Health inspection·December 24, 2025

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 Based on observation, medical record review, and staff and resident interview, the facility failed to ensure showers were provided to dependent residents as scheduled. This affected two (#72 and #37) of three residents reviewed for showers. Additionally, the facility failed to ensure residents received timely assistance with eating. This affected three (#37, #84, and #65) of three residents reviewed for assistance with eating. The facility identified 21 residents who required staff assistance with eating. The facility census was 99. Findings include: 1. Review of the medical record for Resident #72 revealed an admission date of 06/29/23. Diagnoses included hypertensive heart disease with heart failure, unspecified dementia, and orthostatic hypotension.Review of the quarterly Minimum Data Set (MDS) assessment, dated 09/14/25, revealed Resident #72 had intact cognition as evidenced by a Brief Interview for Mental Status (BIMS) score of 15. This resident was assessed to require setup assistance with showering and bathing.Review of the care plan dated 06/29/23 revealed Resident #72 required assistance with activities of daily living (ADLs) related to lumbosacral spondylosis, impaired mobility, chronic pain, and arthritis. Interventions included assisting with showers twice weekly, or per resident preference.Review of the shower documentation for Resident #72 from 11/24/25 through 12/22/25 revealed a shower was given on 11/24/25, 12/11/25, 12/18/25, and 12/22/25 (four of nine opportunities).Interview on 12/18/25 at 9:43 A.M. with Resident #72 revealed showers were to be given on Mondays and Thursdays. Resident #72 further stated she rarely received a shower on Mondays, due to staff being too busy.Interview on 12/22/25 at 10:55 A.M. with Licensed Practical Nurse (LPN) #212 confirmed there was no evidence Resident #72 was provided showers on 12/01/25, 12/08/25, and 12/15/25 (all Mondays).2. Review of the medical record for Resident #37 revealed an admission date of 03/29/23. Diagnoses included hemiplegia and hemiparesis following cerebral infarction (stroke) affecting right dominant side, dysphagia, and dementia.Review of the quarterly MDS assessment, dated 10/02/25, revealed Resident #37 had impaired cognition as evidenced by a BIMS score of five. Resident #37 was dependent on staff to complete ADL care.Review of the care plan dated 03/29/23 revealed Resident #37 required ADL assistance related to cardiovascular accident (stroke) with right hemiparesis, dementia, anxiety, depression, and arthritis. Interventions included assisting with meals and assisting with showers twice weekly. Review of the shower documentation for Resident #37 from 11/26/25 through 12/20/25 revealed a sponge bath was given on 11/26/25 and a bed bath was given on 12/20/25 (two of seven opportunities), with no showers documented. Observation on 12/18/25 at 9:35 A.M. revealed Resident #37 was sitting in a wheelchair near the 600 hall. Resident #37 had dry skin on her scalp and face. Further observation revealed Resident #37 had a large amount of an unknown substance under all of her fingernails. Interview on 12/18/25 at 9:56 A.M. with Certified Nursing Assistant (CNA) #203 revealed shower documentation was only completed in the electronic medical record (EMR) and included the type of shower or washing, how much staff assistance the resident required, and if the resident refused care. CNA #203 confirmed Resident #37 was to receive a shower twice weekly and the Residents Affected - Some (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 12/24/2025 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)