Health inspection·September 25, 2024

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, resident interview, staff interview, and policy review, the facility failed to provide activities of daily living care (ADL) for dependent residents who required assistance from staff with bathing/showers. This affected three of three residents (#38, #41, and #52) reviewed for showers. The facility identified all residents required assistance with showers and bathes. The facility census was 42. Residents Affected - Few Findings include: 1. Review of Resident #38's medical record revealed an admission date of 07/24/24. Diagnoses included Parkinson's disease, morbid obesity, femur fracture, and acute respiratory failure. Review of Resident #38's quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed she was cognitively intact and required substantial/maximum assistance from staff for showers and bathing. Review of Resident #38's care plan revealed she was dependent on staff for bathing and would be clean, dry, and odor free, and appropriately groomed through next review period. Interventions included to assist with showers as scheduled and assist with personal grooming daily and as needed. Review of the facility's shower schedule revealed Resident #38 was to be bathed every Tuesday and Friday on the day shift. Review of Resident #38's ADL record from 08/01/24 to 09/22/24 revealed she was bathed four times during this time on the following dates: a complete bed bath on 08/20/24, a partial bath on 08/28/24, complete bed bath on 09/11/24, and a partial bed bath on 09/18/24. There were 11 missed opportunities for Resident #38 to receive a bed bath/shower. Resident #38's medical record revealed no documentation regarding the reason the bathes/showers were failed to be completed. Interview with Resident #38 on 09/23/24 at 11:22 A.M. revealed she was unable to take showers due to being unable to get out of bed which was her choice. She stated she normally received a bed bath weekly. Interview with the Director of Nursing (DON) on 09/25/24 at 3:05 P.M. verified showers and baths failed to be given timely to Resident #38. 2. Review of Resident #52's medical record revealed an admission date of 11/03/23. Diagnoses included schizophrenia, chronic kidney disease, and diabetes mellitus. Review of Resident #52's MDS assessment revealed the resident was cognitively intact. He required (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 3 Event ID: 365351 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 365351 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Signature Healthcare of Galion 935 Rosewood Dr Galion, OH 44833 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)