Health inspection·November 24, 2025

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, facility policy review, and review of Enhanced Information Dissemination and Collection system (EIDC) the facility failed to ensure an allegation of abuse was investigated and reported. This affected one Resident (#103) of three residents reviewed for falsification of medical records. The facility census was 112.Findings Include:Record review for Resident #103 revealed the resident was admitted to the facility on [DATE] with the following diagnoses: Alzheimer's disease with late onset, vascular dementia with agitation, psychotic disorder with delusions, and delirium (confusion).Review of nurses note dated 10/17/25 at 9:55 P.M. revealed Resident #103 was observed walking up to another resident and pulled their hair. Staff immediately intervened and helped Resident #103 to their room.Review of EIDC records on 11/24/25 at 2:05 P.M. revealed there was no Self-Reported Incident (SRI) for the incident on 10/17/25 at 9:55 P.M.Interview with the Director of Nursing (DON) on 11/24/25 at 2:55 P.M. verified the nurses note but was unable to state why an SRI was not completed.Interview with the Executive Director (ED) on 11/24/25 at 3:40 P.M. verified the presence of the nurses note, further verified there was no SRI completed but there should have been. Further interview stated they were unaware of the incident until noted by the surveyor. ED stated a SRI will be completed today.Review of policy titled Abuse, Neglect and Exploitation, dated 06/11/25, revealed an immediate investigation is warranted when there are reports of abuse. Further review revealed allegations of abuse need to be reported to required agencies no later than 24 hours after an event of abuse that does not involve serious bodily harm.This deficiency represents non-compliance investigated under Complaint Number 2659051. 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 2 Event ID: 365321 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 365321 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oaks of West Kettering The 1150 West Dorothy Lane Kettering, OH 45409 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)