Health inspection·January 31, 2024

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. Based on observation, policy review, and interview, the facility failed to provide a safe and comfortable environment for residents when the front hallway and back hallway were cluttered providing an increased risk of falls or accidents for residents. This affected 12 residents (#3, #5, #11, #17, #19, #22, #25, #33, #44, #57, #87, and #89) of 52 residents in the facility. Findings included: Observation on 01/30/24 at 9:08 A.M. during a tour of the facility revealed in the back hallway by the vending machines and therapy gym there were four bedside tables, one bed frame, one shower chair, 12 boxes, a walker, a geri-chair, and a wheelchair all to the right side of the hallway. Additionally, there were three mechanical lifts, two over the bed tables, four nursing carts, and 13 wheelchairs to the right side of the hallway on the front hall. On one nursing treatment cart, the sharps container was approximately one and a half inches over the fill line and on one nursing medication cart, the sharps container was approximately half an inch over the fill line. Interview on 01/30/24 at 9:26 A.M. with Housekeeping Manager #238 confirmed there were multiple items lining the back hallway. Interview on 01/30/24 at 9:29 A.M. with Registered Nurse (RN) #102 confirmed there were multiple items lining the front hallway. RN #102 shook the sharps container from the medication cart to rearrange sharps which brought it down to the fill line. Interview on 01/30/24 at 1:46 P.M. with Resident #55 revealed when the staff park wheelchairs and equipment in her doorway, it is a nuisance because Resident #55 uses a rolling walker and the hallways are obstructive at times to have the wheelchairs out there because the wheels of her walker could get tangled up in the equipment outside her door as she's walking. Review of a policy titled Means of Egress (not dated) revealed furniture placement shall not narrow means of egress or impede evacuation. This deficiency represents non-compliance investigated under Complaint Number OH00150341. 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: 365794 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 365794 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pataskala Oaks Care Center 144 East Broad Street Pataskala, OH 43062 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)