Health inspection·October 30, 2024

F 0678 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, review of the facility policy, and review of online guidelines per the American Heart Association (AHA), the facility failed to administer cardiopulmonary resuscitation (CPR) per the facility policy and per professional standards of care. This affected one (Resident #132) of three residents reviewed for change in condition. The facility census was 128 residents. Findings include: Review of the medical record for Resident #132 revealed an admission date of [DATE] with diagnoses including multiple sclerosis, dementia, attention-deficit hyperactivity disorder, gastro-esophageal reflux disease, metabolic encephalopathy, morbid obesity and schizophrenia. Resident #132 expired in the facility on [DATE]. Review of the care plan for Resident #132 dated [DATE] revealed the resident's code status was full code. Review of the Minimum Data Set (MDS) assessment for Resident #132 dated [DATE] revealed the resident was moderately impaired for decision making and required staff assistance with activities of daily living (ADLs.) Review of the monthly physician's orders for Resident #132 dated [DATE] revealed the resident's code status was full code. Review of a progress note for Resident #132 per Registered Nurse (RN) #188 dated [DATE] timed at 9:25 P.M. revealed the aide reported to the nurse that the resident was not breathing. When the nurse entered the room, Resident #132 was unresponsive, not responding to verbal stimulation or a sternal rub, and had no pulse, or heart or breath sounds. A code was called per the resident's advance directives with CPR initiated immediately and 911 called. Interview on [DATE] at 2:12 P.M. with RN #188 confirmed Certified Nursing Assistant (CNA) #236 notified the nurse on [DATE] at approximately 9:20 P.M. when doing rounds that Resident #132 was nonresponsive. RN #188 confirmed he immediately went to the resident's room, assessed her, called a code, immediately started chest compressions, and directed CNA #236 to take over chest compressions while the nurse called 911. RN #188 reported they continued with CPR from approximately 9:25 P.M. until 9:32 P.M. with Registered Nursing Supervisor (RNS) #163 arriving later to assist with CPR. RN #188 confirmed emergency services personnel continued CPR for approximately 30 minutes before stopping as Resident #132 was deceased . (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 365005 Printed: 05/15/2026 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 365005 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/30/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Chateau at Mountain Crest Nursing & Rehab Ctr 2586 Lafeuille Avenue Cincinnati, OH 45211 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)