Health inspection·August 22, 2024

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, review of facility policy and resident rights, resident and staff interview, and observation, the facility failed to ensure housekeeping and maintenance services were provided to maintain a sanitary, orderly and comfortable interior. This affected one resident (#75) and had the potential to affect an additional 36 residents (Resident #2, #3, #5, #8, #9, #11, #12, #19, #22, #23, #25, #26, #30, #32, #33, #35, #36, #40, #41, #43, #48, #49, #59, #62, #64, #65, #69, #71, #74, #83, #84, #85, #86, #91, #92, and #94) who resided on the second floor. The facility census was 93. Findings include: Review of Resident #75's medical record revealed an admission date of 12/20/22. Diagnoses included depression, muscle weakness, and peripheral vascular disease. Review of the Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #74 was cognitively intact and required maximum assistance from staff with bathing. Observation on 08/19/24 at 12:13 P.M. of the second-floor community shower room revealed an unpleasant foul odor coming from a drain in the bathroom, and the restroom had a brown smeared substance on the wall. One of the two shower curtains had scattered black dots on it. Observation and interview on 08/19/24 at 4:09 P.M. with State Tested Nursing Assistant (STNA) #272 confirmed a foul odor was present, the restroom had a brown substance on the wall, and one of the two shower curtains had scattered black dots on it. STNA #272 stated it was housekeeping's responsibility to clean the restroom and change the dirty shower curtain. STNA #272 stated a remedy for the foul odor was to run water down the drain. Interview on 08/20/24 at 10:19 A.M. with Resident #75 said the facility does not clean the community restroom/shower room routinely and the smell was terrible in the community shower room. Interview on 08/20/24 at 8:32 A.M. with Clinical Service Manager #400 confirmed the second-floor community shower room was to be cleaned when soiled and to run water down the shower drains to prevent gas buildup. Review of the facility Resident Rights and Facility Responsibilities dated 10/24/23 revealed the residents have the right to a safe and clean living environment. Review of the facility policy on routine cleaning dated 11/30/23 revealed cleaning walls and blinds according to the cleaning schedule and whenever dust or soil is visible. Page 1 of 2 366418 366418 08/22/2024 Dublin Post Acute 4075 West Dublin-Granville Road Dublin, OH 43017

F 0584 This deficiency represents non-compliance investigated under Complaint Number OH00156499. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 366418 Page 2 of 2