Health inspection·June 30, 2024

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, and review of a medical record, the facility failed to maintain flooring in resident rooms in a safe and homelike manner. This affected one (#17) of seven residents reviewed for environment. The facility census was 68 Findings include: Review of the medical record for Resident #17 revealed an admission date of 01/05/24 with diagnoses of acute encephalopathy, pressure ulcer of both feet, stage three (full-thickness skin loss), and sepsis. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #17 was cognitively intact, required set-up assistance for eating, supervision assistance for oral hygiene, toileting hygiene, and wheelchair mobility, and required partial assistance for bathing, dressing, personal hygiene, bed mobility, and transfers. Observation on 06/25/24 at 11:00 A.M. of Resident #17's bedroom noted two areas of missing flooring by the foot of the bed measuring approximately three inches long by six inches wide by 0.5 inches deep. There was also a seam down the middle of the floor with missing flooring measuring approximately 10 inches long by 1.5 inches wide by 0.5 inches deep. Interview with Resident #17 on 06/25/24 at 11:00 A.M. confirmed the two areas missing flooring and the seam in the middle of the floor, and stated the floor was missing since his admission to the room. Resident #17 stated he assumed there was some kind of equipment that sat in the area previous which caused the damage to the floor. Interview on 06/25/24 at 2:28 P.M. with Licensed Practical Nurse (LPN) #200 confirmed the floor in Resident #17's room had two areas of missing flooring measuring approximately three inches long by six inches wide by 0.5 inches deep and also a seam down the middle of the floor with missing flooring measuring approximately 10 inches long by 1.5 inches wide by 0.5 inches deep. LPN #200 also confirmed the areas of the floor had been damaged since Resident #17 was admitted and that the areas with missing flooring seemed moist and was peeling back. Interview on 06/25/24 at 3:01 P.M. with Maintenance Assistant (MA) #201 confirmed the two areas of missing flooring and the seam down the middle of the floor in Resident #17's room. MA #201 also confirmed the areas where the flooring was missing were moist and peeling back. Page 1 of 2 365309 365309 06/30/2024 Arc at Trotwood LLC 5790 Denlinger Road Dayton, OH 45426

F 0584 This deficiency represents non-compliance investigated under Complaint Number OH00154760 and Complaint Number OH00154449. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 365309 Page 2 of 2