F 0729
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Many
Verify that a nurse aide has been trained; and if they haven't worked as a nurse aide for 2 years, receive
retraining.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** THE
FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NON-COMPLIANCE THAT WAS
SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY.
Based on review of personnel files, review of the Ohio Department of Health (ODH) Nurse Aide Registry,
and staff interviews, the facility failed to ensure that three State Tested Nursing Aide's (STNA) registrations
were not expired. This affected three (STNA #36, #123 and #131) out of three STNA's reviewed for active
registrations and had the potential to affect all residents residing in the facility. The facility census was 97.
Findings include:
1. Review of the personnel file for STNA #123 revealed a hire date of [DATE]. Review of the ODH Nurse
Aide Registry revealed STNA #123's registration expired on [DATE] and had a registry status of expired.
The registry stated expired: we have received no work verification in the past 24 months, therefore this
individual is not eligible for employment in a long term care facility.
Interview on [DATE] at 11:27 A.M. with STNA #123 revealed her STNA registration was expired. STNA
#123 said she reported this to the Director of Nursing (DON) last month. STNA #123 said the facility had to
send in paperwork. STNA #123 said human resources was supposed to renew her license. STNA #123
revealed she worked everywhere in the facility.
2. Review of the personnel file for STNA #36 revealed a hire date of [DATE]. Review of the ODH Nurse Aide
Registry revealed STNA #36's registration expired on [DATE] and had a registry status of expired. The
registry stated expired: we have received no work verification in the past 24 months, therefore this
individual is not eligible for employment in a long term care facility.
Interview on [DATE] at 11:36 A.M. with STNA #36 revealed her STNA registration was expired. STNA #36
said she was trained at the facility. STNA #36 stated after 24 years, she hadn't looked at it and indicated
she talked to someone to update the registration for her but the person she talked to went to another
building.
3. Review of the personnel file for STNA #131 revealed a hire date of [DATE]. Review of the ODH Nurse
Aide Registry revealed STNA #131's registration expired on [DATE] and had a registry status of expired.
The registry stated expired: we have received no work verification in the past 24 months, therefore this
individual is not eligible for employment in a long term care facility.
Interview on [DATE] at 12:37 P.M. with STNA #131 revealed he looked at the ODH Nurse Aide Registry
(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:
365839
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
365839
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/06/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Columbus Alzheimer's Care Ctr
700 Jasonway Avenue
Columbus, OH 43214
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 0729
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Many
and saw that his registration had expired. STNA #131 told the Director of Nursing (DON) that his
registration had expired. STNA #131 also revealed that he had been working the whole time it was expired.
Interview on [DATE] at 12:11 P.M. with the DON and Administrator revealed on [DATE], the DON was
notified by an STNA that their STNA registration had expired. The DON stated she was not aware that the
STNA registrations had lapsed. The interview revealed they sent
The deficient practice was corrected on [DATE] when the facility implemented the following corrective
actions:
•
On [DATE], the DON was made aware STNA registrations were expired.
•
On [DATE], a Quality Assurance and Performance Improvement (QAPI) meeting was held to discuss STNA
registrations. The attendees included the Administrator, [NAME] President of Clinical Operations, Regional
Director of Operations, and Regional Nursing Director.
•
On [DATE], the DON completed an initial audit of all STNA's to ensure their STNA registration was valid
and active. All STNA's, including STNA #36, STNA #123, and STNA #131, with an expired license had all
necessary documentation sent to the Ohio Department of Health Nurse Aide Registry to ensure the
STNA's had a valid and active registration.
•
The new Human Resource Representative began employment on [DATE] and was oriented to the process
of verifying STNA registration status by [DATE].
•
Ongoing audits of all STNA's will be conducted once per month by the Human Resource Representative to
ensure STNA registrations remain current and valid.
This deficiency represents non-compliance investigated under Complaint Number OH00151091.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365839
If continuation sheet
Page 2 of 2
