Health inspection·February 22, 2024

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, resident interview, staff interview, and policy review, the facility failed to assist a resident, who was dependent on staff for assistance with incontinence care in a timely manner. This affected one (#23) of three residents reviewed for incontinence care. The facility census was 67. Residents Affected - Few Findings include: Review of Resident #23's medical record revealed an admit date of 01/03/24, with diagnoses including: fractured left femur with joint replacement, diabetes mellitus, chronic kidney disease, pulmonary disease, severe protein-calorie malnutrition, kyphosis of cervical region with cervicalgia (neck pain), anemia, thyrotoxicosis (High levels of circulating thyroid hormones.), and localized swelling, mass, and lump of both lower limbs. Review of Resident #23's Minimum Data Set (MDS) assessment dated [DATE] indicated she had intact cognition, had an indwelling urinary catheter and was occasionally incontinent of bowel. Resident #23's plan of care initiated on 01/17/24 indicated an activity of living self-care performance deficit related to displaced fractured femur. Interventions on the plan of care indicated to provide one staff member to assist with use of the toilet. Interview on 02/13/24 at 8:35 A.M., with Resident #23 revealed she had been waiting for 30 minutes for someone to assist her with incontinence care. Resident #23 stated she had asked State Tested Nursing Assistant (STNA) #74 who told her she would let her aid know of her need for incontinence care. Resident #23 stated she received stool softeners and was unable to feel the urge to have a bowel movement. Observation of Resident #23 on 02/13/24 between 8:35 A.M. and 8:50 A.M. revealed Resident #23 asked several staff members to assist her with her toileting needs. Resident #23 asked State Tested Nurse Aide (STNA) #74 to assist her with incontinence care. STNA #74 responded she had to wait until all the meal trays were picked up and proceeded to push Resident #23 in her wheelchair to her room. A few minutes later Resident #23 propelled herself out of her room stating she was informed by the staff that she would need to provide her with incontinence care because she was supposed to transfer to the assisted living facility. Resident #23 left the common area and propelled herself down the hallway and approached Licensed Practical Nurse (LPN) #82 and asked her to assist with incontinence care. LPN #82 informed Resident #23 she needed to go back to her room to ask for assistance with incontinence care. LPN #82 informed Resident #23 she would need to provide her own incontinence care if Resident #23 wanted to return to the assisted living facility. Approximately five minutes later, LPN #82 asked STNA #74 to assist Resident #23 with her incontinence care. STNA #74 proceeded to push (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 10 Event ID: 366186 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 366186 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aventura at Humility House 755 Ohltown Road Austintown, OH 44515 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)