Health inspection·May 16, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review, staff, and resident interviews, and review of facility policy, the facility failed to ensure a clean, safe, comfortable environment for all residents. This affected 11 (#02, #06, #19, #31, #32, #35, #38, #44, #53, #70, and #71) residents who resided in the facility. The facility census was 77. Findings include: Review of the medical record for Resident #53 revealed the resident was admitted on [DATE]. Diagnoses included hypoxemia, amyotrophic lateral sclerosis (ALS), gastro-esophageal reflux disease (GERD), essential primary hypertension, obstructive sleep apnea (OSA), and diabetes mellitus (DM). Review of the Minimum Data Set (MDS) assessment dated [DATE], revealed Resident #53 was cognitively intact. Resident #53 was dependent on staff for Activities of Daily Living (ADLs). Observation of the facility on 05/13/25 at 11: 30 A.M. with the Director of Housekeeping and Laundry #134 revealed the following findings: a) Resident #02's bathroom was heavily soiled with dirt, debris and an unknown black substance in the corners, the floor was extremely sticky and the cover over the toilet tank was too large and did not properly fit. b) Resident #06's bathroom floor was very sticky, heavily soiled and had black stains throughout the floor. c) The wall behind Resident #19's bed was shredded and torn, the floor around her toilet had an unknown black substance, the cove base below the sink was loose and separated from the wall and there were numerous ceramic tiles missing. d) The wall behind Resident #31's bed was damaged and had exposed drywall, the heater wall was chipped and contained rusted areas, the floor around the toilet was heavily soiled, and the assist bars around the toilet were not secured. e) The wall behind Resident #32's bed was damaged and had exposed drywall, the cove base was separated from the wall under the bathroom sink, and the floor in bathroom was soiled and sticky. f) Resident #35's bed had a heavily soiled sheet with food and debris all over it, the floor had Page 1 of 2 365764 365764 05/16/2025 Centerville Health and Rehab 7300 McEwen Road Dayton, OH 45459

F 0584 food and debris scattered throughout and the floor was extremely sticky. Level of Harm - Minimal harm or potential for actual harm g) Resident #38's bathroom was heavily soiled and stained around the base of the toilet, and in the corners of the bathroom. Residents Affected - Some h) Resident #44's bathroom floor was very sticky, heavily soiled with dirt and debris, and had a large yellow stain around the base of the toilet. i) Resident #70 and Resident #71's entire floor was heavily soiled with a black substance. j) Resident #53's room had numerous chipped ceramic tiles, and the floor was heavily soiled and extremely sticky k) The ice machine in the 200- hallway was heavily soiled, had rusted spots all over the ice machine hopper door. The ice machine had something splattered on it and there was a brown ring inside where the ice was stored. Interview with Director of Housekeeping and Laundry #134 immediately following these observations, verified the above findings. Interview with Resident #53 on 05/13/25 at 2:15 P.M., revealed she was very embarrassed about her room when friends and family visited. Resident #53 stated she ordered a shelf and a rug to try and make the bathroom look more homelike. Review of the facility policy titled, Homelike Environment, dated February 2021, confirmed the facility Residents are provided a safe, clean, comfortable, and homelike environment. The facility staff and management maximize a personalized homelike environment including a clean, sanitary, and orderly environment, and a clean bed This deficiency represents non-compliance investigated under Complaint Number OH00165544. 365764 Page 2 of 2