Health inspection·July 18, 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. Based on Observations, interviews and record review the facility failed to provide privacy during resident care. This affected six (Resident #13, #51, #65, #68, #71, and #106) of 20 residents residing on the memory care unit. Findings include: Review of medical record for Resident #106 revealed an admission date of 07/27/21. Resident #106 had impaired cognition. Review of medical record for Resident #13 revealed an admission date of 08/05/22. Resident #13 had impaired cognition. Review of medical record for Resident #15 revealed an admission date of 01/25/24. Resident #15 had impaired cognition. Review of medical record for Resident #51 revealed an admission date of 04/12/23. Resident #51 had impaired cognition. Review of medical record for Resident #68 revealed an admission date of 08/05/22. Resident #68 had impaired cognition. Review of medical record for Resident #74 revealed an admission date of 04/26/24. Resident #74 had impaired cognition. Observations on 07/18/24 at 9:52 A.M. revealed Podiatrist #152 set up in the dining room/ activity room trimming Resident #106's toenails. Residents #13, #15, #51, #68, and #71 were seated in the room because they also had their toenails trimmed. Interview on 07/18/24 at 9:56 A.M., the Activity Director #151 stated she did not know why the Podiatrist was in the dining room trimming nails. Interview on 07/18/24 at 10:00 A.M., the Activity Assistant #150 stated Podiatrist #152 trimmed the toenails for four other residents. Observations of the area where the trimming took place revealed toenail clippings approximately a two-by-two-foot area on the floor. The activity assistant verified the findings and stated he should have taken the residents to their room to provide care. Interview on 07/18/24 at 10:14 A.M., Podiatrist #152 stated he was not sure why the facility had (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 3 Event ID: 365639 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 365639 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kingston of Vermilion 4210 Telegraph Lane Vermilion, OH 44089 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)