Inspection visit

Health inspectionFebruary 22, 2023

HILLEBRAND NURSING AND REHABILITATION CENTERCMS #36504515 citations on this visit

15 citations recorded

Inspector’s narrative

What the inspector wrote

This survey cited 15 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.

F 0557 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, resident and staff interview, and record review, the facility failed to provide a resident with dignity and respect regarding his personal possessions. This affected two (#21 and #27) of three residents reviewed for dignity and respect of personal possessions. The facility census was 97. Findings include. 1. Record review for Resident #21 revealed and admission date of 01/19/18. Resident #21's diagnoses included: essential primary hypertension, gastro- esophageal reflux disease, heart disease, respiratory failure, hyperlipidemia, anxiety disorder, insomnia, edema, major depressive disorder, tachycardia, dysarthria following cerebral infarction, and dysphagia. Review of the quarterly Minimum Data Set (MDS) assessment, dated 12/08/22, revealed Resident #21 he was mildly cognitively impaired. Further review of the MDS assessment revealed Resident # 21 required extensive assistance from staff with bed mobility, dressing, toilet use, and personal hygiene. He was totally dependent on staff for bathing. Resident #21 required supervision from staff with eating. Resident #21 required the assistance of two or more staff members for transfers in the bed, out of the bed, and personal care. Review of Resident #21's nursing progress notes dated, 02/06/23 revealed Resident #21 has experienced increased confusion. Further review of the progress notes revealed Resident #21 was started on an antibiotic on 02/09/23 for a possible urinary tract infection. The nursing progress notes revealed on 02/14/23 a note stating Resident #21 will play with the bed remote and have his bed up high at times. Review of Resident #21's care plans revealed he had a care plan for mental wellness and his interventions included, If I appear restless or complain of anxiety offer to take me to a quiet area for conversation, talk to me about my family as a distraction. Listen to my concerns and encourage me to express my feelings and assist me with finding ways to cope with these feelings of anxiety. Please offer non- pharmacological coping tools also, such as reading, food and fluids, coloring, music. Encourage me to express my feelings and offer active listening and emotional support. A care plan for cognition revealed Resident #21 has short term memory problems. Resident #21 had a care plan for, a change in mood and his interventions included, Please reassure me that my family and friends are able to be contacted by phone and mail. Help me contact them as I desire. Help me create a MY STORY Notebook so I can show my family and friends what I have been doing while we were apart. Encourage reminiscence while I am working on, MY STORY book. Listen and encourage me to verbalize my feelings. Observe for signs and symptoms of mood disorder or change in behaviors and offer reassurance and comfort. (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 26 Event ID: 365045 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 365045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillebrand Nursing and Rehabilitation Center 4320 Bridgetown Road 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)

F 0557 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 2. Record review for Resident #27 revealed she was admitted to the facility on [DATE]. Her diagnoses included, essential primary hypertension, peripheral vascular disease, anemia, congestive heart failure, history of Coronavirus-2019 (COVID-19), duodenal ulcer, history of pulmonary embolism, and anemia. Review of the quarterly MDS assessment for Resident #27, dated 02/03/23, revealed she was cognitively intact. Resident #27 required extensive assistance from staff with bed mobility, transfers, dressing, and toilet use. Further review of the MDS assessment revealed Resident #27 required limited assistance from staff with personal hygiene and supervision from staff with meals. Interview on 02/15/23 at 1:34 P.M., with Resident #27 revealed she is the spouse and roommate of Resident #21. Resident #27 stated she did not feel the facility staff treated her husband with dignity and respect following the incident that occurred during the night on 02/14/23. Resident #27 stated she is the voice of her husband because is unable to communicate well and is bed bound. Resident #27 stated she was very upset because the staff was very rude to her husband for accidentally knocking his personal items of his bedside table while sleeping. Resident #27 stated the staff entered the room and found Resident #21's personal items all over the floor. Resident #27 stated the night shift nurse aide appeared agitated and she stated, she did not have time for this. Resident #27 stated the State Tested Nurse Aide (STNA) from last night threw all of Resident #21's personal belongings that he kept within reach at this bedside in a plastic trash bag and placed them out of reach from Resident #21. Resident #27 stated she felt very uncomfortable to see someone treat her spouse (Resident #21) this way because she knew it was an accident. Resident #27 stated Resident #21 did not mean to spill his personal items on the floor. Observation on 02/15/23 at 1:50 P.M., revealed the Activity Director (AD) #715 assisted Resident #27 to her room. Resident #27 stated, I may have said too much. AD #715 ask Resident #27 what she had said. Resident #27 stated she told the state surveyor how uncomfortable and upset she felt with the way the night STNA treated her spouse (Resident #21). Interview on 02/15/23 at 1:55 P.M., interview with Resident #21 revealed he was in bed with his bedside table over the bed. Resident #21 appeared to be alert with confusion, however, he was alert to himself. When questioned about the previous evening, Resident #21 pointed at his bed side table and then pointed toward the closet. Resident #21 was unable to verbalize what he pointed at. Observed a basket on his bed side table that included, a comb, a picture book, a list of phone numbers, a stress ball, glasses, and other personal items. Beside the bed toward the back of the headboard, several papers were piled, however, they were not within reach. Interview on 02/15/23 at 2:03 P.M. with STNA #875 revealed she was not the nurse aide for Resident #21, however, she stated she was told when she arrived at work that Resident #27's personal items from this bedside table were thrown in a bag and put in his closet out of reach by a night shift stna. Interview on 02/15/23 at 2:22 P.M. with Resident #30 revealed used to live across the hall from Resident #21 and #27. Resident #30 stated she was so glad that Resident #27 shared what happened to her husband the previous night. Resident #30 stated Resident #27 is her friend and she has never seen her so upset before. Interview on 02/15/23 at 2:24 P.M. with STNA #270 revealed she was the STNA#270 that found Resident #21's personal items in a trash bag and out of reach of Resident #21. STNA #270 stated the bag (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365045 If continuation sheet Page 2 of 26 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 365045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillebrand Nursing and Rehabilitation Center 4320 Bridgetown Road 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)

F 0557 Level of Harm - Minimal harm or potential for actual harm contained all the personal items that were important to Resident #21 including cards from family, a picture book, a list of phone numbers, lotion, a brush, a stress ball, a pencil pouch, and his glasses. STNA #270 stated she was confused on why the nightshift STNA #480 did not put his items back on this bedside table instead of throwing them in a trash bag and out of reach. STNA #270 stated this was the first time she had ever heard of Resident #21 dumping his items on the floor and thought it must have been an accident. Residents Affected - Few Interview on 02/15/23 at 5:30 P.M., with STNA # 480 confirmed she was the night shift STNA who worked with Resident #21 on 02/14/22. STNA #480 stated Resident #21 is alert with confusion and would get confused with which button was his call light and which button operated his bed. STNA #480 stated Resident #21 knocked everything off his bed side table all over the floor. STNA #480 stated she walked into Resident #21's room and saw the mess of personal items on the floor and stated, Why did you do this?. STNA #480 stated she went and got the other staff members (nurse and aides) to see the mess he made all over the floor. STNA #480 stated she took all his items and placed them in a bag and put them out of reach. STNA #480 stated she was saving that for first shift to clean up because she did not have time for that. STNA #480 stated she should have taken a picture of the mess. STNA #480 stated she was not going to clean that up again, so she placed the items out of reach for Resident #21. STNA #480 stated the items all over the floor was just a bunch of stuff, like greeting cards, papers, and items he kept on the bedside table. Interview on 02/15/23 at 5:45 P.M., interview with STNA #350 confirmed she worked the night shift on 02/14/23. STNA #350 stated Resident #21 is confused and will put his call light on in place of using the button that controls that adjust his bed. STNA #350 stated she went into Resident #21's room at one point in the evening related to his call light on, and Resident #21 was asleep. STNA #350 stated there was no unusual behavior from Resident #21. STNA #350 stated the STNA #480 came and got her and the nurse to see the items all over Resident #21's room that fell off his bedside table. STNA #350 stated she helped STNA #480 pick up the items and place them in a bag. STNA #350 stated she did not question why the items were placed in a bag she was there to help. STNA #350 stated she heard #480 say to Resident# 21, Look what you did. Interview on 02/15/23 at 5:58 P.M., interview with Registered Nurse (RN) #300 confirmed she was the nurse caring for Resident #21 on the night shift of 02/14/23. RN #300 stated she did not know why STNA #480 wanted to see mess of personal items on the floor, she just knew this was not normal behavior for the Resident #21 and wanted to confirm he was ok. RN #300 stated she spoke to Resident #21 and believed he may have been dreaming and accidentally knocked the items off the bedside table. RN #300 stated the bedside table was not knocked over and it was just papers and personal items on the floor. RN #300 stated she did not understand why STNA #480 made a big deal about the personal items on the floor or why she bagged them up and put them out of reach. RN #300 confirmed this was the first time this has happened with Resident #21 that she was aware of. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365045 If continuation sheet Page 3 of 26 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 365045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillebrand Nursing and Rehabilitation Center 4320 Bridgetown Road 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)

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and staff interview, the facility failed ensure residents were provided form of communication, to communicate the needs of the resident and have their personal needs met. This affected two resident (#87 and #60) of two residents reviewed for communication. The facility census was 97. Residents Affected - Few Findings include: Review of the medical record for Resident #87 revealed she was admitted to the facility on [DATE]. Diagnoses included metabolic encephalopathy, type two diabetes mellitus with diabetic chronic kidney disease, end stage renal disease, Parkinson's disease, bipolar disorder, mixed hyperlipidemia, thrombocytopenia, major depressive disorder, vitamin d deficiency, and unspecified psychosis not due to a substance or known physiological condition. Review of the admission Minimum Data Set (MDS) assessment, dated 01/17/23, revealed this resident had severely impaired cognition evidenced by a Brief Interview for Mental Status (BIMS) score of 02. This resident was assessed to require extensive assistance for bed mobility, transfer, dressing, toileting, and personal hygiene as well as supervision for eating. Review of the plan of care initiated on 01/11/23 revealed Resident #87 was at risk for impaired communication. Interventions included allow adequate time for resident's response, educate representative/staff on anticipation of resident's needs until an alternate communication method can be established, incorporate alternate means of communication such as music, song, or visual demonstration, resident speaks in native language at times (Spanish), encourage resident to speak in English as resident can speak English fluently but chooses not to at times, and if resident refuses or cannot speak English at that time, anticipate resident needs until an alternate communication method can be established. Interview on 02/14/23 at 12:25 P.M., with State Tested Nursing Assistant (STNA) #365 revealed she had no way to communicate with Resident #87 when she spoke Spanish. STNA #365 stated she would try to encourage Resident #87 to speak English or attempt to identify Resident #87's needs. Observation on 02/14/23 at 1:29 P.M., revealed Resident #87 spoke some Spanish in addition to English, and no alternative communication methods were observed in Resident #87's room. 2. Record review for Resident #60 revealed she was admitted to the facility on [DATE]. Her diagnoses included hemiplegia, hemiparesis, speech and language deficits, syncope, epilepsy, aphasia, dysarthria, atrial fibrillation, and hypothyroidism. Review of the quarterly Minimum Data Set Assessment (MDS) for Resident #60, dated 01/02/23, revealed she had problems with her short term memory and was cognitively impaired. Further review of the MDS assessment revealed Resident #60 required extensive assistance from staff with bed mobility, transfers, dressing, and toilet use. She required limited assistance from staff with personal hygiene and supervision from staff with eating. Resident #60 was marked as unclear speech and rarely understood. Review of Resident #60's communication and cognition care plan revealed, I wish to improve my ability to make needs known by communication verbally and non-verbally. Please remind me of your name (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365045 If continuation sheet Page 4 of 26 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 365045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillebrand Nursing and Rehabilitation Center 4320 Bridgetown Road 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)

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few when caring for me. I have extreme difficulty with word finding. It is imperative that you are patient when conversing with me and allow ample time to form my thoughts and process what you are saying. I can use my communication board for communication with others. Interview on 02/15/23 at 9:54 A.M., with Licensed Practical Nurse (LPN) #775 stated the staff does not utilize a communication board for Resident #60 because the staff understands what Resident #50 trying to tell them. Observation on 02/14/23 at 9:45 A.M., revealed Resident #60 was seated in her wheelchair in the living room area by the nurse's station she was anxious and making sounds. However, no words were heard related to her diagnosis. Observed staff member Administrator in Training (AIT) #345 ask Resident #60 what she needed. Resident #60 anxiously voiced noises and grunts loudly, however, AIT #345 stated he could not help her right now because he was busy. Observed AIT #345 turn and walk away from Resident #60. Interview on 02/14/23 at 10:03 A.M., with AIT #345 confirmed he approached Resident #60 when she was making sounds and attempting to get his attention. AIT #345 confirmed he told Resident #345 he could not help her because he was busy and walked away from Resident #60. AIT #345 confirmed he did not attempt to get another staff member to help Resident #60. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365045 If continuation sheet Page 5 of 26 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 365045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillebrand Nursing and Rehabilitation Center 4320 Bridgetown Road 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)

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Based on record review, staff interview, and review of the facility policy, the facility failed to ensure the resident's attending physician was notified of significant weight loss. This affected one (#22) of eight residents reviewed for nutrition. The facility census was 97. Findings include: Review of the medical record for Resident #22 revealed an admission date of 01/12/23, with diagnoses including fracture to the right tibia and right fibula, Alzheimer's disease, chronic kidney disease, and atherosclerotic heart disease. Review of the Minimum Data Set (MDS) assessment for Resident #22 dated 01/18/23, revealed resident was cognitively impaired and required supervision and one-person physical assistance with activities of daily living (ADLs). Resident's height was 67 inches and weight was 161 pounds. Review of the admission physician orders for Resident #22 dated 01/12/23 revealed orders for a regular diet with thin liquids and Boost nutritional supplement 120 milliliters (ml) twice daily. Review of the nutrition and hydration care plan for Resident #22 dated 01/13/23 revealed care plan resident received a regular diet with highly variable meal intakes and appetite. Resident had variable self-feeding abilities and occasionally needed limited staff assistance depending on mood and energy levels surrounding meal times. Interventions included the following: Boost Plus to encourage by mouth and protein intakes while appetite remains variable, provide select menu, meals served in the dining room or resident's room depending on mood and need for meal encouragement, provide reminders about mealtimes, remind and encourage fluid intakes at and between meals. Review of the dietary progress note for Resident #22 dated 01/13/23, revealed the resident was in the facility for short term rehab status post hospitalization related to a fall at home with a fracture to the right tibia right fibula. Resident was on a regular diet and fed self with supervision and set up assistance. Resident had all natural teeth in good condition, no overt signs of chewing/swallowing difficulty or aspiration noted. Resident's family requested staff to encourage resident at meals. Resident was determined to be at moderate nutritional risk and was started on a nutritional supplement twice daily to increase protein. The dietitian was to monitor resident and the need for further nutrition interventions. Review of meal intake records for Resident #22 dated 01/12/23 to 02/16/23 revealed resident average meal intakes were 51-75 percent (%.) Review of the weight records for Resident #22 revealed weight on 01/16/23 was 159.2 pounds. Weight on 01/18/23 was 161 pounds. Weight on 01/25/23 was 152.5 pounds which was noted to be a loss of 9.4 pounds or 5.9 % loss from the comparison weight of 159.2 Weight on 02/13/23 was 149.5 which was noted to be a loss of 10.2 pounds or a 6.4% loss from the comparison weight of 159.2. Interview on 02/15/23 at 10:18 A.M., with Registered Dietitian (RD) #235 confirmed Resident #22 had experienced a weight loss of 10.2 pounds or 6.4% since admission to the facility. RD #235 confirmed the physician had not been notified of the resident's significant weight loss. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365045 If continuation sheet Page 6 of 26 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 365045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillebrand Nursing and Rehabilitation Center 4320 Bridgetown Road 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)

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 02/16/23 at 4:00 P.M., with the Director of Nursing (DON) confirmed the facility had not notified Resident #22's physician of resident's significant weight loss since admission. Review of the policy titled Weight and Height dated 02/10/21 revealed a weight loss of 5.0% in one month was considered significant. If there was a significant weight loss, therapeutic intervention by the RD, the physician, and the Interdisciplinary Team (IDT) will begin to assist resident in maintaining weight and preventing further unplanned weight loss or gain. Review of the policy titled Change in Resident's Condition or Status dated 03/01/17 revealed the facility would promptly notify the resident his or her attending physician, and representative of changes in the resident's condition or status. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365045 If continuation sheet Page 7 of 26 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 365045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillebrand Nursing and Rehabilitation Center 4320 Bridgetown Road 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)

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on observations, family and staff interviews, the facility failed to provide a clean and homelike environment. This affected five (#30, #82, # 347, #349, and #350) of five residents reviewed for environment. The facility census was 97. Findings include: Interview on 02/14/23 at 2:32 P.M., with Resident #30's daughter, during a family interview, revealed she was concerned with the dust and debris hanging from Resident #30's bathroom vent in the ceiling. Resident #30's daughter stated she has brought this to the attention of management in the past and it has not been resolved. Resident #30's daughter stated she is concerned that her mother is breathing the dust and debris in each time she uses the restroom. Observation on 02/14/32 at 2:35 P.M., revealed Resident #30's bathroom ceiling vent had visible debris and powdered like substance that appeared to be dust hanging from he ceiling vent. Interview on 02/15/23 at 2:14 P.M., with the Housekeeper (HK) #1000 revealed the housekeeping staff will clean the resident rooms and bathrooms daily. HK #1000 could not confirm how often he bathroom ceiling vents are cleaned. Observation on 02/15/23 at 2:15 P.M., with HK #1000, confirmed Resident #30, #82, #347, #349, and #350's bathroom had visible debris and powdered like substance that appeared to be dust piled up and hanging from the ceiling vents. Interview on 02/16/23 at 9:15 A.M., with the Administrator confirmed housekeeping will clean the resident rooms and bathrooms daily. The Administrator confirmed she cannot say how often the Resident bathroom vents are cleaned. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365045 If continuation sheet Page 8 of 26 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 365045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillebrand Nursing and Rehabilitation Center 4320 Bridgetown Road 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)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Based on record review, staff interview, and review of policies, the facility failed to develop care plans for residents receiving dialysis services. This affected one (#38) of four residents reviewed for dialysis. The facility identified six residents receiving hemodialysis services. The facility census was 97. Findings include: Review of the medical record for Resident #38 revealed an admission date of 01/15/23 with diagnoses including metabolic encephalopathy, chronic obstructive pulmonary disease (COPD), pleural effusion, diabetes mellitus (DM), cirrhosis of the liver, end stage renal disease (ESRD), atherosclerotic heart disease. Review of the comprehensive admission Minimum Data Set (MDS) for Resident #38 dated 01/21/23 revealed resident was cognitively intact, required extensive assistance with activities of daily living (ADLs.) Review of the admission physician orders for Resident #38, dated 01/15/23, revealed an order for the resident to receive hemodialysis at the facility's dialysis clinic on Monday, Wednesday, and Friday; and an order to observe dialysis shunt to the left arm daily to check for thrill/bruit and report abnormal findings to the dialysis unit. Review of the care plans for Resident #38 dated 01/15/23 revealed it did not include a care plan regarding dialysis care and services and interventions related to dialysis care. Interview on 02/15/23 at 9:33 A.M., with the Director of Nursing (DON) confirmed Resident #38's care plans did not include a care plan regarding dialysis. Review of the undated policy titled Care Plan- Baseline and Comprehensive revealed the facility would develop a comprehensive care plan for the resident within seven days of the comprehensive MDS. The care plan should identify any professional and/or specialized services which are part of the resident's care. Review of the policy titled Dialysis Outpatient Program dated 08/02/20, revealed when a resident participates in the dialysis program, a coordinated plan of care between the facility, dialysis agency and resident/family will be developed and shall include directives for interchange of information useful and necessary for the care of the resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365045 If continuation sheet Page 9 of 26 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 365045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillebrand Nursing and Rehabilitation Center 4320 Bridgetown Road 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)

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, and policy review, the facility failed to revise care plans as needed. This affected two (#15 and #23) of eight residents reviewed for pressure ulcers and unnecessary medications. The facility census was 97. Findings include: 1. Review of the medical record for Resident #23 revealed she was admitted to the facility on [DATE]. Diagnoses included unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety, dysphagia following unspecified cerebrovascular disease, unspecified nondisplaced fracture of second cervical vertebra, subsequent encounter for fracture with routine healing, anxiety disorder, chronic kidney disease, hyperparathyroidism, epilepsy, unspecified not intractable, without status epilepticus, and moderate protein-calorie malnutrition. Review of the quarterly Minimum Data Set (MDS) assessment, dated 12/31/22, revealed this resident had moderately impaired cognition evidenced by a Brief Interview for Mental Status (BIMS) score of 10. No hallucinations, delusions, or rejection of care was noted in the assessment. This resident was assessed to require extensive assistance for bed mobility, transfer, dressing, eating, toileting, and personal hygiene. Resident #23 was identified as being at risk for pressure ulcers with no current pressure ulcers indicated on the assessment. a. Review of the plan of care for skin initiated on 01/18/22 revealed Resident #23 did not have any current pressure ulcers. Interventions included monitor skin during care and report any breakdown to the nurse and encourage repositioning throughout the day as well as assistance as needed. Further review of the plan of care revealed there had been no updates regarding any changes to Resident #23's skin. Review of the form titled Wound Assessment and Plan dated 01/19/23 revealed Resident #23 was examined by the wound physician for an unstageable wound to the sacrum and an unstageable wound to back of the head. The assessment indicated both wounds had an onset date of 01/17/23. Interview on 02/15/23 at 5:50 P.M., with the Director of Nursing (DON) confirmed Resident #23's care plan had not been updated after she developed two pressure ulcers. b. Review of the plan of care for Resident #23 dated 02/17/22 and updated 04/21/22 revealed the resident had mental wellness needs. Interventions included I wish to adjust to my surrounding and be free from feelings of depression/anxiety. I want to be free from side effects related to my psychoactive medication. Communicate with my doctor to ensure this medication remains effective, necessary, and free from side effects. Please offer nonpharmacological coping tools also, such as reading, food/fluids, coloring, music, etc. Encourage me to express my feelings and offer active listening and emotional support. I enjoy talking with others so please visit with me often and assist me to participate in activities I enjoy. Encourage me to continue to establish my own goals and daily routine. At times I speak of beliefs that are contrary to reality. I am seen by the psychiatrist for medication management as needed. Review of the physician orders for Resident #23 in 2022 and 2023 revealed the Risperdal (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365045 If continuation sheet Page 10 of 26 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 365045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillebrand Nursing and Rehabilitation Center 4320 Bridgetown Road 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)

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few (Anti-psychotic) order for the resident has changed four separate times. Resident #23 is currently ordered 1.5 milligrams (mg) of Risperdal daily. Interview on 02/16/23 at 1:43 P.M., with the Director of Nursing (DON) confirmed Resident #23 had been on Risperdal for the past year and the order had changed multiple times. The DON confirmed the last update to her mental wellness care plan was 04/21/22. Review of the policy titled, Care Plan-Baseline and Comprehensive dated 08/20/20 revealed Comprehensive care plans are revised as changes in the resident's condition dictate. Care plans are reviewed at least quarterly. Updates and revisions are communicated to the supporting staff and the resident. 2. Review of the medical record for Resident #15 revealed an admission date of 01/13/21. Diagnoses for Resident #15 includes: chronic obstructive pulmonary disease (COPD), acute respiratory failure, cellulitis of the left lower limb, urinary tract infection, atrial fibrillation, benign prostatic hypertrophy, hypertension, hyperlipidemia, major depressive disorder, and anxiety disorder. Review of the quarterly Minimum Data Set (MDS) assessments for Resident #15 dated 11/18/22 and 12/06/22 revealed resident was cognitively impaired. No hallucinations, delusions, or rejection of care was noted in the assessment. Resident #15 required extensive assistance of one to two staff with all activities of daily living (ADLs) except eating (supervision). The resident was coded as negative for the presence of pressure ulcers, but at risk for pressure ulcers. Review of the plan of care for Resident #15 dated 01/13/21 and updated on 12/15/22, revealed the resident was at risk for skin issues. Interventions included Ensure I have a pressure reducing mattress to my bed and cushion to my chair. Assist me with applying a barrier cream to my buttocks/coccyx/feet several times a day to help protect my skin. Encourage me to change my position frequently throughout the day and assist me as needed. Report any changes to my skin, such as increased redness, irritation, to my nurse. I have a history of swelling in my legs, assist me with applying ace wraps as ordered and encourage me to elevate my legs 3 x/day x 30 minutes throughout the day to help manage this. I am being followed by Ameriwound for BLE wounds. Please apply my treatments as ordered. Review of the progress notes for Resident #15 dated 12/05/22 at 3:12 P.M., revealed the resident was reported to have 2 small spots on right and left buttocks, unopened. State Tested Nurse Aide (STNA) placed barrier cream to the area. Will continue to monitor. Review of the facility form titled, Wound Observation Assessment for Resident #15, dated 12/08/22, revealed an open area to the left lower leg (rear) that was labeled as vascular. The measurements of the area were 4.3 centimeters (cm) x 3.1 cm x 0.1 cm. There was no mention of any areas to the buttocks. Review of the progress notes for Resident #15 dated 12/13/22 at 12:26 P.M., revealed the resident has old bruising on right hip. Resident also has shearing on sacrum and ointment was placed. Resident has cushions that he sits on. Review of the facility form titled, Wound Observation Assessment for Resident #15 dated 12/13/22, revealed bruising to the right hip measuring 10 centimeter (cm) x 10 cm. Also, the resident was noted to have a pressure ulcer to the sacrum measuring 5 cm x 2 cm x 0.2 cm. The stage of that pressure ulcer was noted to be Stage 2. The wound assessment was completed by Licensed Practical Nurse (LPN) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365045 If continuation sheet Page 11 of 26 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 365045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillebrand Nursing and Rehabilitation Center 4320 Bridgetown Road 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)

F 0657 #755. Level of Harm - Minimal harm or potential for actual harm Review of the Wound Doctor Notes for Resident #15 dated 12/15/22, revealed the resident had multiple venous ulcers to the lower legs. A venous ulcer to the right posterior leg was noted measuring 2.2 cm x 2.4 cm x 0.1 cm. Another venous ulcer to the left anterior leg was noted measuring 1.1 cm x 3.9 cm x 0.1 cm. There was no mention of pressure sore to the buttocks or sacrum. Residents Affected - Few Review of the nursing notes for Resident #15 dated 12/20/22 at 5:09 P.M., revealed the resident has small openings near right and left coccyx. Also, bruising on right back of thigh and left hip. Review of the facility form titled, Wound Observation Assessment for Resident #15 dated 12/21/22, revealed two separate areas labeled as pressure to the coccyx measuring 2 cm x 1 cm and 1 cm x 1 cm. The assessment also noted areas to the right front lower leg and left front lower leg which were labeled as scabs and redness. No depth or stage were given to the pressure ulcers. Review of the Wound Doctor Notes for Resident #15 dated 12/22/22, revealed the resident had multiple venous ulcers to the lower legs. A new area pressure ulcer was noted to the left buttocks area. The pressure ulcer was labeled as a Stage 3. Measurements to the area were 1.2 cm x 0.5 cm x 0.2 cm. New orders were given for wound gel to the area and get the resident a ROHO cushion for his chair. Interview on 02/16/23 at 1:46 P.M., with the Director of Nursing (DON) confirmed the care plan for Resident #15 was not updated since 12/15/22. The DON confirmed the care plan has nothing regarding pressure ulcers specifically. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365045 If continuation sheet Page 12 of 26 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 365045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillebrand Nursing and Rehabilitation Center 4320 Bridgetown Road 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)

F 0685 Assist a resident in gaining access to vision and hearing services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interviews, the facility failed to arrange for a resident to receive services to address hearing difficulties. This affected one (#52) of two residents reviewed for communication. The facility census was 97. Residents Affected - Few Findings include: Review of the medical record for Resident #52 revealed she was admitted to the facility on [DATE]. Diagnoses included atrial fibrillation, acute kidney failure, hypothyroidism, and other specified disorders of the peritoneum. Review of the annual Minimum Data Set (MDS) assessment, dated 12/02/22, revealed this resident had severely impaired cognition evidenced by a Brief Interview for Mental Status (BIMS) score of 05. This resident was assessed to require extensive assistance for bed mobility, dressing, toileting, and personal hygiene as well as supervision for eating. Resident #52 was identified on the assessment as having moderate hearing difficulty with no hearing aid or other hearing appliance used. Review of the plan of care for hearing initiated on 12/04/19 revealed Resident #52 was hard of hearing. Interventions included speak clearly and repeat information as needed. It was noted Resident #52 had hearing aids but did not typically wear them. Further review of the medical record for Resident #52 revealed no documentation related to audiology services. Observation on 02/14/23 at 9:50 A.M., revealed Resident #52 was not wearing hearing aids and had difficulty hearing when being communicated with. Interview on 02/15/23 at 5:55 P.M., with the Administrator and Director of Nursing (DON) revealed activity staff had attempted to provide amplifiers to Resident #52 without success but were unsure of when Resident #52 was last seen by audiology. Interview on 02/16/23 at 12:00 P.M., with the DON confirmed there was no documentation for Resident #52 regarding audiology services. Interview on 02/16/23 at 12:20 P.M., with State Tested Nursing Assistant (STNA) #495 revealed Resident #52 did not have or was wear hearing aids. STNA #495 stated Resident #52 had difficulty hearing at times when being provided with care. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365045 If continuation sheet Page 13 of 26 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 365045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillebrand Nursing and Rehabilitation Center 4320 Bridgetown Road 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)

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. Review of the medical record for Resident #23 revealed an admission date of 01/11/22. Diagnoses for Resident #23 included: unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety, dysphagia following unspecified cerebrovascular disease, unspecified nondisplaced fracture of second cervical vertebra, subsequent encounter for fracture with routine healing, anxiety disorder, chronic kidney disease, hyperparathyroidism, epilepsy, unspecified not intractable, without status epilepticus, and moderate protein-calorie malnutrition. Residents Affected - Few Review of the quarterly Minimum Data Set (MDS) assessment, dated 12/31/22, revealed this resident had moderately impaired cognition evidenced by a Brief Interview for Mental Status (BIMS) score of 10. This resident was assessed to require extensive assistance for bed mobility, transfer, dressing, eating, toileting, and personal hygiene. Resident #23 was identified as being at risk for pressure ulcers with no current pressure ulcers indicated on the assessment. Review of the plan of care for skin initiated on 01/18/22 revealed Resident #23 did not have any current pressure ulcers. Interventions included monitor skin during care and report any breakdown to the nurse and encourage repositioning throughout the day as well as provide assistance as needed. Review of the facility form titled Wound Observation Assessment, dated 01/13/23, revealed no skin issues were noted. Review of the nursing progress note dated 01/15/23, revealed Resident #23 had an open area on the back of her head. The area was described as part boggy and open as well as bright red. The note indicated Resident #23 complained of discomfort, and pain medication was administered per orders, which was effective. The note also revealed the issue would be reported to the next shift. Review of the facility form titled Wound Observation Assessment, dated 01/17/23, revealed Resident #23 had an unstageable pressure wound to the back of her head that measured 1.7 centimeters (cm) in length by 1.3 cm. in width with no depth listed. Review of the form titled, Wound Assessment and Plan dated 01/19/23, revealed Resident #23 was examined by the Wound Physician for an unstageable wound to the sacrum and an unstageable wound to back of the head. The assessment indicated both wounds had an onset date of 01/17/23. The sacrum wound was 1.1 cm in length by 1.4 cm in width with depth obscured. The scalp wound was 1.0 cm in length by 1.9 cm in width with depth obscured. Interview on 02/15/23 at 2:08 P.M., with the Director of Nursing (DON) revealed Resident #23's skin assessment on 01/13/23 indicated she had no skin issues. The DON indicated the skin assessment dated [DATE], listed the pressure ulcer to the back of Resident #23's head as unstageable with no other wounds listed. The DON confirmed the assessment completed by the Wound Physician on 01/19/23 revealed Resident #23 had unstageable pressure ulcers to the sacrum and scalp with an onset date of 01/17/23 for both wounds. The DON expressed the facility was unaware of the progress note dated 01/15/23. Observation on 02/16/23 at 9:11 A.M., of wound care for Resident #23 revealed that pressure ulcers continued to the back of the head and to the sacrum. Wound care was observed with the Wound Physician #970 and he stated that the area to the back of the head was almost healed. The pressure ulcer to the sacrum was noted to be similar as it was the previous week. No other concerns were noted. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365045 If continuation sheet Page 14 of 26 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 365045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillebrand Nursing and Rehabilitation Center 4320 Bridgetown Road 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)

F 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the undated policy titled, Wound Policy revealed the facility staff is to observe skin, find areas of concern (i.e. wounds, skin tears, pressure areas that could break down). Licensed nurse will complete a full head to toe skin assessment on admission/re-admission and weekly thereafter. If a wound is present the licensed nurse will contact the doctor to get treatment orders and refer to wound doctor if necessary. Review of the NPUAP guidelines dated 2014, revealed facilities should educate health professionals on how to undertake a comprehensive skin assessment that includes the techniques for identifying blanching response, localized heat, edema, and induration. Further review of the guidelines revealed ongoing assessment of the skin was necessary in order to detect early signs of pressure damage. Visual assessment for erythema (redness of the skin) was the first component of every skin inspection. Skin redness and tissue edema resulting from capillary occlusion was a response to pressure, especially over bony prominences. Staff should conduct a head-to-toe assessment with particular focus on skin overlying bony prominences including the sacrum, ischial tuberosities, greater trochanters and heels and each time the resident was repositioned was an opportunity to conduct a brief skin assessment. This deficiency represents non-compliance investigated under Complaint Number OH00139975. Based on medical record review, staff interviews, observations, review of policies, and review of guidelines from the National Pressure Ulcer Advisory Panel (NPUAP), the facility failed to thoroughly assess resident's skin, failed to notify the physician when areas developed and change soiled gloves during a dressing change. This affected three (#15, #23, and #155) of four residents reviewed for pressure ulcers. The facility census was 97. Findings include: 1. Review of the medical record for Resident #15 revealed an admission date of 01/13/21. Diagnoses for Resident #15 includes: chronic obstructive pulmonary disease (COPD), acute respiratory failure, cellulitis of the left lower limb, urinary tract infection, atrial fibrillation, benign prostatic hypertrophy, hypertension, hyperlipidemia, major depressive disorder, and anxiety disorder. Review of the quarterly Minimum Data Set (MDS) assessments for Resident #15 dated 11/18/22 and 12/06/22 revealed resident was cognitively impaired. No hallucinations, delusions, or rejection of care was noted in the assessment. Resident #15 required extensive assistance of one to two staff with all activities of daily living (ADLs) except eating (supervision). The resident was coded as negative for the presence of pressure ulcers, but at risk for pressure ulcers. Review of the Braden Scale for Predicting Pressure Assessment for Resident #15 dated 10/01/22, revealed the resident was not at risk for the formation of pressure ulcers. Review of the plan of care for Resident #15 updated on 12/15/22, revealed the resident was at risk for skin issues. Interventions included Ensure I have a pressure reducing mattress to my bed and cushion to my chair. Assist me with applying a barrier cream to my buttocks/coccyx/feet several times a day to help protect my skin. Encourage me to change my position frequently throughout the day and assist me as needed. Report any changes to my skin, such as increased redness, irritation, to my nurse. Review of the progress notes for Resident #15 dated 12/05/22 at 3:12 P.M., revealed the resident was reported to have 2 small spots on right and left buttocks, unopened. State Tested Nurse Aide (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365045 If continuation sheet Page 15 of 26 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 365045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillebrand Nursing and Rehabilitation Center 4320 Bridgetown Road 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)

F 0686 (STNA) placed barrier cream to the area. Will continue to monitor. Level of Harm - Minimal harm or potential for actual harm Review of the facility form titled, Wound Observation Assessment for Resident #15, dated 12/08/22, revealed an open area to the left lower leg (rear) that was labeled as vascular. The measurements of the area were 4.3 centimeters (cm) x 3.1 cm x 0.1 cm. There was no mention of any areas to the buttocks. Residents Affected - Few Review of the progress notes for Resident #15 dated 12/13/22 at 12:26 P.M., revealed the resident has old bruising on right hip. Resident also has shearing on sacrum and ointment was placed. Resident has cushions that he sits on. Review of the facility form titled, Wound Observation Assessment for Resident #15 dated 12/13/22, revealed bruising to the right hip measuring 10 centimeter (cm) x 10 cm. Also, the resident was noted to have a pressure ulcer to the sacrum measuring 5 cm x 2 cm x 0.2 cm. The stage of that pressure ulcer was noted to be Stage 2. The wound assessment was completed by Licensed Practical Nurse (LPN) #755. Review of the Wound Doctor Notes for Resident #15 dated 12/15/22, revealed the resident had multiple venous ulcers to the lower legs. A venous ulcer to the right posterior leg was noted measuring 2.2 cm x 2.4 cm x 0.1 cm. Another venous ulcer to the left anterior leg was noted measuring 1.1 cm x 3.9 cm x 0.1 cm. There was no mention of pressure sore to the buttocks or sacrum. Review of the nursing notes for Resident #15 dated 12/20/22 at 5:09 P.M., revealed the resident has small openings near right and left coccyx. Also, bruising on right back of thigh and left hip. Review of the facility form titled, Wound Observation Assessment for Resident #15 dated 12/21/22, revealed two separate areas labeled as pressure to the coccyx measuring 2 cm x 1 cm and 1 cm x 1 cm. The assessment also noted areas to the right front lower leg and left front lower leg which were labeled as scabs and redness. No depth or stage were given to the pressure ulcers. Review of the Wound Doctor Notes for Resident #15 dated 12/22/22, revealed the resident had multiple venous ulcers to the lower legs. A new area pressure ulcer was noted to the left buttocks area. Measurements to the area were 1.2 cm x 0.5 cm x 0.2 cm. New orders were given for wound gel to the area and get the resident a ROHO cushion for his chair. Review of the physician orders for Resident #15 in December 2022 revealed orders for barrier cream to coccyx area. An order was noted on 12/20/22 through 01/03/23 which stated Clean coccyx wounds with Normal Saline (NS), pat dry, place (non-adherent foam dressing) every morning and at bedtime. The wound doctor order for gel on 12/22/22 is not in the physician orders only on wound notes. On 01/04/23, a new orders for wound gel to the coccyx area was written. No order for a ROHO cushion was in Point Click Care (PCC) for Resident #15 and there is no order for the cushion from the 12/22/22 wound note. Observation on 02/15/23 at 9:31 A.M., of the skin for Resident #15 revealed an area noted to the right buttocks. The open area appeared measure approximately 1 cm x 1 cm and had depth, without drainage. No area was noted on the left buttocks. Interview on 02/15/23 at 1:53 P.M., with the Director of Nursing (DON) confirmed no other treatment was in place from 12/13/22 through 12/19/22 for the pressure ulcer to the left buttocks/coccyx area (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365045 If continuation sheet Page 16 of 26 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 365045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillebrand Nursing and Rehabilitation Center 4320 Bridgetown Road 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)

F 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few other barrier cream. The DON confirmed there was pressure identified by a facility wound assessment on 12/13/22, but there is no proof that the doctor was notified. The DON also confirmed that the Wound Doctor noted the area to the left buttocks as a stage 3 pressure ulcer on 12/22/22. The DON confirmed the wound doctor orders were not implemented until 01/03/23. 2. Review of the medical record for Resident #155 revealed an admission date of 02/07/23 with a diagnoses including metabolic encephalopathy, end stage renal disease (ESRD), and diabetes mellitus (DM). Review of the Minimum Data Set (MDS) assessment for Resident #155 dated 02/13/22 revealed resident was cognitively impaired and required extensive assistance of one staff with activities of daily living (ADLs.) Review of the February 2023 monthly physician orders for Resident #155 revealed an order dated 02/09/23 to cleanse pressure ulcer to resident's left heel with normal saline, pat dry, apply wound gel to wound bed and cover with a dry dressing. Observation of wound care on 02/15/23 at 9:40 A.M., with Licensed Practical Nurse (LPN) #990 revealed the nurse removed an old dressing from resident's left heel wearing clean gloves. The dressing was adhering to the wound and nurse used normal saline to loosen the gauze from the wound and also cleaned the wound with gauze soaked with normal saline. There was dark reddish-brown exudate noted to the old dressing. LPN #990 then applied wound gel and a dry dressing to the wound bed using contaminated gloves. Nurse did not doff contaminated gloves, perform hand hygiene and don clean gloves prior to applying wound gel and a clean dressing to the wound. Interview on 02/15/23 at 9:52 A.M., with LPN #990 confirmed she did not doff contaminated gloves, perform hand hygiene and don clean gloves prior to applying wound gel and a clean dressing to Resident #155's wound. Review of the policy titled Clean Dressing Changes dated 04/21/21 revealed the following ordered steps were required when completing a clean dressing change: wash hands and put on clean gloves, loosen the tape and remove the existing dressing, if needed to minimize skin stripping or pain, moisten with prescribed cleansing solution or use adhesive remover to remove tape, remove gloves, pulling inside out over the dressing, discard into appropriate receptacle, wash hands and put on clean gloves, cleanse the wound as ordered, taking care to riot contaminate other skin surfaces or other surfaces of the wound, pat dry with gauze, wash hands and put on clean gloves, apply topical ointments or creams and dress the wound as ordered, secure dressing, mark with initials and date, discard disposable items and gloves into appropriate trash receptacle and wash hands. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365045 If continuation sheet Page 17 of 26 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 365045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillebrand Nursing and Rehabilitation Center 4320 Bridgetown Road 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)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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 observation, resident and staff interview, record review, and policy review, the facility failed to ensure a resident who smokes was following the facility policy on securing smoking materials. This affected one (#349) of two residents identified as smokers. The facility census was 97. Findings include: Record review for Resident #349 revealed he was admitted to the facility on [DATE]. His diagnoses included malignant neoplasm of extrahepatic bile, chronic obstructive pulmonary disease, Parkinson's Disease, major depressive disorder, hypothyroidism, and overactive bladder. Review of New admission Minimum Data Set (MDS) assessment dated , 01/26/23, revealed Resident # 349 was cognitively intact. Further review of the MDS assessment Resident #349 required limited assistance from staff with bed mobility, transfers, dressing, toilet use, and personal hygiene. Resident # 349 required supervision from staff with walking and eating. Review of Resident #349's care plans revealed a Tobacco Use care plan, dated 01/21/23. The goal was listed as, Resident will adhere to the Tobacco/Smoking policies of the facility. The interventions included, conduct smoking safety evaluation upon admission and as needed. Educate Resident and responsible party of the facility tobacco/smoking policies. If a smoking facility, orient Resident to smoking time and procedures. Review of Resident #349's, Smoking Assessment, dated 01/20/23, Resident #349 was assessed and was listed as an independent smoker. Interview and observation on 2/16/23 at 10:59 A.M., with Resident #349 confirmed he is a smoker. Resident #349 stated keeps his lighter and cigarettes on him. Resident #349 walked over to his coat pocket and pulled out a pack of cigarettes and a blue lighter. Resident #349 stated he usually smokes about five cigarettes a day. Interview and on 02/16/23 at 11:04 A.M., with Stated Tested Nurse Assistant (STNA) #940 confirmed Resident #340 is an independent smoker, however, the facility staff will keep his lighter and cigarettes in a cabinet at the nurse's station. STNA #940 walked over to the cabinet and pulled out a large box of cigarettes. STNA #940 confirmed his lighter was not located in the box. STNA #940 confirmed Resident #340 has his lighter on him in his room. Review of the smoking policy titled, Smoking Policies, dated 03/2011, stated if residents are determined to be safe independently smoking their supplies will be readily available at the nurse's station, if they require assistance with transport to safe/designated smoking areas will provide transport to these areas. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365045 If continuation sheet Page 18 of 26 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 365045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillebrand Nursing and Rehabilitation Center 4320 Bridgetown Road 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)

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. Review of the medical record for Resident #22 revealed an admission date of 01/12/23 with diagnoses including fracture to the right tibia and right fibula, Alzheimer's disease, chronic kidney disease, and atherosclerotic heart disease. Residents Affected - Few Review of the Minimum Data Set (MDS) for Resident #22 dated 01/18/23 revealed resident was cognitively impaired and required supervision and one-person physical assistance with activities of daily living (ADLs.) Resident's height was 67 inches and weight was 161 pounds. Review of the admission physician orders for Resident #22 dated 01/12/23 revealed orders for a regular diet with thin liquids and Boost nutritional supplement 120 milliliters (ml) twice daily. Review of the nutrition and hydration care plan for Resident #22 dated 01/13/23 revealed care plan resident received a regular diet with highly variable meal intakes and appetite. Resident had variable self-feeding abilities and occasionally needed limited staff assistance depending on mood and energy levels surrounding meal times. Interventions included the following: Boost Plus to encourage by mouth and protein intakes while appetite remains variable, provide select menu, meals served in the dining room or resident's room depending on mood and need for meal encouragement, provide reminders about mealtimes, remind and encourage fluid intakes at and between meals. Review of the dietary progress note for Resident #22 dated 01/13/23 revealed resident was in the facility for short term rehab status post hospitalization related to a fall at home with a fracture to the right tibia right fibula. Resident was on a regular diet and fed self with supervision and set up assistance. Res had all natural teeth in good condition, no overt signs of chewing/swallowing difficulty or aspiration noted. Resident's family requested staff to encourage resident at meals. Resident was determined to be at moderate nutritional risk and was started on a nutritional supplement twice daily to increase protein. The dietitian was to monitor resident and the need for further nutrition interventions. Review of meal intake records for Resident #22 dated 01/12/23 to 02/16/23 revealed resident average meal intakes were 51-75 percent (%.) Review of the weight records for Resident #22 revealed weight on 01/16/23 was 159.2 pounds. Weight on 01/18/23 was 161 pounds. Weight on 01/25/23 was 152.5 pounds which was noted to be a loss of 9.4 pounds or 5.9 % loss from the comparison weight of 159.2 Weight on 02/13/23 was 149.5 which was noted to be a loss of 10.2 pounds or a 6.4% loss from the comparison weight of 159.2. Interview on 02/15/23 at 10:18 A.M. with Registered Dietitian (RD) #235 confirmed Resident #22 had experienced a weight loss of 10.2 pounds or 6.4% since admission to the facility. RD #235 confirmed the physician had not been notified of the resident's significant weight loss. RD #235 further confirmed the facility had not initiated any new interventions to prevent further weight loss for Resident #22. Interview on 02/16/23 at 4:00 P.M. with the Director of Nursing (DON) confirmed the facility had not initiated any new interventions to prevent further weight loss for Resident #22. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365045 If continuation sheet Page 19 of 26 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 365045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillebrand Nursing and Rehabilitation Center 4320 Bridgetown Road 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)

F 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the policy titled Weight and Height 02/10/21 revealed a weight loss of 5.0% in one month was considered significant. If there was a significant weight loss, therapeutic intervention by the RD, the physician, and the Interdisciplinary Team (IDT) will begin to assist resident in maintaining weight and preventing further unplanned weight loss or gain. Based on record review, staff interview, and policy review, the facility failed to implement interventions for a resident with significant weight loss and failed to monitor weights per policy. This affected three (#22, #23, and #87) of eight residents reviewed for nutrition. The facility census was 97. Findings include: 1. Review of the medical record for Resident #23 revealed she was admitted to the facility on [DATE]. Diagnoses included unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety, dysphagia following unspecified cerebrovascular disease, unspecified nondisplaced fracture of second cervical vertebra, subsequent encounter for fracture with routine healing, anxiety disorder, chronic kidney disease, hyperparathyroidism, epilepsy, unspecified not intractable, without status epilepticus, and moderate protein-calorie malnutrition. Review of the quarterly Minimum Data Set (MDS) assessment, dated 12/31/22, revealed this resident had moderately impaired cognition evidenced by a Brief Interview for Mental Status (BIMS) score of 10. This resident was assessed to require extensive assistance for bed mobility, transfer, dressing, eating, toileting, and personal hygiene. Review of the plan of care for nutrition revised on 02/15/23 revealed Resident #23 had variable intakes, required total assistance with feeding, and was at high risk for weight fluctuation. Review of the weights documented for Resident #23 revealed she was weighed on 11/01/22 at 139 pounds and was not weighed again until 01/09/23 at 112.4 pounds. On 02/09/23 the residnet was weighed at 115.6 pounds. Interview on 02/15/23 at 5:51 P.M. with the Director of Nursing (DON) confirmed there was no documented weight for Resident #23 between 11/01/22 and 01/09/23. Review of the facility policy titled Weight and Height Policy, revised 02/10/21, revealed all residents were to be weighed monthly. 2. Review of the medical record for Resident #87 revealed she was admitted to the facility on [DATE]. Diagnoses included metabolic encephalopathy, type two diabetes mellitus with diabetic chronic kidney disease, end stage renal disease, Parkinson's disease, bipolar disorder, mixed hyperlipidemia, thrombocytopenia, major depressive disorder, vitamin d deficiency, and unspecified psychosis not due to a substance or known physiological condition. Review of the admission Minimum Data Set (MDS) assessment, dated 01/17/23, revealed this resident had severely impaired cognition evidenced by a Brief Interview for Mental Status (BIMS) score of 02. This resident was assessed to require extensive assistance for bed mobility, transfer, dressing, toileting, and personal hygiene as well as supervision for eating. Review of the plan of care for nutrition initiated on 01/12/23 revealed Resident #87 had variable (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365045 If continuation sheet Page 20 of 26 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 365045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillebrand Nursing and Rehabilitation Center 4320 Bridgetown Road 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)

F 0692 intakes and received dialysis three times a week as well as supplements. Level of Harm - Minimal harm or potential for actual harm Review of the weights documented for Resident #87 revealed she was weighed on 01/11/23 at 138.4 pounds, 01/16/23 at 130.4 pounds, and 02/06/23 at 130.4 pounds. Residents Affected - Few Review of the Medication Administration Record (MAR) for Resident #87 from 01/11/23 through 01/31/23 revealed Resident #87 was to be weighed weekly for four weeks and then monthly. There was a blank space on the MAR for weights on 01/23/23 and 01/30/23. Interview on 02/15/23 at 5:46 P.M. with the DON confirmed the missed weights on 01/23/23 and 01/30/23. Review of the facility policy titled Weight and Height Policy, revised 02/10/21, revealed residents that are newly admitted to the facility were to be weighed weekly for the first four weeks. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365045 If continuation sheet Page 21 of 26 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 365045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillebrand Nursing and Rehabilitation Center 4320 Bridgetown Road 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)

F 0694 Provide for the safe, appropriate administration of IV fluids for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on record review, interview and policy review, the facility failed to ensure a peripherally inserted central catheter (PICC) was maintained. This affected one (Resident #151) of three residents reviewed for IV therapy services. The facility census was 97. Residents Affected - Few Findings include: Review of the medical record for Resident #151 revealed an admission date of 12/29/22 with diagnoses including fracture right humerus, acute osteomyelitis, diabetes mellitus (DM), and end stage renal disease (ESRD). Resident #151 was discharged on 02/03/23. Review of admission physician orders for Resident #151 dated 12/29/22 revealed an order for Vancomycin per IV three times weekly on Monday, Wednesday, and Friday. Review of the orders revealed they did not include orders regarding a dressing or flush to the PICC. Review of the December 2022 and January 2023 Treatment Administration Record (TAR) for Resident #151 revealed no documentation a dressing change or flush was ever performed to the PICC line during Resident #151's stay. During interview on 02/16/23 at 12:08 P.M., Licensed Practical Nurse (LPN) #430 stated IV dressings should be changed weekly at a minimum or as ordered. LPN #430 further confirmed Resident #151 did not have an order for a dressing change to his IV site. Interview on 02/16/23 at 12:02 P.M. with the Director of Nursing (DON) confirmed Resident #151 received IV Vancomycin three times weekly upon admission. DON confirmed Resident #151's record did not include orders for flushing the IV nor did it include orders for changing the dressing to the IV site. Review of the facility policy titled Flushing Intravenous Access Devices, undated, revealed IV access devices should be flushed per physician's orders at least every 12 hours and before and after each use. IVs could be flushed with saline or heparin or both in accordance with the physician's order for flushing the IV. Review of the facility policy titled Clean Dressing Changes, dated 04/22/21, revealed the facility would provide wound care in a manner to decrease potential for infection and/or cross-contamination. Physician's orders would specify type of dressing and frequency of changes. This deficiency represents non-compliance investigated under Complaint Number OH00139975. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365045 If continuation sheet Page 22 of 26 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 365045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillebrand Nursing and Rehabilitation Center 4320 Bridgetown Road 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)

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. Based on record review and interview, the facility failed to ensure residents had an appropriate diagnosis for the use of anti-psychotic medications. This affected two (Residents #23 and #51) of five residents reviewed for unnecessary medications. The facility census was 97. Findings include: 1. Review of the medical record for Resident #51 revealed an admission date of 01/04/21 with a diagnosis of dementia, COVID-19, dysphagia, anxiety disorder, major depressive disorder, and hyperlipidemia. Review of the quarterly Minimum Data Set (MDS) assessment for Resident #51, dated 01/31/23, revealed the resident was cognitively impaired. The assessment revealed no hallucinations, delusions, or rejection of care noted. Review of the physician orders for Resident #51 in February 2022 revealed orders for Seroquel (anti-psychotic) 25 milligrams (mg) in the morning for anxiety and Seroquel 25 mg at bedtime for agitation. During interview on 02/16/23 at 1:39 P.M., the Director of Nursing (DON) confirmed that anxiety and agitation are not correct approved indications for the usage of Seroquel. The DON also confirmed that no correct diagnoses were listed on any psychiatrist notes for Resident #51 for the use of Seroquel. 2. Review of the medical record for Resident #23 revealed an admission date of 01/11/22 with a diagnosis of dementia, COVID-19, dysphagia, history of falling, anxiety disorder, chronic kidney disease, hypertension, and muscle weakness. Review of the Medicare 5-day Minimum Data Set (MDS) assessment for Resident #23 dated 01/02/23 revealed resident was cognitively intact. No hallucinations, delusions, or rejection of care was noted in the assessment. Review of the physician orders for Resident #23 in February 2022 revealed orders for Risperdal (anti-psychotic) 1.5 milligrams (mg) daily for anxiety. During interview on 02/15/23 at 2:15 P.M., the DON confirmed that anxiety is not a correct approved indication for the usage of Risperdal. The DON also confirmed that no correct diagnoses were listed on any psychiatrist notes for Resident #23 for the use of Risperdal. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365045 If continuation sheet Page 23 of 26 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 365045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillebrand Nursing and Rehabilitation Center 4320 Bridgetown Road 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)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observations and staff interview the facility failed to ensure proper storage of medications including ensuring that expired medications were not being used. This affected one of the three medication carts reviewed and one out of two medication storage rooms in the facility. This had the potential to affect 18 residents (#1, #8, #12, #19, #27, #33, #42, #55, #57, #61, #73, #78, #86, #155, #245, #247, #346, #347) due to expired medications. The facility census was 97. Findings include: Observations on 02/14/23 at 8:24 A.M. of the 3rd floor medication room revealed outdated medications. The outdated medications found were Certavite Senior multivitamins dated 08/2021, Iron 325mg dated 12/2022, Calcium 600mg dated 05/2022, Vitamin D 400 iu dated 11/2019, Zinc 50mg dated 11/2022, Calcium Citrate plus Vitamin D dated 07/2017, Fish Oil 1200mg dated 11/2021, Vitamin B6 dated 03/2021. Interview on 02/14/23 at 8:27 A.M. with Licensed Practical Nurse (LPN) #505 confirmed the above outdated medications. Observations on 02/14/23 at 9:00 A.M. of the 3rd floor, Team 2 medication cart revealed outdated medications. The outdated medications found were Vitamin D 10mcg dated 07/2022, and Ferrous Gluconate 240mg dated 10/2021. Interview on 02/14/23 at 9:05 A.M. with LPN #700 confirmed the above outdated medications. The facility was unable to provide a written policy for medication storage. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365045 If continuation sheet Page 24 of 26 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 365045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillebrand Nursing and Rehabilitation Center 4320 Bridgetown Road 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)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, staff interview and policy review, the facility failed to ensure food items were properly sealed and dated and that the ice machine was clean. This had the potential to affect all 97 residents residing in the facility. All 97 residents were served food from the kitchen. The facility census was 97. Findings include: Observation on 02/13/23 at 6:45 P.M. of the walk-in refrigerator revealed two bags of undated shredded cheese, an open and undated box of assorted pastries, an undated bag of carrots, and an undated bag of hard-boiled eggs, which were all confirmed by Dietary Staff #405 at the time of the observation. Observation on 02/13/23 at 6:53 P.M. of the ice machine in the kitchen revealed a black discoloration on the inside of the lid and the side of the ice machine, which was confirmed by Dietary Manager #690 at the time of the observation. Review of the undated facility policy titled DATE MARKING revealed any ready-to-eat, potentially hazardous food prepared and held in refrigeration should be marked utilizing an established procedure to ensure food safety. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365045 If continuation sheet Page 25 of 26 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 365045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillebrand Nursing and Rehabilitation Center 4320 Bridgetown Road 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)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, staff interview, policy review and manufacturer's instructions, the facility failed to properly clean and sanitize the glucometer before and after use. This affected one (#68) of one resident observed for glucometer check. The census was 97. Residents Affected - Few Findings include: During observation on 02/14/23 at 8:06 A.M., Resident #68 was sitting in his wheelchair in the common area with four other residents in the area. Licensed Practical Nurse (LPN) #700 gathered all her supplies at the medication cart. She cleansed the glucometer with an alcohol wipe and did not let it dry. The nurse did have gloves on prior to completing the blood glucose. After obtaining Resident #68's glucose reading, she returned the glucometer to the medication cart without cleaning it. Interview on 02/14/23 at 8:10 A.M. with LPN #700 confirmed that she used an alcohol wipe to cleanse the glucometer before using it to obtain the blood sugar of Resident #68. Review of the facility policy titled Glucometer Testing Policy and Procedure, undated, revealed Each resident that has finger sticks ordered will have their own glucometer machine. The glucometer needs to be disinfected after each use with Germicidal wipes, wipe entire surface three times let sit for minutes and wipe dry cloth. Additionally, the meter should be cleaned and disinfected after use on each patient. Review of the Assure Prism Multi Blood Glucose Monitoring System Manual revealed Before performing a blood glucose test, observe the following safety precautions: the meter should be cleaned and disinfected after use on each patient. The manual goes on to give directives regarding the cleaning and disinfecting of the meter. The cleaning procedure is needed to clean dirt as well as blood and other body fluids on the exterior of the meter before performing the disinfection procedure. The disinfection procedure is needed to prevent transmission of blood-borne pathogens. Clorox Germicidal wipes with 0.55% sodium hypochlorite as the active ingredient have been tested and approved for cleaning and disinfecting the Assure Prism multi Meter. This disinfectant has been shown to be safe for use with this meter. Any disinfectant product with the EPA registration number 67619-12 may be used on this device. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365045 If continuation sheet Page 26 of 26

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Citations

15 citations recorded^*CMS

What do CMS severity letters mean?

Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.

General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.

Each letter combines severity with scope: how many residents the deficiency affected.

0557GeneralS&S Dpotential for harm
F557 - Respect and Dignity
Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions.
0657GeneralS&S Dpotential for harm
F657 - Comprehensive Care Plans
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
0686GeneralS&S Dpotential for harm
F686 - Skin Integrity
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
0689GeneralS&S Dpotential for harm
F689 - Accidents
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
0692GeneralS&S Dpotential for harm
F692 - Assisted nutrition and hydration
Provide enough food/fluids to maintain a resident's health.
0694GeneralS&S Dpotential for harm
F694 - Parenteral Fluids
Provide for the safe, appropriate administration of IV fluids for a resident when needed.
0758GeneralS&S Dpotential for harm
F758 - Medication Errors
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
0761GeneralS&S Epotential for harm
F761 - Labeling of Drugs and Biologicals
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
0880GeneralS&S Dpotential for harm
F880 - Infection Control
Provide and implement an infection prevention and control program.
0558GeneralS&S Dpotential for harm
F558 - The right to reside and receive services in the facility with reasonable
Reasonably accommodate the needs and preferences of each resident.
0580GeneralS&S Dpotential for harm
F580 - Notification of Changes
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
0584GeneralS&S Epotential for harm
F584 - Safe Environment
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
0656GeneralS&S Dpotential for harm
F656 - Comprehensive Care Plans
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
0685GeneralS&S Dpotential for harm
F685 - Vision and hearing
Assist a resident in gaining access to vision and hearing services.
0812GeneralS&S Fpotential for harm
F812 - Food safety requirements
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

FAQ · About this visit

Common questions about this visit

What happened during the February 22, 2023 survey of HILLEBRAND NURSING AND REHABILITATION CENTER?

This was a inspection survey of HILLEBRAND NURSING AND REHABILITATION CENTER on February 22, 2023. The surveyor cited 15 deficiencies, recorded on the federal Form 2567 statement of deficiencies.

Were any deficiencies cited at HILLEBRAND NURSING AND REHABILITATION CENTER on February 22, 2023?

Yes, 15 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions."

What type of survey was this?

This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.

SourceView on CMS Care Compare

Next steps

Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.

Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.

Data from CMS Care Compare public records. Dataset last refreshed June 15, 2026. If you believe any information is inaccurate, report it here.

Health inspection·February 22, 2023