Federal nursing home survey record · CMS-certified nursing home· Not a state assisted-living licensing record

SYCAMORE TRAILS POST ACUTE

MIAMISBURG, OH · 102 certified beds · Last Life Safety survey June 24, 2025

CMS Certification Number 365640 · first certified September 1984

Ownership

Operated by PACS GROUP · For profit - Limited Liability company

  • New ownershipOwnership changed December 1, 2024 (change of ownership)from LEGACY MIAMISBURG OPERATING COMPANY, LLC
17
Citations on file
Rolling three-year window
3
Life Safety surveys
In the same window
4
Tags cited more than once
Across separate surveys
12
Inspection & testing records
Of the citations on file

Position within OH

17 citations — more than 53% 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

Improvingfewer citations at the latest survey than at its earlier surveys in the window.

The latest survey found 5 citations; the earlier surveys in the window averaged 6. With 3 surveys on file this is a direction of travel, not a conclusion.

When is the next survey likely?

The window opens February 2027 — about 5 months from now. This facility’s last Life Safety survey was June 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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Which alerts

4 inspection-and-testing tags have been cited here at more than one survey. Nationally, that pattern is common: about three quarters of cited facilities have at least one repeated tag, and half of the facilities ever cited for sprinkler inspection and testing are cited for it again. A repeat is usually a recordkeeping gap rather than a new hazard.

Physical environment (health survey)

7 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 17 Life Safety citations above. The Physical Environment Index

  • F-0880 Provide and implement an infection prevention and control program.
  • F-0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

How that compares

Citations on file over three years

Compared with the median facility in OH, and nationally. Surveyors differ markedly between states, so the OH figure is the meaningful one.

This facility17OH median16National median11
Citations on file over three years, compared
MeasureCitations
This facility17
Median facility in OH16
Median facility nationally11

Survey history

Citations at each Life Safety survey
82019-0742022-0852025-06
Citations at each Life Safety survey
Survey dateCitations
July 12, 20198
August 25, 20224
June 24, 20255

Most-cited tags

Most-cited tags at this facility
K-02912K-05212K-03532K-03452K-09181K-09141K-02321K-09131
Most-cited tags at this facility
TagWhat the surveyor checksTimes citedLast cited
K-0291Install emergency lighting that can last at least 1 1/2 hours.22025-06-24
K-0521Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.22022-08-25
K-0353Inspect, test, and maintain automatic sprinkler systems.22025-06-24
K-0345Have approved installation, maintenance and testing program for fire alarm systems.22025-06-24
K-0918Have generator or other power source capable of supplying service within 10 seconds.12025-06-24
K-0914Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.12019-07-12
K-0232Have corridors or aisles that are unobstructed and are at least 8 feet in width.12022-08-25
K-0913Ensure operating rooms are properly protected and written records are maintained and available for inspection.12019-07-12

What the citations cover

Citations by CMS category
  • Smoke Deficiencies 6
  • Egress Deficiencies 4
  • Gas, Vacuum, and Electrical Systems Deficiencies 3
  • Services Deficiencies 2
  • Other 2
Citations by CMS category
CategoryCitations
Smoke Deficiencies6
Egress Deficiencies4
Gas, Vacuum, and Electrical Systems Deficiencies3
Services Deficiencies2
Miscellaneous Deficiencies2

Every citation on file

As published by CMS, newest survey first. Descriptions are CMS’s own wording.

June 24, 2025 — 5 citations

Citations issued on June 24, 2025
TagWhat the surveyor checksStatus
K-0291Install emergency lighting that can last at least 1 1/2 hours.Deficient, Provider has date of correction (August 1, 2025)
K-0345Have approved installation, maintenance and testing program for fire alarm systems.Deficient, Provider has date of correction (August 1, 2025)
K-0353Inspect, test, and maintain automatic sprinkler systems.Deficient, Provider has date of correction (August 1, 2025)
K-0741Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.Deficient, Provider has date of correction (August 1, 2025)
K-0918Have generator or other power source capable of supplying service within 10 seconds.Deficient, Provider has date of correction (August 1, 2025)

August 25, 2022 — 4 citations

Citations issued on August 25, 2022
TagWhat the surveyor checksStatus
K-0211Keep aisles, corridors, and exits free of obstruction in case of emergency.Deficient, Provider has date of correction (September 30, 2022)
K-0232Have corridors or aisles that are unobstructed and are at least 8 feet in width.Deficient, Provider has date of correction (September 30, 2022)
K-0372Ensure smoke barriers are constructed to a 1 hour fire resistance rating.Deficient, Provider has date of correction (September 30, 2022)
K-0521Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.Deficient, Provider has date of correction (September 30, 2022)

July 12, 2019 — 8 citations

Citations issued on July 12, 2019
TagWhat the surveyor checksStatus
K-0291Install emergency lighting that can last at least 1 1/2 hours.Deficient, Provider has date of correction (August 30, 2019)
K-0324Provide properly protected cooking facilities.Deficient, Provider has date of correction (August 30, 2019)
K-0345Have approved installation, maintenance and testing program for fire alarm systems.Deficient, Provider has date of correction (August 30, 2019)
K-0353Inspect, test, and maintain automatic sprinkler systems.Deficient, Provider has date of correction (August 30, 2019)
K-0521Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.Deficient, Provider has date of correction (August 30, 2019)
K-0761To conduct inspection, testing and maintenance of fire doors by qualified individuals.Deficient, Provider has date of correction (August 30, 2019)
K-0913Ensure operating rooms are properly protected and written records are maintained and available for inspection.Deficient, Provider has date of correction (August 30, 2019)
K-0914Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.Deficient, Provider has date of correction (August 30, 2019)

Reflects the CMS posting of August 1, 2026. Surveys conducted in the last few months may not appear yet.