Health inspection·September 11, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview the facility failed to ensure comprehensive care plans to address Post Traumatic Stress Disorder (PTSD) and suicidal ideations were initiated. This affected two Residents (#3 and #4) of 18 resident care plans reviewed. The facility census was 53. Findings include:1.Review of the medical record for Resident #3 revealed an admission date of 02/11/25 and a readmission date of 07/25/25 with diagnoses including Post Traumatic Stress Disorder (PTSD), insomnia, anxiety, depression, diabetes mellitus type two and bilateral above the knee amputations. Review of the five day Medicare minimum data set (MDS) assessment dated [DATE] revealed Resident #3 was cognitively intact with no behaviors. Resident #3 needed assistance from the staff to complete activities of daily living. Resident #3 had diagnoses of PTSD, anxiety and depression. Review of the plan of care for Resident #3 revealed no plan of care addressing the PTSD cause, resident triggers, resident reaction behaviors and staff interventions. Interview on 09/11/25 at 8:40 A.M. with the Administrator confirmed Resident #3 had diagnosis of PTSD and the care plan did not address the cause of the PTSD, the resident triggers, resident reaction behaviors and staff plan of action or interventions. 2.Review of the medical record for Resident #4 revealed an admission date of 01/03/23 and readmission date of 04/01/25 with diagnoses including senile degeneration of the brain, anxiety, suicidal ideations, seizure disorder, chronic kidney disease stage three, dementia and malignant neoplasm of overlapping sites of rectum, anus and anal canal. Review of the physician orders dated 09/25 revealed Resident #4 received Depakote sprinkles 125 milligrams (mg) by mouth two times daily for suicidal ideations and depression. Review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #4 had severe cognitive impairment with inattention, disorganized thinking, hallucination, delusions, verbal behaviors towards others and rejection of care. Resident #4 was dependent on the staff to complete activities of daily living. Resident #4 had diagnoses including dementia, anxiety, depression and suicidal ideations. Resident #4 received antianxiety, antidepressant and anticonvulsant medications. Review of the care plan for Resident #4 revealed there was not a care plan addressing the resident's suicidal ideations. Interview on 09/10/25 at 2:47 P.M. with Certified Nursing Assistant (CNA) #470 stated there was nothing on Resident #4 point of care documentation about the resident having suicidal ideations.Interview on 09/11/25 at 8:40 A.M. with the Administrator confirmed Resident #4 had a diagnosis of suicidal ideations, received medication for suicidal ideations and did not have a plan of care addressing the suicidal ideations. 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 5 Event ID: 366202 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 366202 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crystal Care of Coal Grove 813 1/2 Marion Pike Coal Grove, OH 45638 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)