Health inspection·August 11, 2022

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, review of the facility's policy, and resident and staff interview, the facility failed to conduct quarterly care conference meetings. This affected one (Resident #5) of two residents reviewed for participation in care planning. The facility census was 77. Findings include: Review of the medical record for Resident #5 revealed an admission date of 11/05/20. Diagnosis included congested heart failure (CHF), thrombocytopenia, atrial fibrillation, cerebral vascular accident (CVA), candidiasis of skin and nail, major depressive disorder, chronic obstructive respiratory disease (COPD), and prediabetes. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #5 had intact cognition. The resident required extensive two person assistance for bed mobility, and total two person assistance for transfers. Review of the progress notes revealed the most recent care conference occurred on 10/28/21 at 2:32 P.M. Interview on 08/08/22 at 4:19 P.M. with Resident #5 stated he couldn't remember the last time he had participated in a care conference. Interview with the Director of Nursing (DON) on 08/11/22 at 8:26 A.M. confirmed the last care conference held for Resident #5 was on 10/28/21. The DON stated the facility did not have a social worker and they had hired a social worker scheduled to start work on 08/15/22. Review of the facility's policy titled Social Services Guidelines, dated 08/2021, revealed the interdisciplinary care conference is the culmination of the care planning process and is held in conjunction with Minimum Data Set (MDS) activity. Prior to the care conference, the patient is assessed through the MDS assessment process, and based on the findings for each care area, care plans are written and, or revised together with the patient, patient representative and family. The care conference is then scheduled to be held within seven days of the close of the MDS. The purpose of a care conference is for the interdisciplinary team to review their current findings and their focus moving forward. 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 4 Event ID: 365374 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 365374 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beavercreek Post Acute 1974 North Fairfield Road Dayton, OH 45432 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)