F 0690
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate
catheter care, and appropriate care to prevent urinary tract infections.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, record review, facility staff interview, and policy review, the facility failed to maintain proper
position of a urinary catheter drainage bag for one (Resident #23) of one reviewed for urinary catheters.
The facility census was 76.
Findings include:
Review of Resident #23's medical record revealed the resident was admitted to the facility on [DATE].
Diagnoses included metabolic encephalopathy, retention of urine, dementia, benign neoplasm of pituitary
gland, obstructive reflux uropathy, and testicular hypofunction.
Review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident was
severely cognitively impaired and had no behaviors. Resident #23 was coded to have an indwelling urinary
catheter and required partial moderate assistance with toileting.
Observation on 05/05/24 at 2:06 P.M. revealed Resident #23 was observed lying in the bed and his urinary
catheter drainage bag was observed lying uncovered directly on the floor.
Observation on 05/06/24 at 8:17 A.M. revealed Resident #23 was observed lying in the bed and his urinary
catheter drainage bag was observed lying uncovered directly on the floor.
Interview and observation of Resident #23 with State Tested Nursing Assistant (STNA) #264 on 05/06/24 at
8:18 A.M. verified Resident #23's urinary catheter drainage bag was uncovered lying directly on the floor
and the STNA stated the bag should not to be the floor.
Review of policy titled Catheter Care, Urinary, revised August 2022 revealed catheter tubing and drainage
bags should be kept off the floor for infection control purposes.
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:
365618
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
365618
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/08/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Presidential Post-Acute
524 James Way
Marion, OH 43302
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 0695
Provide safe and appropriate respiratory care for a resident when needed.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview, and policy review, the facility failed to maintain a replacement tracheostomy tube at
the bedside of one resident reviewed for tracheostomy care. This affected one of one resident (Resident #7)
reviewed for tracheostomy care. The facility census was 76.
Residents Affected - Few
Findings include:
Review of the medical record for Resident #7 revealed she had an admission date of 08/31/11. Her
diagnoses included diffuse traumatic brain injury with loss of consciousness of unspecified duration,
quadriplegia, aphasia, hydrocephalus, encounter for attention to tracheostomy, other mechanical
complication of ventricular intracranial (communicating) shunt, and acute and chronic respiratory failure
with hypoxia.
Review of Resident #7's Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #7
requires dependent care for all activities of daily living.
Review of Resident #7's care plan revealed the resident exhibits alteration in respiratory status related to
trach. Interventions included to keep a spare trach/obturator/trach kit at bedside.
Observation on 05/05/24 at 5:00 P.M. with Registered Nurse (RN) Manager #410 revealed Resident #7 had
a tracheostomy and a replacement tracheostomy was not found in the room of Resident #7.
Interview on 05/05/24 at 5:00 P.M. with RN Manager #410 confirmed the room did not have a replacement
tracheostomy. RN Manager #410 went to the nurse's station to get the floor nurse to see if it is in Resident
#7's room.
Interview on 05/05/24 at 05:03 P.M. with RN #449 confirmed Resident #7's room did not have a
replacement tracheostomy.
Review of the policy titled, Tracheostomy Care, dated October 2023 revealed a replacement tracheostomy
tube must be available at the bedside at all times.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365618
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
365618
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/08/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Presidential Post-Acute
524 James Way
Marion, OH 43302
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 0812
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve
food in accordance with professional standards.
Based on observation, interviews, and policy review, the facility failed to properly store chemicals in the
kitchen to prevent cross contamination. This had the potential to affect 74 of 76 residents who received food
from the kitchen. The facility identified two residents (Resident #7 and Resident #42) who did not receive
food from the kitchen. The facility census was 76.
Findings include:
Observation on 05/05/24 at 8:49 A.M. with [NAME] #293 revealed comet bleach powder and dawn dish
detergent were stored on the kitchen preparation sink.
Interview on 05/05/24 at 08:49 A.M. with [NAME] #293 revealed the sink is used to prepare food such as
dicing up peppers, onions, slicing tomatoes, and cleaning lettuce. [NAME] #293 verified the comet bleach
powder and dawn dish detergent were stored on the sink and reported she does not know why the
chemicals are there.
Observation on 05/06/24 at 11:01 A.M. with Dietary Director #312 revealed dawn dish detergent was stored
on the kitchen preparation sink again.
Interview on 05/06/24 at 11:01 A.M. with Dietary Director #312 revealed kitchen chemicals are stored in the
chemical supply closet.
Review of the, Chemical Storage Policy for Nursing Home Kitchen, dated March 2019 stated, 1. Proper
Storage: Chemicals must be stored in a designated area separate from food preparation, storage, and
serving areas to prevent contamination.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365618
If continuation sheet
Page 3 of 3
