Health inspection·March 6, 2025

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, review of investigation documents, and review of self-reported incidents, the facility failed to report injuries of unknown origin in a timely manner. This affected two (#17 and #30) of two residents reviewed for injuries of unknown origin. The facility census was 141. Findings Include: 1. Review of the medical record for Resident #17 revealed an admission date of 10/23/24. Diagnoses included encephalopathy, dementia, violent behavior, generalized anxiety, heart failure, malnutrition, and cellulitis. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #17 was assessed as cognitively impaired. Review of Resident #17's progress note created 01/17/25, and back dated to 01/13/25 at 3:06 P.M., titled Post Fall Evaluation, revealed documentation that a fall occurred on 01/13/25. The Post Fall Evaluation revealed vital signs were refused by Resident #17 and no injuries were noted. Review of a progress note created 01/17/25, and back dated to 01/13/25 at 3:28 P.M., titled Nurses Note, revealed a head-to-toe assessment was completed and range of motion (ROM) for all extremities were within normal limits. There were no complaints of pain at that time and neurological checks were initiated. Review of a progress note titled Nurses Note, created and completed on 01/16/25 at 3:55 P.M., revealed Resident #17 complained of pain to the right lower extremity during care, the physician and family were notified, an x-ray was ordered and performed, and the pain medication acetaminophen was ordered and administered. Review of a Nurses Note dated 01/16/25 at 10:39 P.M. revealed Resident #17's x-ray results were obtained, and a proximal femoral fracture was reported. The physician was notified of the findings and orders were obtained to send the resident to hospital. Review of a fracture incident investigation dated 01/16/25 revealed Resident #17 had no pain and had full ROM after the fall on 01/13/25. There was no pain or discomfort reported until 01/16/25. Interview with Director of Nursing (DON) #257 on 03/06/25 at 8:55 A.M. revealed no investigation was completed as an injury of unknown origin for possible causes of Resident #17's fractured femur when it was discovered on 01/16/25. DON #257 indicated Resident #17's fractured femur to the fall on 01/13/25. Interview with Licensed Practical Nurse (LPN) #203 on 03/06/25 at 9:47 A.M. revealed the cause of (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 7 Event ID: 365722 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 365722 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wood Glen Alzheimer's Community 3800 Summit Glen Drive Dayton, OH 45449 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)