Health inspection·February 9, 2026

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** THE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NON-COMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY.Based on record review, interview, facility investigation review and facility policy review, the facility failed to ensure Resident #52 did not leave the facility without staff knowledge. This affected one (Resident #52) of three residents reviewed for elopement. The facility identified nine (Residents #6, #42, #52, #56, #64, #69, #70, #72 and #73) at risk for elopement. The facility census was 82.Findings include:Review of the medical record for Resident #52 revealed an admission date of 10/01/25. Diagnoses included dementia, hypertension, anxiety, and skin cancer.Review of the elopement risk evaluation dated 10/01/25 revealed Resident #52 was not at risk for elopement.Review of the comprehensive Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #52 was severely cognitively impaired. He required help for eating, supervision for oral care, dressing, hygiene and toileting and partial assistance for showering. He was independently mobile.Review of the physicians' orders for January 2026 revealed Resident #52 had been wearing a Wanderguard (a bracelet worn on the wrist or ankle of a resident to alert staff if they try to leave the building) which was ordered on 10/02/25.Review of the nursing progress note dated 11/17/25 at 7:16 P.M. revealed at approximately 11:00 A.M., nursing staff received a phone call from a female who was driving in the area and spotted Resident #52 walking in the community. An elopement code was called, and two staff were sent by a car to the area where the resident was seen. Emergency services were also called and were en route to the location where the resident was last seen. At 11:14 A.M. the resident was located by police and emergency medical services (EMS), and the resident was returned to the facility. The physician was notified and a head-to-toe assessment was completed. Resident #52 was placed on one-to-one supervision. Resident #52's vital signs included blood pressure 149/75, heart rate 61, pulse ox 99% on room air, temperature 97.5 degrees Fahrenheit (F) and respirations 16.Interview on 02/05/26 at 7:47 A.M. with the Administrator revealed the facility received a phone call from the police that Resident #52 was walking down the street, and they were bringing him back. The facility assessed the situation and determined Resident #52 broke the screw that secured his window in his room, removed the screen from his window and placed it under his bed and climbed out his bedroom window. She revealed the last time he was seen was shortly after breakfast, at approximately 8:40 A.M. The call that he was found came in approximately an hour and a half later.Review of the facility investigation dated 11/17/25 revealed Resident #52 was last seen by a staff at approximately 8:40 AM. He was observed walking to his room, lying on his bed and shutting his door, which was his normal routine. Resident #52 resided on the secured memory care unit and had a Wanderguard in place beginning from admission. Resident #52 went out his bedroom window and broke the safety screw off the window and removed the screen. The temperature was identified as 40 degrees F. Resident #52 was wearing a sweatshirt and T-shirt, long pants and shoes. Resident #52 was located approximately 2.5 miles from the facility. (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 2 Event ID: 366375 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 366375 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/09/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Masternick Memorial Health Care Center 5250 Windsor Way New Middletown, OH 44442 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)