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Inspection visit

Inspection

RIVERSIDE NURSING AND REHABILITATION CENTERCMS #3658775 citations on this visit
5 citations recorded

Inspector’s narrative

What the inspector wrote

This survey cited 5 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Review of medical record for Resident #50 revealed an admission date of 07/9/19, with diagnoses including stroke, spastic hemiplegia, chronic obstructive pulmonary disease, contracture of right and left wrist and urinary retention. The resident was admitted to hospice on 01/02/24. Review of the significant change Minimum Data Set (MDS) dated [DATE], revealed the resident was cognitive intact and was dependent for bed mobility, transfers, and toileting hygiene. Residents Affected - Few a. Review of the progress note dated 01/30/24 revealed Registered Nurse (RN) #318 documented at 3:56 P.M. she discovered a large amount of urine on the mattress of Resident #50's bed. She then noted there was urine coming from the nephrostomy site. Also, the connection from the nephrostomy tubing and the catheter leg bag tubing was leaking as well. RN #318 documented she was later informed by an unidentified State Tested Nursing Assistant, she, and Unit Manager Registered Nurse (UM) #274 had noted urine leaking from the nephrostomy site earlier during A.M. care and they placed a washcloth to catch the urine. RN #318 updated Certified Nurse Practitioner (CNP) #390 of her findings. CNP #390 advised her to see if the correct drainage bag could be obtained and to monitor the drainage site. Review of the physician orders dated 01/30/24, for Resident #50 revealed a new order to cleanse the nephrostomy area with normal saline, pat dry, apply an abdominal pad (ABD) and secure with paper tape every sift and as needed with a start date of 01/30/24 at 6:54 P.M. Interview on 01/31/24 at 10:45 A.M., with UM #274 revealed during care of Resident #50 on 01/30/24, urine was noted to be coming from the nephrostomy tube and catheter tubing connector. UM #274 later contacted the facility physician who ordered dressing for the nephrostomy site for protection of the area. UM #274 stated she also called the urology physician to schedule an appointment, and stated she informed the office the nephrostomy was leaking. UM #274 stated she had not yet checked to observe, or question staff if a urine leak remained, or what type of drainage bag the nephrostomy was attached to. UM #274 acknowledged she had not received any training regarding nephrostomies prior to Resident #50's return after his 12/13/23 nephrostomy placement. Interview on 01/31/24 at 10:52 A.M., with CNP #390 along with UM #274 revealed CNP #390 stated she was informed yesterday, early evening the nephrostomy was leaking, from the connection site. CNP #390 noted during an earlier assessment the nephrostomy was attached to a catheter leg bag. CNP #390 stated he was not ambulatory and ordered the nurse to change the bag and if it continued to leak, the resident needed to be sent for an evaluation. UM #274 stated she was unsure if it was leaking but believed it may be and would investigate. Observation on 01/31/24 at 11:11 A.M., with UM #274 and RN #318 revealed the nephrostomy tubing was connected to catheter leg bag tubing and a slight leak was noted. UM #274 then removed the tape (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 11 Event ID: 365877 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 365877 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Nursing and Rehabilitation Center 1390 King Tree Drive Dayton, OH 45405 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few from the ABD dressing to expose the nephrostomy site. No drainage was noted on the dressing or from the site, however tubing was folded over upon itself. UM #274 straightened the tubing and reapplied the dressing. UM #274 verified the nephrostomy tubing was completely kinked. UM #274 left to contact Emergency Medical Services (EMS) since the tubing was still leaking, to have it evaluated. Interview on 01/31/24 at 11:16 A.M., with RN #318 revealed when she left on 01/30/24, the nephrostomy tubing had an adapter which appeared to be sutured to the nephrostomy tubing on one end and then attached to the catheter tubing on the other. She then pointed out the nephrostomy tubing was directly hooked to the catheter tubing, and stated she was unsure where the adaptation piece was. RN #318 acknowledged she had not received any education regarding the care of nephrostomies prior to Resident #50's return from nephrostomy placement. Interview on 01/31/24 at 3:00 P.M., with Assistant Director of Nursing (ADON) #240 revealed there was no policy for Nephrostomy care and no education had been provided to nursing staff prior to Resident #50's return after his Nephrostomy placement. Review of a progress note dated 01/31/24, revealed a follow up call was placed to the hospital for an update of Resident #50's evaluation for the leaking nephrostomy. The note documented the nephrostomy adapter was missing; however it was later found, and the bag was replaced. Review of the Agency for Clinical Innovation Urology Network Nursing management of patients with nephrostomy tubes, at https://aci.health.nsw.gov.au/__data/assets/pdf_file/0011/165917/Nephrostomy-Tubes-Toolkit.pdf, documented to inspect nephrostomy tube to ensure it was secure and no kinking had occurred. Observe for leakage at connection joints and seek advice if evident. And lastly, the nephrostomy tube must be connected to a sterile closed drainage system. b. Review of the wound note dated 01/25/24, for Resident #50 revealed a left lateral foot arterial wound measuring 2.5-centimeter (cm) x 1.8 cm x 0.2 cm and a left heel arterial wound measuring 7.5 cm x 5.1 cm x 0.2 cm. Review of the physician orders revealed an order placed on 12/14/23, to cleanse the left shin with wound cleanser, pat dry and apply Puraply (antimicrobial wound matrix) weekly on Thursday. Review of the December Treatment Administration Record (TAR) for Resident #50, revealed an entry to cleanse the left shin with wound cleanser, pat dry and apply Puraply (antimicrobial wound matrix) weekly with a start date of 12/16/23. There was no documentation, this was completed on 12/16/23. Review of the physician orders dated 12/14/23, revealed an order for daily wound assessments of the left shin. Review of the December TAR revealed an entry for daily wound assessment for the left shin with a start date of 12/14/23. There was no documentation as being completed on 12/18/23 through 12/21/23. Review of the December TAR for Resident #50 revealed a to entry to cleanse the left lateral foot with wound cleanser, pat dry and apply Puraply (antimicrobial wound matrix) every day shift on Monday, Thursday, Saturday, and Sunday with a start date of 12/16/23. There was no documentation that this was completed on 12/18/23 or 12/21/23. Review of the December TAR for Resident #50 revealed an entry to assess the left lateral foot wound (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365877 If continuation sheet Page 2 of 11 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 365877 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Nursing and Rehabilitation Center 1390 King Tree Drive Dayton, OH 45405 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few daily to include if the dressing was dry and intact, odor and or pain present with a start date of 12/14/23. This was not documented as being completed on 12/18/23 through 12/21/23, 12/23/23, 12/27/23 or 12/27/23. Review of the January TAR revealed an entry to cleanse left shin with wound cleanser, pat dry and apply Puraply every day shift on Monday, Thursday, Saturday, and Sunday. There was no documentation, this was completed on 01/01/24. Review of the January TAR for Resident #50 revealed an entry to cleanse left shin with wound cleanser, pat dry, apply Xerofoam (petroleum dressing) and cover with border foam with a start date of 12/23/23. This was not documented as completed on 01/01/24. Review of the January TAR revealed an entry for left heel assessment to include document drainage, dressing dry and intact, infection, odor, and pain with a start date of 12/21/23. This was not documented as completed from 01/01/24 through 01/30/24. Review of the January TAR revealed an entry to cleanse the right plantar great toe with soap and water, apply skin prep and leave open to air every shift with a start date of 12/28/23. This was not documented as completed day shift on 01/01/24. Interview on 01/31/24 at 4:20 P.M., with Regional Director of Clinical Operations #386 verified the missing treatments were not documented as being completed. 3. Review of medical record for Resident #157 revealed admission date of 07/27/23. The resident was admitted with diagnoses including bilateral at knee level amputation, schizoaffective disorder. Review of the quarterly MDS assessment, dated 11/10/23, revealed the resident had intact cognition and required supervision for eating and supervision, dependent for bed mobility, transfers, and toileting hygiene. Review of the wound documentation by CNP #387 dated 01/25/24, revealed an abdominal surgical dehiscence wound. No other wounds were documented on the abdomen. Further review revealed documentation of a left lateral stump neuropathic wound which measured 11.5 centimeters (cm) by (x) 2.0 cm x 0.1 cm. Interview on 01/31/24 at 3:44 P.M., with Wound CNP #387 acknowledged there were four separate wounds on the left anterior thigh of Resident #157. CNP #387 explained rather than differentiate each wound, she made the decision to measure the area of the wound locations. She measured from the outer points of the wounds for her measurement documentation. Measuring the outer points of the upper and lower wounds for length and the outer points of the outside wounds for width. Observation on 01/31/24 at 4:05 P.M., of wounds to left thigh and abdomen of Resident #157 with Licensed Practical Nurse LPN #175 revealed there were four to the left thigh. The wounds were neuropathic in nature. The left anterior thigh upper lateral wound measured 1.5 centimeters (cm) by (x) 1.8 cm x 0.1 cm, lower lateral 1.0 cm x 1.0 cm x 0 cm, medial upper 0.5 cm x 0.5 cm x 0.1 cm and medial lower was 1.0 cm x 1.0 cm x 0.1 cm. Three abdominal left lateral wounds were also neuropathic in nature. The left lateral upper measured 1.0 cm x 1.0 cm x 0 cm, medial wound measured 1.5 cm x 1.5 cm x 1.0 cm and the left lower lateral measured 1.0 cm x 1.0 cm x 0.1 cm. LPN #175 verified there were four individual wounds on Resident #157's left anterior thigh and three similar wounds on her abdomen. She further verified the documentation did not document the abdominal wounds and documented one (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365877 If continuation sheet Page 3 of 11 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 365877 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Nursing and Rehabilitation Center 1390 King Tree Drive Dayton, OH 45405 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 0684 wound to her left stump. Level of Harm - Minimal harm or potential for actual harm Review of the undated policy titled, Skin Care and Wound Care, stated the facility strived to prevent resident/patient skin impairment and to promote the healing of existing wounds. The policy stated the skin care and wound management program included daily monitoring of existing wounds and to document treatment on the treatment administration record (TAR). The policy also stated the required documentation for pressure ulcers and skin impairments included measurements to indicate if healing had occurred. Residents Affected - Few This deficiency represents non-compliance investigated under Master Complaint Number OH0150491 and complaint number OH00150167. Based on observations, medical record review, resident interviews, staff interviews, policy review, and review of the Agency for Clinical Innovation Urology Network, the facility failed to ensure physician ordered treatments were completed for surgical and non pressure wounds; failed to accurately monitor and asses wounds; and provide care and treatment of a resident with a nephrostomy tube. This affected three (#50, #51, and #157) residents out of the four residents reviewed for wound care. The facility census was 170. Findings included: 1. Review of the Resident #51's medical record revealed an admission date of 06/23/23, with medical diagnoses of pulmonary fibrosis, Hepatitis C, right hip necrosis wound status post right hip antibiotic hip spacer, psychosis, and osteoarthritis. Review of the medical record revealed Resident #51 discharged to the hospital on [DATE] for right hip arthroplasty and returned to the facility on [DATE]. Further review of the medical record revealed Resident #51 was admitted to the hospital on [DATE] for severe post operation anemia. Review of the quarterly Minimum Data Set (MDS) assessment, dated 11/02/23, which indicated Resident #51 was cognitively intact and was independent with eating, bathing, toilet hygiene, bed mobility, and transfers. No skin issues were noted on the MDS. Review of the hospital discharge orders, dated 01/19/24, revealed physician orders for a wound vacuum (vac) to protect the incision, help prevent infection and promote healing by increasing the blood flow to the incision. The order stated to ensure the tubing to the wound vac did not become kinked or pinched. The order also stated if the facility experienced any issues with the wound vac to contact the wound vac company for technical assistance. Review of a nurse's note, dated 01/19/24 (Friday) at 4:10 P.M., stated Resident #51 returned to the facility with a wound vac and surgery site was intact. Review of a skin grid non-pressure assessments dated 01/19/24 documented right hip: surgical site with wound vac in place. Review of the medical record revealed no evidence of documentation to support the facility entered any wound care orders on 01/19/24 related to right hip incision or the wound vac or treatment to the right hip incision. Review of a nurse's note dated 01/21/23 (Sunday) at 11:37 A.M., written by Registered Nurse (RN) #318, stated Resident #51's wound vac machine was not attached to the dressing on the right hip. The note stated Resident #51 informed RN #318 that the wound vac had not been functioning since he (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365877 If continuation sheet Page 4 of 11 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 365877 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Nursing and Rehabilitation Center 1390 King Tree Drive Dayton, OH 45405 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few returned on 01/19/24. Further review of the nurse's notes on 01/21/24 revealed RN #318 attempted to contact the wound vac provider and Resident #51's orthopedic surgeon without success. Review of a physician order, dated 01/21/24, stated to ensure wound vac was connected and functioning properly and to call wound vac company with any problems. The medical record revealed an order dated 01/21/24, to keep the wound clean and dry, reinforce the dressing as needed and do not remove. Review of a nurse's note dated 01/22/24 (Monday) at 11:00 A.M., stated the wound vac remained unhooked and the dressing to right hip incision remained intact. Further review revealed a nurse's note dated 01/22/24 at 11:36 A.M., which stated orders were received from the orthopedic surgeon for wound care and Resident #51 was to follow up in their office on 01/25/24. Review of the physician order dated 01/22/24, to cleanse the right trochanter with normal saline, pat dry, apply bordered gauze two times per day and as needed. Review of the January medication administration record and the treatment administration record revealed no evidence of wound treatments until 01/22/24. Interview on 01/31/24 at 9:40 A.M., with RN #318 confirmed she was the nurse taking care of Resident #51 on 01/20/24, 01/21/24, and 01/22/24. RN #318 stated she was not aware Resident #51 had a wound vac to the surgical site on his right hip because he did not have any orders to monitor the wound. RN #318 stated Resident #51 informed her on 01/21/24 that his wound vac had not been attached to his wound since he returned on 01/19/24. Resident #51 stated the wound vac became dislodged on the transport back to the facility. RN #318 stated she found Resident #51's wound vac sitting on a chair in the corner of his room and attempted to reattach it to the wound, but the wound vac would not suction. RN #318 stated she called the wound vac provider and the orthopedic doctor on call without success. RN #318 stated the facility notified the orthopedic physician on 01/22/24 of the wound vac not functioning properly and new orders were received. RN #318 stated the staff are to add orders to monitor wounds every shift for any resident with wounds. Interview on 01/31/24 at 9:55 A.M., Regional Director of Clinical Operations (RDCO) #386 confirmed the medical record for Resident #51 did not contain documentation to support Resident #51's wound vac was monitored by facility staff, which included to ensure the wound vac was attached and functioning properly. RDCO #386 confirmed the facility did not enter any wound care orders on 01/19/24. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365877 If continuation sheet Page 5 of 11 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 365877 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Nursing and Rehabilitation Center 1390 King Tree Drive Dayton, OH 45405 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, medical record review and staff interview, the facility failed to ensure physician ordered pressure wound treatments were completed. This affected one ( #50) of three residents reviewed for wounds. The facility census was 170. Residents Affected - Few Findings include: Review of medical record for Resident #50 revealed admission date of 07/9/19, with diagnoses including stroke, spastic hemiplegia, chronic obstructive pulmonary disease, contracture of right and left wrist and urinary retention. The resident was admitted to hospice on 01/02/24. Review of the significant change Minimum Data Set (MDS) assessment dated [DATE] revealed dependent for bed mobility, transfers and toileting hygiene. Review of the wound note dated 01/25/24, for Resident #50 revealed an unstageable sacral wound measuring 6.8 centimeters (cm) by (x) 6.0 cm x 0.2 cm and unstageable left buttock wound measuring 3.0 cm x 2.9 cm x 0.3 cm. Review of the physician orders revealed an order dated 12/21/23, to cleanse sacrum with wound cleanser, pat dry, apply caster oil to wound every shift. Record review of the December TAR for Resident #50 revealed an entry to cleanse sacral wound with wound cleanser, pat dry and apply castor oil to wound every shift with a start date of 12/21/23. There was no documentation this was completed day shift on 12/23/23 or 12/27/23 or the night shift on 12/29/23. Review of the January TAR for Resident #50 revealed an entry to cleanse sacral wound with wound cleanser, pat dry and apply castor oil to wound every shift. There was no documentation this was completed on 01/01/24 day shift. Review of the January TAR revealed an entry to cleanse the left buttock with soap and water, pat dry and apply castor oil and leave open to air every shift with a start date of 12/28/23. This was not documented as completed day shift on 01/01/24. Interview on 01/31/24 at 4:20 P.M., with Regional Director of Clinical Operations #386 reviewed the missing treatments and verified the treatments were no documented as being completed as ordered. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365877 If continuation sheet Page 6 of 11 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 365877 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Nursing and Rehabilitation Center 1390 King Tree Drive Dayton, OH 45405 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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, staff interview and review of the Agency for Clinical Innovation Urology Network website, the facility failed to ensure staff was educated and trained to provide care for a nephrostomy tube. This affected one (#50) of one resident in the facility identified as having a nephrostomy tube. The facility census was 170. Findings include: Review of medical record for Resident #50 revealed an admission date of 07/9/19, with diagnoses including stroke, spastic hemiplegia, chronic obstructive pulmonary disease, contracture of right and left wrist and urinary retention. The resident was admitted to hospice on 01/02/24. Review of the significant change Minimum Data Set (MDS) assessment dated [DATE], revealed the resident was cognitive intact and was dependent for bed mobility, transfers, and toileting hygiene. Review of the progress note dated 01/30/24 revealed Registered Nurse (RN) #318 documented at 3:56 P.M. she discovered a large amount of urine on the mattress of Resident #50's bed. She then noted there was urine coming from the nephrostomy site. Also, the connection from the nephrostomy tubing and the catheter leg bag tubing was leaking as well. RN #318 documented she was later informed by an unidentified State Tested Nursing Assistant, she, and Unit Manager Registered Nurse (UM) #274 had noted urine leaking from the nephrostomy site earlier during A.M. care and they placed a washcloth to catch the urine. RN #318 updated Certified Nurse Practitioner (CNP) #390 of her findings. CNP #390 advised her to see if the correct drainage bag could be obtained and to monitor the drainage site. Review of the physician orders dated 01/30/24, for Resident #50 revealed a new order to cleanse the nephrostomy area with normal saline, pat dry, apply an abdominal pad (ABD) and secure with paper tape every sift and as needed with a start date of 01/30/24 at 6:54 P.M. Interview on 01/31/24 at 10:45 A.M., with UM #274 revealed during care of Resident #50 on 01/30/24, urine was noted to be coming from the nephrostomy tube and catheter tubing connector. UM #274 later contacted the facility physician who ordered dressing for the nephrostomy site for protection of the area. UM #274 stated she also called the urology physician to schedule an appointment, and stated she informed the office the nephrostomy was leaking. UM #274 stated she had not yet checked to observe, or question staff if a urine leak remained, or what type of drainage bag the nephrostomy was attached to. UM #274 acknowledged she had not received any training regarding nephrostomies prior to Resident #50's return after his 12/13/23 nephrostomy placement. Interview on 01/31/24 at 10:52 A.M., with CNP #390 along with UM #274 revealed CNP #390 stated she was informed yesterday, early evening the nephrostomy was leaking, from the connection site. CNP #390 noted during an earlier assessment the nephrostomy was attached to a catheter leg bag. CNP #390 stated he was not ambulatory and ordered the nurse to change the bag and if it continued to leak, the resident needed to be sent for an evaluation. UM #274 stated she was unsure if it was leaking but believed it may be and would investigate. Observation on 01/31/24 at 11:11 A.M., with UM #274 and RN #318 revealed the nephrostomy tubing was connected to catheter leg bag tubing and a slight leak was noted. UM #274 then removed the tape from the ABD dressing to expose the nephrostomy site. No drainage was noted on the dressing or from the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365877 If continuation sheet Page 7 of 11 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 365877 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Nursing and Rehabilitation Center 1390 King Tree Drive Dayton, OH 45405 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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few site, however tubing was folded over upon itself. UM #274 straightened the tubing and reapplied the dressing. UM #274 verified the nephrostomy tubing was completely kinked. UM #274 left to contact Emergency Medical Services (EMS) since the tubing was still leaking, to have it evaluated. Interview on 01/31/24 at 11:16 A.M., with RN #318 revealed when she left on 01/30/24, the nephrostomy tubing had an adapter which appeared to be sutured to the nephrostomy tubing on one end and then attached to the catheter tubing on the other. She then pointed out the nephrostomy tubing was directly hooked to the catheter tubing, and stated she was unsure where the adaptation piece was. RN #318 acknowledged she had not received any education regarding the care of nephrostomies prior to Resident #50's return from nephrostomy placement. Interview on 01/31/24 at 3:00 P.M., with Assistant Director of Nursing (ADON) #240 revealed there was no policy for Nephrostomy care and no education had been provided to nursing staff prior to Resident #50's return after his Nephrostomy placement. Review of the Agency for Clinical Innovation Urology Network Nursing management of patients with nephrostomy tubes, at https://aci.health.nsw.gov.au/__data/assets/pdf_file/0011/165917/Nephrostomy-Tubes-Toolkit.pdf, documented to inspect nephrostomy tube to ensure it was secure and no kinking had occurred. Observe for leakage at connection joints and seek advice if evident. And lastly, the nephrostomy tube must be connected to a sterile closed drainage system. This deficiency represents non-compliance investigated under Complaint Number OH00150167. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365877 If continuation sheet Page 8 of 11 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 365877 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Nursing and Rehabilitation Center 1390 King Tree Drive Dayton, OH 45405 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observation, record review, resident interview, staff interviews and review of policy, the facility failed to ensure medications were available for administration. This affected two (#52 and #56) of six residents records reviewed for medications. The facility census was 170. Findings include: 1. Review of medical record for Resident #52 revealed admission date of 06/26/23, with diagnoses including stroke, anxiety, and hepatic (liver) failure. Review of the physician orders for Resident #52 revealed an order for Rifaximin 550 milligram (mg) one tablet every morning and at bedtime with a start date of 09/20/23. Observation on 01/30/24 at 10:13 A.M., of medication administration by Registered Nurse (RN) #318 for Resident #52 revealed Rifaximin (a medication for hepatic encephalopathy) 550 milligrams (mg) was not in the medication cart and not administered. Interview with RN #318, at the time of the observation, revealed the medication was not ordered timely and voiced a concern for the frequency medication was unavailable at the facility. 2. Review of the medical record for Resident #56 revealed an admission date of 11/17/23, with medical diagnoses of diabetes mellitus (DM), atherosclerotic heart disease (ASHD), anxiety, hypertension, and obesity. Review of the medical record for Resident #56 revealed an admission minimum data set assessment, dated 11/24/23, which indicated Resident #56 was cognitively intact and was independent for eating, bed mobility, transfers, and required moderate staff assistance for showers. Review of the medical record for Resident #56 revealed a physician order dated 11/24/23, for Trulicity (DM medication) 1.5 milligram (mg) per milliliter (ml) pen-injector subcutaneous (SQ), to inject 1.5 mg every Friday morning. Review of the order revealed the medication was discontinued on 12/06/23. Review of the physician orders revealed an order dated 12/08/23 for Trulicity 0.75 mg per 0.5 ml SQ, to inject 0.75 mg SQ every Friday morning. Further review of the physician orders revealed an order dated 12/12/23 for Trulicity 0.75 mg per 0.5 ml SQ, inject 0.75 mg SQ every Tuesday morning. Review of the medical record for Resident #56 revealed the medication administration record (MAR) for December 2023 revealed no documentation to support Resident #56 received the Trulicity on 12/01/23 as ordered and revealed the Trulicity was coded as not available for 12/08/23 dose. Interview on 01/30/24 at 1:40 P.M., with Resident #56 stated he did not get his Trulicity as ordered in December 2023, and that he informed his nurse. Resident #56 stated the Trulicity order was changed, and he went almost two weeks without his Trulicity but denied any concerns related to blood sugar levels during that time. Interview on 01/31/24 at 3:01 P.M., with Regional Director of Clinical Operations (RDCO) #386 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365877 If continuation sheet Page 9 of 11 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 365877 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Nursing and Rehabilitation Center 1390 King Tree Drive Dayton, OH 45405 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few confirmed Resident #56 did not receive the Trulicity as ordered on 12/01/23 and 12/08/23. RDCO #386 stated the Trulicity order was changed on 12/08/23 and the dose was coded as not available due to the medication not arriving from the pharmacy timely. RDCO #386 confirmed Resident #56 received Trulicity as ordered on 11/24/23 and did not receive another dose of Trulicity until 12/12/23. Review of the undated policy titled, Medication Administration, stated the facility was to administer medications as prescribed by the physician which included the right dose and right time. The policy also stated medications would be administered within the timeframe of one hour before and up to one hour after the time ordered. This deficiency represents non-compliance investigated under Complaint Number OH00150178 and Complaint Number OH00150167. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365877 If continuation sheet Page 10 of 11 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 365877 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Nursing and Rehabilitation Center 1390 King Tree Drive Dayton, OH 45405 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 0880 Provide and implement an infection prevention and control program. 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 interview, policy review, and [NAME] journal review, the facility failed to change gloves and/ or wash hands between cleansing wound and applying treatment; and change gloves between different wounds to prevent possible cross contamination. This affected one (#157) of three residents reviewed for wound care. The facility census was 170. Residents Affected - Few Findings include: Review of medical record for Resident #157 revealed admission date of 07/27/23, with diagnoses including bilateral at knee level amputation and schizoaffective disorder. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE], revealed the resident was cognitively intact and required supervision for eating and supervision, dependent for bed mobility, transfers, and toileting hygiene. Observation on 01/31/24 at 1:03 P.M., of wound treatment revealed Licensed Practical Nurse (LPN) #304 cleansed the midline abdominal dehisced wound with a wound cleanser, patted dry with a four (4) by (x) 4 gauze. Without removing her gloves, LPN #304 then applied the same treatments to three additional approximate 1.0-centimeter (cm) x 1.0 cm neuropathic wounds, located on the left side of the abdomen. LPN #304 then applied Hydrogel wound gel to an abdominal pad, covering the dehisced wound. She then applied the gel to the three neuropathic wounds, covered them with an abdominal pad and secured them with tape. At this time, LPN #304 then removed her gloves, and without washing her hands she opened a drawer to the treatment cart to get more tape. She placed the tape on the bedside table and washed her hands before putting on another pair of gloves. LPN #304 then cleansed each of the four neuropathic wounds, which appeared to be 1.0 cm x 1.0 cm on the left anterior thigh of Resident #157 with wound cleanser, patted dry with a 4 x 4 gauze, applied Hydrogel, and covered with an abdominal pad without changing her gloves. Interview with LPN #304, immediately following the dressing change, verified she did not remove her gloves in between the treatment of Resident #157's abdominal wound, or thigh wounds and between the soiled areas to applying the treatment and clean bandages. LPN #304 acknowledged that not removing gloves could cause the contamination of wounds. Review of the undated policy titled,Infection Control, stated the residents have a right to reside in a safe environment that promotes health and reduces the risk of acquiring infections. The policy stated staff and resident education would focus on practices to decrease the risk of infection including but not limited to hand hygiene compliance Review of the [NAME] journal article titled, Glove utilization in the prevention of cross transmission: A systematic review, at https://journals.lww.com/jbisrir/fulltext/2015/13040/glove_utilization_in_the_prevention_of_cross.13.aspx, April 2015, revealed gloves must be worn as single-use items, and changed between different patients and between different care/treatment activities on the same patient to prevent cross-contamination of body sites. This deficiency represents the continued non compliance form the survey dated 01/09/24. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365877 If continuation sheet Page 11 of 11

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Citations

5 citations recorded*CMS

What do CMS severity letters mean?

Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.

General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.

Each letter combines severity with scope: how many residents the deficiency affected.

  • 0880GeneralS&S Dpotential for harm

    F880 - Infection Control

    Provide and implement an infection prevention and control program.

  • 0684GeneralS&S Dpotential for harm

    F684 - Quality of care

    Provide appropriate treatment and care according to orders, resident’s preferences and goals.

  • 0686GeneralS&S Dpotential for harm

    F686 - Skin Integrity

    Provide appropriate pressure ulcer care and prevent new ulcers from developing.

  • 0726GeneralS&S Dpotential for harm

    F726 - Nursing Services

    Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.

  • 0755GeneralS&S Dpotential for harm

    F755 - Pharmacy Services

    Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

FAQ · About this visit

Common questions about this visit

What happened during the January 31, 2024 survey of RIVERSIDE NURSING AND REHABILITATION CENTER?

This was a inspection survey of RIVERSIDE NURSING AND REHABILITATION CENTER on January 31, 2024. The surveyor cited 5 deficiencies, recorded on the federal Form 2567 statement of deficiencies.

Were any deficiencies cited at RIVERSIDE NURSING AND REHABILITATION CENTER on January 31, 2024?

Yes, 5 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Provide and implement an infection prevention and control program."

What type of survey was this?

This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.

SourceView on CMS Care Compare

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Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.