Health inspection·September 19, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on observation and interview the facility failed to ensure residents were provided a dignified dining experience. This affected two residents (Resident #50 and #137) but had the potential to affect 16 residents (Resident #37, #46, #47, #52, #53, #55, #69, #80, #93, #94, #108, #109, #112, #120, #123 and #137) of 24 residents who ate meals in the 100 hall and 200 hall dining room and do not use adaptive cups. The census was 136. Findings include: Observation of dining room on the 100-Hall and 200-Hall on 09/18/24 at 5:00 P.M. revealed Resident #37, #46, #47, #52, #53, #55, #69, #80, #93, #94, #108, #109, #112, #120, #123 and #137) had styrofoam cups with water, coffee and/or hot chocolate. Interview on 09/18/24 at 5:10 P.M. with State Tested Nurses Assistant (STNA) #321 verified that styrofoam cups were being used for water, coffee and hot chocolate for residents that did not require adaptive cups. STNA #321 stated the silverware, and drinks are brought to the dining room prior to the delivery of the meal trays and there are not enough cups for coffee/hot chocolate, so they use styrofoam cups and the large water glasses are not on the beverage cart, so styrofoam cups are also used for water. Interview of 09/18/24 at 5:19 P.M. with Resident #52 stated staff use styrofoam cups every day and he does not like to use styrofoam cups for his beverages. Interview on 09/18/24 at 5:23 P.M. with Resident #137 stated he does not like to drink out of a styrofoam cup and prefers to drink out of real cups and glasses. Interview of 09/19/24 at 11:15 A.M. with Dietary Manager (DM) #308 stated more coffee cups need to be ordered due to not having enough cups for mealtimes. DM #308 stated the water glasses are to be put on the meal tray for ice water during the meal. The drink cart is sent out to the dining rooms and staff will use the styrofoam cups for water, hot coffee and hot chocolate. When they run out of cups the staff are not asking for more cups and will just use the styrofoam cups and not ask for more cups or glasses. This deficiency represents non-compliance investigated under Complaint Number OH00156585. 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: 366333 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 366333 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scenic Pointe Nursing and Rehab Ctr 8067 Township Road 334 Millersburg, OH 44654 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)