Inspection·June 14, 2024

F 0732 Post nurse staffing information every day. Level of Harm - Potential for minimal harm Based on record review, interview and policy review, the facility failed to ensure the posted staffing document included the total number and the actual hours worked for each discipline and failed to ensure the staffing document reflected any staff absences due to call-offs or illness. This had the potential to affect all residents residing in the facility. Residents Affected - Many Findings include: The facility's document titled Report of Nursing Staff Directly Responsible for Resident Care, for the time frame from 05/13/2024 through 06/13/2024, used by the facility to post the daily staffing, did not reflect the actual hours worked for each discipline nor did it reflect any staff absences or changes due to call-outs or illness. The Report of Nursing Staff Directly Responsible for Resident Care document did not include any RN hours for 05/31/2024 and 06/10/2024. A document titled, Daily Coverage Report, for 05/31/2024 and 06/10/20024 revealed there was RN coverage that was not reflected on the facility's Report of Nursing Staff Directly Responsible for Resident Care forms for 05/31/2024 and 06/10/2024. During an interview on 06/14/2024 at 12:55 PM, the Scheduler stated she had been told to include how many nurses, RNs, LPNs, and state tested nurse aides (STNAs) that were working on the form. She said no one told her she needed to include the total number of actual hours worked on the form. The Scheduler stated she only updated the form at the beginning of the day when she completed it and did not make any changes to the posted forms to reflect any call-ins. During an interview on 06/14/2024 at 3:30 PM, the Director of Nursing (DON) stated she thought the staff postings in the lobby only had to include the number of RNs, LPNs, and STNAs for the day, but she did not know the actual hours worked also needed to be posted. The DON said she was unaware the numbers needed to be updated per shift; she thought it was just at the beginning of the day. The DON stated she expected the information to be posted accurately. During an interview on 06/14/2024 at 1:05 PM, the Administrator stated the forms should include the census, the number of staff from each discipline, the DON, and the Administrator on the top as well as the total census. The Administrator said the form should be updated with each shift if they had any call ins, however, she was unaware it needed to include the total number and actual hours worked per shift for each discipline. Review of the policy titled Staffing & Scheduling, last reviewed on 06/08/22, revealed, Facility will follow CMS [Centers for Medicare and Medicaid Services] Staffing requirements, maintain staffing schedule, and posting of staffing. 1. Facility will comply with CMS and state staffing requirements (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: 365616 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 365616 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kettering Heights Post Acute 3313 Wilmington Pike Kettering, OH 45429 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)