Riverside Nursing And Rehabilitation Center

Federal health inspectors cited RIVERSIDE NURSING AND REHABILITATION CENTER in DAYTON, OH for a deficiency under regulatory tag F-F0565 during a standard health inspection conducted on 2025-09-02.

Category: Resident Rights Deficiencies

The facility was found deficient in the following area: Honor the resident's right to organize and participate in resident/family groups in the facility.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 12 deficiencies cited during this inspection of RIVERSIDE NURSING AND REHABILITATION CENTER.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-09-30.

Federal health inspectors cited RIVERSIDE NURSING AND REHABILITATION CENTER in DAYTON, OH for a deficiency under regulatory tag F-F0574 during a standard health inspection conducted on 2025-09-02.

Category: Resident Rights Deficiencies

The facility was found deficient in the following area: The resident has the right to receive notices in a format and a language he or she understands.

Scope/Severity Level E: pattern, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 12 deficiencies cited during this inspection of RIVERSIDE NURSING AND REHABILITATION CENTER.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-09-30.

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

the light was short and the resident couldn't reach it. The resident stated the lights have been burned out for some time now and his string was not long enough for him to reach it.

Interview and observation of Resident #65's room on 08/05/25 at 7:36 A.M. revealed the string to his light

on the back wall behind his bed was short and the resident could not reach it because he was bed bound.

There were gouges out of the wall behind his bed and to the side of it. There were missing hooks off his privacy curtain and the curtain is hanging in that area. The resident stated he doesn't get out of bed, and he isn't able to reach his light to be able to turn his light on and off from his bed because the cord wasn't long enough.

Interview with the Maintenance Director #499 on 08/07/25 at 2:57 P.M. toured the above-mentioned rooms and confirmed the problems in the rooms.

1. 4. Review of the medical record for Resident #112 revealed an admission date of 02/19/24. Diagnoses

included dementia, anxiety disorder, and cerebrovascular accident.

Review of the MDS assessment dated [DATE REDACTED] revealed Resident #112 had moderate cognitive impairment as evidenced by a Brief Interview for Mental Status (BIMS) score of nine. This resident was assessed to require setup with eating, substantial assistance with toileting, bathing, and dressing, and supervision with transfers.

Observation on 08/04/25 at 1:38 P.M. revealed five gashes about 12 inches in length behind the headboard of Resident #112's bed.

Interview on 08/07/25 at 9:10 A.M. with Maintenance Director #499 verified the gashes behind the headboard of Resident #112's bed.

This deficiency represents non-compliance investigated under Complaint Numbers 1259570 and 2573764.

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/02/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Riverside Nursing and Rehabilitation Center

1390 King Tree Drive Dayton, OH 45405

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)

F 0609 Level of Harm - Minimal harm or potential for actual harm

and appeared that they didn't know who each other were. UM/LPN #406 stated the previous Administrator at the time of the incident did not feel it was necessary to complete a SRI for the incident. UM/LPN #406 also stated an incident report was not completed.This deficiency represents non-compliance investigated under Complaint Numbers 1259568 and 1259561.

Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/02/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Riverside Nursing and Rehabilitation Center

1390 King Tree Drive Dayton, OH 45405

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)

F 0610 Level of Harm - Minimal harm or potential for actual harm

Administrator at the time of the incident did not feel it was necessary to complete a SRI for the incident.

UM/LPN #406 also stated an incident report was not completed. This deficiency represents non-compliance investigated under Complaint Numbers 1259568 and 1259561.

Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/02/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Riverside Nursing and Rehabilitation Center

1390 King Tree Drive Dayton, OH 45405

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)

Federal health inspectors cited RIVERSIDE NURSING AND REHABILITATION CENTER in DAYTON, OH for a deficiency under regulatory tag F-F0645 during a standard health inspection conducted on 2025-09-02.

Category: Resident Assessment and Care Planning Deficiencies

The facility was found deficient in the following area: PASARR screening for Mental disorders or Intellectual Disabilities

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 12 deficiencies cited during this inspection of RIVERSIDE NURSING AND REHABILITATION CENTER.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-09-30.

Federal health inspectors cited RIVERSIDE NURSING AND REHABILITATION CENTER in DAYTON, OH for a deficiency under regulatory tag F-F0656 during a standard health inspection conducted on 2025-09-02.

Category: Resident Assessment and Care Planning Deficiencies

The facility was found deficient in the following area: Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 12 deficiencies cited during this inspection of RIVERSIDE NURSING AND REHABILITATION CENTER.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-09-30.

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

daughter stated UM #406 called her and told her Resident #160 and Resident #49 were found in her room with their pants off. Resident #160's daughter reported SSD #447 called her the following day and asked her to give consent to Resident #160 having sexual activity. Resident #160's daughter did not give consent.

Interview on 08/06/25 at 3:31 P.M. with LPN #491 revealed CNA #436 was completing rounds when she called LPN #491 into Resident #160's room. LPN #491 stated Resident #160 was sitting on her bed with no pants or depends on, and Resident #49 was standing in front of her about two feet apart. Resident #49 was fully clothed and was asked to leave the room. LPN #491 explained she educated both residents and completed a head-to-toe assessment on Resident #160 with no negative findings. LPN #491 stated she tried to ensure Resident #160 and Resident #49 were separated the rest of the shift. Interview on 08/14/25 at 1:55 P.M. with UM/LPN #406 revealed LPN #491 reported Resident #49 was found in Resident #160's room. Resident #160 was found with no pants or depends on, sitting on her bed. Resident #49 was fully clothed and asked to leave the room. UM/LPN #406 reported she reached out to Resident #160's daughter and informed her of the incident. UM/LPN #406 stated both residents had progressive dementia and appeared that they didn't know who each other were. UM/LPN #406 stated the previous Administrator at

the time of the incident did not feel it was necessary to complete an SRI for the incident. UM/LPN #406 also stated an incident report was not completed. Interview on 08/14/25 at 3:22 P.M. with MD #801 verified Resident #160 had memory loss and some cognitive and behavioral issues. MD #801 reported Resident #49 had vascular dementia and post-traumatic stress disorder (PTSD). MD #801 stated Resident #49 had memory loss as well. MD #801 stated both residents had memory issues and could not state if she felt that either resident could give consent to sexual activity. Interview on 08/14/25 at 3:52 P.M. with CNA #436 reported on 04/28/25 she came onto shift at 3:00 P.M., and Resident #49 and Resident #160 were in the common area watching television. About 15-20 minutes later, CNA #436 walked by, and both residents were gone. CNA #436 stated she saw Resident #160's door was closed to her room, which wasn't unusual, but she had a gut feeling to go in and check. CNA #436 knocked on her door and went in and found Resident #160 on her bed with her pants halfway down her legs, and Resident #49 standing in front of her fully clothed. CNA #436 stated Resident #49 was asked to leave the room. CNA #436 explained Resident #160 became aggressive and started calling her names. CNA #436 reported neither resident was placed

on a 1:1. Review of the facility policy titled, Unit Supervision, revealed the policy of the facility was to provide resident centered care that met the psychosocial, physical, and emotional needs and concerns of

the residents. Safety was a primary concern for the residents, staff, and visitors. The Unit Supervisor was a licensed nurse with the skills and competency to safely and appropriately monitor and delegate tasks to others and perform duties consistent with safe and effective care and treatment of the assigned residents.

Supervision responsibilities were assigned by the DON or designee to provide for the care and treatment of

the residents, direct services of on-duty staff, and assume responsibility for a safe environment during the time the nurse was working the shift for the specific unit the nurse was assigned. This deficiency represents non-compliance investigated under Complaint Numbers 1259562 and 2585469.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/02/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Riverside Nursing and Rehabilitation Center

1390 King Tree Drive Dayton, OH 45405

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)

Federal health inspectors cited RIVERSIDE NURSING AND REHABILITATION CENTER in DAYTON, OH for a deficiency under regulatory tag F-F0692 during a standard health inspection conducted on 2025-09-02.

Category: Quality of Life and Care Deficiencies

The facility was found deficient in the following area: Provide enough food/fluids to maintain a resident's health.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 12 deficiencies cited during this inspection of RIVERSIDE NURSING AND REHABILITATION CENTER.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-09-30.

Federal health inspectors cited RIVERSIDE NURSING AND REHABILITATION CENTER in DAYTON, OH for a deficiency under regulatory tag F-F0693 during a standard health inspection conducted on 2025-09-02.

Category: Quality of Life and Care Deficiencies

The facility was found deficient in the following area: 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.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 12 deficiencies cited during this inspection of RIVERSIDE NURSING AND REHABILITATION CENTER.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-09-30.

F 0760

Ensure that residents are free from significant medication errors.

Level of Harm - Minimal harm or potential for actual harm

Based on medical record review, Nurse Practitioner (NP) interview, and policy review, the facility failed to administer medication as ordered which resulted in a significant medication error. This affected one (#02) resident out four residents reviewed for medication administration. The facility census was 164. Review of

the medical record for Resident #02 revealed an admission date of 02/09/23 with medical diagnoses of right hemiplegia, chronic obstructive pulmonary disease, end stage renal disease, dependence on dialysis, and bipolar disorder. Review of the medical record for Resident #02 revealed a Minimum Data Set (MDS) assessment, dated 07/07/25, which indicated Resident #02 was cognitively intact and was dependent upon staff for toilet hygiene, showers/bathes, transfers and bed mobility. Review of the medical record for Resident #02 revealed a physician order dated 11/30/24 for Midodrine (hypotension medication) oral tablet 2.5 milligram (mg) one tablet by mouth every eight hours as needed for hypotension. Hold if systolic blood pressure (SBP) is greater than 110 and administer if SBP is less than 110. Review of the medical record for Resident #02 revealed a blood pressure reading on 06/03/25 of 97 (SBP)/50 diastolic blood pressure (DPB) milliliters in mercury (mmHg). Review of the medical record revealed pre-dialysis assessments on 07/24/25 with a documented blood pressure of 105/78 mmHg, on 07/31/25 with documented blood pressure of 106/64 mmHg, and on 08/05/25 with a documented blood pressure of 104/67 mmHg. Review of the medical record for Resident #02 revealed the Medication Administration Records (MAR) for June, July and August 2025 did not have documentation to support Midodrine was administered on 06/03/25, 07/24/25, 07/31/25, and 08/05/25. Interview on 08/07/25 at 10:23 A.M. with NP #800 stated the order was supposed to be entered to administer Midodrine 2.5 mg one tablet every eight hours for hypotension and to hold if SBP is greater than 110 and to administer if SBP less than 110. NP #800 stated Resident #02 should have her blood pressure checked three times per day for the facility to monitor her for possible Midodrine administration. NP #800 also stated the facility staff should have administered Midodrine as ordered prior to dialysis. NP #800 confirmed the facility had not administered Midodrine as ordered on 06/03/25, 07/24/25, 07/31/25, and 08/05/25. Review of the facility policy titled, Medication Administration, revealed the facility is to provide resident centered care the meets the psychosocial, physician, and emotional needs and concerns of the residents. The policy continued to state staff are to administer medication only as prescribed by the provider. This deficiency represents non-compliance investigated under Complaint Number 1259566.

Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/02/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Riverside Nursing and Rehabilitation Center

1390 King Tree Drive Dayton, OH 45405

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)

F 0835

Administer the facility in a manner that enables it to use its resources effectively and efficiently.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

review of documentation from an employment agency, review of documentation from Board of Executives of Long-Term Services and Supports (BELTSS), interview with Board Administrator at BELTSS, and staff interview, the facility failed to ensure Administrator had a valid Nursing Home Administrator (NHA) license.

This had the potential to affect all the residents. The facility census was 164. Interview on 08/05/25 at 10:09 A.M. with Regional Director of Operations (RDO) #750 confirmed the facility had employed interim NHA #630 from 05/12/25 through 06/10/25. RDO #750 stated interim NHA #630 had been hired through an employment agency and provided documentation interim #630 had an active NHA license. Interview on 08/06/25 at 4:15 P.M. with Board Administrator #635 stated BELTSS was notified of a concern about the validity of interim NHA #630's license. Board Administrator #635 stated after an investigation it was determined that interim NHA #630 had used the license number for NHA ##700 to obtain a position as a NHA. Board Administrator #635 stated interim NHA #630 and NHA #700 had similar names but different Social Security Numbers, addresses, and date of birth s. Board Administrator #635 confirmed interim NHA #630 did not have a valid NHA license. Review of the documentation from the employment agency provided to the facility revealed interim NHA #630's date of birth was 10/23/73 and resided in Cincinnati. Review of

the documentation revealed interim NHA #630 had used NHA license number 7258. Review of documentation from BELTSS revealed NHA #700 had an active license of number 7258, a date of birth of [DATE REDACTED] and resided in Englewood. Review of BELTSS documentation revealed interim NHA #630 was registered as an Administrator in Training and did not have an active NHA license. This deficiency represents non-compliance investigated under Complaint Number 2578224.

Residents Affected - Many

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet