Inspection visit
Inspection
1 citation recorded
Inspector’s narrative
What the inspector wrote
This survey cited 1 deficiency. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0880
Provide and implement an infection prevention and control program.
Level of Harm - Minimal harm
or potential for actual harm
Based on review of facility infection control records, observations, staff interviews, review of electronic mail
(e-mail) correspondence, review of facility policies and procedures, review of the Center for Disease Control
and Prevention CDC) guidance, and review of Ohio Department of Health's (ODH) guidance for reporting
infectious diseases, the facility failed to develop and implement effective infection control policies and
practices which includes a failure to ensure cleaning schedules for ice buckets were
developed/implemented, failure to ensure storage areas were maintained in a sanitary manner to
potentially prevent rodent/animal contamination, failure to ensure the handwashing sink in the kitchen was
appropriately functioning, failure to develop written policies and procedures which included when and to
who potentially communicable diseases should be reported, and failure to ensure the local health
department was notified in a timely manner of a Campylobacter illness outbreak. This affected a total of
nine (Resident #10, #32, #43, #45, #48, #54, #61, #65 and #66) residents who experienced gastrointestinal
symptoms, five of which (Resident #10, #32, #48, #61 and #66) tested positive for Campylobacter. This had
the potential to affect all 67 residents residing in the facility. The facility census was 67.
Residents Affected - Many
Findings include:
Review of the facility infection control records for a 2024 gastrointestinal outbreak revealed the onset of the
outbreak was 03/12/24 and the reporting date was 04/01/24. The facility had nine (#10, #32, #43, #45, #48,
#54, #61, #65 and #66) residents who experienced gastrointestinal illness including symptoms of vomiting
and/or diarrhea (loose stools) from 03/12/24 through 03/31/24. On 03/12/24, Resident #66 experienced
loose stools. On 03/17/24, Resident #32 experienced loose stools. On 03/18/24, Resident #10 experienced
both vomiting and loose stools. On 03/22/24, Resident #45 experienced vomiting. On 03/25/24, Resident
#61 experienced loose stools. On 03/27/24, Resident #65 experienced loose stools. On 03/30/24, Resident
#43 experienced loose stools and Resident #48 experienced both vomiting and loose stools. On 03/31/24,
Resident #54 experienced loose stools. Five (#10, #32, #48, #61 and #66) residents tested positive for
Campylobacter
Further review of the infection control records revealed the facility had five (Director of Nursing (DON),
State Tested Nursing Assistant (STNA) #220, Licensed Practical Nurse (LPN) #312, Registered Nurse
#223 and #300) staff members who experienced gastrointestinal illness including symptoms of vomiting,
diarrhea (loose stools), and/or nausea from 03/11/24 through 04/06/24. There were no confirmed cases of
Campylobacter among the staff.
Initial tour of the facility on 04/11/24 at 8:17 A.M. through 8:35 A.M. with Human Resource Director #246,
revealed the kitchen had one sink with soap and hand towels for handwashing but observations revealed
the sink did not have working hot water. Observations revealed there was no sign indicating the hot water
was not working and/or no sign indicating where staff should wash their hands.
(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:
365607
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
365607
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
04/11/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Ayden Healthcare of Piqua
275 Kienle Drive
Piqua, OH 45356
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)
F 0880
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Many
While completing the facility tour, an interview on 04/11/24 at 8:33 A.M. with [NAME] #252, confirmed she
was not sure how long the hot water had not been working but knows it has been at least a couple of days.
[NAME] #252 also revealed management has been working on it. [NAME] #252 revealed staff has been
washing their hands in the 3-sink area. [NAME] #252 confirmed there is no soap or hand towels in 3-sink
area, but she just uses what is available in the sink area that is not working. [NAME] #252 also confirmed
other staff members would not know which sink to use unless told because there is not a sign hung to let
staff know the hot water is not working and to use the other sink.
Interview on 04/11/24 at 10:47 A.M. with [NAME] #310 confirmed the hot water in the hand washing sink is
not working and it hasn't worked for a couple weeks. [NAME] #310 also confirmed the last Administrator
was told it was not working before he left. [NAME] #310 confirmed staff wash their hands in the
3-compartment sink area and the staff use the hand soap and hand towels available at the hand washing
sink which is approximately eight feet away. [NAME] #310 confirmed the new ice buckets have only been
brought to the kitchen one time since 04/08/24 to be run through the dishwasher. [NAME] #310 is not aware
of a cleaning schedule for the ice buckets, which are used to pass ice to the residents.
During an interview on 04/11/24 at 11:38 A.M., the DON confirmed the local health department was not
notified of the gastrointestinal outbreak until 04/01/24, which was approximately 20 days after the outbreak
began. The DON also confirmed there was no policy which specified when and to whom communicable
diseases should be reported. The DON also confirmed gloves and Styrofoam cups that were stored in the
garage that was contaminated with possible rodents and cat feces and these items were being used.
Observations of the storage garage and interview with the DON revealed the area had been cleaned up
and there was currently no evidence of rodents or cats in the area. The DON confirmed that new ice
buckets have been purchased based on the recent health departments recommendations but there is not a
cleaning schedule in place, but there are expectations of the night shift floor staff to take them to the
kitchen and change them out nightly for clean ones. The DON confirmed a total of nine (#10, #32, #43, #45,
#48, #54, #61, #65 and #66) residents who experienced gastrointestinal symptoms and five (#10, #32, #48,
#61 and #66) residents tested positive for Campylobacter. The DON confirmed there were five (DON, STNA
#220, LPN #312, RN #223 and #300) staff members who experienced gastrointestinal illness including
symptoms of vomiting, diarrhea (loose stools), and/or nausea from 03/11/24 through 04/06/24 but there
were no confirmed cases of Campylobacter among these staff members.
Interview on 04/11/24 at 2:20 P.M. with LPN #326 confirmed when gloves and Styrofoam cups were needed
staff would go to the garage and pull the extra from the stock. LPN #326 confirmed there were evidence in
the garage, before all of the outbreak, of cats using the garage as a litter box. LPN #326 confirmed gloves
would be worn to pull supplies out of the garage so not to touch any nasty items.
Interview on 04/11/24 at 2:39 P.M. with STNA #220 confirmed no knowledge of who's responsible for
cleaning the ice buckets on the halls. STNA #220 confirmed the ice buckets are used to pass ice to
residents. STNA #220 confirmed gloves and Styrofoam cups were pulled from the garage when it was dirty
and had possible animal feces everywhere.
Interview on 04/11/24 at 4:11 P.M. with the Administrator confirmed he was not aware of the hot water not
working in the hand washing sink in the kitchen until today. The Administrator also confirmed the staff in the
kitchen were aware to wash their hands in the prep sink and there was soap available for use. The
Administrator confirmed there was no sign at the hand washing sink in the kitchen to inform staff the sink
was not working and to use the prep sink. The Administrator confirmed staff members who do not work in
the kitchen, would not know to wash their hands elsewhere. The
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365607
If continuation sheet
Page 2 of 3
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
365607
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
04/11/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Ayden Healthcare of Piqua
275 Kienle Drive
Piqua, OH 45356
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)
F 0880
Administrator confirmed the hot water in the hand washing sink was fixed during the investigation.
Level of Harm - Minimal harm
or potential for actual harm
Review of the e-mail correspondence from the local health department, dated 04/01/24, revealed after
reviewing the line list, the Campylobacter was the infection with the first positive case being on 03/14/24
and the local health department notification was on 04/01/24. The health department inquired about any
other interventions implemented such as staff being kept from work for at least 48 hours past resolution of
symptoms.
Residents Affected - Many
Review of the facility policy titled Infection Prevention and Control Program (IPCP), revised 11/15/21,
revealed the IPCP designee should report communicable diseases that are reportable to local/state public
health authorities. The policy did not contain specific information regarding when and to whom potentially
communicable diseases would be reported.
Review of the CDC guidance titled Guideline for the Prevention and Control of Campylobacter
Gastroenteritis Outbreaks in Healthcare Settings dated 07/03/23, revealed as with all outbreaks, notify
appropriate local and state health departments, as required by state and local public health regulations, if
an outbreak of Campylobacter is suspected.
Review of ODH guidance titled, Know Your ABCs: A Quick Guide to Reportable Infectious Diseases in Ohio,
effective 08/01/19 revealed Campylobacter was listed under the section Class B. Facilities should report an
outbreak, unusual incident or epidemic of other diseases by the end of the next business day.
This deficiency represents non-compliance investigated under Complaint Number OH00152778.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365607
If continuation sheet
Page 3 of 3
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Back to topCitations
1 citation recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F880 - Infection Control
Provide and implement an infection prevention and control program.
FAQ · About this visit
Common questions about this visit
What happened during the April 11, 2024 survey of AYDEN HEALTHCARE OF PIQUA?
This was a inspection survey of AYDEN HEALTHCARE OF PIQUA on April 11, 2024. The surveyor cited 1 deficiency, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at AYDEN HEALTHCARE OF PIQUA on April 11, 2024?
Yes, 1 deficiency was cited, each with a CMS Scope and Severity grade. The first was: "Provide and implement an infection prevention and control program."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
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Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.