Maple Knoll Village

Based on medical record review, observation, resident interview, staff interview, and review of the facility policy, the facility failed to ensure staff provided timely incontinence care.

This affected two (Residents #15 and #16) of three residents reviewed for call light response.

The facility census was 66 residents.

Findings include:

Review of the medical record for Resident #15 revealed an admission date of 02/16/24 with diagnoses including cerebral infarction, diabetes, and depression.

Review of the Minimum Data Set (MDS) assessment for Resident #15 dated 08/06/25 revealed the resident had no cognitive impairments and required substantial assistance to total dependence on staff for activities of daily living (ADLs).

Review of the medical record for Resident #16 revealed an admission date of 01/06/23 with diagnoses including dementia, depression, and Barrett's esophagus.

Review of the MDS assessment for Resident #16 dated 09/05/25 revealed the resident had no cognitive impairment and was dependent of staff for ADLs.

Observation on 09/22/25 from 3:05 P.M. until 3:25 P.M. revealed Residents #15 and #16's call lights were sounding.

Staff did not respond to the call lights.

Interview on 09/22/25 at 3:25 P.M. with Resident #15 confirmed he had activated his call light because he needed assistance with being changed.

Interview on 09/22/25 at 3:26 P.M with Resident #16 confirmed she had activated her call light because she needed to be changed as she was soiled and had diarrhea.

Observation on 09/22/25 at 3:34 P.M. revealed Certified Nursing Assistant (CNA) #25 entered Resident #15's room and turned off his call light without providing care.

Interview on 09/22/25 at 3:36 P.M. with CNA #25 confirmed she had been off the unit on a lunch break and had just returned. CNA #25 confirmed she was unaware no one had been available to answer the call lights from 3:05 P.M. to 3:25 P.M.

Review of the facility policy titled Supporting Activities of Daily Living undated revealed residents who were unable to carry out ADLs independently would receive the services necessary to maintain good nutrition, grooming, personal and oral hygiene.

This deficiency represents noncompliance investigated under Complaint Number 2580344 and and Complaint Number 135097 (OH00161949) and Complaint Number 1395096 (OH00161797) and Complaint Number 1395095 (OH00160987.)

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

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

09/25/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Maple Knoll Village

11100 Springfield Pike Cincinnati, OH 45246

SUMMARY STATEMENT OF DEFICIENCIES