Health inspection·June 8, 2023

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm Based on observations, medical record review, resident and staff interviews, and policy review, the facility failed to assist residents who required assistance with activities of daily living (ADL) with showers and personal hygiene needs. This affected two (#19 and #39) of three residents reviewed for ADLs. The facility identified 70 residents who required assistance with bathing. The facility census was 73. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #19 revealed an admission date of 11/11/19. Diagnoses included atrial fibrillation, chronic obstructive pulmonary disease (COPD), anxiety, chronic kidney disease, and hypertension (HTN). Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 04/07/23, revealed Resident #19 had moderate cognitive impairment and required extensive staff assistance with personal hygiene and was dependent upon staff for bathing. Review of the ADL care plan revealed Resident #19 required extensive staff assistance for bathing and personal hygiene. Review of the bathing records from 05/01/23 to 06/06/23 revealed Resident #19 received a shower/bath three times on 05/23/23, 05/26/23, and 06/06/23. There was no documentation to support Resident #19 received any other showers/baths during this time period from 05/01/23 to 06/06/23. Review of the unit shower/bath schedule revealed Resident #19 was scheduled for showers/bathes on Tuesdays and Fridays. Interview on 06/05/23 at 10:22 A.M. with Resident #19 stated she doesn't get showers or baths as scheduled. Interview on 06/07/23 at 11:15 A.M. with Regional Registered Nurse (RN) #508 confirmed the medical record for Resident #19 revealed Resident #19 received a shower/bath on 05/23/23, 05/26/23, and 06/06/23. Regional RN #508 confirmed the medical record did not contain documentation to support Resident #19 received showers/bathes as scheduled from 05/01/23 to 06/06/23. 2. Review of the medical record for Resident #39 revealed an admission date of 10/25/22. Diagnoses included chronic obstructive pulmonary disease (COPD), atrial fibrillation, and hypertension (HTN). Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 04/14/23, revealed Resident (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 4 Event ID: 365896 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 365896 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fox Run Manor 11745 Township Road 145 Findlay, OH 45840 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)