Kettering Heights Post Acute

F 0573 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Brief Interview of Mental Status (BIMS) of seven, indicating impaired cognition. Review of authorization to disclose health information dated 01/13/25 revealed a record request was made for all records by Resident #101. Review of the letter dated 07/29/25 revealed a records request for Resident #101 requesting the medical record. MR #301 revealed this was a subpoena for documents. Review of email communication dated 08/04/25 from regional legal staff to additional regional legal staff as well as MR #301 revealed the

record request was valid and requested for documents to be prepared and files shared with legal to authorize release. Interviews on 08/11/25 from 2:48 P.M. to 3:10 P.M. with MR #301 confirmed she had not provided any medical records since 01/2025 when the new company took over ownership. MR #301 stated records had not been sent to Resident #101 or his attorney. She confirmed she was unaware and never saw the medical release request from 01/2025. MR #301 did not have knowledge or understanding of the requirement to provide records in a timely manner even when residents were admitted under a previous ownership name. MR #301 acknowledged the policy stated record requests should be provided within two business days upon written or oral request and confirmed the facility did not follow that policy/procedure.

Review of policy titled, Access to Personal and Medical Records, dated 05/2017 revealed each resident had the right to access and or obtain copies of his or her personal and medical records upon request. It stated a request shall be submitted orally or in writing. Access shall be provided within 24 hours (excluding weekends and holidays and two business days for copies of the records. This deficiency represents non-compliance investigated under Complaint Number 2581293.

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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

08/12/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Kettering Heights Post Acute

3313 Wilmington Pike Kettering, OH 45429

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 0684

treatment for santyl for enzymatic debriding with bordered gauze daily and as needed was recommended.

Level of Harm - Actual harm

Interview on 08/07/25 at 1:10 P.M. with Wound Nurse #345 revealed she began employment around 01/20/25. She revealed upon admission, a resident should have a full skin assessment completed by two staff with findings documented in the medical record. She revealed the wound NP would come to facility once weekly and could be reached for questions on days she was not onsite at the facility. Wound Nurse #345 verified all skin impairments shall be documented so they can be followed until healed including scratches, bruising, skin tear, pressure wounds, and surgical incisions.

Residents Affected - Few

Interview on 08/07/25 at 2:15 P.M. with the DON and the Administrator confirmed the admission assessment for Resident #99 had four skin items marked, left foot dorsal wound, heel soft, surgical incision with 36 staples, and a pressure stage four to coccyx/sacrum. The DON confirmed she completed the second assessment the same day (01/02/25) that included two skin notations including the dorsal foot open wound and the stage four pressure sore to the sacrum. The DON reported the heel being soft would not need to go on a skin assessment as it had no treatment. The DON also reported she typically would not put surgical incisions as well as incisions with staples on a comprehensive skin assessment stating, “we don’t always have dressings for surgical incisions.” The DON verified staff would monitor incision sites each shift for signs of infection and also verified the facility had no evidence of orders or documentation to monitor areas and incision sites and confirmed no record of staff documentation of monitoring.

Interview on 08/11/25 at 11:00 A.M. with the Administrator revealed the facility had identified non-compliance for skin and wounds and were back in compliance. The Administrator verified compliance meant wound assessments were completed according to nursing standards and per interview with the DON and Administrator on 08/07/25, the expectations for staff did not meet standards of practice. The Administrator confirmed staff should document any and all skin impairments including scratches, bruising, soft heels, and surgical wounds.

Interview on 08/11/25 at 3:48 P.M. with Licensed Practical Nurse (LPN) #312 verified all skin impairments should be documented on the admission and weekly assessment no matter the size. He revealed he did not remember caring for Resident #99, but if a wound treatment was mentioned on hospital discharge paperwork, the facility should make a note if they did not see the skin impairment on facility admission skin exam and get clarification from medical provider. LPN #312 also stated the importance of documenting a soft heel due to higher risk of developing a pressure sore and stated it would need increased monitoring or interventions.

Review of facility policy titled, Prevention of Pressure Injuries, dated 04/2020, revealed facility shall identify risk factors as well as interventions. Facility shall conduct a comprehensive skin assessment upon admission and as indicated.

This deficiency represents non-compliance investigated under Complaint Number 1306087 and 1306090.

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

08/12/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Kettering Heights Post Acute

3313 Wilmington Pike Kettering, OH 45429

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 0686 Level of Harm - Actual harm Residents Affected - Few

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

items marked including a left foot dorsal wound, a soft left heel, a surgical incision with 36 staples and a stage four pressure wound to the coccyx/sacrum. The DON confirmed she completed a second assessment the same day (01/02/25) that included two skin notations including the dorsal foot open wound and the stage four pressure sore to the sacrum. The DON confirmed the baseline care plan was not thoroughly completed including no mentions of wound care or skin protection and treatments. The DON confirmed she signed off on the baseline care plan and revealed it was a new form the facility was not familiar with and confirmed there was no documented evidence of wound or pressure relieving interventions on the care plan. The DON confirmed the wound NP #362 saw Resident #99 for the foot wound on 01/02/25 and did not see Resident #99 for the pressure wound until 01/08/25. The DON had no explanation for the delay in the NP seeing the wound as she had assessed his foot wound the week prior, and no explanation for the delay in treatment/interventions until he was seen by the wound NP on 01/08/25.

Interview on 08/07/25 at 3:51 P.M. with Wound Nurse Practitioner (WNP) #362 revealed she was onsite once weekly at the facility. She confirmed she rounded with the wound nurse and worked from the list of residents from the prior week while adding residents based on the nursing report of new admissions or new wounds that needed evaluation. She reported the facility would place a consult for a resident with wounds and she could follow the resident for any and all wounds as needed. WNP #362 revealed Resident #99 was admitted while the facility was between wound nurses. WNP #362 revealed she would round with the DON or bedside nurses during that time. She confirmed she was not informed of the stage four pressure wound for Resident #99 and stated she would definitely want to see a resident with a stage four pressure wound

during her rounds. The WNP confirmed she only saw the foot wound on the first visit with Resident #99 on 01/02/25 and confirmed the pressure wound had no treatment orders in place until her first assessment of it

on 01/08/25.Interview on 08/11/25 at 11:00 A.M. with the Administrator revealed she thought the wound had improved but acknowledged the measurements increased and that Resident #99's wound, going from stage four to unstable, was a decline. Interview on 08/11/25 at 12:50 P.M. with the Administrator, the DON, Regional Nurse #365, and Wound Nurse #345 confirmed the facility identified errors and non-compliance regarding Resident #99's care but stated they had made changes such as terminating the previous wound nurse on 12/30/24 and hiring Wound Nurse #345. They revealed the facility was going through a change in ownership and the facility had put new practices in place. They acknowledged Resident #99 was admitted

during the time the wound nurse had been terminated. Review of the facility policy titled, Pressure Ulcer/Skin Breakdown - Clinical Protocol, dated 04/2018, revealed nursing staff and practitioners (NP) shall assess and document risk factors for pressure ulcers. The nurse shall also document a full assessment of pressure sores. The NP shall examine skin for evidence of pressure ulcers. The Physician shall order pertinent wound treatments including wound dressings and treatments. Review of the facility policy titled, Care Plan - Baseline, dated 03/2022, revealed the facility shall include instructions needed to provide effective person-centered care. The baseline care plan was used until staff could complete the comprehensive care plan. The baseline care plan shall include any services and treatments to be administered by facility and personnel acting on behalf of the facility.This deficiency represents non-compliance investigated under Complaint Number OH001306087.

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