Inspection·February 12, 2024

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on medical record review, observation, staff interview and review of the facility policy the facility failed to ensure fall prevention interventions were in place to prevent resident injury from falls. This affected two (Residents #20 and #41) of three residents reviewed for falls. The facility census was 111 residents. Findings include: 1.Review of the medical record for Resident #20 revealed an admission date of 05/24/11 with diagnoses including diabetes, malnutrition, heart disease, anxiety, chronic pain, and dementia. Review of the Minimum Data Set (MDS) assessment for Resident #20 dated 12/26/23 revealed the resident was cognitively impaired and required partial to moderate assistance for ambulation, moving in bed, and moving from a sitting to a standing position. Review of the plan of care for Resident #20 updated 02/07/24 revealed the resident was at risk for falls due to decreased endurance, impaired judgment and cognitive impairment. Interventions included the following: assist with toileting as needed, bilateral bedrails to enable mobility in bed, keep call light and frequently used items in reach, monitor for safety, non-skid footwear, non-skid strip to toilet and side of bed and bathroom, keep pathways free of clutter and well-lit, perimeter mattress, signage on walker to remind resident to use walker when ambulating, staff to anticipate needs, toileting program, toileting schedule initiated, transfer using maxi-move, unplug bed remote at appropriate height, resident to be up in common area for increased supervision while awake, signage to remind staff to take resident to the common area. Observation on 02/07/24 at 10:38 A.M. revealed Resident #20 was resting in bed, and the bed was in a high position. Interview on 02/07/24 at 10:38 A.M. with Licensed Practical Nurse (LPN) #210 confirmed Resident #20 was resting in bed and the bed was in a high position. LPN #210 confirmed she was not sure if Resident #20's bed was supposed to be in a high or low position. Interview on 02/08/24 at 10:40 A.M. with State Tested Nursing Assistant (STNA) #205 confirmed Resident #20 was in bed resting with her bed in the high position, and the resident's bed was supposed to be kept in a low position when the resident was in bed to prevent the risk of injury from falling. The Surveyor attempted to interview Resident #20 on 02/08/24 at 11:10 A.M. but the resident was unable to participate in an interview or answer questions due to cognitive impairment. (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: 365917 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 365917 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/12/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Oakwood Village 1500 Villa Road Springfield, OH 45503 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)