Inspection·March 18, 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 medical record review, resident interview, review of the Certification and Licensure System (CALS), staff interview and review of facility policy, the facility failed to report an allegation of inappropriate staff touching as potential resident abuse to the Ohio Department of Health (ODH). This affected one resident (#38) of three residents reviewed for abuse. The facility census was 83. Findings include: Review of Resident #38's medical record revealed an admission date of 09/17/24. Diagnoses included chronic respiratory failure, morbid (severe) obesity and Type II diabetes. Review of the quarterly Minimum Data Set (MDS), dated [DATE], revealed Resident #38 was cognitively intact, required set-up assistance with eating and oral hygiene, partial staff assistance with bed mobility and transfers, and substantial staff assistance with toileting hygiene, bathing, dressing, personal hygiene, and wheelchair mobility. Review of the physician orders revealed an order dated 02/22/25 for No Male Care for showers every shift for Post traumatic Stress Disorder (PTSD). Review of the care plan, dated 03/15/25, revealed Resident #38 preferred no male staff for showers, with a goal to not receive showers from male staff. Interventions included to keep a list of no male showers in the schedule book and respect resident's preference and carry them out while resident is in the facility. Interview on 03/18/25 at 11:01 A.M. with Resident #38 revealed a male Certified Nursing Assistant (CNA) had touched her inappropriately on two occasions. Further interview confirmed the male CNA was CNA #174. Resident #38 was unable to recall the date of the first incident but reported CNA #174 tickled her under her arms when she had her shirt on, which she did not like and it made her uncomfortable. Resident #38 stated she reported it at that time. Resident #38 reported that about one week ago, CNA #174 again tickled her under her arms. This time she had no shirt on. Resident #38 stated she did not like CNA #174 touching her under her arms, near her breasts, and she felt uncomfortable. Resident #38 stated she reported her concerns to the Director of Nursing (DON). The resident confirmed CNA #174 had not been back in her room but she was uncomfortable when he was around. Review of the facility submitted Self-Reported Incidents (SRIs) from 02/01/25 through 03/17/25, located in CALS, revealed no evidence the facility reported Resident #38's allegations of inappropriate staff touching. (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 4 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 03/18/2025 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)