Doylestown Health Care Center
Inspection Findings
F-Tag F0684
F 0684 Level of Harm - Actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
lacerations, swelling and vital signs. If the fall involved a possible head injury, check the pupils and level of consciousness, obtain a statement of what occurred from anyone who witnessed the incident and/or resident if capable, notify the attending physician if the resident has sustained any serious injury, notify the family or responsible party, write an incident report, notify your supervisor, and notify the oncoming nurse.
This deficiency represents non-compliance investigated under Complaint Number 2576943 and Self-Reported Incident Control Number 1281390.
Event ID:
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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
08/11/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Doylestown Health Care Center
95 Black Drive Doylestown, OH 44230
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-Tag F0689
F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
the bed. Assistant Director of Nursing (ADON) #87 was notified that the resident's body pillow was missing from the left side of her bed. CNA #80 was observed putting the body pillow to the left side of Resident #13 underneath the bottom sheet. Interview, during the observation, with CNA #80 revealed CNA #80 did not assist Resident #13 to bed after lunch. Interview on 08/05/25 at 2:25 P.M. with CNA #82 revealed CNA #82 had assisted the resident of bed and the resident was supposed to have the body pillow underneath her body sheet to prevent the resident from falling. Interview on 08/05/25 at 2:39 P.M. with LPN #81 verified Resident #13 did not have Dycem on either side of the bed while the resident was in bed. Interview on 08/05/25 at 2:48 P.M. with CNA #80 verified Resident #13's body pillow had been sitting on the resident's recliner and not in the bed with the resident. Interview on 08/11/25 at 2:05 P.M. with the DON verified it was her expectation that if a fall intervention was listed on the care plan, the intervention would be in place for
the resident. Review of the facility policy, Fall Prevention and Fall Management, revised November 2024 revealed fall management included to develop a care plan with interviews based on risk review and follow care plan for transfer status and staff assistance required. When a fall occurs, the following protocol will be followed by the nurse: assess the resident's vital signs, level of consciousness and orientation to the environment, assess the resident's body of any injury and will assess range of motion as able. The assessment will include neurological assessment if resident hit their head or displays a change in level of awareness/consciousness of if fall unwitnessed and unable to determine if resident hit their head, will not move the resident from the floor until the basic physical assessment is complete, complete a Risk Management/quality assurance (QA) incident report, implement a plan of care intervention to reduce the risk of another fall based on the initial evaluation and investigation, notify the physician of the fall and assessment., notify the resident/resident's representative of the incident and intervention, document the assessment of the resident and any orders/interventions in the medical record, and the QA incident report and fall incident investigation are forwarded to the DON and are reviewed by the interdisciplinary team to discuss the need for further evaluation, investigation or intervention implementation. This deficiency represents non-compliance investigated under Complaint Number 2576943 and Self-Reported Incident Control Number 1281390.
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Facility ID:
If continuation sheet
DOYLESTOWN HEALTH CARE CENTER in DOYLESTOWN, OH inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in DOYLESTOWN, OH, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from DOYLESTOWN HEALTH CARE CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.