Inspection·January 22, 2025

F 0624 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few to participate with the evaluation when the resident became more agitated and stated he could not move his left leg due to pain. When PT attempted to work with the resident for leg for movement, the resident refused and stated he did not want to complete any therapy until his leg was healed and he had no pain. The OT assessment was mostly the same and the resident was only agreeable to bed level activities of daily living (ADLs) and would only move the right leg. The resident had minimal participation of both PT and OT and it was the opinion of PT, the resident would not participate well in therapy due to frequent refusals in the future and was discharged from therapies due to refusal. Review of the facility's Summary of Events completed by the Administrator revealed the following: a) On 01/14/25, Caseworker #500 came to see the resident. Caseworker #500 spoke with the Administrator and informed her Resident #90 had violent unprovoked behaviors and should not be in the facility. The facility started fifteen-minute checks on the resident due to the reported violent behaviors. Caseworker #500 stated he informed the hospital of the resident's behaviors prior to discharge. b) On 01/16/25, Resident #90 was discharged with little notice to a homeless shelter per Caseworker #500. The facility agreed to take the resident to the shelter in the facility's van. When the facility discharged the resident to the homeless shelter he wore a hospital gown wrapped in blankets due to not having any clothes. The homeless shelter refused the resident due to resident's violent behaviors and setting fires at shelters in the past, therefore ,the facility staff returned the resident to the facility. The facility called Caseworker #500 and informed him of what happened at the shelter. Caseworker #500 noted he would return to the facility on [DATE] to find the resident placement. On 01/17/25 Caseworker #500 returned to the facility and brought the resident some clothes and stated he was taking the resident to a group home. It was then determined due to the resident needing medical care and assistance with ambulation he should not go to a group home. Caseworker #500 then decided he would take the resident back to the hospital and make them admit him. Caseworker #500 told the facility he would take full responsibility for the resident without a confirmed placement for the resident. Caseworker #500 signed for medications and instructions. Review of a facility document titled Care Conference dated 01/16/25, revealed Resident #90 and SSD #101 attended a meeting for a discharge plan. SSD #110 notified the resident that Caseworker #500 and Caseworker Manager #501 wanted the resident to go to the shelter today. Resident #90 declined the facility's services and equipment at this time. Review of a progress note for Resident #90 dated 01/16/25, revealed the resident was taken to a homeless shelter. Review of a statement by Director or Nursing (DON) dated 01/17/25 at 11:00 A.M., revealed she escorted Caseworker #500 to the resident's room to assist in discharging the resident to a group home due to his issues transferring and showing signs of paranoia along with other psychological issues of hearing voices. It was determined that Resident #90 would be discharged into the care of Caseworker #500 who was going to accompany the resident to the hospital to be admitted for psychological. Resident #90 was dressed and assisted on the facility bus and was followed to the hospital by Caseworker #500. Review of a statement by Licensed Practical Nurse (LPN) #03 dated 01/17/25, revealed Resident #90 was being discharged to a facility where his psychiatric needs along with his nursing needs could be met. LPN #03 met with Caseworker #500 about the discharge. The resident was helped by LPN #03 and two other staff members in a transportation wheelchair because the resident stated he could not walk (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365044 If continuation sheet Page 2 of 3 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 365044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arc at Cincinnati 4001 Rosslyn Drive Cincinnati, OH 45209 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 0624 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few or stand. The resident stated he was hearing voices like the devil, and they wouldn't stop. Caseworker #500 stated Resident #90 could be released in his care and he would take the resident back to the discharging hospital. Resident #90 was informed of what was happening and the resident understood. LPN #03 and the DON assisted the resident to the facility bus and the bus drove off with Caseworker #500 following. Review of Resident #90's discharge Minimum Data Set (MDS) assessment dated [DATE], revealed the resident was cognitively intact, required minimal assistance with care and ambulation was impaired due to recent survey. Resident #90 needed daily wound care and had staples in his knee. Review of a progress note for Resident #90 dated 01/17/25, revealed the resident was discharged in care of Caseworker #500 with discharge instructions, future appointments, medications and belongings. Interview with the SSD #110 on 01/22/25 at 9:30 A.M., verified Resident #90 was not provided with a thirty day discharge notice nor did she try to find the resident alternative placement. SSD #100 noted Caseworker #500 set everything up and the facility just followed the plan. Interview with Caseworker Manager #501 via phone on 01/22/25 at 2:00 P.M., revealed Resident #90 was improperly placed in the facility on 01/12/25 by the hospital. Caseworker Manager #501 noted she was not court appointed, and her agency assisted with placement and help for patients to get mental health services. Caseworker Manager #501 stated Caseworker #500 should have never taken responsibility for Resident #90 on 01/16/25. Caseworker Manager #501 stated on 01/17/25, the resident was returned to the discharging hospital, and they refused to accept the resident. Caseworker #500 took the resident to another hospital, and they refused to accept him. Caseworker #500 then returned to the resident to the original hospital who discharged him, and they finally admitted him. Interview with the SSD #110 on 01/22/25 at 9:30 A.M. revealed Resident #90 was not given a thirty-day notice, nor did she try to find proper placement for the resident. SSD#110 noted Caseworker #500 set everything up. Interview with the Administrator on 01/22/25 at 12:00 P.M. revealed Resident #90 did not exhibit any violent behaviors while he resided in the facility. The Administrator noted she was only following Caseworker #500's lead with the discharge. Interview with the homeless shelter staff on 01/22/25 at 2:50 P.M., revealed the shelter would not accept Resident #90 even if he did not have the previous violent behaviors. The shelter staff stated they had no medically trained employees to give medications or provide dressing changes. Review of facility policy titled Notice of Transfer and discharged dated 10/24, revealed the facility provide a reason for the discharge, effective date of discharge, location to where resident is being transferred or discharged to, a statement of the resident's rights to appeal, the name and number of the state ombudsman and will be made at least 30 days before the resident is discharged . This deficiency represents non-compliance investigated under Complaint Number OH00161716. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365044 If continuation sheet Page 3 of 3