Inspection visit
Inspection
5 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 5 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0684
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
medical record review, observation, staff interview, and review of the facility policy, the facility failed to timely
a assess and treat resident injuries following falls. This affected one (Resident #67) resident of three
residents reviewed for falls. The facility census was 76 residents.
Residents Affected - Few
Findings include:
Review of the medical record for Resident #67 revealed an admission date of 10/25/23 with diagnoses
including pulmonary hypertension and chronic kidney disease.
Review of the care plan for Resident #67 dated 11/01/23 revealed the resident was at risk for falls related to
new surroundings, impaired safety awareness, and history of falls. Interventions included the following:
anticipate and meet the resident's needs, ensure call light was within reach, keep personal items within
reach, monitor for behavior changes, monitor for side effects from medications.
Review of the quarterly Minimum Data Set (MDS) assessment for Resident #67 dated 04/13/24 revealed
the resident had intact cognition, was dependent with toileting, and required moderate assistance with
bathing, dressing, and transfers.
Review of the timeline for Resident #67's fall revealed the resident fell on [DATE] at approximately 9:00 P.M.
while receiving incontinence care. There was no documentation made in the resident's medical record on
05/03/24 regarding the fall or a post-fall assessment. On 05/04/24 at approximately 8:23 A.M. State Tested
Nursing Assistant (STNA) #16 notified Registered Nurse (RN) #30 that Resident #67 was unable to transfer
related to pain, swelling, and bruising to right lower extremity. The physician was notified, and an x-ray was
ordered at approximately 8:40 A.M. on 05/04/24. The x-ray results were finalized at 12:34 P.M. on 05/04/24
with multiple fractures noted to Resident #67's right and left leg. On 05/04/24 at approximately 1:30 P.M.
emergency services arrived at the facility and took Resident #67 to the hospital.
Review of the progress note for Resident #67 dated 05/04/24 timed at 8:23 A.M. revealed the resident
reported she had fallen on night shift and was unable to transfer related to pain. Resident #67 had swelling
and bruising on her right leg and was complaining of severe pain. RN #30 spoke to LPN #26, who worked
night shift on 05/03/24. Licensed Practical Nurse (LPN) #26 reported STNA #15 had lowered Resident #67
to the floor. RN #30 notified Resident #67's physician of findings and received an order for x-rays. The x-ray
technician arrived at the facility the morning after the fall, and results showed an acute comminuted
moderately displaced fracture to the tibia and fibula neck on right lower extremity and an acute mildly
displaced fracture of the femur with reactive soft tissue swelling
(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 8
Event ID:
365309
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
365309
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
06/03/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Arc at Trotwood LLC
5790 Denlinger Road
Dayton, OH 45426
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)
F 0684
on left lower extremity. Emergency services were called, and Resident #67 was sent to the hospital.
Level of Harm - Minimal harm
or potential for actual harm
Review of the progress note for Resident #67 dated 05/06/24 timed at 4:48 P.M. revealed the note was a
late entry for a fall which occurred on 05/03/24 at approximately 9:00 P.M. Resident #67 was being assisted
with incontinence care and was standing while facing the chair. Resident #67's legs gave way, and she fell
onto her knees and then backwards on the floor. Staff assessed the resident and lifted her into bed.
Resident #67 declined to go the hospital against staff recommendation. Resident #67 had increased pain in
the morning, and staff received orders for an x-ray and was sent to the emergency room the morning
following the fall related to results from x-ray and pain and discomfort.
Residents Affected - Few
Review of the witness statement per STNA #15 dated 05/06/24 revealed Resident #67 was standing up
next to bed while receiving incontinence care when the resident fell to the floor onto her knees. STNA #15
went to get LPN #26 after the fall. STNA #15 reported Resident #67 refused to be moved off of the floor
because it was too painful. LPN #26 tried to convince Resident #67 to go to the hospital, but she refused
and allowed STNA #15 and LPN #26 to put her back into bed.
Review of the witness statement dated 05/06/24 by LPN #26 revealed Resident #67 was lowered to the
floor by staff. LPN #26 assessed Resident #67, and she did not want to go to the hospital. Resident #67
was assessed for injuries and did not appear to have any open areas or discoloration noted. Resident #67
was assisted back to bed, and the physician was notified.
Review of the x-ray order for Resident #67 dated 05/04/24 revealed a stat (immediate) x-ray was submitted
for the resident for right and left knee related to localized swelling and pain.
Review of the x-ray results dated 05/04/24 revealed Resident #67 had an acute, comminuted moderately
displaced fracture of the right tibia and fibula and a mildly displaced fracture of the left femur.
Interview on 05/30/24 at 1:04 P.M. with Regional Nurse #40 confirmed LPN #26 was terminated for failure
to follow protocol on a residents fall according to the facility policy, because the nurse did not assess and
treat Rsident #67 for injuried following the resident's fall on 05/03/24.
Interview on 05/31/24 at 9:22 A.M. with x-ray company staff confirmed a stat x-ray was ordered for Resident
#67 on 05/04/24 by phone at approximately 8:40 A.M. per RN #30. The x-ray company staff further
confirmed stat x-rays should be completed within four to six hours of ordering.
Review of the facility policy titled Change in Condition dated March 2018 revealed the staff would assess
residents for change in condition and would monitor and document the resident's progress and would notify
the attending physician so treatment could be adjusted accordingly.
This deficiency represents noncompliance investigated under Complaint Number OH00153637.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365309
If continuation sheet
Page 2 of 8
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
365309
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
06/03/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Arc at Trotwood LLC
5790 Denlinger Road
Dayton, OH 45426
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)
F 0697
Provide safe, appropriate pain management for a resident who requires such services.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
medical record review, observation, resident interview, staff interview, and review of the facility policy, the
facility failed to adequately assess and treat resident pain following a fall. This affected one (Resident #67)
of three residents reviewed for falls. The facility census was 76.
Residents Affected - Few
Findings include:
Review of the medical record for Resident #67 revealed an admission date of 10/25/23 with diagnoses
including pulmonary hypertension and chronic kidney disease.
Review of the care plan for Resident #67 dated 11/01/23 revealed the resident had the potential for
pain/alteration in comfort related to osteoarthritis, weakness, and history of falls. Interventions included the
following: monitor need for scheduled analgesics, evaluate the effectiveness of pain intervention, review for
compliance, alleviating of symptoms, dosing schedules and residents satisfaction with results, impact of
functional ability and impact on cognition, monitor/document for probable cause of each pain episode,
remove/limit causes where possible, monitor/document for side effects of pain medication, monitor/record
pain characteristics: quality, severity, anatomical location, onset, duration, aggravating factors, relieving
factors, monitor/report to the nurse any signs and symptoms of non-verbal pain, notify physician if
interventions are unsuccessful or if current complaint is a significant change from resident's past
experience of pain, report to nurse resident complaints of pain or request for pain treatment.
Review of the quarterly Minimum Data Set (MDS) assessment for Resident #67 dated 04/13/24 revealed
the resident had intact cognition, was dependent with toileting, and required moderate assistance with
bathing, dressing, and transfers.
Review of the progress note for Resident #67 dated 05/06/24 at 4:48 P.M. revealed the note was a late
entry documenting a witnessed fall which occurred on 05/03/24 at approximately 9:00 P.M. Further review
of the note revealed it did not include an assessment of the resident's pain level at the time of the fall.
Resident #67 complained of pain in the morning and the facility obtained an order for an x-ray which
showed multiple fractures, and the resident was transported to the hospital.
Review of the x-ray results dated 05/04/24 revealed Resident #67 had an acute, comminuted moderately
displaced fracture of the right tibia and fibula and a mildly displaced fracture of the left femur.
Review of the physician's orders for Resident #67 revealed an order dated 11/18/23 for Tylenol extra
strength 500 milligrams (mg), give two tablets by mouth every six hours a day routinely for pain at 12:00
A.M., 6:00 A.M., 12:00 P.M., and 6:00 P.M.
Review of the Medication Administration Record (MAR) for Resident #67 dated May 2024 revealed the
resident received Tylenol as ordered on 05/04/24 at 12:00 A.M., 6:00 A.M., and 12:00 P.M. before the
resident was sent to the hospital for fractures related to the fall on 05/03/24.
Review of the medical record revealed Resident #67 did not receive pain medication until approximately
three hours after the incident occurred nor did the record include an assessment of the resident's pain
following the incident until 05/04/24 at 8:23 A.M.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365309
If continuation sheet
Page 3 of 8
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
365309
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
06/03/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Arc at Trotwood LLC
5790 Denlinger Road
Dayton, OH 45426
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)
F 0697
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Review of the progress note for Resident #67 dated 05/04/24 timed at 8:23 A.M. revealed the resident was
complaining of severe pain to her lower extremities and was unable to move due to swelling and bruising to
the lower extremities. Review of the record revealed it did not include documentation of facility staff
interventions for the resident's pain.
Interview on 05/30/24 at 11:47 A.M. with Resident #67 confirmed she was in excruciating pain following her
fall which occurred on 05/03/24 at approximately 9:00 P.M. Resident #67 confirmed she received no pain
medication following the fall except for her routine Tylenol, and she did not receive a dose of Tylenol until
approximately three hours following the fall.
Interview on 05/30/24 at 1:51 P.M. with State Tested Nursing Assistant (STNA) #16 confirmed Resident #67
did not want to get out of bed in the morning on 05/04/24, and the resident complained of pain and
discomfort to the bilateral lower extremities. STNA #16 reported Resident #67 had bruising, dark purple
and black in color, and extreme swelling from her knee down to her ankle on her right leg. STNA #16 also
stated she was not notified in report by STNA #15 that Resident #67 had fallen on the previous shift.
Interview on 05/30/24 at 1:59 P.M. with Resident #66, Resident #67's roommate, confirmed after Resident
#67 fell on [DATE] at approximately 9:00 P.M. the resident was crying and screaming out all night in pain.
Interview on 05/30/24 at 2:22 P.M. with the Director of Nursing (DON) confirmed Resident #67 had a fall on
05/03/24 at approximately 9:00 P.M. The DON confirmed Resident #67's medical record did not include an
assessment of the resident's pain following the fall and the resident did not receive pain medication until
three hours after the fall. The DON confirmed the facility staff documented the resident was in excruciating
pain on 05/04/23 at 8:23 A.M. but the staff did not obtain orders for additional pain medication nor did the
staff document the implementation of nonpharmacological measures for pain.
Review of the facility policy titled Administering Pain Medications dated October 2022 revealed the pain
management program was based on a facility-wide commitment to appropriate assessment and treatment
of pain, based on professional standards of practice, the comprehensive care plan, and the resident's
choices related to pain management. Acute pain should be assessed every 30 to 60 minutes after onset
and reassessed as indicated until relief was obtained. Facility staff should also evaluate and document the
effectiveness of nonpharmacological interventions for pain management.
This deficiency represents noncompliance investigated under Complaint Number OH00153637.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365309
If continuation sheet
Page 4 of 8
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
365309
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
06/03/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Arc at Trotwood LLC
5790 Denlinger Road
Dayton, OH 45426
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)
F 0812
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve
food in accordance with professional standards.
Based on observation, staff interview, review of the facility policy, and review of Material Safety Data Sheets
(MSDS), the facility failed to store, prepare, and distribute food in a sanitary manner. This had the potential
to affect 75 residents residing at the facility. The facility identified one (Resident #50) who did not receive
food from the facility kitchen. The facility census was 76.
Findings include:
Initial tour of the facility kitchen on 05/28/24 at 8:57 A.M. with Dietary Director (DD) #301 revealed there
was a large hole in the floor with a missing floor tile at the end of the tray line counter. There was rust and
metal flaking off the end of the tray line counter that was used for food preparation. The tray line counter
also had food debris and splatter running down the side. The trash cans located in the kitchen had food
splatter running down the sides and did not have lids on them. There was black dirt, black smudge, and
food debris all along the walls and under the appliances. There were grease stains on the front of the oven.
There was a large container of oven and grill cleaner chemical cleaner sitting on a lower table near the
oven in the food preparation area. There was a tall metal cart which contained nine loaves of expired bread
and half a pack of expired hamburger buns with a use by date of 03/11/24.
Interview on 05/28/24 at 8:57 A.M. and during the tour with DD #301 confirmed the hole in the floor, the rust
and metal flaking on the counter, the dirt and debris on the tray line counter and trash cans, the absence of
lids for the trash cans, the presence of general dirt and debris on the walls and the under appliances, the
presence of hazardous cleaning chemicals in the food preparation area and the expired bread and
hamburger buns.
Observation of the walk-in refrigerator on 05/28/24 at 9:10 A.M. with DD #301 revealed the refrigerator
contained the following items: a sliced tomato, wrapped in plastic and undated, a large plastic bag of
cheese which was open and undated, nine individual dessert cups of pudding which were unlabeled and
undated, a large metal container of mashed potatoes which was unlabeled and undated, an undated
unlabeled and opened package of sliced turkey, a large metal container of unlabeled and undated
mechanical soft chicken, a large opened plastic bag of coleslaw undated, a large opened plastic bag of
lettuce undated, a large metal pan of tomato sauce undated, two large metal containers of greens beans
undated.
Interview on 05/28/24 at 9:10 A.M. and during the tour with DD #301 confirmed the identity of all unlabeled
foods observed. DD #301 confirmed all the observations of opened and undated food and confirmed all
stored foods should be labeled and should be dated when opened.
Observation on 05/28/24 at 11:24 A.M. with Maintenance Supervisor (MS) #300 revealed the facility
garbage disposal was broken. MS #300 approached the sink in the facility kitchen and used flashlight to
illuminate the inside of the garbage disposal which revealed rotten food debris and brown looking sludge.
The sludge from the broken disposal was leaking onto the floor below. There were numerous gnats flying
around the garbage disposal. There was a yellow tag on the garbage disposal dated 08/16/23.
Interview on 05/28/24 at 11:24 A.M. with MS #300 confirmed the garbage disposal had not been working
for several months and he could not get payment approved for repair. MS #300 confirmed the rotten
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365309
If continuation sheet
Page 5 of 8
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
365309
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
06/03/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Arc at Trotwood LLC
5790 Denlinger Road
Dayton, OH 45426
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)
F 0812
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
food debris in the disposal, the sludge leaking onto the floor below, and the presence of gnats flying around
the garbage disposal.
Interview on 05/28/24 at 11:25 A.M. with DD #301 confirmed the yellow tag hanging from the garbage
disposal was dated 08/16/23 and indicated the disposal had been taken out of service at that time. DD
#301 further confirmed the yellow tag was hung to prevent staff from using broken equipment.
Review of the facility policy titled Sanitization dated October 2008 revealed the facility food service area
should be maintained in a clean and sanitary manner. The facility kitchen areas should be kept clean and
free of litter, rubbish, and insects. Further review of the policy confirmed the kitchen surfaces not in contact
with food should be cleaned on a regular schedule to prevent the accumulation of grime.
This deficiency represents noncompliance investigated under Complaint Number OH00153570.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365309
If continuation sheet
Page 6 of 8
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
365309
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
06/03/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Arc at Trotwood LLC
5790 Denlinger Road
Dayton, OH 45426
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)
F 0880
Provide and implement an infection prevention and control program.
Level of Harm - Minimal harm
or potential for actual harm
Based on record review, observation, staff interview, and review of the facility policy, the facility failed to
provide adequate incontinence care in a sanitary manner. This affected one (Resident #13) of three
residents reviewed for incontinence care. The facility census was 76.
Residents Affected - Few
Findings include:
Review of the medical record for Resident #13 revealed an admission date of 07/02/23 with diagnoses
including cerebral palsy, heart failure, schizoaffective disorder, and type two diabetes mellitus.
Review of the quarterly Minimum Data Set (MDS) assessment for Resident #13 dated 04/17/24 the
resident had intact cognition was dependent on staff with toileting and was always incontinent of bowel and
bladder.
Review of the physician's order for Resident #13 revealed an order dated 05/03/24 for staff to apply zinc
oxide topical ointment to the peri-area and buttocks after each incontinent episode.
Observation of incontinence care on 05/28/24 at 1:09 P.M. for Resident #13 per State Tested Nursing
Assistants (STNAs) #10 and #11 revealed the resident's incontinence brief was heavily saturated with
urine. The STNAs removed Resident #13's soiled brief, and STNA #11 cleansed the front of the resident's
peri area with a washcloth and then immediately used the same soiled washcloth to cleanse the resident's
buttocks. STNA #11 then applied zinc oxide and a clean incontinence brief.
Interview on 05/28/24 at 1:35 P.M. with STNA #11 confirmed she used the same washcloth to clean
Resident #13's front peri area and then immediately cleansed the resident's buttocks using the same soiled
washcloth before applying zinc oxide and a clean incontinence brief.
Interview on 05/28/24 at 1:49 P.M. with the Director of Nursing (DON) confirmed staff should not use the
same washcloth for cleaning a resident front to back during incontinence care.
Review of the facility policy titled Supporting Activities of Daily Living dated March 2018 revealed residents
would be provided with care, treatment, and services as appropriate to maintain or improve their ability to
carry out activities of daily living. Residents who were unable to carry out activities of daily living
independently would receive the services necessary to maintain good nutrition, grooming, and personal
and oral hygiene.
This deficiency represents noncompliance investigated under Complaint Number OH00153552.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365309
If continuation sheet
Page 7 of 8
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
365309
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
06/03/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Arc at Trotwood LLC
5790 Denlinger Road
Dayton, OH 45426
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)
F 0908
Keep all essential equipment working safely.
Level of Harm - Minimal harm
or potential for actual harm
Based on observation, staff interview, and review of the facility policy the facility failed to maintain
mechanical equipment in a safe operating condition. This had the potential to affect all residents residing in
the facility. The facility census was 76.
Residents Affected - Many
Findings include:
Observation of the laundry room on 05/28/24 at 8:47 A.M. with the Maintenance Supervisor (MS) # 300
revealed the facility had three dryers in use for resident laundry. All three dryers had a thick layer of lint on
the vents.
Interview on 05/28/24 at 8:47 A.M. with MS #300 confirmed the lint on all three dryer vents was very thick
and it appeared they had not been cleaned for several loads or possibly even several days of use. MS #300
confirmed the vents should be cleared of lint after each load of laundry. MS #300 confirmed the facility
should have a lint cleaning log in the laundry with signatures of staff to verify cleaning of the vents after
each load, but the facility did not have a record of the dryer vent cleaning.
Interview on 05/28/24 at 8:49 A.M. with Laundry Worker (LW) #302 confirmed he had completed several
loads of laundry since the beginning of the shift, and he had not cleaned the dryer vents since 05/27/24.
Interview on 06/03/24 at 8:16 A.M. with the Administrator confirmed the staff should clean the lint from the
dryers after each load as an environmental safety measure and should sign off completion of the task.
Review of the facility job description titled Laundry Worker undated revealed the laundry worker was to
establish safety precautions when performing tasks and when using equipment.
Review of the facility policy titled Homelike Environment dated February 2021 revealed residents should be
provided with a safe, clean, comfortable, and homelike environment.
This deficiency represents noncompliance investigated under Complaint Number OH00153570.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365309
If continuation sheet
Page 8 of 8
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Back to topCitations
5 citations recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F684 - Quality of care
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
F697 - Pain Management
Provide safe, appropriate pain management for a resident who requires such services.
F812 - Food safety requirements
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
F880 - Infection Control
Provide and implement an infection prevention and control program.
F908 - Maintain all mechanical, electrical, and patient care equipment in safe
Keep all essential equipment working safely.
FAQ · About this visit
Common questions about this visit
What happened during the June 3, 2024 survey of ARC AT TROTWOOD LLC?
This was a inspection survey of ARC AT TROTWOOD LLC on June 3, 2024. The surveyor cited 5 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at ARC AT TROTWOOD LLC on June 3, 2024?
Yes, 5 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Provide appropriate treatment and care according to orders, resident’s preferences and goals."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.
Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.
Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.