Health inspection·May 12, 2025

F 0640 Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment. 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 and staff interview, the facility failed to ensure Minimum Data Set (MDS) assessments were completed and transmitted within 14 days. This affected two (Residents #401 and #402) of six residents reviewed for assessments. The facility census was 38 residents. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #401 revealed an admission date of 03/29/25 with diagnoses including cellulitis of the left finger, asthma, and type two diabetes mellitus and a discharged from the facility on 04/21/25. Review of the admission Minimum Data Set (MDS) assessment for Resident #401 dated 04/04/25 revealed the resident was cognitively intact and required staff assistance with activities of daily living (ADLs.) Review of the discharge return anticipated (DRA) MDS assessment for Resident #401 dated 04/19/25 revealed the MDS was in progress and had not been transmitted. Review of the progress note for Resident #401 dated 04/19/25 timed at 11:42 A.M. revealed the resident's representative called the urologist and was instructed to take the resident to the emergency room (ER). Resident #401 left the facility with two friends and his representative in an automobile. Review of the progress note for Resident #401 dated 04/20/25 timed at 7:18 P.M. revealed the resident returned to the facility at 6:50 P.M. Review of the DRA MDS assessment for Resident #401 dated 04/21/25 revealed the MDS was in progress and had not been transmitted. Review of the progress note for Resident #401 dated 04/21/25 timed at 11:55 A.M. revealed the resident had discharged home. Interview on 05/12/25 at 3:46 P.M with MDS Licensed Practical Nurse (LPN) #215 confirmed the DRA MDS assessments dated 04/19/25 and 04/21/25 for Resident #401 had not been transmitted within 14 days as required. 2. Review of the medical record for Resident #402 revealed an admission date of 07/11/24 with diagnoses including cerebral infarction, generalized anxiety disorder, major depressive disorder, and a (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 3 Event ID: 366216 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 366216 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mason Health Care Center 5640 Cox-Smith Road Mason, OH 45040 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)