Health inspection·February 11, 2025

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff and physician interviews and policy review, the facility failed to ensure residents with gastrostomy tubes were administered enteral feedings with a valid physician's order. This affected one (#25) of one residents reviewed for gastrostomy tube care and services. The facility census was 51. Findings include: Review of the medical record revealed Resident #25 was admitted to the facility on [DATE]. Diagnoses included hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side, dysarthria, dysphagia, type II diabetes, unspecified anxiety disorder, stage II pressure ulcer, and gastrostomy status. Review of the most recent Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #25 had severely impaired cognition, had no behaviors, did not wander, and did not reject care. Review of care plan dated 01/09/23 revealed Resident #25 required tube feeding and an oral diet to meet nutrition and hydration needs to support metabolic demands. Interventions included to provide assistance with meals as needed, provide diet/supplements/medications as ordered, and administer tube feeding as ordered. Review of the medical record revealed Resident # 25 had physician orders for a diet of fortified foods, pureed texture, with nectar thickened liquids and one-on-one (1:1) feeding assistance with all meals. Additionally, Resident #25 had orders to flush gastrostomy tube with 400 cubic centimeters (cc) of water every six hours, and 30 cc of water before and after medication pass. Resident #25 had no active orders for supplemental tube feeding. Review of progress note dated 02/02/25 at 1:19 AM revealed an unidentified aide reported to Registered Nurse (RN) #273 that Resident #25 did not receive dinner. RN #273 documented she administered unspecified tube feeding to supplement the missed meal. Resident #25 coughed up some of the tube feed and required the bed linens to be changed. Review of form titled Teachable Moment dated 02/04/25 revealed RN #273 stated to management she had given Jevity 1.5 in a 240 milliliter (ml) bolus to Resident #25 without an order. During the survey, RN #273 was unable to be reached by telephone for interview on 02/06/25 at 11:42 A.M. (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 3 Event ID: 366490 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 366490 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vienna Springs Health Campus 2510 Vienna Pkwy Dayton, OH 45459 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)