Inspection visit

InspectionJanuary 24, 2024

AYDEN HEALTHCARE OF MADEIRACMS #36518627 citations on this visit

27 citations recorded

Inspector’s narrative

What the inspector wrote

This survey cited 27 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, interview, and policy review, the facility failed to ensure staff were not assigned to residents who specified they did not want that caregiver and failed to ensure residents received their phone calls. This affected two (Residents #26 and #336) of two residents reviewed for resident rights. The census was 87. Findings include: 1. Record review revealed Resident #26 was admitted on [DATE] with diagnoses including multiple sclerosis and heart failure. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #26 was cognitively intact. Review of a facility Self-Reported Incident (SRI), #242077 dated 12/12/23, documented the facility received an anonymous letter from a church in the community alleging possible abuse or neglect of Resident #26. When staff spoke with Resident #26 she said there were two staff members she didn't want to care for her because of personal reasons. During an interview on 01/17/24 at 2:31 P.M., Resident #26 stated she did not want State Tested Nursing Assistant (STNA) #53 to take care of her because the STNA said to her in conversation at least I can wipe my own [expletive] (buttocks). Resident #26 said she told the nursing staff she didn't want STNA #53 to care for her anymore, but the STNA #53 continued to care for her and she cared for her this morning. During an interview on 01/17/24 at 2:59 P.M., Licensed Social Worker (LSW) #114 stated she remembered one of the STNA's mentioned in the SRI was STNA #53. LSW #114 said Resident #26 doesn't like STNA #53 to take care of her. During an interview on 01/17/24 at 4:50 P.M., STNA #53 denied she made the above comment to Resident #26. STNA#53 said Resident #26 did not like her to provide care to her. She said she was assigned to care for Resident #26 this day. 2. Record review revealed Resident #336 was admitted on [DATE]. Review of the admission MDS dated [DATE] revealed Resident #336 was cognitively intact. During an interview on 01/17/24 at 1:59 P.M., Resident #336 stated she called churches to help her (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 32 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 01/24/2024 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)

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few with food and other items. She has stopped receiving the phone calls. She said Receptionist #107 came to her room and said her phone calls were being screened because it was inappropriate to call churches and ask them to help her. During an interview on 01/17/24 at 3:03 P.M., Receptionist #107 said she usually sent the calls back to the resident's room and if the resident didn't answer, she would take a message and let the resident know someone called. She said Resident #336 was making calls to churches and telling them she was hungry. Receptionist #107 said she was told to screen the calls to Resident #226 and give the numbers to the Administrator and he would return the calls. During an interview on 01/17/24 at 3:43 P.M., the Administrator stated he did not screen calls for Resident #336. He stated Resident #336 would call food banks telling them she needed money for food and cigarettes. He told the receptionist to write down the location of the church or the name and give it to him. He wanted to know who the resident was calling and telling the church she needs money because she is hungry, because it wasn't true. The resident was fabricating things to the church. Review of the policy titled Resident Rights, dated 12/01/16 revealed the resident had the right to communicate with and access to people and services, both inside and outside the facility. The resident can exercise their rights as a resident at the facility and be supported by the facility in exercising his or her rights. The residents can exercise rights without interference, coercion, discrimination or reprisal from the facility. The resident's will have access to a phone and may communicate with outside agencies. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365186 If continuation sheet Page 2 of 32 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 01/24/2024 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)

F 0565 Honor the resident's right to organize and participate in resident/family groups in the facility. Level of Harm - Minimal harm or potential for actual harm Based on record review, interview and policy review, the facility failed to address concerns brought forth by the Resident Council in a timely manner. This directly affected 15 residents who attended the resident council meetings and had the potential to affect all residents. The census was 87. Residents Affected - Some Findings include: Review of resident council meeting minutes dated 01/26/23 documented the residents were concerned about the availability of a substitute menu. When they call down to the kitchen they are told the items aren't available and that additional portions had been thrown away. The minutes dated 03/23/23 documented the residents stated they would like a weekly menu. The minutes dated 04/20/23 documented he residents complained they weren't seeing their concerns reviewed in a timely manner and not seeing resolutions to the concerns. The residents were not pleased with the quality of food presentation and not knowing what the daily meals are going to be. The residents complained of the taste of the food and receiving unwanted items and don't think the diet orders are being followed. The minutes dated 05/25/23 documented the residents complained about not receiving menus and about the quality of the food. The minutes dated 06/22/23 documented the residents were still not receiving menus, receiving wrong items and not receiving requested items. The residents requested to see the dietician, but she didn't come to the meeting. The minutes dated 07/20/23 documented the residents would like their meal tickets updated as they were still receiving items not requested, no weekly menus, and still told alternatives posted are not available. The minutes dated 08/09/23 documented the residents were told there was no alternative meals available, that they cannot get extra food because it was thrown away, menus are not available and the resident's don't know what is being served. They complained about the quality of the food. The minutes dated 09/21/23 documented all of the issues were addressed by the appropriate department heads with resolutions to the problems, but it was not listed what was resolved or how it was resolved. The minutes dated 11/30/23 documented unavailable food alternatives, preferences weren't being honored and residents were receiving food items they were allergic to or didn't like. Review of minutes dated 12/21/23 documented food preferences were not being followed and residents were not receiving a menu. During an interview on 01/22/24 at 3:01 P.M., the Administrator stated he had not discussed the food concerns including menus, alternatives or food related concerns in his Quality Assurance Performance Improvement (QAPI) meetings because he hasn't had any meetings since he took over the facility a year ago in January 2023. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365186 If continuation sheet Page 3 of 32 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 01/24/2024 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)

F 0565 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview on 01/23/24 at 9:26 A.M., Activity Director )AD) #41 stated she conducts the Resident Council meeting monthly for the residents. She stated month after month the residents complain about the food and menus and she writes out the concern forms and gives them to the dietary manager. She stated when the complaints aren't getting addressed and continue to be a complaint she speaks to the Administrator about the problem. She confirmed the complaints from the Resident Council have not been resolved in a timely manner. Review of the policy titled Resident Council dated 04/01/17 revealed a Resident Council Response Form will be utilized to track issues and their resolution. The facility department related to any issues will be responsible for addressing the item(s) of concern. The QAPI Committee will review information and feedback from the Resident Council as part of their quality review. Issues documented on council response forms may be referred to the QAPI Committee, if applicable (i.e., the issue is of serious nature or if there is a pattern, etc.). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365186 If continuation sheet Page 4 of 32 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 01/24/2024 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)

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 observation, interview, and policy review, the facility failed to ensure the environment and resident equipment were in good repair. This affected four (Residents#5, #27, #29, and #33) of five reviewed for environment. The census was 87. Findings include: 1. During an observation on 01/16/24 at 11:29 A.M., Resident #5's room had splashes of a yellowish substance on the right side of the toilet. Two light globes at the top of the mirror in the bathroom had thick dust on them and the bulb was burnt out in the left light. There were multiple holes in the wall behind the sink in the bathroom. The privacy curtain in the room was soiled with a black and yellow substance. 2. During an observation on 01/17/24 at 7:46 A.M., Resident #27's window blinds were not in place properly and were missing slats. 3. During an observation on 01/16/24 at 1:44 P.M., Resident #29's bedroom floor had stains. The lights in the bathroom were covered with dust. The tile next to the right side of the toilet was coming up from the floor. The wallpaper was coming off the wall going into the bathroom, and the outside of the bathroom door was scuffed up. During interview at the time of the observation, Resident #29 stated he felt the room was dirty and needed some repairs. 4. During an observation on 01/16/24 at 2:34 P.M., Resident #33's room had an old heating unit in the right corner of the room that was scuffed and had a yellow substance running down the side of it. The light in the bed \room wasn't working, all of the walls had a yellow substance running down the them, and the floors had a black substance on them. During interview on 01/22/24 at 9:50 A.M., Maintenance Supervisor #42 confirmed all of the items aforementioned were either in disrepair or dirty. Review of policy titled Homelike Environment dated 02/01/11 revealed residents will be provided with a safe, clean, comfortable and homelike environment. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365186 If continuation sheet Page 5 of 32 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 01/24/2024 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)

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to complete a new Preadmission Screening and Resident Review (PASRR) when a new mental health diagnosis was given. This affected two (Residents #33 and #45) of six reviewed for PASRR. The facility census was 87. Findings include: 1. Review of the record for Resident #33 revealed he was admitted [DATE] with diagnoses including schizophrenia (08/08/22), bipolar disorder, anxiety disorder, and panic disorder. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #33 was cognitively intact. Review of the medical record revealed a PASRR was completed on 07/20/20. However, a new PASRR was not completed for Resident #33 after the diagnosis of schizophrenia was added 08/08/22. 2. Review of the record for Resident #45 revealed he was admitted [DATE] with diagnoses including dementia with psychotic disturbance, delusional disorder (10/28/21), major depression and anxiety disorder. Review of the MDS dated [DATE] revealed Resident #45 was severely cognitively impaired. Review of the medical record revealed a PASRR for Resident #45 was completed on dated 05/11/20. However, a new PASRR was not completed for Resident #45 after the diagnosis of delusional disorder was added on 10/28/21. During an interview on 01/18/24 at 2:10 P.M., Licensed Social Worker (LSW) #114 she confirmed the PASRR screenings were not completed again when new mental health diagnoses were added. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365186 If continuation sheet Page 6 of 32 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 01/24/2024 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)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review, and policy review, the facility failed to ensure residents had complete and accurate care plans and failed to ensure that care plans were implemented. This affected six (Residents #22, #29, #33, #76, #336, and #82) of twenty-four residents sampled for care plans. The facility census was 87. Findings include: 1. Review of the medical record revealed Resident #22 was admitted to the facility on [DATE] and had diagnoses including unspecified cerebral infarction with hemiplegia and hemiparesis affecting the left dominant side, paranoid schizophrenia, type II diabetes, unspecified chronic obstructive pulmonary disease, type II diabetes, and schizoaffective disorder. Review of the most recent Minimum Data Set (MDS) assessment, dated 11/03/23, revealed Resident #22 was cognitively intact, had no behaviors, did not wander, and did not reject care. Resident #22 had impairment on one side which caused functional limitation in range of motion. Review of the care plan dated 01/16/24 revealed Resident # 22 was at risk for decline in Activities of Daily Living (ADL) function as evidenced by need for assistance with ADL's, transfers, ambulation, and toileting related to diagnoses. Interventions included manual wheelchair, adaptive reacher device , encourage resident participation in ADL's, report declines in ADL function to physician, and therapy to evaluate and treat as needed. There was no care plan related to contractures or limited range of motion. Observation on 01/16/24 at 2:13 P.M. revealed Resident #22 had a noticeable contracture to the right wrist. During an interview on 01/22/24 at 10:16 AM Therapy Director (TD) #86 verified Resident #22 had a contracture to his right wrist related to history of stroke. TD #86 stated occupational therapy had worked with the resident in April 2023 to tolerate a resting hand splint but he refused all trials. He eventually had to be discontinued from therapy for non-participation. Therapy went back and screened the resident quarterly, but he was never interested in participating again. During an interview on 01/22/2024 3:27 P.M. Licensed Practical Nurse (LPN) #109 verified the patient had a contracture to his right wrist and did not have a care plan for contractures. 2. Medical record review for Resident #29 revealed an admission date of 03/24/23. His medical diagnoses included cerebrovascular accident, diabetes, hypertension, and heart failure. Review of quarterly MDS dated [DATE] revealed Resident #29 was cognitively intact. He required partial/moderate assistance for toileting, and he required supervision for bed mobility and transfers. Review of the record revealed he didn't have a care plan for bathing. 3. Medical record review for Resident #33 revealed an admission date of 07/23/20. Medical diagnoses included traumatic spinal cord dysfunction. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365186 If continuation sheet Page 7 of 32 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 01/24/2024 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)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of quarterly MDS dated [DATE] revealed Resident #33 was cognitively intact. He required supervision for toileting, bed mobility, and transfers. Review of the care plans for the resident revealed there wasn't one for bathing. 4. Medical record review for Resident #336 revealed an admission date of 12/15/23. Her medical diagnoses included hypertension, diabetes, arthritis, and manic depression. The resident was a smoker. Review of admission MDS dated [DATE] revealed Resident #336 was cognitively intact. Review of the care plans for the resident revealed there wasn't one for smoking. 5. Medical record review for Resident #76 revealed an admission date of 05/12/23. His medical diagnoses included fractures. The resident was a smoker. Review of the quarterly MDS dated [DATE] revealed he was cognitively intact. Review of the care plans for the resident revealed there wasn't one for smoking. Interview with MDS nurse (MDSRN) #97 dated 01/22/24 at 2:41 P.M. revealed there wasn't evidence in the records concerning care plans for the above issues regarding Residents #29, #33, #336 and #76. 6. Review of the medical record for Resident #82 revealed he was admitted to the facility on [DATE] with diagnoses including metabolic encephalopathy, abnormal weight loss, abdominal aortic aneurysm, dementia, dizziness and giddiness and difficulty walking. Review of the MDS dated [DATE] revealed Resident #82 had extensive cognitive impairment. His functional status is listed as dependent on staff for most activities of daily living. Review of the care plan dated 10/25/23 revealed the facility does not have a care plan for activities for this resident. Interview with the Director of Nursing on 01/22/24 at 10:00 A.M. confirmed no care plan for Resident #82 for activities. She also confirmed the facility did not have a policy for care planning. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365186 If continuation sheet Page 8 of 32 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 01/24/2024 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)

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, interview, and policy review, the facility failed to ensure residents received quarterly care conferences. This affected two (Residents #6 and #62) of three residents sampled for care conferences. The facility census was 87. Findings include: 1. Review of the medical record revealed Resident # 6 was admitted to the facility on [DATE] and had diagnoses including unspecified cerebral palsy, COPD, type II diabetes, (03/14/13) unspecified bipolar disorder, unspecified hallucinations, contracture to unspecified joint. unspecified major depressive disorder, and other chronic pain. Review of the most recent Minimum Data Set (MDS) assessment dated [DATE] revealed Resident # 6 was cognitively intact, had no behaviors, did not wander, and did not reject care. Record review revealed there were only two care conferences held in 2023 for Resident #6 on 04/25/23 and 07/28/23. 2. Review of the medical record revealed Resident # 62 was admitted to the facility on [DATE] and had diagnoses including dysphagia following cerebrovascular disease, unspecified asthma, unspecified dementia, left wrist flexion deformity, type II diabetes, and seizures. Review of most recent MDS assessment, dated 12/08/23, revealed Resident #62 had severely impaired cognition, had no behaviors, did not wander, and did not reject care. Review of the medical record revealed there were only two care conferences held in 2023 for Resident #62 on 03/31/23 and 08/08/23. During an interview on 01/16/23 at 11:05 A.M. Resident #62 stated he did not receive regular care conferences. During an interview on 01/16/2024 at 12:19 P.M., Resident #6 stated she was not receiving care conferences regularly. During an interview on 01/18/24 at 12:45 P.M., Social Worker #114 stated care conferences were supposed to happen quarterly in conjunction with quarterly MDS assessments. The social worker explained she had been unable to keep up with care conferences for a period of time as she was expected to schedule transportation for resident appointments. She verified Residents #6 and #62 had not received quarterly care conferences. Review of the policy titled Care Conference, dated 11/08/23, documented care conferences were held for all residents upon admission, quarterly, and additionally as needed for significant change in resident condition, re-admission, and Medicare residents receiving skilled services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365186 If continuation sheet Page 9 of 32 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 01/24/2024 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)

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and policy review, the facility failed to ensure showers were given. This affected two (Residents #29 and #33) of two reviewed for activities of daily living. The census was 87. Residents Affected - Few Findings included: 1. Record review for Resident #29 revealed an admission date of 03/24/23. His medical diagnoses included cerebrovascular accident, diabetes, hypertension, and heart failure. Review of progress notes dated 09/01/23 through 01/18/24 revealed no refusals for showers. Review of quarterly MDS dated [DATE] revealed Resident #29 was cognitively intact. There was no care plan for bathing or showers in his record. Review of the documentation for Resident #29 revealed since 11/14/23 revealed Resident #29 had received six showers out of 20 opportunities. During an interview on 01/16/24 at 1:44 P.M., Resident #29 stated he gets showers but he goes a little longer than he would like to in between showers. He stated there wasn't enough aides on nights to give him a shower and he has voiced it to the facility's management. 2. Record review for Resident #33 revealed an admission date of 07/23/20. Medical diagnoses included traumatic spinal cord dysfunction. Review of shower documentation for Resident #33 revealed since 11/09/23, Resident #33 has received four showers out of 18 opportunities. He refused three showers. Review of quarterly MDS dated [DATE] revealed Resident #33 was cognitively intact. There was no care plan for bathing or showers in his record. During an interview on 01/16/24 at 1:59 P.M., Resident #33 stated he wasn't getting enough showers and the staff keep telling him they don't have a shower bed for him to go to the shower. He didn't know who the staff were. During an interview on 01/18/24 at 1:15 P.M., the Director of Nursing (DON) stated she couldn't provide any evidence Resident #29 or Resident #33 were receiving showers as requested. Review of the policy titled Bathing Policy, dated 08/01/23, revealed the residents will have the option to take a bath/shower/bed bath as often as they would like and choose what time of the day. The shower sheets for the STNA's [State Tested Nursing Assistant] to record bathing will be changed monthly. Every effort will be made to maintain a consistent bathing schedule for each of our residents. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365186 If continuation sheet Page 10 of 32 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 01/24/2024 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)

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** Based on record review and interview, the facility failed to ensure a pressure ulcer was monitored when hospice took over the care of the resident. This affected one (Resident #27) of two residents reviewed for pressure ulcers. The facility identified three residents with pressure ulcers in the facility. The census was 87. Residents Affected - Few Findings include: Record review for Resident #27 revealed an admission date of 02/22/23. His medical diagnoses included traumatic brain disorder, cerebrovascular accident (CVA), non-Alzheimer's dementia, malnutrition, and schizophrenia. Review of the initial pressure ulcer assessment dated [DATE] documented a pressure injury wound to the right trochanter measured seven centimeters (cm) by 6.5 cm by two cm with 100 percent granulation tissue. There was moderate exudate and and the peri-wound was normal and the wound had no signs of infection. Review of the inial pressure ulcer assessment dated [DATE] documented a pressure injury to the coccyx that measured 2.7 cm by 1.5 cm by one cm with 100 percent granulation tissue. There was moderate exudate and peri-wound was normal and no signs of infection. Review of the initial assessment dated [DATE] documented a pressure injury wound to the left trochanter that measured nine cm by eight cm. Depth could not be determined. There was 60 percent granulation tissue, 40 percent slough and peri-wound was normal. There were no signs of infection. Review of the care plan dated 03/10/23 revealed Resident #27 had experienced skin pressure to the right and left trochanter and coccyx. Interventions were to administer medications as ordered. Monitor/document for side effects and effectiveness. Administer treatments as ordered and monitor for effectiveness. Follow facility policies/protocols for the prevention/treatment of skin breakdown. Monitor dressing to ensure it is intact and adhering. Report lose dressing to Treatment nurse. Monitor nutritional status. Serve diet as ordered, monitor intake and record. Monitor/document/report to physician as needed changes in skin status: appearance, color, wound healing, signs and symptoms of infection, wound size (length times width times depth), stage. Give Prostat as ordered. Treat pain as per orders prior to treatment/turning to ensure the resident's, comfort. The care plan also revealed the resident had pressure ulcers related to bilateral contractures with impaired knee and hip flexion. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #27 was cognitively intact. He required extensive assistance for eating, toileting, bed mobility, and for transfers. He was frequently incontinent of bowel and bladder. Review of wound documentation dated 10/05/23 revealed the left trochanter wound measured 8.5 cm by 5.5 cm by 0.3 cm, thick underlying structure and 100 percent granulation. There was a moderate amount of drainage, red, no odor, unchanged. Review of wound documentation dated 10/05/23 revealed the wound to the coccyx was measured at 3.4 cm by one cm by one cm with 100 percent granulation. There was moderate exudate and the peri-wound was normal. This wound was healing. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365186 If continuation sheet Page 11 of 32 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 01/24/2024 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)

F 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of wound documentation dated 10/05/23 revealed the wound to the right trochanter was measured at 12.5 cm by eight cm by 0.4 cm with 60 percent granulation and 40 percent slough. There was moderate exudate and the peri-wound was normal. There were no signs and symptoms of infection. This wound was healing. Review of the record revealed hospice started caring for the resident on 10/11/23 and the facility only provided the care for the wounds one time a week. Review of the hospice documentation from 10/11/23 through 01/23/24 revealed there were no wound measurements taken. Hospice staff were changing the dressings and changing order for the wounds if needed. Review of the medical record revealed the facility had not measured the wounds since 10/05/23. During observations on 01/17/24 at 7:42 A.M. and 12:56 P.M. and on 01/18/24 at 07:55 A.M., Resident #27 was lying on a air mattress and he had his knees folded up to his chest lying on his right trochanter. Resident #27 refused an observation of care. During interview on 01/18/24 at 9:03 A.M., the Director of Nursing (DON) stated she did not have any documentation from hospice concerning the wounds. The DON also verified the facility had not measured the wounds since 10/05/23, when hospice assumed Resident #27's care. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365186 If continuation sheet Page 12 of 32 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 01/24/2024 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)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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 record review, observation, interview and policy review, the facility failed to ensure residents smoked in designated areas and failed to ensure smoking materials were kept secured. This affected four (Residents #45, #33, #336 and #76) of five residents reviewed for smoking. The facility identified 62 residents who smoked. The facility census was 87. Findings include: 1. Record review for Resident #45 revealed an admission date of 01/08/18. Medical diagnoses included traumatic brain dysfunction. There was not a current smoking assessment. The last smoking assessment in Resident #45's record was dated 04/12/21. Review of the annual Minimum Data Set (MDS) assessment, dated 12/01/23, revealed Resident #45 was severely cognitively impaired. Review of the care plan for Resident #45 dated 12/01/23 revealed the resident was at risk for injury related to smoking. Intervention was to provide supervision at all times for smoking. Smoking items are to be kept at the nursing station. Review of the progress notes dated 12/24/23 at 6:11 P.M. revealed Resident #45 was propelling himself in his wheelchair toward his room. A strong smell of smoke was noted. As the resident approached he puffed a lit cigarette in his left hand and smoke coming out of his mouth. The cigarette was extinguished and smoking rules were explained to the resident and he propelled away. 2. Record review for Resident #33 revealed an admission date of 07/23/20. Medical diagnoses included traumatic spinal cord dysfunction. There was not a current smoking assessment. The last smoking assessment in Resident #33's record was dated 04/12/21. Review of quarterly MDS dated [DATE] revealed Resident #33 was cognitively intact. Review of his care plan for smoking dated 12/01/23 revealed Resident #33 was at risk for injury related to smoking. Interventions was for resident to verbalize safe smoking practices and smoking items should be kept in the nursing station. During observation on 01/16/24 at 2:13 P.M., Resident #33 was propelling himself down the 100 hall in his wheelchair with an unlit cigarette in his mouth and his lighter in his lap. Resident #33 stated at this time he kept his smoking materials in his room and knew he wasn't supposed to. During an interview on 01/16/23 at 2:16 P.M., Receptionist #107 verified the resident was coming down the hall with a cigarette in his mouth and lighter in his lap. She stated no one was supposed to keep smoking materials in their room. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365186 If continuation sheet Page 13 of 32 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 01/24/2024 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)

F 0689 Level of Harm - Minimal harm or potential for actual harm 3. Record review for Resident #336 revealed an admission date of 12/15/23. Her medical diagnoses included hypertension, diabetes, arthritis, and manic depression. Review of admission MDS dated [DATE] revealed Resident #336 was cognitively intact. Review of the record revealed no care plan related to smoking. Residents Affected - Some During interview and observation on 01/16/24 at 2:39 P.M., Resident #336 stated she her cigarettes in her purse. She opened her purse and she had a lighter and two cigarettes. 4. Record review for Resident #76 revealed an admission date of 05/12/23. His medical diagnoses included fractures. Review of the quarterly MDS dated [DATE] revealed he was cognitively intact. Review of the record revealed no care plan related to smoking. He also had no smoking assessment. Review of progress note dated 11/11/23 and 12/08/23 revealed Resident #76 was smoking in unauthorized areas and in his room and was reeducated. During an interview on 01/16/24 at 2:54 P.M., State Tested Nursing Assistant (STNA) #72 stated she had no idea what the residents were supposed to do with their cigarettes and lighters or if they could keep them on their person. During an interview on 01/16/24 at 3:00 P.M., STNA #101 stated residents could keep their cigarettes on their person if they were alert and oriented. During interview on 01/17/24 at 1:45 P.M., the Director of Nursing (DON) confirmed all of the residents aforementioned were smoking in unauthorized places or in their rooms, and and the residents were not supposed to be keeping any smoking materials on their person even if they are alert and oriented. She said it has been a real struggle with the smoking materials because as soon as the materials are confiscated the residents will go across the street to buy them again. During an interview on 01/22/24 at 2:36 P.M., the Resident Council President stated she had a concern of the residents smoking in the wrong places. There was a meeting last week with the administration and nursing to discuss smoking rules and appropriate places to smoke. She stated the public relations employee had been telling potential residents they could smoke where they wanted to smoke. People were smoking in their rooms and it wasn't safe since there was a lot of oxygen in the facility. Review of the policy titled Smoking Policy, dated 08/01/21, revealed this facility is dedicated to the preservation and enhancement of good health. Our goal is to provide a comfortable and productive environment for all residents and employees. We are committed to protecting the health of those living and working in our facilities. 1. Residents that live/stay within the licensed nursing home: a. Residents in the Nursing Center who smoke tobacco-cigarettes will be assessed using a Smoking Assessment. b. Residents may be discouraged from smoking on an individual basis, if it is not medically (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365186 If continuation sheet Page 14 of 32 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 01/24/2024 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)

F 0689 advisable or safe for the resident to smoke, as documented in their medical record. Level of Harm - Minimal harm or potential for actual harm 2. There will be no smoking in areas, rooms, apartments or homes where oxygen is in use or is stored. Residents Affected - Some 3. Residents are to smoke in outside designated smoking areas if determined to be a safe smoker as assessed. 4. Visitors or family must leave smoking materials for resident at nurse station. 5. Smoking times are listed on the smoking schedule. 6. The use of nicotine vape electronic smoking devices will be used outside the facility in the designated smoking area. 7. Violation of the smoking policy may result in immediate or 30 day discharge from the facility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365186 If continuation sheet Page 15 of 32 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 01/24/2024 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)

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. Based on observation, interview, record review and policy review, the facility failed to provide incontinence care in a manner to prevent urinary tract infection. This affected one (Resident #11) resident reviewed for incontinence. The facility identified 45 residents who were incontinent. The facility census was 87. Findings include: Review of the medical record for Resident #11 revealed an admission date of 02/12/19. Diagnoses included diabetes mellitus type II, spondylosis, post menopausal bleeding, hypertension, anxiety disorder, morbid obesity due to excess calories. Review of the Minimum Data Set (MDS) assessment for Resident #11, dated 10/27/23, revealed the resident had intact cognition. The resident required the assistance of two persons for activities of daily living and was totally dependent for transfers. The resident had no pressure ulcers. During an interview on 01/22/24 at 10:30 A.M., Resident #11 stated she had a urinary tract infection about a month ago. During an observation of incontinence care for Resident #11 on 01/22/24 at 10:30 A.M., State Tested Nursing Assistant (STNA) #21 washed the resident's buttocks and anus first. She then asked the resident to turn to her side and washed her peri-area from behind. She did not pull the labia apart and wash down both sides with a clean section of the washcloth. During an interview on 01/22/24 at 10:40 A.M., STNA #21 confirmed she did not pull the labia apart and clean down both sides with a clean section of the cloth. Review of the facility policy titled Incontinence Care, dated August 2022 revealed to separate the labia with one hand and wash with the other, using gently downward strokes from the front to the back of the perineum. Use a clean section of the washcloth with each stroke. Avoid the anus. This deficiency represents non-compliance investigated under Complaint OH00150146. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365186 If continuation sheet Page 16 of 32 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 01/24/2024 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)

F 0727 Level of Harm - Minimal harm or potential for actual harm Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. Based on record review and interview, the facility failed to have a Registered Nurse on duty for two days on the weekends. This affected all residents in the facility. The facility census was 87. Residents Affected - Many Findings include: Review of the time punches and daily schedules the facility did not have a registered nurse on duty on Saturday 01/13/24 and Sunday 01/14/24. Interview with Resident #43 and Resident #66 on 01/18/24 at 10:00 A.M. revealed the facility is short staffed on the weekends. Interview with the Director of Nursing on 01/18/24 at 2:00 P.M. confirmed she did not have a registered nurse on duty for the weekend of 01/13/24 and 01/14/24. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365186 If continuation sheet Page 17 of 32 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 01/24/2024 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)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. Medical record review for Resident #29 revealed an admission date of 03/24/23. His diagnoses included cerebrovascular accident, diabetes, hypertension, and heart failure. Review of physician orders dated 03/24/23 revealed Xarelto tablet, 15 mg in the evening for anticoagulation. There was a physician order dated 03/24/23 for Carvedilol tablet, 25 mg two times a day for hypertension and Clonidine HCI tablet 0.2 mg every morning and bedtime for hypertension. Review of the MAR for December 2023 and January 2024 documented the Xarelto was not given on 12/02,23, 12/03/23, and 01/02/24. The morning dose of Carvedilol was not given on 12/04/23, 12/05/23, 12/07/23, 12/08/23, 12/10/23, 12/15/23, 12/18/23, 12/20/23, 12/20/23, 12/21/23, 12/22/23, 01/01/24 and 01/02/24. The evening dose of Carvedilol was not given on 12/01/23, 12/03/23, 12/04/23, 12/07/23 through 12/11/23, 12/13/23, 12/15/23, 12/18/23, 12/20/23 through 12/25/23, 01/02/24, 01/04/24, 01/06/24 and 01/07/24. The morning dose of Clonidine was not given on 12/03/23, 12/06/23, 12/07/23, 12/10/23, 12/18/23, 12/23/23, 01/02/24 and 01/12/24. The evening dose of Clonidine was not given 12/19/24. Review of the progress notes from 12/01/23 through 01/22/24 revealed no documentation as to why the aforementioned medications were not given. During an interview on 01/16/24 1:44 P.M., Resident #29 stated he was not getting his medications in a timely manner. He stated he wasn't getting his blood pressure medication or his blood thinners. He said the facility was consistently running out of his medications and he didn't know why they couldn't get it fixed. During an interview on 01/22/24 at 1:54 P.M., the Director of Nursing confirmed the aforementioned medications were not given. because they weren't available in the facility. She said the staff are not writing a note because they were out of the medication and this has been an ongoing problem in the facility. Review of policy titled Administering Medications, dated December 2012, revealed medications were administered in a safe and timely manner and as prescribed. 2. Review of the record for Resident #45 revealed he was admitted [DATE] with diagnoses including dementia with psychotic disturbance, chronic obstructive pulmonary disease, moderate protein-calorie malnutrition, congestive heart failure, peripheral vascular disease, atherosclerotic heart disease, hypertension, delusional disorder, major depression and anxiety disorder. Resident #45 had a physician order for Clonidine 0.3 milligram patch applied transdermally every Sunday related to hypertensive heart disease and chronic kidney disease. Review of his Medication Administration Record (MAR) for January 2024 revealed the patch was not applied 01/07/24 or 01/14/24 and was refused by Resident #45 on 01/21/24. During an observation on 01/22/24 at 10:24 A.M., Resident #45 had a Clonidine patch adhered to the back of his left shoulder dated 12/31/23. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365186 If continuation sheet Page 18 of 32 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 01/24/2024 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)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 01/22/24 at 10:26 A.M., LPN #55 confirmed the Clonidine patch on Resident #45 was dated 12/31/23 and should have been replaced each Sunday. Based on observation, interview, and record review, the facility failed to ensure residents received medications as ordered. This affected three (Residents # 18, #45, and #29) of six residents sampled for medication administration. The facility census was 87. Findings include: 1. Review of the medical record revealed Resident #18 was admitted to the facility on [DATE] and had diagnoses including unspecified anxiety disorder, major depressive disorder, unspecified ankle contracture, unspecified pain, and hereditary spastic paraplegia. Review of the most recent Minimum Data Set (MDS) assessment, dated 12/02/23, revealed Resident #18 was cognitively intact, had no behaviors, did not wander, and did not reject care. Resident #18 had an indwelling urinary catheter. Review of the medical record revealed Resident #18 had physician orders for medications including cranberry capsule 425 milligrams (mg) by mouth once daily; ferrous sulfate 300 mg/5 milliliters (ml), give 5 ml by mouth once daily; loratadine 10 mg by mouth once daily; and Visine solution 0.05% instill one drop in each eye once daily. During an observation on 01/18/24 at 9:07 A.M., Licensed Practical Nurse (LPN) #59 prepared medications for administration to Resident #18 and medications including Cranberry Capsule 425 mg, Loratadine 10 mg, Ferrous sulfate 300 mg/5 ml, and Visine 0.05% solution. LPN #59 attempted to search for the medications in the 200-300 hall medication room, but there were no medications stored in that room. LPN #59 attempted to acquire medications from the 100 hall medication room, but did have keys to access the room and was not able to locate the 100 hall nurse, who had the keys. During an interview on 01/18/24 at 9:36 A.M. LPN #59 verified Resident #18's medications were not available in medication cart or the medication room. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365186 If continuation sheet Page 19 of 32 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 01/24/2024 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)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure medications were not left at the bedside. This affected one (Resident #43) out of 21 residents the nurse administered medications to. The facility census was 87. Findings include: Review of Resident #43's medical record revealed he was admitted to the facility on [DATE] with a diagnoses including chronic obstructive pulmonary disease, diabetes mellitus type II, morbid obesity, peripheral vascular disease, chronic atrial fibrillation, and acute respiratory failure. Review of the Minimum Data Set (MDS) assessment, dated 10/20/23, revealed Resident #43 was cognitively intact. During an observation on 01/16/24 at 10:30 A.M., there was a cup of medications at Resident #43's bedside. During an interview at the time of the observation, Resident #43 stated he has trouble taking all of the medication at once. He asked the nurse to leave the medication and he would take it later. During an interview on 01/16/24 at 10:45 A.M., Nurse #77 stated he left the medication for Resident #43 to consumed at will. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365186 If continuation sheet Page 20 of 32 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 01/24/2024 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)

F 0791 Provide or obtain dental services for each resident. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review and interview, the facility failed to ensure dental services were provided to residents. This affected two (Residents #33 and #73) four residents reviewed for dental services. The facility census was 87. Residents Affected - Few Findings include: 1. Medical record review for Resident #33 revealed an admission date of 07/23/20. Diagnoses included traumatic spinal cord dysfunction. Review of a visit for the dentist on 08/24/23 revealed the resident was seen in his room. The recommendation was to bring the resident to the clinic. There was moderate plaque, calculus, and gingivitis. Recommended staff assistance with daily oral care, brushing two times a day to decrease bacterial load. Review of quarterly Minimum Data Set (MDS) assessment, dated 12/14/23, revealed Resident #33 was cognitively intact. During an interview on 01/16/24 at 2:08 P.M., Resident #33 stated he was supposed to visit the dentist office and it hasn't been set up yet. He said the staff told the dentist he refused to go, but they didn't get him up out of bed to go to the dentist. He denied he had pain in his mouth. Review of the progress notes revealed no documentation Resident #33 had refused to go to the dentist. 2. Medical record review for Resident #73 revealed an admission date of 05/04/23. Diagnoses included non-traumatic brain dysfunction and paranoid schizophrenia. Review of a dental visit dated 06/29/23 revealed the dentist was unable to obtain X-rays and cleaning due to resident being seen in room. Resident has severe periodontal disease and bone loss, all remaining teeth will need to be extracted, oral surgeon referral was completed and left at the facility. Limited mouth opening, resident just started up on antibiotic 6/28/23. Please assist with daily mouth care. Review of quarterly MDS assessment, dated 10/27/23, revealed Resident #73 was severely cognitively impaired. Resident #73 saw the dental hygienist on 12/26/23 and 01/02/24. During an interview on 01/22/24 at 11:33 A.M., Resident #73 stated she has pain in her mouth, but the staff gave her pain medication. She said she was able to eat her meals. During an interview on 01/18/24 at 1:42 P.M., the Director of Nursing verified the visit to the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365186 If continuation sheet Page 21 of 32 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 01/24/2024 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)

F 0791 Level of Harm - Minimal harm or potential for actual harm dentist had not been completed for either resident. She stated it has been a struggle for a long time because the facility bus was broken and there just wasn't any way to take them to the appointment. During an interview on 01/22/24 at 12:33 P.M., Appointment Scheduler (AS) #105 stated there wasn't any dental appointments scheduled for Resident #33 and #73. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365186 If continuation sheet Page 22 of 32 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 01/24/2024 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)

F 0803 Level of Harm - Minimal harm or potential for actual harm 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 5. Record review for Resident #29 revealed an admission date of 03/24/23. Residents Affected - Many Review of the quarterly MDS, dated [DATE], revealed Resident #29 was cognitively intact. During an interview on 01/16/24 at 1:44 P.M., Resident #29 stated the food was inedible. They put hot food with the cold food on the same plate. He said sometimes the food was cold. There were no menus and even if they had one they wouldn't follow the menu. He stated he goes to resident council meeting every month and complains about it every month and nothing has been fixed. He stated there may be an alternate and there may not be. During observation at this time, there was no menu available in the room. 6. Record review for Resident #33 revealed an admission date of 07/23/20. Review of quarterly MDS, dated [DATE], revealed Resident #33 was cognitively intact. During an interview on 01/16/24 at 2:01 P.M., Resident #33 stated the food doesn't taste good and there hasn't been a menu either. He said at times there was an alternate. During observation at this time, there was no menu available in the room. 7. Record review for Resident #56 revealed an admission date of 12/23/18. Review of quarterly MDS, dated [DATE], revealed Resident #56 was cognitively intact. During an interview on 01/16/24 at 12:29 P.M., Resident #56 stated the food wasn't good and sometimes the food looked odd and sometimes it was a total throwaway. He stated sometimes he could get an alternate and sometimes he couldn't get one because the kitchen runs out of the alternates. During observation at this time, there was no menu available in the room. 8. During an interview 01/16/24 at 3:34 P.M., STNA's #75, and #101 stated they didn't have any idea what the residents were going to have for their meals and they get whatever is sent on the trays. There was no menu or alternates posted at the nursing station. 9. Review of the menu for lunch on 01/18/24 revealed the meal was supposed to be beef macaroni casserole, Normandy vegetables, garlic roll, crushed pineapple, choice of milk and beverage. Review of the menu the staff switched to was spaghetti with meat sauce, salad, Oreo fluff, garlic buttered dinner roll, and choice of milk or beverage. Observations of the trays that were served to the residents revealed the meal on 01/18/24 at 2:10 P.M. was spaghetti, mandarin oranges, salad and a roll. During an interview on 01/18/24 at 2:20 P.M., Dietary Aide #115 stated she didn't follow the menu for lunch this day because the kitchen didn't have the Normandy vegetables or crushed pineapple, so she made something else. She stated she didn't make the Oreo fluff because she didn't know what it was and didn't have the ingredients in the kitchen for it. She said there was no substitute for the Oreo fluff. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365186 If continuation sheet Page 23 of 32 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 01/24/2024 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)

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many 10. Review of the lunch menu for 01/22/24 revealed the meal was supposed to be garlic crusted pork loin, buttered noodles, california blend vegetables, wheat bread, mixed fruit, and a choice of milk and beverage. The staff switched to spaghetti and meat sauce, salad, garlic buttered dinner roll, Oreo fluff, and choice of milk or beverage. Review of the actual tray served to the residents for lunch on 01/22/24 at 12:30 P.M. revealed it was spaghetti and meat sauce, california blend vegetables, a roll, applesauce, and choice of milk and beverage. During an interview on 01/22/24 at 12:43 P.M., Dietary Manager (DM) #44 stated the staff didn't serve what was on the original menu because they didn't have any pork loin to serve. There was no Oreo fluff. DM #44 stated she let the residents know there were going to be substitutions and she let the receptionist know about the substitutions so she could let the residents know about the changes to the menu. During an interview on 01/22/24 at 4:33 P.M., Receptionist #107 stated she didn't tell any of the residents there were substitutions on 01/18/24 or on 01/22/24. 11. Review of the substitutions list revealed on 01/18/24 the scheduled food item was chili macaroni, and blended vegetables. On 01/27/24 there was nothing in the scheduled meal slot and substituted with spaghetti and meat sauce and apples. Reason for substitution was out of stock. This is recite from the survey dated 12/28/23. Based on observations, interviews, and policy review, the facility failed to ensure residents had reasonable access to menus to meet resident needs, facility failed to have alternate menus, failed to ensure residents were notified of menu substitutions, and failed to prepare meals according to the menu. This directly affected seven (Residents #3, #6 #11, #62, #29, #33 and #56) residents and had the potential to affect all residents who received food from the kitchen. The facility census was 87. Findings include: 1. Review of the medical record revealed Resident #3 was admitted to the facility on [DATE]. Review of the most recent Minimum Data Set (MDS) assessment, dated 11/24/23, revealed Resident #3 was cognitively intact. During an interview on 01/16/24 at 3:02 P.M., Resident #6 had stated she had no menu, and the food served was a surprise. She and other residents had asked for menus to be printed, but she thought it would be senseless, because they tell you one thing was being served and something else was sent up from the kitchen. During observation at this time, there was no menu available in the room. 2. Review of the medical record revealed Resident #6 was admitted to the facility on [DATE]. Review of the most recent MDS assessment dated [DATE] revealed Resident #6 was cognitively intact. During an interview on 01/16/24 at 12:20 P.M., Resident #6 stated the food was bad, they served the same stuff over and over again. She said she had not received a menu for a couple of years. During observation at this time, there was no menu available in the room. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365186 If continuation sheet Page 24 of 32 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 01/24/2024 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)

F 0803 3. Review of the medical record revealed Resident #11 was admitted to the facility on [DATE]. Level of Harm - Minimal harm or potential for actual harm Review of the most recent MDS assessment, dated 12/11/23, revealed the resident was cognitively intact. Residents Affected - Many During an interview on 01/16/24 at 2:40 P.M., Resident #11 stated the residents were not given food choices. The facility served some version of a macaroni and hamburger variety three times a week. Resident #11 said she did not have a current menu, and if they did get a menu, it did not match what they were served. She attended monthly food committee meetings and resident council but nothing changed. People with food allergies were still served things that could make them sick and they did not get menus. During observation at this time, there was no menu available in the room. 4. Review of the medical record revealed Resident #62 was admitted to the facility on [DATE]. Review of most recent MDS assessment, dated 12/08/23, revealed Resident #62 had severely impaired cognition. , During an interview on 01/16/2024 at 11:09 A.M., Resident #62 stated the food was worthless, he received no menus, and they got whatever was thrown on the plate. The resident stated he could ask for something else but had to wait a long time to get it. Resident #62 stated the kitchen ran out of food around the second week of every month. The resident stated the portions were not consistent. The kitchen would send a carton of milk for breakfast one day and the next day they only sent half a cup of milk and it was warm. During observation at this time, there was no menu available in the room. During an interview on 01/16/24 at 4:35 P.M. the Administrator stated the facility provided two seasonal menus starting April and October which provided meals in a four week rotation throughout the season. When asked if the Administrator believed it was a reasonable expectation that residents could keep the menus for the six month period and be able to keep track of which week of the rotation was being served, the Administrator did not comment. The administrator stated menus were blown up and available at each nurse's station and at the front desk. During observations on 01/22/2023 from 2:30 P.M. to 3:05 P.M. revealed there were no menus available at the nurse's stations. During interviews on 01/22/24 from 2:30 P.M. to 3:05 P.M., State Tested Nursing Assistants (STNA) #21 and #82 each verified there were no menus available at the nurse's station. STNA #82 stated she would call down to the kitchen or ask dietary staff if she passed them in the hall what was being served for the day, and the STNA #21 stated she only told the residents on her assignment whom she knew would ask her about the menu. Licensed Practical Nurses (LPN) #91 and #109 each verified there were no menus available at the nurse's station. Each stated they did not know if residents had menus available in their rooms. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365186 If continuation sheet Page 25 of 32 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 01/24/2024 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)

F 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm Based on observation, and interview, the facility failed to ensure the food looked appetizing and was palatable. This affected all of the residents in the facility. The census was 87. Residents Affected - Many Findings include: Observation of the lunch tray on 01/22/24 at 12:30 P.M. revealed it was spaghetti with meat sauce and cheese on the top, roll, and Normandy blend of vegetables. The vegetables looked brownish. The roll was sitting on the plate and the juices from the other foods made the roll soggy. Interview with the Dietary Manager #44 on 01/22/24 at 12:35 P.M. agreed the meal looked over cooked. She confirmed the roll was soggy from the juices on the plate. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365186 If continuation sheet Page 26 of 32 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 01/24/2024 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)

F 0810 Provide special eating equipment and utensils for residents who need them and appropriate assistance. 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 interview, the facility failed to provide a resident with adaptive equipment at meals. This affected one (Resident #62) resident. The census was 87. Residents Affected - Few Findings include: Review of the medical record revealed Resident #62 was admitted to the facility on [DATE] and had diagnoses including dysphagia following cerebrovascular disease, unspecified asthma, unspecified dementia, left wrist flexion deformity, type II diabetes, and seizures. Review of the care plan, dated 04/16/21, revealed Resident #62 was at risk for decline in activities of daily living (ADL) function as evidenced by need for assistance with ADL's. Interventions included adaptive equipment including built up spoon/fork utensils, and plate guards. Review of most recent Minimum Data Set (MDS) assessment, dated 12/08/23, revealed Resident #62 had severely impaired cognition. The resident had no functional impairment or limitation in range of motion. Review of the medical record revealed Resident # 62 had physician orders dated 12/11/23 for non-weighted utensils and a plate guard for ease in self feeding as tolerated. During an interview on 01/16/24 at 11:12 A.M., Resident #62 stated he needs adaptive silverware and they never send it. The resident stated therapy had brought foam covers for silverware in case the kitchen did not bring adaptive utensils. He stated he did not receive a plate guard. During an observation on 01/18/24 at 8:52 A.M., State Teste Nursing Assistant (STNA) #101 delivered a breakfast tray to Resident #62. The meal was served on a regular plate with no plate guard and had adaptive silverware on the tray. During an interview on 01/18/24 at 8:55 A.M., STNA #101 confirmed the food was served on a regular plate and there was no plate guard. There was no indication on the ticket that the resident was to have a plate guard. During an interview on 01/18/24 at 1:14 P.M., [NAME] #66 stated the plate guard was a plastic ring that was placed on a regular or divided plate and Resident #62 was the only resident in the facility to use one. During an observation on 01/18/24 at 1:21 P.M. Resident #62 did not have a plate guard for the lunch meal. During an interview on 01/18/2024 at 1:22 P.M. STNA #66 verified when she delivered lunch tray, Resident # 62 did not have plate guard. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365186 If continuation sheet Page 27 of 32 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 01/24/2024 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)

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 and interview, the facility failed to ensure opened food items were dated, staff wore hair coverings and that food was stored properly in the freezer. This had the potential to affect all residents who received food from the kitchen. The facility census was 87. Findings include: 1. During an observation of the reach in freezer on 01/16/24 at 9:00 A.M., there was opened lettuce, hot dogs, turkey lunch meat, bologna, cheese, left over soup, left over enchiladas, and open tuna salad without dates. Nutritional Juice Drinks 6 ounces without dates (Four orange pineapple, six apple juice, 13 cranberry juice) were taken from their original boxes and placed into the refrigerator without a date on them. 2. During an observation on 01/16/24 at 9:10 A.M., there was a large box of beef on the floor of the freezer. 3. During an observation of the tray line on 01/16/24 at 11:30 A.M, [NAME] #66, and Dietary Aides #26 and #30 were not wearing a covering ot wearing hair on 01/16/24 at 11:30 A.M. during tray line, without covering their facial hair. During an interview on 01/16/24 at 11:35 A.M., Dietary Manager #44 confirmed the above observations. Review of the facility policy titled Date Marking, dated November 2005, revealed all refrigerated, ready to eat, potentially hazardous food prepared and held refrigerated food shall be clearly marked at the time of preparation to indicate the date by which the food shall be consumed or discarded. Certain unpackaged food should be clearly marked to indicate the date by which food must be discarded. Review of the facility policy titled Hair Restraints dated November 2005, revealed hair restraints shall be worn by all dietary employees while on duty to cover ALL hair. This is a recite from the survey dated 12/28/23. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365186 If continuation sheet Page 28 of 32 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 01/24/2024 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)

F 0865 Have a plan that describes the process for conducting QAPI and QAA activities. Level of Harm - Minimal harm or potential for actual harm Based on record review and interview, the facility failed to implement a quality assurance performance improvement (QAPI) plan. This had the potential to affect all 87 residents residing in the facility. Residents Affected - Many Findings include: During the entrance conference on 01/17/24 at 10:04 A.M., the facility's QAPI plan was requested to be provided. During the course of the survey, the QAPI plan was not received. During an interview on 01/22/24 at 3:01 P.M., the Administrator stated he had been working in the facility since January of 2023 and he didn't have a QAPI plan. He stated he goes over the areas of concerns in the morning meetings with the staff and had nothing documented. Review of the policy titled Quality Assurance Performance Improvement Program, dated 10/01/18, revealed this facility shall develop, implement, and maintain an ongoing, facility-wide QAPI program that builds on the Quality Assessment and Assurance Program to actively pursue quality of care and quality of life goals. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365186 If continuation sheet Page 29 of 32 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 01/24/2024 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)

F 0868 Have the Quality Assessment and Assurance group have the required members and meet at least quarterly Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to provide evidence a quarterly quality assessment and assurance (QAA) meeting was held. This had the potential to affect all 87 residents residing in the facility. Residents Affected - Many Findings include: Evidence of the facility's quarterly QAA meetings for the last 12 months were requested. Nothing was provided by the end of the survey. During interview on 01/22/24 a 3:01 P.M., the Administrator said he could provide no evidence QAA meetings were held. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365186 If continuation sheet Page 30 of 32 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 01/24/2024 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)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Medical record review for Resident #27 revealed an admission date of 02/22/23. Diagnoses included traumatic brain disorder, cerebrovascular accident (CVA), Non-Alzheimer's dementia, malnutrition, and Schizophrenia. Residents Affected - Few Review of quarterly MDS, dated [DATE], revealed Resident #27 was cognitively intact. He was frequently incontinent of bowel and bladder. Review of physician orders dated 04/07/23 revealed the resident was to remain in transmission-based precautions due to Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae (CPCR) specifically the Acinetobacter Baumannii, every shift for enhanced barrier precautions. During an interview on 01/16/24 at 4:43 P.M., Hospice Registered Nurse (RN) #116 stated there wasn't a sign on the door, but a cart was outside the door. She took the blood pressure and the resident's temperature. She was not wearing any PPE for contact precautions on while in the room. She stated she didn't see a sign on the door and asked the nurse if he was still in contact precautions and she said no. She confirmed she didn't have PPE while in the room. During interview on 01/16/24 at 4:50 P.M., Licensed Practical Nurse (LPN) #55 confirmed Resident #27 was in contact isolation and there wasn't a sign on the door. Review of policy titled Transmission-Based Precautions, dated 08/21/23, revealed Transmission-based precautions were implemented including appropriate signage and PPE available outside the resident's room when a resident developed signs and symptoms of a transmissible infection based on clinical presentation and likely category of pathogens. Based on record review, observation, interview and policy review, the facility failed to implement appropriate infection control measure for residents in transmission-based precautions. This affected two (Residents #48, and #27) of four residents sampled for infection control. The facility census was 87. Findings include: 1. Review of the medical record revealed Resident #48 was admitted to the facility on [DATE] and had diagnoses including type II diabetes, chronic obstructive pulmonary disease, chronic viral hepatitis B, and chronic viral hepatitis C. Review of the most recent Minimum Data Set (MDS) assessment, completed on 11/03/23, revealed Resident #48 was cognitively intact, had no behaviors, did not wander, and did not reject care. Review of progress notes dated 01/14/24 at 5:37 P.M. revealed Resident #48 had a red rash under the right breast which was associated with pain. The nurse called the on-call provider and passed it on to the night shift nurse in report. On 01/14/23 at 10:51 P.M. the night shift nurse documented Resident #48 had received a new order for Zovirax 800 milligrams (mg) by mouth five times daily for seven days for the treatment of shingles. The night shift nurse assessed the patient and found four blisters underneath the patient's right breast and a cluster of blisters on the resident's right scapula. The resident was encouraged not to scratch the area. There was no mention in the progress notes regarding transmission-based precautions. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365186 If continuation sheet Page 31 of 32 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 01/24/2024 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)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the medical record revealed Resident #48 had physician orders dated 01/15/24 for Zovirax 800 mg by mouth five times daily for seven days for treatment of shingles and dated 01/17/24 for contact isolation every day and night shift until 01/22/24 due to shingles diagnosis. During an interview on 01/16/24 at 1:53 P.M., Resident #48 stated a nurse had told her the night before that she was in quarantine for shingles. The resident stated staff were wearing face masks but were not wearing any other personal protective equipment (PPE) when they entered the room. During an interview on 01/16/24 at 4:28 P.M., the Director of Nursing (DON) verified Resident #48 had shingles for the past couple days and had not been placed in transmission-based precautions yet because they were unsure what level of transmission-based precaution was required for shingles. The DON verified there was no sign on the door and was no bin with PPE outside the resident's room. During an observation on 01/16/24 at 1:53 P.M. there was no sign on Resident #48 door and no isolation cart with PPE available for staff outside of Resident #48's room. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365186 If continuation sheet Page 32 of 32

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Citations

27 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.

0880GeneralS&S Dpotential for harm
F880 - Infection Control
Provide and implement an infection prevention and control program.
0550GeneralS&S Dpotential for harm
F550 - Resident Rights
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
0686GeneralS&S Dpotential for harm
F686 - Skin Integrity
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
0689GeneralS&S Epotential for harm
F689 - Accidents
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
0761GeneralS&S Dpotential 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.
0791GeneralS&S Dpotential for harm
F791 - Dental Services
Provide or obtain dental services for each resident.
0690GeneralS&S Dpotential for harm
F690 - Incontinence
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
0222GeneralS&S Fpotential for harm
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
0341GeneralS&S Fpotential for harm
Install a fire alarm system that can be heard throughout the facility.
0345GeneralS&S Fpotential for harm
Have approved installation, maintenance and testing program for fire alarm systems.
0353GeneralS&S Fpotential for harm
Inspect, test, and maintain automatic sprinkler systems.
0363GeneralS&S Fpotential for harm
Install corridor and hallway doors that block smoke.
0521GeneralS&S Fpotential for harm
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
0565GeneralS&S Epotential for harm
F565 - The resident has a right to organize and participate in resident groups in the
Honor the resident's right to organize and participate in resident/family groups in the facility.
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.
0644GeneralS&S Dpotential for harm
F644 - Coordination
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
0656GeneralS&S Epotential 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.
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.
0677GeneralS&S Dpotential for harm
F677 - A resident who is unable to carry out activities of daily living receives
Provide care and assistance to perform activities of daily living for any resident who is unable.
0727GeneralS&S Fpotential for harm
F727 - Except when waived under paragraph (f) or (g) of this section, the
Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.
0755GeneralS&S Dpotential for harm
F755 - Pharmacy Services
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
0803GeneralS&S Fpotential for harm
F803 - Menus and nutritional adequacy
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.
0804GeneralS&S Fpotential for harm
F804 - Food and drink
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
0810GeneralS&S Dpotential for harm
F810 - Assistive devices
Provide special eating equipment and utensils for residents who need them and appropriate assistance.
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.
0865GeneralS&S Fpotential for harm
F865 - Quality assurance and performance improvement (QAPI) program
Have a plan that describes the process for conducting QAPI and QAA activities.
0868GeneralS&S Fpotential for harm
F868 - Quality assessment and assurance
Have the Quality Assessment and Assurance group have the required members and meet at least quarterly

FAQ · About this visit

Common questions about this visit

What happened during the January 24, 2024 survey of AYDEN HEALTHCARE OF MADEIRA?

This was a inspection survey of AYDEN HEALTHCARE OF MADEIRA on January 24, 2024. The surveyor cited 27 deficiencies, recorded on the federal Form 2567 statement of deficiencies.

Were any deficiencies cited at AYDEN HEALTHCARE OF MADEIRA on January 24, 2024?

Yes, 27 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Provide and implement an infection prevention and control program."

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.

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Data from CMS Care Compare public records. Dataset last refreshed June 8, 2026. If you believe any information is inaccurate, report it here.

Inspection·January 24, 2024