Inspection·November 13, 2023

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 medical record review, staff interview, and review of a facility policy, the facility failed to ensure residents received appropriate assistance with bathing. This affected three (#13, #16, and #23) of four residents reviewed for bathing assistance. The census was 54. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #13 revealed an admission date of 10/13/23. Medical diagnoses included diabetes mellitus type II, sleep apnea, and malignant neoplasm of the prostate. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed the resident was assessed as having intact cognition, and required set up assistance for eating, was dependent for toileting, bed mobility, and transfers, and required substantial to maximal assistance for showers and bathing. Record review of shower documentation revealed Resident #13's showers were scheduled twice weekly (on Tuesday and Friday) on the day shift. Further review of the shower documentation between 10/13/23 and 11/03/23 for Resident #13 revealed showers were documented as given on 10/16/23, 10/18/23, 10/26/23, and 11/03/23. 2. Review of the medical record for Resident #23 revealed an admission date of 12/01/21. Medical diagnoses included stroke, hemiparesis, Parkinson's disease, and dementia. Review of the Significant Change MDS assessment dated [DATE] revealed the resident was assessed as cognitively impaired, and required extensive assistance for bed mobility, eating, and toileting, and was dependent for showers. Record review of the shower documentation revealed Resident #23's showers were scheduled twice weekly (on Monday and Thursday) on the day shift. Further review of the shower documentation between 10/05/23 and 10/26/23 revealed Resident #23 was provided a shower on 10/05/23, 10/09/23, 10/12//23, 10/15/23, 10/16/23, and then not again until 10/26/23. 3. Review of the medical record for Resident #16 revealed an admission date of 01/13/23. Medical diagnoses included chronic obstructive pulmonary disease, fracture of the left fibula, diabetes mellitus, and congestive heart failure. Review of the MDS assessment dated [DATE] revealed the resident was assessed with moderate cognitive impairment, and was dependent for bathing and toileting. (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: 365773 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 365773 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Laurels of Kettering 694 Isaac Prugh Way Kettering, OH 45429 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)