Health inspection·November 26, 2024

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, staff and resident interview, and policy review, the facility failed to ensure the appropriate size brief was provided to the residents who require and prefer a specific size brief. This affected two (#8 and #16) of two residents reviewed for briefs. The facility census was 60. Residents Affected - Few Findings include: 1. Medical record review for Resident #7 revealed an admission date of 03/20/17. Diagnoses included cerebrovascular attack, coronary artery disease, and morbid obesity. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #7 was cognitively intact. Resident #7 was dependent on staff for toileting and was incontinent for bowel and bladder. Interview with Resident #7 on 11/21/24 at 3:21 P.M. revealed the nursing aides do not provide her with a brief that fits. She has asked many times for a three x-large (XML) brief and the facility doesn't have them. Observation of Resident #7 on 11/21/24 at 3:30 P.M. with Certified Nursing Aide (CNA) #169 revealed CNA #169 stated Resident #7 had on a two XL brief and the right side was fastened ok, but the left side you could see her skin exposed through the fasteners. Interview with CNA #169 on 11/21/24 at 3:35 P.M. verified Resident #7 had on a two XL brief, and Resident #7 required a three XL brief. CNA #169 stated the facility doesn't have any three XL briefs in the facility so she wasn't able to put one on the resident. During an observation of incontinence care for Resident #7 and staff interviews on 11/24/24 at 6:40 A.M. with CNA #186 and CNA #188 both said the brief that was on the resident was a two XL and the agency worked yesterday and didn't put on a three XL on the resident. CNA #186 stated she searched the closet and there wasn't any three XL briefs, so a two XL was placed on Resident #7. Again the right side of the brief fit the resident, but the left side of the brief, one could see her skin through the fasteners. Observation of the three supply rooms in the facility on 11/25/24 at 1:45 P.M. with the Dietary Manager (DM) #116 revealed there wasn't any three XL briefs found. DM #116 verified there were no three XL briefs found in the three supply rooms. 2. Medical record review for Resident #16 revealed an admission date of 02/01/22. Diagnoses (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 6 Event ID: 365789 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 365789 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sanctuary at Wilmington Place 264 Wilmington Avenue Dayton, OH 45420 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)