Inspection·May 13, 2024

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 medical record review, observations and resident and staff interviews, the facility failed to ensure perineal care was provided for a resident. This affected one (#38) of three reviewed for incontinent care. The facility census is 87. Residents Affected - Few Findings include Medical record review for Resident #38 revealed an admission on [DATE] with diagnoses including but not limited to congestive heart failure, asthma, hypotension, and neuromuscular dysfunction of the bladder. Review of the comprehension Minimum Data Set (MDS) assessment dated [DATE] for Resident #38 revealed the resident had intact cognition. Resident #38 was not coded with refusals or rejections of care. Resident #38 required set up for meals, dependent for toileting, maximum assistance for transfers and moderate assistance for bed mobility. Resident #38 was coded as incontinent of bladder and bowel. Review of the plan of care for Resident #38 revealed resident required assistance with activities of daily living (ADL) due to hypertension, diabetes, obesity, chronic pain,osteoarthritis, asthma, heart failure and overall medical condition. She is at risk for decline in ADL self-care. Interventions include toileting with extensive to total assistance with one or two staff members. Review of the plan of care for Resident #38 revealed resident has bladder incontinence related to neurogenic disorder dated 02/21/24. Interventions include clean peri-area with each incontinence episode, encourage fluids during the day to promote prompted voiding responses. Review of the facility bladder and bowel review for Resident #38 revealed the resident was continent of bowel and bladder. Assessment indicated Resident #38 has not had a change in continence status and as not been checked for a urinary tract infection. Resident #38 is alert and oriented with adequate vision and uses a wheelchair for mobility. Resident #38 requires one person assist and is occasionally incontinent and frequently incontinence of bladder. Resident #38 takes diuretics daily. Review of the electronic health record state testing nursing assistant (STNA) documentation for the toileting task for Resident #38 dated 04/19/24 through 05/13/24 revealed only two shifts, on 04/23/24 and 05/12/24, with documented episodes of perineal care on night shift. All other days for the thirty day look back period contained no documentation for incontinent services on the night shift. Interview and observation on 05/13/24 at 12:30 P.M. with Resident #38 states the STNA's put two (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 2 Event ID: 365186 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365186 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/13/2024 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)