Inspection·February 6, 2020

F 0730 Observe each nurse aide's job performance and give regular training. Level of Harm - Minimal harm or potential for actual harm Based on personnel record review and staff interview, the facility failed to ensure three State Tested Nursing Assistants (STNAs) of five reviewed received at least 12 hours of on-going training annually. This had the potential to affect all 42 residents of the facility. Residents Affected - Many Findings include: 1. Review of STNA #223's personnel file revealed the STNA had a hire date of 10/14/16. There was no evidence the STNA received 12 hours of ongoing training annually. 2. Review of STNA #221's personnel file revealed the STNA had a hire date of 01/31/17. There was no evidence the STNA received 12 hours of ongoing training annually. 3. Review of STNA #214's personnel file revealed the STNA had a hire date of 06/28/16. There was no evidence the STNA received 12 hours of ongoing training annually. Interview on 02/04/20 at 1:11 P.M. with Human Resource Supervisor (HR) #217 confirmed STNA #223, #221 and #214 had not completed twelve hours on on-going training and in-services. 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: 366445 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 366445 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/06/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Otterbein Loveland 6405 Small House Circle Loveland, OH 45140 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)