Health inspection·August 27, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, resident and staff interviews, record review, and review of the facility policy, the facility failed to ensure the residents had a homelike environment. This affected three (#22, #23,and #24) of four residents reviewed for homelike environment. The facility census was 72.1. Review of the medical record for Resident #22 revealed a re-admission on [DATE]. Diagnoses included chronic obstructive pulmonary disease and seizures. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #22 had severe cognitive impairment.Observation and interview on 08/14/25 at 8:45 A.M. of Resident #22's bathroom revealed a sink with a built in soap dispenser holder without a soap container in the holder. There was not any soap or paper towels available. Interview on 08/14/25 at 8:45 A.M. with Resident #22 stated she ambulates with one assist to the restroom. Resident #22 stated to wash his hands, the Certified Nursing Aide (CNA) would have to get a washcloth and soap from outside of the room. Resident #22 stated to dry his hands he would have to use a towel if no paper towels were available. Interview on 08/14/25 at 8:51 A.M. with Housekeeper #159 revealed if a resident does not have hand soap in the bathroom, they would immediately replace it. Housekeeper #159 stated at times the delivery truck does not show up with products and they run short. Interview on 08/14/25 at 11:10 A.M. with Plant Operations Director (POD) #102 confirmed Resident #22 did not have hand soap or paper towels available. 2. Review of the medical record for Resident #23 revealed an admission on [DATE]. Diagnoses included fracture of left femur and chronic obstructive pulmonary disease. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #23 was cognitively intact. Interview on 08/14/25 at 8:23 A.M. with Resident #23 revealed the soap dispenser in her room did not work. Resident #23 stated she spoke to Housekeeping Director (HD) #121 without result. Resident #23 stated she had to purchase her own hand soap due to the facility not providing it for her. Resident #23 stated she was unable to use the sink that was by the entrance door to her room due to being in a wheelchair and not being able to reach the soap dispenser. Observation on 08/14/25 at 8:30 A.M. of Resident #23's bathroom revealed a sink that had a built in soap dispenser. The soap dispenser was empty and difficult to push down. Their were no paper towels available. Interview on 08/14/25 at 8:51 A.M. with Housekeeper #159 revealed if a resident does not have hand soap in the bathroom, they would immediately replace it. When asked why Resident #23 did not have any soap available, Housekeeper #159 stated that was the old dispensers and were unsure if they had soap to fit it. Housekeeper #159 stated at times the delivery truck does not show up with products and they run short. Interview on 08/14/25 at 11:10 A.M. with Plant Operations Director (POD) #102 confirmed Resident #23 did not have soap or paper towels available in the bathroom. 3. Review of the medical record for Resident #24 revealed an admission on [DATE]. Diagnoses included acute osteomyelitis and end stage renal disease. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #24 was cognitively (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 4 Event ID: 365101 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365101 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Spring Creek Nursing and Rehabilitation Center LLC 401 N Broadway St Green Springs, OH 44836 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)