Health inspection·September 26, 2019

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, resident interview, staff interview, and review of facility policy, the facility failed to respect the rights of two residents (#47 and #178) of two observed wearing smoking aprons when they were not needed. The facility census was 81. Findings include: 1. Review of Resident #47's medical record revealed an admission date of 7/18/18 with diagnoses including type two diabetes mellitus, congestive heart failure, left above the knee amputation, and major depressive disorder. Review of Resident #47's care plan dated 07/19/19 revealed the resident had a history of smoking and desired to smoke. Interventions included to smoke safely in designated areas, offer smoking cessation options, staff to provide smoking materials and light cigarettes and not to leave resident unattended when smoking. Review of Resident #47's smoking assessment dated [DATE] revealed interventions included allowing the resident to smoke independently in designated areas, and the resident did not require a smoking apron or vest. Review of Resident #47's Minimum Data Set (MDS) dated [DATE] revealed resident was cognitively intact. Observation of residents smoking on 09/23/19 at 10:03 A.M. revealed State Tested Nurse Aide (STNA) #520 placed a smoking apron on Resident #47. Interview with Resident # 47 on 09/24/19 at 8:51 A.M. revealed the facility had never put smoking aprons on the residents in the past and wearing a smoking apron made him feel uncomfortable and embarrassed. 2. Review of Resident #178's medical record revealed an admission date of 09/21/19 with diagnoses including cerebral infarction (stroke) and anxiety disorder. Review of Resident #178's care plan dated 9/22/19 revealed the resident had a history of smoking and desired to smoke with interventions to smoke safely in designated areas, offer smoking cessation options, staff to provide smoking materials, light cigarettes and not to leave resident unattended when smoking. (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 5 Event ID: 365621 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 365621 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillsboro Post Acute 1141 Northview Drive Hillsboro, OH 45133 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)