Inspection·May 26, 2023

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to provide baths/showers to dependent residents as scheduled. This affected two (#61 and #63) of three residents reviewed for bathing/showering. The census was 69. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #61 revealed an admission date of 02/20/12. His diagnoses were cerebral infarction, bipolar disorder, dementia, hemiplegia and hemiparesis, hyperlipidemia, personality disorder, psychosis, type II diabetes, obesity, cerebral atherosclerosis, mild cognitive impairment, peripheral vascular disease, anxiety disorder, insomnia, and atherosclerotic heart disease. Review of Resident #61's minimum data set (MDS) assessment, dated 02/24/23, revealed he had a mild cognitive impairment. Review of Resident #61 MDS Assessment, section G, revealed he needed a total of one-person physical assistance for bathing. Review of Resident #61's bathing schedule revealed prior to 04/11/23, his scheduled shower/bath days were Sunday and Wednesday evenings. On 04/11/23 to present, his shower/bath days were Tuesday and Saturday evenings. Review of Resident #61's bathing logs, dated 03/01/23 to 05/26/23, revealed a total of 14 missed scheduled showers/baths. 2. Review of the medical record for Resident #63 revealed an admission date of 07/01/11. Her diagnoses were osteoarthritis, dementia, major depressive disorder, osteoporosis, hypertension, macular degeneration, cardiomegaly, and arthropathy. Review of Resident #61's MDS assessment dated [DATE], revealed she had a significant cognitive impairment. Review of section G revealed she needed physical assistance from one person for bathing. Review of Resident #63's bathing schedule revealed her shower/bath days were Wednesdays and Saturdays. Review of Resident #63's bathing logs, dated 03/01/23 to 05/26/23, revealed a total of 10 missed scheduled showers/baths. Interview with State Tested Nursing Aide (STNA) #104, STNA #105, Registered Nurse (RN) #107, and (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 2 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 05/26/2023 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)