Inspection·October 31, 2024

F 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, and review of Self-Reported Incidents (SRIs), the facility failed to thoroughly investigate an allegation of resident-to-resident abuse. This affected two (Residents #4 and #21) of three residents reviewed for abuse. The facility census was 102. Residents Affected - Few Findings include: Medical record review revealed Resident #4 admitted to the facility on [DATE] with diagnoses of dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety. Review of the Quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #4 was cognitively impaired. Resident required set-up assistance with eating, required supervision assistance with wheelchair mobility, required partial assistance with oral hygiene and bed mobility, and required substantial assistance with toileting hygiene, bathing, dressing, personal hygiene, and transfers. Review of the care plan dated 07/22/24 revealed Resident #4 was at risk for alteration in mood state due to dementia, anxiety, and history of psychotic disorder. Interventions included the facility will monitor/record/report to physician as needed (PRN) risk for harming others: increased anger, labile mood or agitation, feels threatened by others or thoughts of harming someone. Review of the nurses note dated 10/09/24 at 2:34 P.M. revealed Resident #4 was wandering around the facility in wheelchair, going into other resident's rooms, swatting and hitting staff, exit seeking, and not easily re-directable. PRN orders for Ativan were given, awaiting effectiveness, psych Nurse Practitioner (NP) in the facility and increased dose to 0.5 milliliters (ml). Review of the nurses note for Resident #4 dated 10/09/24 at 3:56 P.M. revealed Resident #4 grabbed another resident by the throat and would not let go. Review of the nurses note dated 10/10/24 at 10:53 A.M. revealed, Correction on previous note, Resident #4 did not grab another resident by the throat. Resident #4 put her hand towards another resident, her hand did touch the resident's neck, but no force nor grabbing motion occurred. Resident #4 was attempting to keep the other resident away from her. Both residents were redirected and taken to separate locations. The note was written by the Director of Nursing (DON). Review of the undated witness statement signed by Staffing Coordinator (SC) #570 revealed, on 10/10/24 around 3:30 P.M. to 4:30 P.M. SC #570 witnessed Resident #21 wheel herself up to Resident #4. It looked like a friendly conversation between the two residents, then Resident #4 pushed Resident #21 (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: 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 10/31/2024 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)