Inspection·December 30, 2024

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 record review, observation, resident and staff interviews, and review of facility policy, the facility failed to ensure staff timely answered a resident's call light. This affected one (#9) of six residents reviewed for call lights. The census was 83. Findings include: Review Resident #9's medical record revealed an admission date of 08/14/24. Diagnoses listed included type two diabetes mellitus, hypertension, major depressive disorder, and acute kidney failure. Review of a quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #9 had moderate cognitive impairment, was frequently incontinent of bowel, and had a indwelling urinary catheter. Observation on 12/23/24 at 10:04 A.M. revealed the call light was on for Resident #9's room. The light above the door was illuminated and an audible beeping could be heard. At 10:12 A.M. Licensed Practical Nurse (LPN) #160 could be seen sitting at the nurse's station at the end of the hall. Resident #9's room call light remained on. At 10:25 A.M. LPN #160 walked by Resident #9's room and LPN #160 did not address the call light. At 10:26 A.M. the Administrator and entered Resident #9's room to answer the call light. During an interview on 12/23/24 at 10:29 A.M. interview with the Administrator revealed Resident #9 had his call light on to ask to had incontinence brief changed. The Administrator confirmed a call light should be answered timely. The Administrator confirmed confirmed 22 minutes was not considered timely. The Administrator confirmed any staff member can address a resident call light. The Administrator confirmed LPN #160 should have addressed Resident #9's call light. Interview with Resident #9 on 12/23/24 at 12/23/24 at 10:33 A.M. revealed he had his call light on due to concerns with his urinary catheter leaking. Resident #9 stated it takes awhile to have call lights answered. Review of the facility policy titled Call Lights dated effective 04/01/22 revealed call lights should be answered in a timely manner. This deficiency represents non-compliance investigated under Complaint Number OH00160868. 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: 365627 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 365627 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/30/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurels of Huber Heights The 5440 Charlesgate Road Huber Heights, OH 45424 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)