F 0728
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Many
Ensure that nurse aides who have worked more than 4 months, are trained and competent; and nurse
aides who have worked less than 4 months are enrolled in appropriate training.
Based on review of staffing agency information, review of facility census, staff interview, staffing agency
personnel interview, and review of the State of Ohio Nurse Aide Registry, review the Office of Health
Assurance and Licensing (OHAL) website, the facility failed to ensure an aide had completed an approved
nurse aide training and competency evaluation program (NATCEP) before working the facility. This affected
one (Agency Aide #150) of three personnel files reviewed and had the potential to affect all 66 residents
residing in the facility. The facility census was 66.
Findings Include:
Review of staffing information provided by the facility and a staffing agency revealed Agency Aide #150
worked in the facility from 09/13/23 through 12/22/23.
Review of the State of Ohio Nurse Aide Registry revealed Agency Aide #150 was not registered as an state
tested nursing assistant (STNA).
Review of a NATCEP certificate provide by a staffing agency revealed Agency Aide #150 had completed a
NATCEP program on 07/31/23.
Review the OHAL website revealed the NATCEP program listed on Agency Aide #150's certificate had
closed on 10/01/17.
Phone interview with Staffing Agency Personnel (SAP) #200 on 01/25/24 at 1:39 P.M. revealed Agency
Aide #150 was employed by the staffing agency and worked at the facility from 09/13/23 through 12/22/23.
Agency Aide #150 was terminated on 12/22/23.
During an interview on 01/25/24 at 2:25 P.M. the Director of Nursing (DON) stated Agency Aide #150 was
terminated when a completed background check revealed offenses that disqualified her from working in a
nursing facility.
During an interview on 01/29/24 at 11:50 A.M. the DON and Assistant Director of Nursing (ADON) #110
stated Aide #150 had worked various shifts and various units of the facility. The DON and ADON #110
confirmed there had been no concerns regarding Agency Aide #150 while she worked at the facility
including the care she provided.
This deficiency represents non-compliance investigated under Complaint Number OH00150031.
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:
366178
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
366178
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/29/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Widows Home of Dayton
50 South Findlay Street
Dayton, OH 45403
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 0729
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Verify that a nurse aide has been trained; and if they haven't worked as a nurse aide for 2 years, receive
retraining.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
review of personnel record, staffing schedule information, review of facility census, staff interview, and
review of the State of Ohio Nurse Aide Registry, the facility failed to ensure a state tested nursing
assistant's (STNA) registration was not expired. This affected one (STNA #130) of three personnel files
reviewed and had the potential to affect 17 (#39, #40, #41, #42, #43, #44, #45, #46, #47, #48, #49, #50,
#51, #52, #53, #54, and #55) residents that STNA #130 regularly cared for. The facility census was 66.
Findings Include:
Review of STNA #130's personnel file revealed a hire date of [DATE].
Review of the State of Ohio Nurse Aide Registry revealed STNA #130 was not eligible to work in a
long-term care facility due to not having work verification in the past 24 months. STNA #10's nurse aide
registration expired on [DATE].
Review of staffing schedule information revealed STNA #130 worked in Rehab Unit on [DATE], [DATE],
[DATE], and [DATE] from 7:00 A. M to 7:00 P.M.
During an interview on [DATE] at 11:45 A.M. the Director of Nursing (DON) and Human Resources (HR)
#100 confirmed STNA #130 was not current and in good standing State of Ohio Nurse Aide Registry.
Documents had been sent to the State of Ohio Nurse Aide Registry, but no follow-up had been received.
STNA #130 was a current employee and had recently worked in the facility.
Review of the facility census revealed Residents (#39, #40, #41, #42, #43, #44, #45, #46, #47, #48, #49,
#50, #51, #52, #53, #54, and #55) resided in the Rehab Unit.
This deficiency represents non-compliance investigated under Complaint Number OH00150031.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366178
If continuation sheet
Page 2 of 2
