F 0908
Keep all essential equipment working safely.
Level of Harm - Minimal harm
or potential for actual harm
Based on observation, record review and interview the facility failed to maintain a permanent operational
and functional Heating, Ventilation and Air Conditioning (HVAC) system and failed to ensure necessary
repairs to the existing system were addressed/completed timely to prevent potential interruption of
heating/cooling services. This had the potential to affect all 79 residents who resided in the facility.
Residents Affected - Many
Findings include:
On 12/13/24 an onsite complaint survey was initiated due to complaints there was no working heating
system in the facility/building. Review of the facility survey history revealed since May 2024 the facility
HVAC system was not fully operational.
Observations on 12/13/24 from 9:20 A.M. to 12:45 P.M. revealed the facility HVAC system was not fully
operational and approximately 12 portable heat pump units were observed providing heat throughout the
facility. Air temperatures throughout the facility were ranging from 74 degrees Fahrenheit (F) to 78 degrees
F.
Interview with the Director of Nursing on 12/13/24 at 9:30 A.M. reveled the facility used a water type HVAC
system with a water chilling tower on the roof. The facility had two busted water pipes in May of 2024 and
had been using the portable heating and cooling units since then to provide heat and cooling.
During the onsite investigation, the facility provided a timeline and estimates for repairs for the system. This
included the following:
In May 2024 there was an initial failure of the circulating pump for the water tower. This caused the several
of the fittings on pipes that circulate water to the heat pumps to fail which in turn caused major flooding in
one hallway of the building. The day after this occurred the facility brought in temporary HVAC units in order
to maintain the appropriate temperature within the building.
In June 2024 following the repairs made to the initial area of concern the system was brought back online
and tested. It was then discovered that there was a larger issue as a separate part of the building had a
previously undiscovered failure. The system had to be taken back offline.
In July 2024 the facility received quotes for the necessary repairs needed for the HVAC system. The quote,
dated 07/19/24 revealed a total of 26 new multi-head ductless mini split systems units were recommended
to be installed.
(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:
365838
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
365838
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/19/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Hennis Care Centre of Dover
1720 Cross Street
Dover, OH 44622
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)
F 0908
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Many
However, the facility did not approve the quote until 10/2024 and repair work did not begin until 11/2024. As
of 12/13/24 the HVAC systems repairs had not been completed and the facility remained dependent on
temporary portable heating units to maintain heating/cooling in the facility.
On 12/13/24 at 12:30 P.M. interview with the Director of Nursing (DON) verified the HVAC system had not
been completely installed as of this time with initial issues/concerns first occurring in May 2024. No
additional information was provided as to why there was a delay in the necessary repairs or evidence the
facility had a fully operational permanent HVAC system at the time of the onsite investigation.
On 12/19/2024 at 10:26 A.M., interview with the Director of Maintenance revealed that he was new to the
position starting sometime around the first week of November 2024 and had no knowledge pertaining to
time lines.
This deficiency represents non-compliance investigated under Complaint Number OH00160647 and
Complaint Number OH00159348.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365838
If continuation sheet
Page 2 of 2
