Inspection·February 10, 2026

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, review of the hospital records, staff interview, and policy review, the facility failed to ensure timely treatment of a left leg fracture. This resulted in Actual Harm when Resident #91 complained of a new onset of left leg pain on 12/18/25. After examination, Nurse Practitioner (NP) #235 ordered X-rays for the wrong limb. Upon realizing the error, NP #235 ordered X-rays for the correct limb on 12/19/25; however, the X-rays were not completed until 12/21/25, revealing Resident #91 had a suspected bicondylar fracture of the left distal femur. Resident #91 was sent to the hospital for evaluation and treatment on 12/22/25 where the resident required surgery for an Open Reduction and Internal Fixation (ORIF) on 12/24/25. This affected one (#91) of three residents reviewed for care post fall. The facility census was 89.Findings include:Review of the medical record revealed Resident #91 was admitted to the facility on [DATE] and was discharged on 01/06/26. Diagnoses included unspecified nutritional deficiency, displaced fracture of the lateral condyle of the left femur, other fracture to the lower end of the left femur, major depressive disorder, ischemic cardiomyopathy, unspecified cerebral infarction of the right middle cerebral artery, type II diabetes, and unspecified heart failure.Review of the annual Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident had severely impaired cognition, had verbal behaviors, did not reject care, and did not wander. Resident #91 was dependent on staff for toileting, mechanical lift transfers, and bed mobility.Review of the care plan dated 10/04/24 revealed Resident #91 was at risk for pain. Interventions included evaluating the effectiveness of pain interventions.Review of a progress note dated 12/18/25 at an unspecified time revealed NP #235 documented she acutely evaluated Resident #91 for reports of a possible fall out of bed prior to the current shift. Resident #91 reported he rolled out of bed onto the floor on his right side with knees colliding together. There was no nursing documentation reflecting a fall or change-in-plane status. Notes pertaining to the left leg evaluation were contradictory. The documentation read, no crepitus or difficulty with range of motion (ROM) in the knee or the ankle with passive motion. Resident #91 reported pain with passive ROM and does not participate in active ROM. Completed adduction and abduction of left hip with continued complaints of discomfort. Left leg is stiff with upper leg muscle contractions. The assessment and plan included a possible fall occurring within the last 24 hours without supporting documentation from nursing staff. Resident #91 reported pain in the left leg with no participation in active ROM. No abnormalities with passive ROM. STAT (at once) imaging ordered. Verbal orders were given to the nursing staff for the resident to receive one gram of acetaminophen (pain reliever) now and apply Lidocaine (pain reliever) patch. Will re-evaluate Resident #91 in the morning.Review of a progress note dated 12/18/25 at 4:10 P.M. revealed Resident #91 reported an unwitnessed fall occurring on the previous shift. Resident #91 complained of pain to the left knee which upon assessment appeared swollen. Registered Nurse (RN) #104 notified NP #235 who assessed and found Resident #91 was unable to participate in ROM to the left leg due to pain. New orders were placed and entered by NP #235 for an X-ray to the left leg, a one-time dose for Tylenol (acetaminophen) and a lidocaine patch to the left leg. Pain medications were administered and were effective.Review of the medical record revealed Resident #91 had physician orders dated 12/18/25 for an X-ray of the right hip two views STAT for pain, acetaminophen 500 milligrams (mg) give two tablets by mouth for pain now, and Lidocaine External four percent patch topically to the right posterior hip for twelve hours and remove for twelve hours.Review of the X-ray results dated 12/18/25 revealed Resident #91 had an X-ray to the right knee completed at 9:00 P.M. and reported on 12/18/25 at 10:13 P.M. which revealed modest arthritis of the right knee. Additionally, on 12/18/25 Residents Affected - Few Note: The nursing home is disputing this citation. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365044 If continuation sheet Page 2 of 4 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 02/10/2026 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 0684 Level of Harm - Actual harm Residents Affected - Few Note: The nursing home is disputing this citation. Resident #91 had an X-ray completed of the right hip at 9:03 P.M., and reported at 9:32 P.M., which showed modest osteoarthritis of the right hip.Review of the progress note dated 12/19/25 and untimed, revealed Resident #91 had left knee swelling for an unwitnessed fall on 12/18/25 was treated topically. Review of an X-ray of the right hip noted osteoarthritis. New orders were placed for medications including oral anti-inflammatory twice daily and a muscle relaxer for seven days and X-rays of the left hip and knee.Review of the medical record revealed Resident #91 had physician orders dated 12/19/25 for an X-ray of the left hip two views for pain and an X-ray of the left knee two views for pain. Additionally, the physician discontinued the ordered Lidocaine patch to the posterior right hip. New orders for Lidocaine four percent topical patch to the left posterior hip for pain (on 12 hours, off 12 hours), Ibuprofen 600 mg by mouth three times daily for osteoarthritis of the knee for seven days, and methocarbamol (a muscle relaxer) 750 mg by mouth twice daily for osteoarthritis of the knee for 10 days.Review of the X-ray results dated 12/21/25 revealed Resident #91 had X-rays of the left knee and the left hip at 12:51 P.M. Results reported on 12/21/25 at 6:00 P.M. revealed the left knee was highly suspicious for a minimally displaced distal femoral metaphyseal fracture only seen in the lateral view. The X-ray of the left hip showed mild degenerative changes without acute fracture or dislocation.Review of a progress note dated 12/22/25 at 10:27 A.M. revealed NP #235 reviewed the X-ray results for the left side as previously ordered post fall. Resident #91 was sent to the hospital due to a suspicious, non-confirmed fracture of the left leg.Review of a progress note dated 12/22/25 at 1:22 P.M. revealed therapy notified nursing that Resident #91 was being transferred to the hospital for further evaluation for suspicion of a left leg fracture. Emergency Medical Services (EMS) personnel transported Resident #91 to the hospital where he was admitted for evaluation of a possible left distal femur fracture and bradycardia.Review of hospital documentation dated 12/26/25 revealed Resident #91 was admitted on [DATE] and treated for a closed bicondylar fracture of the left distal femur with Open Reduction and Internal Fixation (ORIF) on 12/24/25. The fracture was of unknown morphology. The resident stated he had fallen out of his bed on the left side while at the facility but was unable to provide more information due to baseline dementia. The hospital was unable to contact the nursing facility staff for further information.During an interview on 01/28/26 at 8:35 A.M., NP #235 said she arrived at the facility on 12/18/25 around 8:35 A.M., Resident #91 was seated in his wheelchair in the dining room and had not complained of pain or appeared to be in any pain. Around 4:00 P.M., RN #104 reported Resident #91 was complaining of pain and needed to be assessed. Upon arrival in the room, Resident #91 was already in bed. He was complaining of pain in the left leg. NP #235 stated she placed the orders for him to have X-rays of the right hip by mistake and had not realized the mistake until she saw the results the next day. On Friday, 12/19/25, she ordered X-rays to the left hip and knee, and routine oral pain medications including Ibuprofen and Robaxin for pain. NP #235 stated when she arrived at the facility on Monday morning. She checked the facsimile (fax) machine; Resident #91's X-ray results, dated 12/21/25, were on the fax machine and indicated he had a fracture. Resident #91 had not appeared to have uncontrolled pain on Monday morning when she saw him. NP #235 stated she sent Resident #91 to the hospital for further evaluation and treatment.During an interview on 01/29/26 at 11:50 A.M., the facility Medical Doctor (MD) #245 stated he was not informed of Resident #91's alleged fall, fractured leg requiring ORIF, or of NP #235's incorrect orders until 01/29/26.During an interview on 02/10/26 at 12:14 P.M., Regional Consultant #242 stated she had spoken with NP #235's direct supervisor, no specified date, and asked her to educate NP #235 regarding professional standards related to the delay in care.During a telephone interview on 02/10/26 at 1:37 P.M. Regional Director of Med Elite of Ohio #255 stated she spoke with NP #235 in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365044 If continuation sheet Page 3 of 4 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 02/10/2026 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 0684 Level of Harm - Actual harm Residents Affected - Few Note: The nursing home is disputing this citation. FORM CMS-2567 (02/99) Previous Versions Obsolete December 2025, date not specified, regarding errors in physician orders which resulted in a delay of care for Resident #91. She stated they discussed how important accuracy of orders was related to patient safety and care. The regional director stated they spoke about having the appropriate practices in place to ensure orders were created for correct limb. The NP #235 acknowledged her error and owned up to her mistake. The regional director stated she might have some notes written down in her office about the conversation, but she was unable to provide more details as she was out of town at a medical conference.During a follow-up interview on 02/10/26 at 2:49 P.M., Regional Consultant #242 stated she was unaware of any additional corrective actions the facility had taken regarding the delay of care which affected Resident #91.Review of a policy titled Attending Physician Responsibilities dated August 2014 revealed attending physicians were responsible for providing appropriate and timely medical orders and treatments to enable safe, effective continuing care and to support facility compliance with regulations and care standards.This deficiency represents noncompliance investigated under Complaint Number 2716105. Event ID: Facility ID: 365044 If continuation sheet Page 4 of 4