Inspection·December 28, 2023

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. Based on record review, observation, and staff interviews, the facility failed to prepare an adequate amount of food to serve all the residents and failed to follow the prepared menu. This had the potential to affect all residents residing in the facility. The facility census was 87. Findings include: Review of the lunch menu dated 12/27/23 revealed lunch service included spaghetti with meat sauce, Caesar salad, garlic buttered dinner roll, Oreo fluff, choice of milk, and beverage of choice. Observation of the lunch service tray line on 12/27/23 at 12:05 P.M. through 1:05 P.M. revealed [NAME] #26 was serving spaghetti with meat sauce and ran out of spaghetti with five trays remaining and had to serve hot dogs or hamburgers as an alternative even though an alternative meal was not requested. During tray line observation, a regular salad had replaced the Caesar salad, and a garlic butter dinner roll was supposed to be served but was not available to be put on the trays. Interview on 12/27/23 at 1:19 P.M. with Resident #21 reported that she would have preferred to have spaghetti but stated she was not picky. Interview on 12/27/23 at 1:23 P.M. with Resident #20 reported that the facility is always running out of food. Resident #20 stated that the facility ran out of hamburgers on Saturday 12/23/23 and then ran out of hot dogs on Sunday 12/24/23. Interview on 12/27/23 at 1:33 P.M. with Kitchen Manager (KM) #29 verified there was no dinner roll served with the spaghetti and they were not available to serve. KM #30 stated she knew she was forgetting something. Interview on 12/27/23 at 1:51 P.M. with [NAME] #26 verified that the kitchen ran out of hamburgers on 12/23/23 and hotdogs on 12/24/23. Review of the Food Ordering Policy (dated 11/05) revealed a one-week supply of staple foods, and a two-to-three-day supply of perishable foods shall be maintained at all times. This deficiency represents non-compliance investigated under Complaint Number OH00148816. Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 365186 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 365186 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ayden Healthcare of Madeira 5970 Kenwood Road Cincinnati, OH 45243 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)