Health inspection·December 2, 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 Based on medical record review, observation, staff and resident interviews, and policy review, the facility failed to provide care and services to ensure fingernails were trimmed and free of dirt and debris. This affected one (#30) out of three residents reviewed for Activities of Daily Living (ADL's). The facility census was 69. Residents Affected - Few Findings include: Review of the medical record for Resident #30 revealed an admission ate of 12/11/18 with medical diagnoses of multiple sclerosis (MS), joint contracture's, and dysphagia. Review of the medical record for Resident #30 revealed a quarterly Minimum Data Set (MDS) assessment, dated 09/27/24, which indicated Resident #30 was cognitively intact and was dependent for all activities of daily living (ADL's) and had limited ROM to one upper extremity. Review of the medical record for Resident #30 revealed documentation to support Resident #30 received a bath or shower on 11/11/24, 11/18/24, and 11/22/24 but did not contain documentation to support nail care was provided. Observation with interview on 11/25/24 at 1:27 P.M. of Resident #30 revealed his fingernails to bilateral hands were long, had jagged edges, and had dirt and debris under the fingernails. Resident #30 stated the facility staff do not cut his fingernails often. Interview on 11/25/24 at 1:30 P.M. with State Tested Nursing Assistant (STNA) # 228 stated residents are to have their fingernails trimmed and cleaned on shower/bath daily. STNA #228 confirmed Resident #30's fingernails were long, had jagged edges, and had dirt and debris underneath the fingernails. Review of the facility policy titled, Activities of Daily Living (ADL), revised March 2018, stated residents would be provided with care, treatment and services as appropriate to maintain or improve their ability to carry out ADL's. The policy stated care and services would be provided for residents who are unable to carry out ADL's independently, with the consent of the resident and in accordance with the plan of care including appropriate support and assistance with hygiene (bathing, dressing, grooming, and oral care), mobility, elimination, and dining. This deficiency represents non-compliance investigated under Complaint Number OH00160055. 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 6 Event ID: 365764 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 365764 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Centerville Health and Rehab 7300 McEwen Road Dayton, OH 45459 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)