. Cited by the health surveyors under Appendix PP, not the Life Safety Code surveyor: equipment in safe operating condition, the call system, bed rails, pest control, hazards, the environment. Counted separately from the 13 Life Safety citations above. The Physical Environment Index
- F-0880 Provide and implement an infection prevention and control program.
- F-0584 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.
- F-0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
How that compares
Compared with the median facility in OH, and nationally. Surveyors differ markedly between states, so the OH figure is the meaningful one.
| Measure | Citations |
|---|---|
| This facility | 13 |
| Median facility in OH | 16 |
| Median facility nationally | 11 |
Survey history
| Survey date | Citations |
|---|---|
| July 3, 2019 | 3 |
| August 18, 2022 | 8 |
| July 11, 2025 | 2 |
Most-cited tags
| Tag | What the surveyor checks | Times cited | Last cited |
|---|---|---|---|
| K-0711 | Provide a written emergency evacuation plan. | 3 | 2025-07-11 |
| K-0346 | Follow proper procedures when the fire alarm was out of service for more than 4 hours. | 1 | 2022-08-18 |
| K-0351 | Install an approved automatic sprinkler system. | 1 | 2019-07-03 |
| K-0928 | Ensure equipment listed for use in oxygen-enriched atmospheres are correctly labeled. | 1 | 2019-07-03 |
| K-0354 | Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours. | 1 | 2022-08-18 |
| K-0923 | Have proper medical gas storage and administration areas. | 1 | 2025-07-11 |
| E-0031 | Provide emergency officials' contact information. | 1 | 2022-08-18 |
| K-0345 | Have approved installation, maintenance and testing program for fire alarm systems. | 1 | 2022-08-18 |
What the citations cover
- Smoke Deficiencies 4
- Miscellaneous Deficiencies 4
- Emergency Preparedness Deficiencies 2
- Gas, Vacuum, and Electrical Systems Deficiencies 2
- Other 1
| Category | Citations |
|---|---|
| Smoke Deficiencies | 4 |
| Miscellaneous Deficiencies | 4 |
| Emergency Preparedness Deficiencies | 2 |
| Gas, Vacuum, and Electrical Systems Deficiencies | 2 |
| Egress Deficiencies | 1 |
Every citation on file
As published by CMS, newest survey first. Descriptions are CMS’s own wording.
July 11, 2025 — 2 citations
August 18, 2022 — 8 citations
| Tag | What the surveyor checks | Status |
|---|---|---|
| E-0030 | List the names and contact information of those in the facility. | Deficient, Provider has date of correction (September 25, 2022) |
| E-0031 | Provide emergency officials' contact information. | Deficient, Provider has date of correction (September 25, 2022) |
| K-0222 | 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. | Deficient, Provider has date of correction (September 25, 2022) |
| K-0345 | Have approved installation, maintenance and testing program for fire alarm systems. | Deficient, Provider has date of correction (September 25, 2022) |
| K-0346 | Follow proper procedures when the fire alarm was out of service for more than 4 hours. | Deficient, Provider has date of correction (September 25, 2022) |
| K-0354 | Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours. | Deficient, Provider has date of correction (September 25, 2022) |
| K-0711 | Provide a written emergency evacuation plan. | Deficient, Provider has date of correction (September 25, 2022) |
| K-0712 | Have simulated fire drills held at unexpected times. | Deficient, Provider has date of correction (September 25, 2022) |
July 3, 2019 — 3 citations
| Tag | What the surveyor checks | Status |
|---|---|---|
| K-0351 | Install an approved automatic sprinkler system. | Deficient, Provider has date of correction (August 15, 2019) |
| K-0711 | Provide a written emergency evacuation plan. | Deficient, Provider has date of correction (August 15, 2019) |
| K-0928 | Ensure equipment listed for use in oxygen-enriched atmospheres are correctly labeled. | Deficient, Provider has date of correction (August 15, 2019) |
Reflects the CMS posting of August 1, 2026. Surveys conducted in the last few months may not appear yet.