Health inspection·September 19, 2025

F 0921 Level of Harm - Potential for minimal harm Residents Affected - Many Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on observations, record review, and resident and staff interview, the facility failed to ensure a clean and sanitary environment. This had the potential to affect all 92 residents residing in the facility. Findings include:Review of quote summary for facility hallways dated 09/18/25 with an expiration date upon 30 days notice, revealed there was an estimate to replace the flooring throughout the facility. The facility was unable to provide any other quote summaries for replacement of the flooring. Observation on 09/19/25 at 10:21 A.M. revealed widespread soiling, staining and wear throughout the facility's carpeted areas. Carpet tiles, each measuring 20 in length by (x) 20 inches in width, were found in poor condition with extensive dark brown discoloration, water damage, bright yellow blotches and sticky adhesive residue. The overall appearance of carpet was grimy and heavily trafficked, with visible signs of neglect, staining and deterioration. Observation on 09/19/25 at 10:24 A.M. revealed hallway 200-218 (431 Hall), approximately measuring 81 tiles in length by five in width, totaling around 405 tiles. Of these, 52 tiles were visibly soiled. Stains varied in size from small two x two-inch spots to full-tile coverage. The carpet displayed irregularities such as hardened adhesive buildup, deep-set wear patterns and fiber pilling. Many stains appeared dark, crusted and dried into the fibers, with a heavy concentration in the first part of the hallway, giving the impression of long-term accumulation. Interview on 09/19/25 at 10:24 A.M. revealed Housekeeping Staff Member (HSM) #386, who stated she worked at the facility for years, confirmed the carpets were extremely stained throughout and have been in this condition for some time. Interview on 09/19/25 at 10:26 A.M. revealed Registered Nurse #174 stated the carpets have always been dirty and worn. She noted that the flooring was consistently soiled throughout the hallways in the entire facility and mentioned hearing from management that floor replacement was being considered. Observation on 09/19/25 at 10:30 A.M. revealed hallway 219-232 (437 Hall), measuring 64 tiles in length by five in width, totaling 320 tiles. A total of 37 tiles were soiled. Cart track marks and shadowing formed visible linear patterns, with six tiles on the left, three on the right and another three on the left again. The largest stain, located about a quarter of the way down the hallway, affected four corner tiles and appeared dark, greasy and oil-like, covering roughly 25% of each tile. Smaller stains were scattered and sticky, resembling dried glue or adhesive. The carpet showed signs of wear, fiber breakdown and embedded grime. Interview on 09/19/25 at 10:31 A.M. revealed HSM #142 reported that due to reduced staffing hours, carpets were no longer cleaned regularly. HSM #142 described the flooring as being covered in random stains and admitted that despite efforts to maintain cleanliness, the condition has worsened over time. Observation on 09/19/25 at 10:34 A.M. revealed hallway 233-241, measuring 44 tiles in length by five in width, totaling approximately 220 tiles. Nine tiles were soiled, primarily with small splatter-like stains scattered across the surface. The carpet showed signs of adhesive residue, wear staining and fiber pilling, giving the area a patchy and unkempt appearance. Observation on 09/19/25 at 10:40 A.M. revealed hallway 325 near the elevator had a large, Page 1 of 2 366100 366100 09/19/2025 Centerville Post Acute 1001 Alex Bell Road Centerville, OH 45459

F 0921 Level of Harm - Potential for minimal harm Residents Affected - Many dark stain measuring approximately nine feet by four feet, leading toward the nurses' station. Five additional stains of varying sizes were present, ranging from small splatters to larger patches covering some of the tiles. A dark trail extended from the elevator along the right-hand side, with scattered blotches and heavy discoloration that suggested frequent foot traffic and liquid spills. Observation on 09/19/25 at 10:42 A.M. revealed the area outside the downstairs' main dining room had 10 carpet tiles with visible water damage and six with signs of wear and tear. A particularly egregious stain, dark and irregular in shape, stretched approximately eight feet by two feet, appearing as if liquid had been repeatedly spilled and left to soak into the fibers. Observation on 09/19/25 at 10:45 A.M. revealed severe staining outside the nurses' station. The carpet was heavily discolored with dirt, shadowing and water stains in various shades of brown and gray. A four by one-foot dark stain was located near the nurses' cart, with ripple-like water stains extending beyond its edges. Near the water fountain, a dark blotch measuring approximately three by two feet was observed. The flooring in front of the nurses' station was deeply worn and appeared saturated with soil. The area measured eight tiles in length and four tiles in depth. Observation on 09/19/25 at 10:44 A.M. revealed hallway 338, measuring 74 tiles in length by five in width, totaling approximately 370 tiles. A total of 43 tiles were soiled with shadowing, dark patches and embedded grime. The carpet showed signs of adhesive buildup and fiber breakdown, contributing to a dull and dirty appearance. Observation on 09/19/25 at 10:47 A.M. revealed hallway 332, measuring 65 tiles in length by five in width, totaling approximately 325 tiles. A total of 115 tiles were soiled. The carpet was scattered by widespread staining, adhesive residue and worn fibers. Observation on 09/19/25 at 10:49 A.M. revealed hallway 333, measuring 67 tiles in length by five in width, totaling approximately 335 tiles. A total of 69 tiles were soiled. The stains were varied in size and shape, with many appearing as dark blotches or sticky patches. The carpet was visibly worn and discolored. Observation on 09/19/25 at 10:50 A.M. revealed the front lobby area had a high-traffic zone around the desk with shadowing on the carpet measuring approximately two feet by eight feet. The discoloration was consistent with prolonged wear and heavy foot traffic. Interview on 09/19/25 at 10:58 A.M. revealed Maintenance Director #189 confirmed the facility was working on replacing the carpets. He could not specify when quotes were first requested but stated bids were currently being collected. He acknowledged the carpets were covered in numerous stains scattered throughout the facility. Interview on 09/19/25 at 10:59 A.M. revealed the Director of Nursing confirmed that all carpeted areas in the facility, including the main entrance, hallways 332, 333, 325, 338, 431 and a currently closed hallway, were stained throughout. The DON confirmed the facility had been working on getting new carpets throughout the facility since acquisition in February of 2025. Interview on 09/19/25 at 11:26 A.M. revealed HSM #661 confirmed the carpets were soiled. Interview on 09/19/25 at 11:42 A.M. revealed Certified Nursing Assistant (CNA) #184, who stated she has worked at the facility for three months, stated that many items were dropped on the carpets during meal service and other tasks. She noted that housekeepers try to clean the carpets, but they were in such poor condition they cannot be salvaged. Interview conducted 09/19/25 at 1:38 PM with Resident #64 confirmed carpets in the hallway were very soiled, they have may stains and look very dirty. Resident #64 voiced significant soiling outside the elevator stating the floor looks black. Review of the facilities homelike policy dated 02/2021 revealed residents are provided with a safe, clean, comfortable and homelike environment. The facility staff and management maximize, to the extent possible, the characteristics of the facility that reflect a personalized homelike setting. These characteristics include: a clean, sanitary and orderly environment. This deficiency represents non-compliance investigated under Complaint Number 2609903. 366100 Page 2 of 2