Health inspection·December 17, 2024

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, review of the Electronic Information Dissemination and Collection (EIDC) portal for Self-Reporting Incidents (SRI) and review of the facility policy, the facility failed to report an allegation of sexual abuse to the state agency and failed to implement the abuse policy. This affected one (Resident #64) of three reviewed for sexual abuse. The facility census was 82. Findings include: Medical record review revealed Resident #64 was admitted to the facility on [DATE] with diagnoses including Alzheimer's disease, diabetes mellitus type two, psychotic disorder, dementia, and depression. Review of Resident #64's admission Minimum Data Set (MDS) assessment dated [DATE] indicated Resident #64 had a Brief Interview for Mental Status (BIMS) score of one of 15, indicating severely impaired cognition. Resident #64 required staff assistance with activities of daily living. Review of Resident #64 nursing progress notes dated 11/29/24 through 12/18/24 revealed no documentation related to the allegation of sexual abuse, initial assessment of resident, physician notification or family notification. Review of the plan of care dated 12/17/24 revealed Resident #64 had behavioral symptoms related to inappropriate sexual behaviors. The goal was to have fewer episodes of behaviors by the review date. The interventions included administering medications as ordered, assessing the residents understanding of the situation, allowing resident time to express himself, providing re-education, discussing the situation calmly, documenting episodes of inappropriate behaviors and interventions to decrease the behavior. Review of the EIDC for online SRI reporting on 12/17/24 confirmed the facility did not report the allegation of sexual abuse on 12/08/24. Review of the incident/accident log for October 2024, November 2024 and December 2024 revealed no incidents documented related to sexual abuse allegations. Attempted an interview on 12/17/24 at 12:01 P.M. with Resident #64 revealed the resident was alert, oriented to name only and could not focus on questions. Interview on 12/17/24 at 12:56 P.M. with Licensed Practical Nurse (LPN) #55 revealed she had notified Director of Nursing (DON) #47 about the allegation of sexual abuse as reported by Certified Nursing Assistant (CNA) #20 and #56 on 12/08/24. (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 2 Event ID: 365791 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 365791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sanctuary at Ohio Valley 2932 South 5th Street Ironton, OH 45638 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)