Inspection·April 27, 2023

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 observations, medical record review and staff interviews, the facility failed to provide appropriate personal care for residents who required assistance. This affected two (#53 and #58) of 33 residents reviewed for care and treatment. The facility census was 122. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #53 revealed admission date of 02/16/18 with diagnoses of cerebral infarction, hemiplegia and hemiparesis, and Diabetes Mellitus type two. Review of Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #53 had severe cognitive impairment, no behaviors of refusal of care, and required extensive to total assistance of one person for personal hygiene and bathing. Review of progress notes revealed Resident #53 refused baths on 04/21/23 at 11:59 A.M., 04/18/23 on 9:10 A.M., and 04/13/23 at 8:55 A.M. Observation on 04/25/23 at 11:34 A.M., revealed Resident #53 in bed and had long fingernails that were untrimmed and jagged. Interview and observation on 04/26/23 at 2:50 P.M., with Licensed Practical Nurse (LPN) #54 stated there had been some issues with refusal of baths and showers with Resident #53. She did indicate that Resident #53 would consent to a bath and then change her mind part way through. LPN #54 verified that Resident #53's fingernails were long, jagged, and dirty. 2. Review of medical record for Resident #58 revealed an admission date of 11/10/21, with diagnoses including fracture of one rib on right side, paroxysmal tachycardia, and protein calorie malnutrition. Review of MDS assessment dated [DATE] revealed Resident #58 had severe cognitive impairment, no behaviors exhibited, and required extensive to total assistance of one for bathing and personal hygiene. Review of care plan revealed no care plan related to refusal of care or behaviors. Observation on 04/26/23 at 9:07 A.M. Resident #58 noted to have strong odor of urine. Interview and observation on 04/24/23 at 12:40 P.M., with State Tested Nursing Assistant (STNA) #64 verified that Resident #58 smelled strongly of urine, and she sometimes became agitated when offered care. 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: 366301 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 366301 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritagespring Healthcare Center of West Chester 7235 Heritagespring Drive West Chester, OH 45069 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)