Health inspection·February 8, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interviews, the facility failed to ensure all residents were treated with respect and dignity. This affected one (#77) out of three residents reviewed for respect and dignity. The facility census was 69. Findings include: Review of the medical record for Resident #77 revealed he was admitted to the facility on [DATE] and discharged on 01/12/24. Diagnoses included dependence on respirator, congenital malformation of brain, acute and chronic respiratory failure with hypoxia, other seizures, fusion of spine, arthropathy, acute infarction of spinal cord, disorder of central nervous system, scoliosis, vitamin d deficiency, anxiety disorder, chronic pain syndrome, and cortical blindness. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 12/11/23, revealed Resident #77 was in a persistent vegetative state and was unable to be assessed for cognitive status. Resident #77 was dependent on staff for oral hygiene, toileting, bathing, dressing, personal hygiene, bed mobility, and transfer. Resident #77 also required the use of a feeding tube. Review of the facility investigation revealed a camera in the room of Resident #77 had recorded State Tested Nursing Assistant (STNA) #800 sitting in the room on her phone with a hand in her pants. Interview on 02/07/24 at 2:02 P.M. via phone with State Tested Nursing Assistant (STNA) #800 revealed she was sent into Resident #77's room by the nurse to observe his breathing treatment. STNA #800 confirmed she was on her phone while in the room, and that she was scratching herself because she had shaved recently and had an itch. Interview on 02/07/24 at 4:35 P.M. with the Administrator and Assistant Director of Nursing (ADON) #108 revealed ADON #108 advised it was not best practice for staff to have phones out in resident rooms. The Administrator reported that he had just met with a detective from the local police department today because Resident #77's family had filed a police report regarding the situation of STNA #800 being in the residents room on a phone and having her hand in her pants. The Administrator stated he had watched the video at the police station, but it was different than what he was shown by Resident #77's family. The Administrator expressed STNA #800 was sitting in a chair with a hand in her pants area and was using her phone. Interview on 02/08/24 at 11:35 A.M. with Social Services Director #55 revealed she had observed the brief video and believed STNA #800's behavior was inappropriate and disrespectful to Resident #77. (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 6 Event ID: 365363 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 365363 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkside Nursing and Rehabilitation Center 908 Symmes Road Fairfield, OH 45014 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)