Inspection·December 16, 2025

F 0576 Ensure residents have reasonable access to and privacy in their use of communication methods. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observations, staff and resident interviews and policy review, the facility failed to provide a private space for phone conversations without being overheard. This affected one (#80) out of three residents reviewed for reasonable access to privacy. The facility census was 78. Findings include: Review of the medical record for Resident #80 revealed an admission on [DATE] with diagnoses that include dementia without behaviors, anxiety and stroke. Review of the quarterly Minimum Data Set (MDS) assessment for Resident #80 dated 09/30/25 revealed a brief interview for mental status score of 13 indicating a normal thinking and memory. Review of the plan of care for Resident #80 revealed resident requires a private room related to behaviors and psychosocial needs dated 09/29/25. Interventions include psychosocial support and remain in private room. Observation on 12/11/25 at 10:30 A.M. revealed Resident #80 was in his room resting in bed without a phone visualized. Interview on 12/16/25 at 11:00 A.M. with Licensed Practical Nurse (LPN) #117 stated the residents that want to use the phone can use the phone at the nurses' station. LPN #117 stated the 600 hall has one resident that routinely uses the nurses' station phone. LPN #117 stated the area where the phone is located does not provide for private communication due to the potential of visitors, staff, or residents overhearing the conversation inadvertently. Interview on 12/16/25 at 12:00 P.M. with Registered Nurse (RN) #111 stated the nursing station in the memory care unit had a cordless phone for residents to use. Observation on 12/16/25 at 12:00 P.M. revealed a cordless telephone base on the nursing station without the cordless phone in the base. Further observation of the cordless phone base revealed the unit was not attached to any power source, additionally RN #111 attached the phone to the base after connecting it to power and revealed the cordless phone was not charged or operational. Interview on 12/16/25 at 12:03 P.M. with RN #111 stated Resident #80 resident uses the phone at the nurses station to call his family. Additionally, stated that the staff will leave the area to provide privacy. RN #111 verified the area was not enclosed and would not be private in the event of staff/visitors entering the secured dementia unit. Interview on 12/16/25 at 1:30 P.M. with Administrator verified the cordless phones would not work with the current phone system. The Administrator stated the facility did not have a designated area for residents to use facility phones allowing for private conversations. Interview on 12/16/25 at 3:47 P.M. with Resident #80 verified he receives and makes calls from the phone at the nursing station. Resident #80 stated he has not been provided a cordless phone to ensure private conversations. Observation on 12/16/25 at 5:40 P.M. of Resident #80's room revealed there was a corded phone on the stand beside the bed. Interview on 12/16/25 at 5:45 P.M. with Certified Nursing Assistant (CNA) #176 verified Resident #80 did not have the phone in his previous room and did not know who or when the phone arrived in the room. CNA #176 verified the phone was not plugged into the phone jack. CNA #176 plugged the phone into the phone jack and verified the phone was not operational. CNA #176 stated Resident #80 just spoke with his family at the nurses station. CNA #176 stated she Residents Affected - Few (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 4 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 12/16/2025 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)