Inspection·May 2, 2024

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. Based on record review, observations, staff interviews and policy review, the facility failed to ensure a resident's enteral tube feeding orders were implemented as ordered. This affected one (#82) of three residents reviewed for enteral tube feeding. The facility census was 68. Findings include: Review of medical record for Resident #82 revealed admission date of 04/05/24. Diagnoses include chronic obstructive pulmonary disease, lupus, gastrostomy tube, and west nile virus. Resident #82 remains in the facility. Review of the physician orders dated 04/26/24 for Resident #82 revealed an order for Jevity (enteral nutrition) 1.5 calories at 70 milliliters (ml) an hour for 22 hours (12:00 P.M. to 10:00 A.M.). Review of the physician orders dated 04/26/24 for Resident #82 revealed an order for a 50 ml free water flush for 22 hours (12:00 P.M. to 10:00 A.M.). Interview on 05/01/24 at 10:00 A.M. with Licensed Practical Nurse (LPN) #109 stated the enteral nutrition order for Resident #82 was for the tube feeding to run continuously at 70 milliliters (ml) with a 250 milliliter flush every four hours. LPN #109 verified he was the nurse for Resident #82 on 04/30/24 and he did not stop the enteral nutrition for a set amount of time during his shift. Interview and observation on 05/01/24 at 11:30 A.M. with the Director of Nursing (DON) revealed the pump providing enteral feeding and flushes for Resident #82 was programmed to provide feeding at 70 ml an hour and water flushes of 250 ml every four hours. The DON verified the date on the enteral feed bag was dated 04/30/24 at 10:00 A.M. A follow up interview with the DON on 05/01/24 at 11:44 A.M. verified the enteral nutrition and fluid flush order for Resident #82 was not followed as ordered. The DON also confirmed the enteral bag was still being used and not changed after 24 hours, which was the expectation. Review of the facility policy, Care and Treatment of Feeding Tubes dated 05/01/24 revealed feeding tubes will be utilized according to physician orders. This deficiency represents non-compliance investigated under Complaint Number OH00152784. 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 05/02/2024 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)