Aventura At Oakwood Village

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

#107) was moved to a private room related to Resident #108's concerns.Review of a handwritten statement dated 09/25/25 by Social Worker Director (SWD) #245 documented she went to Resident #107's room to ask about this morning. He said, my neck was hurting. I asked again and he said, my neck was hurting, my birthday was in 18 days. Review of a handwritten statement dated 09/26/25 the Social Worker Director (SWD) #245 documented she had talked to Resident #108 about his concerns. Resident #108 stated his roommate was yelling and hitting the aides and he thought if he could do that to them, he could do that to me. He stated, I felt scared. The roommate moved to a different room yesterday and the resident stated he was happy about that. Resident did state he did not do anything to me; he did it to the staff.Interview on 12/16/25 at 2:13 P.M. Licensed Practical Nurse (LPN) #248 said she went to Resident #108's room because he was calling out to her in the hallway. She went into the room and heard Resident #107 yelling shut up, shut up! Ill kick your expletive! LPN #248 said Resident #108 was concerned about his safety. LPN #248 said she separated both residents.Interview on 12/17/25 at 3:55 P.M. LPN #253 said when she took care of Resident #107 at the facility when residents or staff would walk by or was near, Resident #107 when he was angry would swing and hit everyone who was in the way. This included staff and other residents. LPN #253 stated she could not remember the staff or the residents' names at that time. No one was hurt, but Resident #107 did yell and swing at everyone.Interview on 12/23/25 at 11:25 A.M. the Director of Nursing (DON) said Resident #107 had developmental delays and was used to one-on-one because where he came from. The DON said she was out of the facility and had to ask to see if anyone had investigated the incident. Interview on 12/23/25 at 1:32 P.M. the Corporate Nurse #207 said she was notified by Licensed Practical Nurse (LPN) #248 that Resident #107 and Resident #108 had a possible altercation. The Corporate Nurse #207 asked the residents be separated and made safe and would get back to the LPN. The Corporate Nurse #207 said it was during shift change that morning and she had never told the Administrator.Interview on 12/23/25 at 1:47 P.M. the Unit Manager (UM) #215 it was reported to her and she interviewed Resident #108 that day who said he was not comfortable in the room with Resident #107 and he was scared. The UM #215 said the incident was discussed in our team meeting that morning about what happened with Resident #107 and Resident #108. The UM #215 asked Resident #108 what Resident #107 had said to him. The UM #215 stated Resident #108 had said that Resident #107 kept telling him to shut up, shut up! Resident #108 had stated Resident #107 was cursing and yelling at him.

Interview on 12/23/25 at 1:59 P.M. the Social Worker Director (SWD) #245 said she had interviewed Resident #108 who stated to her that Resident #107 had yelled and hit staff, and not him. The SWD #245 said she had not documented a progress note of the interview with Resident #108 as she did not think it was important. The SWD #245 said the facility had not interviewed all residents who had a BIMS of 10 and above, because the facility determined there was no risk for abuse towards other residents.Interview on 12/23/25 at 5:37 P.M. the Administrator said he was never notified of any possible verbal abuse between Resident #107 and Resident #108 on 09/25/25. Review of the facility policy titled Residents Rights to Freedom from Abuse, Neglect, Misappropriation of Residents Property dated 2025 revealed the facility policy was to ensure that residents are free from abuse, neglect, misappropriation of their property, and exploitation.This deficiency represents non-compliance investigated under Complaint Number 2641868.

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

12/24/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Aventura at Oakwood Village

1500 Villa Road Springfield, OH 45503

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 Residents Affected - Few

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

documented she had talked to Resident #108 about his concerns. Resident #108 stated his roommate was yelling and hitting the aides and he thought if he could do that to them, he could do that to me. He stated, I felt scared. The roommate moved to a different room yesterday and the resident stated he was happy about that. Resident did state he did not do anything to me; he did it to the staff.Interview on 12/16/25 at 2:13 P.M.

Licensed Practical Nurse (LPN) #248 said she went to Resident #108's room because he was calling out to her in the hallway. She went into the room and heard Resident #107 yelling shut up, shut up! Ill kick your expletive! LPN #248 said Resident #108 was concerned about his safety. LPN #248 said she separated both residents.Interview on 12/17/25 at 3:55 P.M. LPN #253 said when she took care of Resident #107 at

the facility when residents or staff would walk by or was near, Resident #107 when he was angry would swing and hit everyone who was in the way. This included staff and other residents. LPN #253 stated she could not remember the staff or the residents' names at that time. No one was hurt, but Resident #107 did yell and swing at everyone.Interview on 12/23/25 at 11:25 A.M. the Director of Nursing (DON) said Resident #107 had developmental delays and was used to one-on-one because where he came from. The DON said

she was out of the facility and had to ask to see if anyone had investigated the incident. Interview on 12/23/25 at 1:32 P.M. the Corporate Nurse #207 said she was notified by Licensed Practical Nurse (LPN) #248 that Resident #107 and Resident #108 had a possible altercation. The Corporate Nurse #207 asked

the residents be separated and made safe and would get back to the LPN. The Corporate Nurse #207 said

it was during shift change that morning and she had never told the Administrator.Interview on 12/23/25 at 1:47 P.M. the Unit Manager (UM) #215 it was reported to her and she interviewed Resident #108 that day who said he was not comfortable in the room with Resident #107 and he was scared. The UM #215 said

the incident was discussed in our team meeting that morning about what happened with Resident #107 and Resident #108. The UM #215 asked Resident #108 what Resident #107 had said to him. The UM #215 stated Resident #108 had said that Resident #107 kept telling him to shut up, shut up! Resident #108 had stated Resident #107 was cursing and yelling at him. Interview on 12/23/25 at 1:59 P.M. the Social Worker Director (SWD) #245 said she had interviewed Resident #108 who stated to her that Resident #107 had yelled and hit staff, and not him. The SWD #245 said she had not documented a progress note of the

interview with Resident #108 as she did not think it was important. The SWD #245 said the facility had not interviewed all residents who had a BIMS of 10 and above, because the facility determined there was no risk for abuse towards other residents.Interview on 12/23/25 at 5:37 P.M. the Administrator said he was never notified of any possible verbal abuse between Resident #107 and Resident #108 on 09/25/25.

Review of the Self Reported Incidents dated from 08/01/25 through 12/24/25 revealed no reports were made for the alleged incidents on 08/19/25 and 09/25/25.Review of the facility policy titled Residents Rights to Freedom from Abuse, Neglect, Misappropriation of Residents Property dated 2025 revealed the facility policy was to ensure that residents are free from abuse, neglect, misappropriation of their property, and exploitation. The facility shall review altercations from resident to resident as a potential situation of abuse.

Staff will monitor behaviors that may provoke a reaction by residents including verbal aggressive behavior such as cursing and screaming and physically aggressive behavior including hitting, kicking, throwing objects, and threatening gestures.This deficiency represents non-compliance investigated under Complaint Number 2641868.

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

12/24/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Aventura at Oakwood Village

1500 Villa Road Springfield, OH 45503

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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, staff interview, and policy review, the facility failed to ensure fall interventions were in place for a resident who was at high risk for falls. This affected one (#92) out of three residents reviewed for falls. The facility census was 100. Findings Included:Based on medical record review,

observation, staff interview, and policy review, the facility failed to ensure fall interventions were in place for

a resident who was at high risk for falls. This affected one (#92) out of three residents reviewed for falls. The facility census was 100.Findings Included:Review of the medical record revealed Resident #92 admitted to

the facility on [DATE REDACTED]. Diagnoses included palliative care, Parkinson's disease, chronic obstructive pulmonary disease, and dementia.Review of the quarterly minimum data set (MDS) assessment dated [DATE REDACTED] revealed Resident #92 had an unfinished Brief Interview of Mental Status (BIMS) indicating severe cognitive impairment. Resident #92 required setup and clean-up for meals. Resident #92 was dependent for personal hygiene, placing on and off shoes, bathing, dressing lower body, and toileting hygiene. Resident #92 was substantial maximal assistance for oral hygiene and dressing upper body. Review of the plan of care dated 11/03/25 revealed Resident #92 had a potential for falls related to impulsivity or poor safety awareness. Interventions included assist the resident on and off the toilet, do not leave resident unattended

in the bathroom, do not leave unattended in the dining room, a dycem mat in the wheelchair, evaluate medication regimen, fall matt to the left side of the bed, get resident up into wheelchair when restless, keep bed in lowest position, keep call bell within reach, encourage to use call bell, keep environment clutter free, keep room well lighted, make sure wearing proper footwear, and use a gait belt with transfer.Review of the Morse Fall Scale assessment dated [DATE REDACTED] revealed Resident #92 was a fall risk with a high risk for falling score of 65.0. Resident #92 had fallen before, had more than one diagnoses in chart, had no ambulatory aids, had no intravenous apparatus, was weak, overestimates or forgets limits when alone. The Morse fall scoring was: low risk was 0-24, moderate risk was 25-44, and high risk was a score of 45 and higher.Review of the fall and incident log dated 07/01/25 to current revealed Resident #92 had falls on 07/10/25, 07/11/25, and 07/29/25. Observation on 12/23/25 at 9:30 A.M. Resident #92 had no call light, it was wrapped under the bed wheel. Interview on 12/23/25 at 9:30 A.M. with Certified Nursing Assistant (CNA) #225 verified Resident #92 had no call light in reach and the call light was under the bed wheel.

Observation on 12/23/25 at 10:45 A.M. Resident #92 was in her bed that was in the high position. Resident #92's fall mat was located on the right side of the bed. No staff were observed in the room.Interview on 12/23/25 at 11:03 A.M. CNA #220 verified when entering the room Resident #92's bed was in the high position with no staff present in the room. CNA #220 verified that the fall mat was on the right side of her bed.Review of the facility policy titled Accidents and Incidents-Investigation and Reporting dated July 2017 revealed all accidents or incidents involving residents, employees, visitors, vendors, occurring on our property shall be investigated and reported to the administrator. This deficiency represents non-compliance investigated under Complaint Number 2620622 and 2566128.

Event ID:

Facility ID:

If continuation sheet