General Information: SYCAMORE GLEN HEALTH CENTER
Nursing home name SYCAMORE GLEN HEALTH CENTER
Address2175 LEITER ROAD
MIAMISBURG, OH 45342
Phone number (937) 384-4308
Located within a hospital No
Type of ownership Non profit - Church related
Owner operates multiple homesYes
Accept Medicare or Medicaid Medicare and Medicaid
Continue Care Retirement CommunityNo
Resident and family councils Both
Certified number of beds 100
Total number of residents 99
Perc of occupied beds 99
Sprinkler status Yes
Number of Facility Reported Incidents0
Number of Substantiated Complaints4
Number of Fines0
Total Amount of Fines$0
Total Number of Penalties0
Total Number of Penalties0
Ratings Summary: SYCAMORE GLEN HEALTH CENTER
Overall rating 3
3
Nursing Home Staffing 3
3
Registered Nurses only 2
2
Health Inspections 3
3
Quality Measures 4
4
Nursing Home Staffing Info: SYCAMORE GLEN HEALTH CENTER
National AverageOhio AverageSYCAMORE GLEN HEALTH CENTER
Overall staff rating NA NA 3
3
Registered Nurses only rating NANA 2
2
Total Number of Residents NA NA 99
Total Number of Nurse Staff Hours per Resident per Day 4.11 hours 4.0 hours 4.05 hours
Total Number of Licensed Nurse Staff Hours per Resident per Day 1.64 hours 1.69 hours 1.79 hours
Registered Nurses Hours per Residents per Day 0.81 hours 0.79 hours 0.64 hours
Licensed Practical or Vacation Nurses Hours per Resident per Day 0.83 hours 0.9 hours 1.15 hours
Certified Nursing Assistants Hours per Residents per Day 2.47 hours 2.31 hours 2.26 hours
Physical Therapy Staffing Hours per Resident Per Day 0.1 hours 0.07 hours 0.06 hours
Health Survey: SYCAMORE GLEN HEALTH CENTER
Heath Survey Summary on 2013-01-24
Total Number of Health Deficiencies 0
Scope and Severity of most Severe Health Deficiency
Heath Survey Summary on 2011-09-29
Total Number of Health Deficiencies 9
Scope and Severity of most Severe Health Deficiency Pattern/Minimal harm or potential for actual harm
Heath Survey Summary on 2010-08-19
Total Number of Health Deficiencies 7
Scope and Severity of most Severe Health Deficiency Pattern/Minimal harm or potential for actual harm
Health Survey Details: SYCAMORE GLEN HEALTH CENTER
Inspection Results: 09/29/2011
Corrected Deficiency Scope and Severity
11/10/2011 Keep each resident free from physical restraints, unless needed for medical treatment. Isolated/Minimal harm or potential for actual harm
11/10/2011 Conduct initial and periodic assessments of each resident's functional capacity. Isolated/Minimal harm or potential for actual harm
11/10/2011 Ensure each resident receives an accurate assessment by a qualified health professional. Isolated/Minimal harm or potential for actual harm
11/10/2011 Develop a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Pattern/Minimal harm or potential for actual harm
11/10/2011 Provide care by qualified persons according to each resident's written plan of care. Isolated/Minimal harm or potential for actual harm
11/10/2011 Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores. Isolated/Minimal harm or potential for actual harm
11/10/2011 Ensure that each resident's 1) entire drug/medication regimen is free from unnecessary drugs; and 2) is managed and monitored to achieve highest level of well-being. Pattern/Minimal harm or potential for actual harm
11/10/2011 Maintain drug records and properly mark/label drugs and other similar products according to accepted professional standards. Pattern/Minimal harm or potential for actual harm
11/10/2011 1) Review the work of each nurse aide every year; and 2) give regular in-service training based upon these reviews. Widespread/Potential for minimal harm
Inspection Results: 08/19/2010
Corrected Deficiency Scope and Severity
10/06/2010 Ensure each resident receives an accurate assessment by a qualified health professional. Isolated/Minimal harm or potential for actual harm
10/06/2010 Develop a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Isolated/Minimal harm or potential for actual harm
10/06/2010 Provide necessary care and services to maintain or improve the highest well being of each resident . Isolated/Minimal harm or potential for actual harm
10/06/2010 Ensure that each resident's 1) entire drug/medication regimen is free from unnecessary drugs; and 2) is managed and monitored to achieve highest level of well-being. Isolated/Minimal harm or potential for actual harm
10/06/2010 Keep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5%. Pattern/Minimal harm or potential for actual harm
10/06/2010 Use a registered nurse at least 8 hours a day, 7 days a week. Pattern/Potential for minimal harm
10/06/2010 Store, cook, and serve food in a safe and clean way. Pattern/Minimal harm or potential for actual harm

Fire Safety Survey: SYCAMORE GLEN HEALTH CENTER
Fire Safety Survey Summary on 2013-01-22
Total Number of Fire SafetyDeficiencies 1
Scope and Severity of most Severe Health Deficiency Isolated/Minimal harm or potential for actual harm
Fire Safety Survey Summary on 2011-09-29
Total Number of Fire SafetyDeficiencies 3
Scope and Severity of most Severe Health Deficiency Widespread /Minimal harm or potential for actual harm
Fire Safety Survey Summary on 2010-08-16
Total Number of Fire SafetyDeficiencies 4
Scope and Severity of most Severe Health Deficiency Widespread /Minimal harm or potential for actual harm
Fire Safety Survey: SYCAMORE GLEN HEALTH CENTER
Fire Safety Survey Results: 01/22/2013
Corrected Deficiency Severity
02/08/2013 Special areas constructed so that walls can resist fire for one hour or an approved fire extinguishing system. Isolated/Minimal harm or potential for actual harm
Fire Safety Survey Results: 09/29/2011
Corrected Deficiency Severity
11/10/2011 Record of quarterly fire drills for each shift under varying conditions. Widespread /Minimal harm or potential for actual harm
11/10/2011 Back-up procedures in place for a faulty automatic sprinkler system. Widespread /Minimal harm or potential for actual harm
11/10/2011 An approved back-up procedure for a faulty fire alarm system. Widespread /Minimal harm or potential for actual harm
Fire Safety Survey Results: 08/16/2010
Corrected Deficiency Severity
10/06/2010 Corridor and hallway doors that block smoke. Pattern/Minimal harm or potential for actual harm
10/06/2010 Record of quarterly fire drills for each shift under varying conditions. Widespread /Minimal harm or potential for actual harm
10/06/2010 Automatic sprinkler systems that have been maintained in working order. Widespread /Minimal harm or potential for actual harm
10/06/2010 Proper medical gas storage and administration areas. Isolated/Minimal harm or potential for actual harm

Resident Complaints: SYCAMORE GLEN HEALTH CENTER
Date Complaint Substantiated: 07/24/2013
CorrectedCategoryDeficiencySeverity
08/23/2013Develop and implement policies for 1) screening and training employees; and the 2) prevention, identification, investigation, and reporting of any abuse, neglect, mistreatment and misappropriation of property. D
08/23/20131) Hire only people with no legal history of abusing, neglecting or mistreating residents; or 2) report and investigate any acts or reports of abuse, neglect or mistreatment of residents. D

Quality Measures: SYCAMORE GLEN HEALTH CENTER
Quality Measures National Average Ohio Average SYCAMORE GLEN HEALTH CENTER
Overall quality rating NA NA 4
4
Long-Stay Residents
Percent of Long Stay Residents Whose Need for Help with ADLs has Increased 15.4% 14.3% 23.4%
Percent of Long Stay Residents Who Self Report Moderate to Severe Pain 8.3% 8.7% 17.5%
Percent of High Risk Long Stay Residents With Pressure Ulcers 6.1% 5.6% 3.4%
Percent of Long Stay Residents Who Lose Too Much Weight 7.2% 7.4% 4.3%
Percent of Low Risk Long Stay Residents Who Lose Control of Their Bowel or Bladder 43.9% 38.6% 36.2%
Percent of Long Stay Residents with a Catheter Inserted and Left in Their Bladder 3.2% 3.2% 3.1%
Percent of Long Stay Residents With a Urinary Tract Infection 6.2% 6.0% 3.3%
Percent of Long Stay Residents Who Have Depressive Symptoms 6.3% 14.4% 8.4%
Percent of Long Stay Residents Who Were Physically Restrained 1.4% 1.7% 0.0%
Percent of Long Stay Residents Experiencing One or More Falls with Major Injury 3.2% 3.4% 7.0%
Percent of Long Stay Residents Assessed and Appropriately Given the Seasonal Influenza Vaccine 92.7% 92.1% 94.4%
Percent of Long Stay Residents Assessed and Appropriately Given the Pneumococcal Vaccine 94.3% 95.2% 93.5%
Percent of Long Stay Residents Who Received an Antipsychotic Medication 20.7% 22.8% 9.0%
Short-Stay Residents
Percent of Short Stay Residents Who Self Report Moderate to Severe Pain 19.2% 22.1% 28.8%
Percent of Short Stay Residents With Pressure Ulcers That Are New or Worsened 1.2% 1.0% 0.0%
Percent of Short Stay Residents Who Were Assessed and Appropriately Given the Seasonal Influenza Vaccine 83.4% 84.9% 88.8%
Percent of Short Stay Residents Assessed and Appropriately Given the Pneumococcal Vaccine 82.4% 85.2% 99.1%
Percent of Short Stay Residents Who Newly Received an Antipsychotic Medication 2.6% 2.5% 1.3%

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