Health inspection·December 23, 2024

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 record review, review of the facility's shower schedules, resident interview, staff interview, and policy review, the facility failed to ensure residents, who were dependent on staff for personal care, received the assistance needed to receive showers as scheduled. This affected three (Resident #3, #9, and #30) of three residents reviewed for activities of daily living (ADL). Residents Affected - Few Findings include: 1. Review of Resident #3's medical record revealed he was admitted to the facility on [DATE]. His diagnoses included a dislocation of his right hip prosthesis, unsteadiness on feet, repeated falls, diabetes mellitus with diabetic neuropathy, muscle weakness, malignant neoplasm of the prostate, congestive heart failure, and hypertension. Review of Resident #3's admission Minimum Data Set (MDS) assessment dated [DATE] revealed the resident did not have any communication issues and was cognitively intact. He was not known to display any behaviors nor was he known to reject care during the seven days of the assessment period. He required substantial assistance with showers/baths and transfers. Review of Resident #3's care plan revealed he had a care plan in place for ADL functional status which required therapy services related to a decline in his prior level of function of ADL's/mobility. It was due to an impaired ability to perform ADL's and difficulty walking and the goal was for his ADL function to improve. The interventions included allowing him as much independence with ADL's as possible while still maintaining his safety, provide encouragement as needed to participate with ADL's daily and to offer praise for his efforts, provide assistance as needed with ADL's and to refer to the resident's profile for ADL assistance needed. Review of the Unit 2 shower schedule revealed Resident #3 was to receive a shower/bath every Tuesday, Thursday, and Saturday on the day shift. Review of Resident #3's shower documentation from 11/26/24 to 12/21/24 revealed the resident had no documented evidence of receiving showers/baths on his scheduled shower days on six of the 12 opportunities he was to receive one. There was no evidence he received a shower or bath on 11/30/24, 12/05/24, 12/07/24, 12/10/24, 12/19/24 or 12/21/24. He was further indicated to have only received a partial bed bath on 11/28/24, which was a scheduled shower day. 2. Review of Resident #9's medical record revealed he was admitted to the facility on [DATE]. He remained in the facility until he was discharged home on [DATE]. His diagnoses included orthopedic aftercare, infection of a surgical site, fracture of the upper end of his femur, difficulty walking, (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: 365750 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 365750 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare Somerset Inc. 411 South Columbus Street Somerset, OH 43783 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)