Inspection visit

InspectionAugust 16, 2023

PLEASANT RIDGE HEALTHCARE CENTERCMS #36519639 citations on this visit

39 citations recorded

Inspector’s narrative

What the inspector wrote

This survey cited 39 deficiencies, 1 of them serious (actual harm or immediate jeopardy). The full statement and the facility’s plan of correction follow, verbatim from the federal record.

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, resident interview, staff interview, and policy review, the facility failed to honor a resident's request to get out of bed to smoke. This affected one resident (#25) of three residents reviewed for choices. The facility census was 86. Findings include: Review of the medical record for Resident #25 revealed an admission date of 05/05/23. The resident transferred to the hospital on [DATE] and was readmitted to the facility on [DATE]. Diagnoses included vascular dementia, hemiplegia and hemiparesis following cerebral infarction, affecting left non-dominant side, cerebrovascular disease, chronic obstructive pulmonary disease (COPD), congestive heart failure, paraplegia, pulmonary hypertension, and chronic respiratory failure with hypoxia. Review of the quarterly Minimum Data Set (MDS) assessment 3.0 dated 07/25/23, revealed the resident had intact cognition. The resident was assessed as not exhibiting behaviors during the assessment period. The resident required extensive assistance of two staff for bed mobility and transfers. Review of the Smoking Assessments dated 05/07/23 and 08/07/23, revealed the resident required supervision for smoking and was aware of the risks of the use of nicotine. Review of the Activities of Daily Living (ADL) task charting dated 08/07/23, revealed there was no charting to indicate Resident #25 was transferred nor was assisted with locomotion on or off the unit. Review of ADL task charting for 08/06/23 revealed transfers and assistance with locomotion on and off the unit were coded as the activity did not occur. Observation and interview on 08/07/23 at 3:20 P.M., Resident #25 was observed lying in bed. The resident stated she was frustrated because the staff informed her, they could not get her out of bed because there was no Hoyer pad available. The resident stated she wanted to go outside and smoke and had not been able to do so in the last three days. Interview on 08/07/23 at 3:31 P.M., Licensed Practical Nurse (LPN) #500 stated she was trying to keep Resident #25 in bed because she was trying to keep Resident #25 from smoking because she had just returned from the hospital for hypoxia, and she was trying to help the resident get her strength up. LPN #500 stated she was not aware of the Hoyer pads being unavailable. Review of the facility policy titled, Routine Resident Care, undated, revealed the facility would honor the resident's lifestyle preferences while in the care of the facility, and all aspects of care (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 36 Event ID: 365196 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 365196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Healthcare Center 5501 Verulam Cincinnati, OH 45213 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 0561 would be observed and documented. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 2 of 36 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 365196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Healthcare Center 5501 Verulam Cincinnati, OH 45213 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. 2) Review of the medical record for Resident #67 revealed an admission date of 01/04/22 with diagnoses including metabolic encephalopathy, osteomyelitis, chronic pulmonary edema, diabetes mellitus (DM), atherosclerotic heart disease, congestive heart failure (CHF), and adult failure to thrive (FTT.) Further review of the medical record for Resident #67 revealed the hard chart for resident located in the nurse's station contained an undated sheet placed under the advanced directive tab which indicated resident's code status was a full code. The medical record did not contain any other forms regarding the resident's code status. Review of a code status form for Resident #67 dated 03/06/23 and signed by the physician, revealed the resident's code status was DNR-CC-Arrest. Review of the physician's order for Resident #67 dated 03/10/23 revealed resident's code status was DNRCC-Arrest. Review of the nurse practitioner (NP) provider note for Resident #67 dated 04/08/23, revealed the resident's code status was DNRCC-Arrest. Review of the care plan for Resident #67 dated 05/08/23 revealed the resident had code status of Do Not Resuscitate Comfort Care Arrest. Interventions included the following: code status will be established at time of admission/re-admission. and reviewed quarterly and as needed, obtain copies of advanced directives from resident/resident representative to have on file, obtain medical provider order for code status, obtain the state specific form regarding code status. Review of the MDS for Resident #67 dated 07/12/23, revealed the resident was cognitively impaired and required extensive assistance of one to two staff with activities of daily living (ADLs.) Interview on 08/08/23 at 10:07 A.M. with LPN #345 confirmed the form located in Resident #67's hard chart indicated resident's code status was full code. LPN #345 confirmed the resident's chart did not include a state of Ohio DNRCC-Arrest form so he would be presumed to be a full code. Interview on 08/08/23 at 10:56 A.M. with the Director of Nursing (DON) confirmed resident's correct code status was DNRCC-Arrest and his state form indicating his code status was not available in his chart. Interview and observation on 08/09/23 at 3:12 P.M. with the DON confirmed the facility had located Resident #67's signed DNRCC-Arrest form dated 03/06/23 and it should have been placed under the advanced directive tab of the chart. Review of the undated facility policy titled Advanced Directives revealed should the resident have an advanced directive; copies would be made and placed on the hard chart medical record and should be communicated to the staff. Based on medical record review, staff interview, and policy review, the facility failed to ensure an accurate code status was in the medical records. This affected two residents (#03 and #67) of the 18 residents reviewed for advance directives. The facility census was 86. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 3 of 36 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 365196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Healthcare Center 5501 Verulam Cincinnati, OH 45213 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 0578 Findings include: Level of Harm - Minimal harm or potential for actual harm 1) Review of the medical record of Resident #03 revealed an admission date of 05/20/22. Diagnoses included Parkinson's disease and essential hypertension. Further review of the medical record revealed no signed Do Not Resuscitate (DNR) was able to be located. Residents Affected - Few Review of the care plan dated 06/01/23 for Resident #03, revealed the resident was a DNR code status. Review of the quarterly Minimum Data Set (MDS) assessment 3.0 dated 06/07/23 revealed the resident had intact cognition. The resident did not reject care during the assessment period. The resident required extensive assistance of one staff for personal hygiene. Review of a physician's order dated 08/07/23 revealed an order for the resident to be a DNR. No additional information was noted in the order. Further review of physician orders revealed an order dated 05/20/22 and discontinued 08/02/23 for the resident to be a DNR. Interview on 08/08/23 at 12:31 P.M., Licensed Practical Nurse (LPN) #500, verified the code status order for Resident #03 was incomplete and did not include whether the resident was DNR comfort care (CC) or DNR comfort care-arrest (CCA). LPN #500 further verified there was evidence of a signed DNR in the resident's chart. Interview on 08/08/23 at 3:15 P.M., Regional Nurse (RN) #510 stated the original discontinuation of the order on 08/02/23 was a mistake and was corrected 08/07/23. RN #510 further verified there was no evidence of a signed advance directive in the resident's chart at the time of the medical record review. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 4 of 36 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 365196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Healthcare Center 5501 Verulam Cincinnati, OH 45213 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 0582 Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. Level of Harm - Minimal harm or potential for actual harm Based on record review, resident interview, and staff interview, the facility failed to provide required Notification of Medicare Non-Coverage (NOMNC) to two Residents (#48 and #65) of the three residents reviewed for notification to Medicare beneficiaries. The facility census was 86. Residents Affected - Few Findings include: 1) Review of the medical record for Resident #48 revealed an admission date of 01/17/23 with diagnoses including paraplegia and pyogenic arthritis. Review of the Minimum Data Set (MDS) assessment 3.0 for Resident #48 dated 07/11/23 revealed resident was cognitively intact and required extensive assistance with activities of daily living. Review of the form completed by the facility titled Skilled Nursing Facility (SNF) Beneficiary Notice Review revealed Resident #48 had Medicare Part-A service episode starting on 06/13/23 and was discharged from Medicare Part-A services on 07/25/23 with Medicare days remaining. Further review of the form revealed the facility did not provide Resident #48 with Center for Medicare Medicaid Services (CMS) Form SNF Advanced Beneficiary Notice nor CMS Form Expedited Review Notice -NOMNC due to the facility not having a social worker. 2) Review of the medical record for Resident #65 revealed an admission date of 04/13/23 with diagnoses including chronic kidney disease (CKD) depression, osteoarthritis, and hypothyroidism. Review of the MDS assessment 3.0 for Resident #65 dated 06/30/23 revealed the resident was cognitively intact and required supervision with ADLs. Review of the form completed by the facility titled SNF Beneficiary Notice Review revealed Resident #48 had Medicare Part-A service episode starting on 04/13/23 and was discharged from Medicare Part-A services on 06/29/23 with Medicare days remaining. Further review of the form revealed the facility did not provide Resident #65 with a SNF Advanced Beneficiary Notice nor Expedited Review Notice -NOMNC due to the facility not having a social worker. Interview on 08/09/23 at 9:08 A.M. with Resident #65 revealed the resident was discharged from therapy and her Medicare part-A services were stopped in June 2023 but she did not receive anything in writing. Resident #65 confirmed she believed she could have benefited from more therapy and wished she had been given the opportunity to appeal the decision. Interview on 08/10/23 at 1:43 P.M. with the Administrator confirmed Residents (#48 and #65) did not receive required notices regarding Medicare non-coverage due to the facility not having a social worker to perform the tasks. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 5 of 36 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 365196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Healthcare Center 5501 Verulam Cincinnati, OH 45213 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 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to ensure the Ombudsman was notified when residents were transferred to the hospital. This affected two Residents (#48 and #88) of two residents reviewed for hospitalization. The facility census was 86. Findings include: 1) Review of the medical record of Resident #48 revealed an admission date of 01/17/23. Diagnoses included paraplegia, moderate protein-calorie malnutrition, osteomyelitis of vertebra, sacral, and sacrococcygeal region, generalized anxiety disorder, schizophrenia, major depressive d/o, post-traumatic stress disorder, psychosis, and cachexia. Review of the 5-day Minimum Data Set (MDS) assessment 3.0 dated 07/11/23 revealed the resident had intact cognition. Review of the medical record for Resident #48 revealed the resident discharged to the hospital on [DATE] and readmitted to the facility on [DATE]. There was no documentation to indicate the ombudsman was notified of the resident's transfer. Interview on 08/10/23 at 9:19 A.M., Regional Director of Clinical Operations (RDCO) #510, verified the Ombudsman was not notified of Resident #48's transfer to the hospital and stated the notification was not completed because the facility did not have a social worker. Review of the medical record revealed the resident discharged to the hospital on [DATE] and readmitted to the facility on [DATE]. There was no documentation to indicate the ombudsman was notified of th resident's discharge. Interview on 08/10/23 at 9:19 A.M., RN #510 verified the Ombudsman was not notified of Resident #48's transfer to the hospital and stated the notification was not completed because the facility did not have a social worker. 2) Review of the medical record for Resident #88 revealed an admission date of 03/21/23 and a discharge date of 07/05/23. Diagnoses included chronic viral hepatitis-C, panic disorder, altered mental status, and opioid dependence. Review of the MDS assessment 3.0 dated 06/22/23 revealed the resident had intact cognition as evidenced by a Brief Interview for Mental Status (BIMS) score of 13. Review of the transfer form dated 06/30/23 for Resident #88, revealed the resident went out to the hospital for a change in condition. Review of the medical record for Resident #88, revealed there was no documentation for a notification of the Ombudsmen related to hospitalization transfer. Interview on 08/09/23 04:02 P.M. with RDCO #510, verified there was no documentation regarding notification of the Ombudsmen related to hospitalization FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 6 of 36 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 365196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Healthcare Center 5501 Verulam Cincinnati, OH 45213 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. Based on medical record review and staff interview, the facility failed to ensure a Preadmission Screening and Resident Review (PASARR) was completed correctly. This affected one resident (#26) of one resident reviewed for PASARRs. The facility census was 86. Findings include: Review of the medical record of Resident #26 revealed an admission date of 01/31/23. Diagnoses included cerebral infarction, psychotic disorder with delusions, cocaine abuse, schizophrenia, and bipolar disorder. Review of the quarterly Minimum Data Set (MDS) assessment 3.0 dated 06/07/23 revealed the resident had moderately impaired cognition. The resident exhibited one to three days of verbal behavioral symptoms directed towards others during the assessment period. The resident required limited assistance of one staff for bed mobility, extensive assistance of two for transfers, extensive assist of one for toileting, and supervision for eating. Review of the Preadmission Screening and Resident Review identification screen dated 03/03/23, revealed the resident was reassessed due to an expiring hospital exemption. Under section E, indications of serious mental illness, boxes were checked for mood disorders and other psychotic disorders. The box for schizophrenia was not checked. Interview on 08/09/23 at 3:54 P.M., Registered Nurse (RN) #510 verified Resident #26's PASARR was not completed accurately as it did not include Resident #26's diagnosis of schizophrenia. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 7 of 36 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 365196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Healthcare Center 5501 Verulam Cincinnati, OH 45213 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 8) Review of the medical record for Resident #140 revealed an admission date of 07/11/23 with diagnoses including hemiplegia affecting left non-dominant side, traumatic subdural hemorrhage with loss of consciousness, cerebral infarction, viral hepatitis, malignant neoplasm of ovary, human immunodeficiency virus (HIV), and psychoactive substance abuse. Review of the MDS for Resident #140 dated 07/24/23 revealed resident was cognitively intact and required extensive assistance of one to two staff with ADLs. Review of the admission evaluation/baseline care plan for Resident #140 dated 07/11/23 revealed the baseline care plan section had not been completed and/or signed by resident/resident representative and staff. Interview on 08/09/23 at 2:38 P.M. with the Director of nursing (DON) confirmed the facility had not completed a baseline care plan for Resident #140. Review of the undated facility policy titled Care Plan Overview revealed the facility would provide a copy of the baseline care plan to the resident and their representative. Based on medical record review, staff interview, and policy review, the facility failed to ensure a baseline care plan was completed within 48 hours of admission. This affected eight residents (#41, #243, #26, #244, #27, #89, #61, and #140) of the eleven residents reviewed for baseline care plans. The facility census was 86. Findings include: 1) Review of the medical record of Resident #26 revealed an admission date of 01/31/23. Diagnoses included cerebral infarction, psychotic disorder with delusions, cocaine abuse, schizophrenia, and bipolar disorder. Review of the quarterly [NAME] Data Set (MDS) assessment 3.0 dated 06/07/23 revealed the resident had moderately impaired cognition. The resident exhibited one to three days of verbal behavioral symptoms directed towards others during the assessment period. The resident required limited assistance of one staff for bed mobility, extensive assistance of two for transfers, extensive assist of one for toileting, and supervision for eating. Review of the admission Initial Evaluation dated 01/31/23 revealed the assessment was locked on 07/13/23. Further review of the assessment revealed the 48-hour baseline care plan was not completed until 07/13/23. 2) Review of the medical record of Resident #27 revealed an admission date of 03/22/23. Diagnoses included cerebral infarction, hemiplegia and hemiparesis, atrial fibrillation, essential hypertension, oropharyngeal dysphagia, and depression. Review of the quarterly MDS assessment 3.0 dated 07/05/23 revealed the resident had intact cognition. The resident was not assessed as having any behaviors during the assessment period. The resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 8 of 36 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 365196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Healthcare Center 5501 Verulam Cincinnati, OH 45213 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 0655 was independent with bed mobility and required supervision for transfers, eating, and toileting. Level of Harm - Minimal harm or potential for actual harm Review of the admission Initial Evaluation dated 03/23/23 and locked on 07/11/23 revealed the 48-hour baseline care plan was not completed until 07/11/23. Residents Affected - Some 3) Review of the medical record of Resident #61 revealed an admission date of 12/22/22. Diagnoses included malignant neoplasm of prostate, essential hypertension, benign prostatic hyperplasia, depression, anxiety, dementia with behavioral disturbance, and syncope and collapse. Review of the quarterly MDS assessment 3.0 dated 07/14/23 revealed the resident had severely impaired cognition. The resident did not refuse care during the assessment period. The resident was independent after setup with personal hygiene. Review of the admission Initial Evaluation dated 12/22/22 revealed the assessment was incomplete and the 48-hour baseline care plan was incomplete. 4. Review of the medical record of Resident #89 revealed an admission date of 12/31/22. The resident passed away in the facility on 05/10/23. Diagnoses included acute respiratory failure with hypoxia, chronic systolic heart failure, cardiomyopathy, acute ischemic heart disease, chronic obstructive pulmonary disease, myocardial infarction (heart attack), and obesity. Review of the quarterly MDS assessment 3.0 dated 04/15/23 revealed the resident had severely impaired cognition. The resident was independent with all activities of daily living. Review of the admission Initial Evaluation dated 12/31/22 revealed the 48-hour baseline care plan was not completed. 5) Review of the medical record for Resident #41 revealed an admission date of 05/21/23. Diagnoses included Guillian-Barre syndrome, atrial fibrillation, type two diabetes mellitus (DM II), depression, chronic kidney disease, and hypertension. Review of the Quarterly MDS assessment dated [DATE], revealed Resident #41 had intact cognition as evidenced by a Brief Interview for Mental Status (BIMS) score of 15. This resident was assessed to require independent with transfers, dressing, eating, toileting, and bathing. Review of the admission initial evaluation dated 05/21/23 revealed the 48-hour baseline care plan was not completed until 06/27/23. 6) Review of the medical record for Resident #243 revealed an admission date of 07/28/23. Diagnoses included quadriplegia, major depressive disorder, pressure ulcer of sacral region, and neuromuscular dysfunction of the bladder. Review of the MDS assessment dated [DATE] revealed Resident #243 had intact cognition as evidenced by a BIMS score of 15. This resident was assessed to require two-person total dependence with transfers, one-person extensive assistance with dressing and eating, and one-person total dependence with toileting and bathing. Review of the medical record for Resident #243 revealed he did not have an initial admission evaluation completed including the 48-hour baseline care plan. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 9 of 36 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 365196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Healthcare Center 5501 Verulam Cincinnati, OH 45213 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 7) Review of the medical record for Resident #244 revealed an admission date of 07/31/23. Diagnoses included acute right ankle osteomyelitis, paraplegia, third degree burn on right foot, and stage four pressure ulcer of right buttock. Review of the admission MDS assessment dated [DATE] revealed Resident #244 had intact cognition as evidenced by a BIMS score of 15. This resident was assessed to require supervision with transfers, dressing, eating, and toileting, and independent with bathing. Review of the medical record for Resident #244 revealed the 48-hour baseline care plan was not completed. Interview on 08/10/23 at 11:03 A.M. with Regional Director of Clinical Operations (RDCO) #510, verified Resident #26, #27, #41, #61, #89, #243, and #244's baseline care plans had not completed within 48 hours. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 10 of 36 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 365196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Healthcare Center 5501 Verulam Cincinnati, OH 45213 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Based on record review, interviews, and policy review, the facility failed to develop a comprehensive care plan. This affected one resident (#41) of the 11 residents reviewed for care plans. The facility census was 86. Findings include: Review of the medical record for Resident #41 revealed an admission date of 05/21/23. Diagnoses included Guillian-Barre syndrome, atrial fibrillation, type two diabetes mellitus (DM II), depression, chronic kidney disease, and hypertension. Review of the Quarterly Minimum Data Set (MDS) assessment 3.0 dated 07/17/23 revealed Resident #41 had intact cognition as evidenced by a Brief Interview for Mental Status (BIMS) score of 15. This resident was assessed to require independent with transfers, dressing, eating, toileting, and bathing. Review of the medical record for Resident #41 revealed the facility did not complete a comprehensive care plan based on the resident's needs including diabetes and psychotropic medications. Interview on 08/10/23 at 11:03 A.M. with Regional Director of Clinical Operations (RDCO) #510 verified Resident #41 did not have an accurate comprehensive care plan completed. Review of the facility policy titled, Plan of Care Overview, revealed the care plan was a written treatment provided for a resident that was resident-centered and provided for optimal personalized care. Residents and their representatives had the right to participate in the development and implementation of his/her own plan of care. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 11 of 36 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 365196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Healthcare Center 5501 Verulam Cincinnati, OH 45213 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 - Some Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. Based on record review, staff interview, and review of the facility policy, the facility failed to provide care conferences to residents/resident representatives to discuss the resident's care plan. This affected four residents (#24, #41, #44, and #67) of the 20 residents sampled. The facility census was 86. Findings include: 1) Review of the medical record for Resident #24 revealed an admission date of 05/18/19 with diagnoses including chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM), atherosclerotic heart disease, atrial fibrillation, anxiety disorder, polyosteoarthritis, hyperlipidemia, and hypertension (HTN.) Review of the Minimum Data Set (MDS) assessment 3.0 for Resident #24 dated 06/04/23 revealed the resident was cognitively impaired and required extensive assistance of one staff with activities of daily living (ADLs.) Review of the medical record for Resident #24 revealed it did not include documentation of care conferences for the resident from August 2022 to August 2023. Interview with Resident #24 on 08/07/23 at 11:29 A.M. confirmed the facility did not offer regular care conferences for her to offer input and discussion of her plan of care. Interview with Regional Director of Clinical Operations (RDCO) #510 on 08/09/23 at 2:00 P.M., confirmed the facility had not held care conferences for Resident #24 from August 2022 to August 2023. 2) Review of the medical record for Resident #44 revealed an admission date of 11/29/22 with diagnoses including cerebral infarction (stoke), hemiplegia, and hemiparesis, right and left above the knee amputation, and atherosclerotic heart disease. Review of the MDS assessment 3.0 for Resident #44 dated 04/26/23 revealed the resident was cognitively intact and required supervision with ADLs. Review of the medical record for Resident #44 revealed it did not include documentation of care conferences for resident from November 2022 to August 2023. Interview of Resident #44 on 08/08/23 at 8:53 A.M., confirmed he had never been invited to a care conference since his admission to the facility and he knew the facility was supposed to have regular conferences so he could discuss his care concerns. Interview with RDCO #510 on 08/09/23 at 2:00 P.M., confirmed the facility had not held care conferences for Resident #44 from November 2022 to August 2023. 3) Review of the medical record for Resident #67 revealed an admission date of 01/04/22 with diagnoses including metabolic encephalopathy, osteomyelitis, chronic pulmonary edema, DM, atherosclerotic heart disease, congestive heart failure (CHF), and adult failure to thrive (FTT.) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 12 of 36 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 365196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Healthcare Center 5501 Verulam Cincinnati, OH 45213 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 Review of the MDS assessment 3.0 for Resident #67 dated 07/12/23 revealed resident was cognitively impaired and required extensive assistance of one to two staff with ADLs. Review of the medical record for Resident #67 revealed it did not include documentation of care conferences for resident from August 2022 to August 2023. Residents Affected - Some Interview with Resident #67 on 08/07/23 at 2:30 P.M. confirmed he did not recall having a care conference since his admission to the facility. Interview with RDCO #510 on 08/09/23 at 2:00 P.M. confirmed the facility had not held care conferences for Resident #67 from August 2022 to August 2023. RDCO #510 further confirmed care conferences should be held upon admission, quarterly, with a significant change in resident status, and upon resident/resident representative request. 4) Review of the medical record for Resident #41 revealed an admission date of 05/21/23. Diagnoses included Guillian-Barre syndrome, atrial fibrillation, DM, depression, chronic kidney disease, and hypertension. Review of the Quarterly MDS assessment 3.0 dated 07/17/23 revealed Resident #41 had intact cognition as evidenced by a Brief Interview for Mental Status (BIMS) score of 15. This resident was assessed to require independent with transfers, dressing, eating, toileting, and bathing. Review of the medical record for Resident #41 for care conferences revealed there was no documentation of care conferences provided by the facility. Interview with RDCO #510 on 08/09/23 at 2:02 P.M. confirmed there were no care conferences or documentation to confirm Resident #41 had a care conference completed since admission. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 13 of 36 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 365196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Healthcare Center 5501 Verulam Cincinnati, OH 45213 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 0661 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. Based on record review and staff interview the facility failed to complete a discharge summary of recapitulation of resident's stay for two residents (#49 and #87) of three residents sampled for discharge rights. The facility census was 86. Findings include: 1) Review of the medical record for Resident #49 revealed an admission date of 02/09/23 with diagnoses including cerebral infarction, viral hepatitis, chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM), hypertension (HTN), and depression. Review of the Minimum Data Set (MDS) assessment 3.0 for Resident #49 dated 05/26/23 revealed resident was cognitively intact and was independent with activities of daily living (ADLs.) Further review of the MDS for Resident #87 dated 07/28/23, revealed the resident was discharged with a return not anticipated. Review of a nurse's progress note dated 07/28/23 for Resident #49, revealed the resident was discharged from the facility and received education of self-administration of medications. Review of the medical record for Resident #49 revealed it did not include a discharge summary and recapitulation of stay for the resident. 2) Review of the medical record for Resident #87 revealed an admission date of 06/20/23 with diagnoses including cerebral infarction, fracture right tibia, atrial fibrillation, viral hepatitis, congestive heart failure (CHF), and hypertension. Review of the MDS for Resident #87 dated 06/20/23 revealed the resident was cognitively impaired and required extensive assistance of one to two staff with ADLs. Further review of the MDS for Resident #87 dated 07/08/23, revealed the resident was discharged with a return not anticipated. Review of a nurse's progress note dated 07/08/23 for Resident #87, revealed the resident was discharged from the facility against medical advice (AMA) and was transported to her home per family. The nurse notified the physician of resident's discharge. Review the AMA form dated 07/28/23 for Resident #87, revealed the form was signed by the resident and her representative at 4:25 P.M. Review of the medical record for Resident #87 revealed it did not include a discharge summary and recapitulation of stay for resident. Interview on 08/09/23 at 2:39 P.M. with the Director of Nursing (DON) confirmed Resident #49's and #87's records did not include a discharge summary and/or recapitulation of stay. The DON confirmed this should be completed for all residents upon discharge. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 14 of 36 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 365196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Healthcare Center 5501 Verulam Cincinnati, OH 45213 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 observation, medical record review, staff interview, and policy review, the facility failed to ensure resident's fingernails were trimmed and clean. This affected two residents (#03 and #61) of four residents reviewed for Activities of Daily Living (ADLs.) The facility census was 86. Residents Affected - Few Findings include: 1) Review of the medical record of Resident #03 revealed an admission date of 05/20/22. Diagnoses included Parkinson's disease and essential hypertension. Review of the quarterly Minimum Data Set (MDS) assessment 3.0 dated 06/07/23 revealed the resident had intact cognition. The resident did not reject care during the assessment period and the resident required extensive assistance of one staff for personal hygiene. Observation on 08/07/23 at 12:24 P.M. revealed Resident #03 was lying in bed. Resident #03's fingernails were observed to extend approximately a half inch beyond his fingertips. Further observation revealed the underside of Resident #03's fingernails was coated in a brown substance. Interview on 08/07/23 at 12:24 P.M., Resident #03 stated he kept asking staff to clip his fingernails and they had not done so. Interview on 08/07/23 at 12:32 P.M., Licensed Practical Nurse (LPN) #505 verified Resident #03's fingernails were long and had a brown substance below and needed to be cut and soaked. 2) Review of the medical record of Resident #61 revealed an admission date of 12/22/22. Diagnoses included malignant neoplasm of prostate, essential hypertension, benign prostatic hyperplasia, depression, anxiety, dementia with behavioral disturbance, and syncope and collapse. Review of the quarterly MDS assessment dated [DATE] revealed the resident had severely impaired cognition. The resident did not reject care during the assessment period and the resident was independent after setup with personal hygiene. Observation on 08/07/23 at 11:41 A.M. revealed Resident #61 sitting at the edge of his bed. Resident #61's fingernails were observed to extend approximately a half inch beyond his fingertip. Interview on 08/07/23 at 11:41 A.M., Resident #61 stated he did not like his fingernails to be that long and stated he had asked staff to help him with clipping his fingernails, which had been that way for about two weeks. Interview on 08/07/23 at 12:22 P.M., LPN #500 verified Resident #61's fingernails were long and needed to be clipped. Interview on 08/10/23 at 1:41 P.M., LPN #265 stated Resident #61 was not capable of clipping his own fingernails. LPN #265 further stated the resident had a history of cutting off his Wanderguard with anything he can get at, including fingernail clippers. Review of the undated facility policy titled, Routine Resident Care, revealed residents are (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 15 of 36 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 365196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Healthcare Center 5501 Verulam Cincinnati, OH 45213 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 provided with routine daily care by a certified nursing assistant, including assisting with activities of daily living. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 16 of 36 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 365196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Healthcare Center 5501 Verulam Cincinnati, OH 45213 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 0680 Ensure the activities program is directed by a qualified professional. Level of Harm - Minimal harm or potential for actual harm Based on review of personnel files, staff interview, and review of job descriptions, the facility failed to ensure the services of a qualified Activity Director (AD). This had the potential to affect all residents residing in the facility with the exception of the 42 residents (#1, #3, #5, #7, #9, #11, #13, #15, #21, #22, #23, #26, #30, #31, #32, #34, #35, #39, #40, #41, #42, #44, #47, #50 #52, #61, #62, #64, #67, #68, #71, #72, #73, #75,#80, #84,#140, #240, #241, #243, #243, #244) who the facility identified as not participating in any facility led activities. The facility census was 86. Residents Affected - Some Findings include: Review of personnel record for Interim AD #145, revealed the employee changed positions from that of Activity Assistant (AA) on 05/20/23 to the AD. Review of personnel record for AD #145 revealed employee did not meet the qualifications required of an AD. Interview on 08/09/23 at 9:35 A.M. of Interim AD #145 confirmed she was asked to fill in as Interim AD when the former AD left employment in May 2023. Interim AD #145 confirmed she did not meet the qualifications required of an AD. Interview on 08/10/23 at 1:43 P.M. with the Administrator confirmed the facility had not had a qualified AD since 05/22/23 Administrator confirmed AD #145 had worked as an AA and started as the facility AD on 05/23/23. Administrator confirmed AD #145 did not meet the qualifications to be an AD. Review of the job description titled Activities Director June 2019 revealed the AD would establish and activity program of a wide variety for the residents, enhancing the resident's wellness in harmony with the overall plan of care. The AD should have a bachelor's degree in therapeutic recreation or related field or completion of a 90-hour course for activity professionals and continuing education. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 17 of 36 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 365196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Healthcare Center 5501 Verulam Cincinnati, OH 45213 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. Based on record review, observation, and staff interview, the facility failed to ensure splints were applied as ordered. This affected one resident (#47) of two residents reviewed for splints/contracture management. The facility identified six residents with contractures. The facility census was 86. Findings include: Review of the medical record for Resident #47 revealed an admission date of 06/18/20 with diagnoses including cerebral infarction (stroke), hemiplegia and hemiparesis, hypertension (HTN), vascular dementia, and major depressive disorder. Review of occupational therapy (OT) discharge note for Resident #47 dated 07/31/21, revealed the resident had a goal to tolerate appropriate positioning device to the right upper extremity (RUE) to reduce further contracture and had progressed in therapy to tolerating eight hours of wearing time per day with no complaints of pain. Review of the physician's order for Resident #47 dated 12/06/21, revealed an order for resident to have RUE resting hand splint donned each day for three to four hours at a time in order to maintain range of motion (ROM) gains made following discharge from therapy services and continue to inhibit contracture formation overtime. Thorough skin integrity checks to be performed with donning/doffing. Review of the care plan for Resident #47 updated 11/01/22, revealed the resident was at neurological risk. Resident #47 had a cerebral vascular accident (CVA) affecting his right side with hemiplegia, communication (unclear speech, hypophonia), strength, balance. Goal was for resident to be free from signs and symptoms of complications of CVA including contractures. Interventions included the following: activity as tolerated, out of bed in chair if tolerated, give medications as ordered by the physician, monitor/document side effects and effectiveness, monitor/document mobility status, if resident is presenting with problems or paralysis, obtain order for physical therapy and occupational therapy to evaluate and treat, monitor/document residents abilities for activities of daily living (ADLs) and assist resident as needed, encourage resident to do what he/she is capable of doing for self, monitor/document/report as needed for neurological deficits: level of consciousness, visual function changes, aphasia, dizziness, weakness, restlessness, range of motion exercises several times a day. Review of the Minimum Data Set (MDS) assessment 3.0 for Resident #47 dated 07/13/23, revealed resident was cognitively impaired, required extensive assistance of one to two staff with ADLs, and had impaired range of motion to one side of the upper extremities. Review of the July and August 2023 Treatment Administration Record (TAR) for Resident #47, revealed the records did not include documentation regarding the use of the RUE splint for the resident. Observations of Resident #47 on 08/07/23 at 9:52 A.M. and 08/08/23 at 2:00 P.M. revealed the resident's right hand was contracted, and there was no splint in place. Interview on 08/08/23 at 2:00 P.M. with State Tested Nursing Assistant (STNA) #215 confirmed resident's right hand was contracted, he was not wearing splint, and she didn't think he had orders to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 18 of 36 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 365196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Healthcare Center 5501 Verulam Cincinnati, OH 45213 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 0688 wear a splint. Level of Harm - Minimal harm or potential for actual harm Observation of Resident #47 on 08/09/23 at 12:30 PM., revealed the resident was not wearing a splint. Residents Affected - Few Interview on 08/09/23 at 12:30 P.M. with STNA #445 confirmed Resident #47's right hand was very contracted and he was supposed to wear the splint for three to fours at a time throughout the day as tolerated. STNA #445 confirmed she had taken the splint off to give resident a shower and she forgot to put it back on. STNA #445 confirmed staff did not document donning or doffing of the splint. Observation of Resident #47 on 08/10/23 at 9:08 A.M. revealed the resident was wearing a right-hand splint and was tolerating it well. Interview on 08/10/23 at 9:08 A.M. with Licensed Practical Nurse (LPN) #230 confirmed Resident #47 had a contracture of his right hand and had orders to wear a splint for three to four hours at a time throughout the day. LPN #230 confirmed the facility did not document application of the splint and she was unsure how often he actually wore the splint. Interview on 08/10/23 at 9:20 A.M. with LPN #345 confirmed Resident #47 had a current active physician's order for the RUE splint but the facility was not documenting application of the splint, so she was unsure if the order was being followed or not. Interview on 08/10/23 at 3:00 P.M. with Regional Director of Clinical Operations (RDCO) #510 confirmed the facility did not have a policy regarding contracture management and/or the use of splints. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 19 of 36 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 365196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Healthcare Center 5501 Verulam Cincinnati, OH 45213 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. 2) Review of the medical record of Resident #48 revealed an admission date of 01/17/23. Diagnoses included paraplegia, moderate protein-calorie malnutrition, osteomyelitis of vertebra, sacral, and sacrococcygeal region, generalized anxiety disorder, schizophrenia, major depressive disorder, post-traumatic stress disorder, psychosis, and cachexia. Review of the 5-day MDS assessment 3.0 for Resident #48 dated 07/11/23 revealed the resident had intact cognition. The resident did not exhibit behaviors during the assessment period. The resident required extensive assistance of one for bed mobility, transfers, and toileting and was independent with eating. Review of the Fall Risk Observation assessment tool for Resident #48 dated 07/13/23, revealed the resident was at risk for falls. Review of the nursing progress note for Resident #48 dated 04/23/23 at 10:33 P.M., revealed the nurse was passing medications and heard the resident yelling out. Upon arrival to the room, the resident was lying on the floor next to the restroom door with the wheelchair next to him. The resident was assessed for injuries. The resident denied hitting his head. The resident's vital signs were obtained, the resident was assisted back to bed, and neurological assessments were initiated. Review of the documents supplied upon request (08/10/23) of the fall investigation dated 04/23/23, revealed neurological (neuro) checks and an incident checklist were completed. There was no additional information regarding a root-cause analysis nor circumstances of the fall. Review of a progress note dated 07/27/23 at 12:45 P.M. (a late entry dated 08/09/23, after a fall investigation had been requested) revealed a staff member reported the resident was lying on the ground in front of the building and the nurse went to assess. The resident stated part of his wheelchair was in the street and the other on the sidewalk. The resident was alert and oriented and denied hitting his head. The resident was assessed and assisted back into the wheelchair. While escorting the resident back into the building for further assessment, the resident appeared to roll his head. Vital signs were obtained, though the resident's blood pressure was unable to be obtained. The resident was assisted into bed. The Nurse Practitioner (NP) assessed the resident, and the resident was sent to the hospital for evaluation. Review of the NP progress note dated 07/27/23, revealed the resident was found outside on the ground after reportedly rolling off the curb and falling out of his motorized scooter. Per nursing staff, the resident was diaphoretic but alert and disoriented. The resident was taken back to his room where he became unresponsive with a pulse for approximately 2-3 minutes with cyanotic lips and hypotension. Emergency Medical Services (EMS) was called. The NP arrived to the room and the resident was starting to wake up and hit himself in the head with his right arm. The resident's behavior was erratic, and he could not stop talking to answer any of their questions. The resident denied the use of illicit drugs. EMS arrived and took the resident to the hospital for further evaluation. Review of the documents supplied upon request (08/10/23) of the fall investigation dated 07/27/23 revealed neuro checks and employee statements were completed. There was not additional information regarding a root-cause analysis nor circumstances of the fall. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 20 of 36 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 365196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Healthcare Center 5501 Verulam Cincinnati, OH 45213 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 08/10/23 at 2:45 P.M., RDCO #510 verified documents supplied were not indicative of a thorough fall investigation. RDCO #510 stated the information supplied to surveyors was all that was available. Review of the facility policy titled, Fall Prevention and Management, dated 06/01/22, revealed, following a fall, the resident should be assessed, an investigation should begin, a post-fall intervention implemented, family and physician should be notified, documentation completed, followed by an interdisciplinary team (IDT) review, in which all information regarding the fall is reviewed, and a root cause investigation discussed. A progress note of the discussion should be placed in the chart and the Interdisciplinary Team (IDT) should review Risk Watch to assure all information is complete and accurate. Based on record review, staff interviews, review of fall investigations, and policy review, the facility failed to conduct a thorough fall investigation. This affected two residents (#41 and #48) residents reviewed for falls. The facility census was 86. Findings include: 1) Review of the medical record for Resident #41 revealed an admission date of 05/21/23. Diagnoses included Guillian-Barre syndrome, atrial fibrillation, diabetes mellitus (DM), depression, chronic kidney disease, and hypertension. Review of the Quarterly Minimum Data Set (MDS) assessment 3.0 dated 07/17/23 revealed Resident #41 had intact cognition as evidenced by a Brief Interview for Mental Status (BIMS) score of 15. This resident was assessed to be independent with transfers, dressing, eating, toileting, and bathing. Review of the progress note dated 06/01/23 at 1:32 P.M. revealed Resident #41 had an unwitnessed fall in the shower room. Staff responded to a call light in the shower room where Resident #41 was lying on the floor complaining of right hip and head pain. An assessment was completed. Emergency services were called, and Resident #44 was transported to the hospital to be evaluated. Review of the progress note dated 06/21/23 at 10:27 P.M. revealed Resident #41 returned from the hospital with no new orders. Resident #41 was educated on calling for help when showering and to sit in shower seat while showering. Resident #41 voiced understanding. Review of the fall investigation date 06/21/23 for Resident #41 revealed the only documentation completed for the fall investigation were witness statements completed by two staff members. Interview on 08/10/23 at 2:45 P.M. with the Regional Director of Clinical Operations (RDCO) #510 verified the fall investigation for Resident #41 was incomplete and not a thorough investigation. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 21 of 36 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 365196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Healthcare Center 5501 Verulam Cincinnati, OH 45213 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Actual harm Based on record review, observation, resident interview, and staff interview, the facility failed to monitor and identify residents with weight loss and failed to ensure appropriate nutritional interventions were recommended and implemented to prevent severe weight loss. This resulted in Actual Harm when Resident #67, with a with a diagnosis of failure to thrive (FTT) and was at nutritional risk related to a body mass index (BMI) (A measure of body fat based on height and weight) of 19.5 was not weighed from 04/08/23 through 07/04/23. There was a lack of nutritional interventions and Resident #67's weight was not monitored while Resident #67 had decreased meal intakes from 04/08/23 to 07/04/23. Subsequently on 07/05/23, Resident #67's weight was obtained at 102.3 pounds which was a severe weight loss of 29.7 pounds or 22.5 percent (%). This affected one resident (#67) of four residents reviewed for nutrition. The facility census was 86. Residents Affected - Few Findings include: Review of the medical record for Resident #67 revealed an admission date of 01/04/22 with diagnoses including FTT, congestive heart failure (CHF), metabolic encephalopathy, osteomyelitis, chronic pulmonary edema, diabetes mellitus (DM), and atherosclerotic heart disease. Review of the weight record for Resident #67 dated 04/07/23, revealed the resident weighed 132 pounds. There was no documented evidence of any weights being recorded from 04/07/23 to 07/04/23. There were no notations of Resident #67 refusing to be weighed during this time. Review of a nutrition progress note for Resident #67 dated 04/27/23, revealed the resident's current body weight was 132 pounds and the resident's intakes had been low from 25 to 50 percent. There were no new diet recommendations. Review of the nutrition progress note for Resident #67 dated 05/26/23, revealed the resident's current body weight was 132 pounds based on the weight obtained on 04/07/23. There were no recommendations to prevent weight loss. Review of the care plan for Resident #67 updated 05/26/23, revealed the resident had the potential for altered nutrition status/nutrition related problems due to significant weight loss, chewing and swallowing issues including dysphagia and FTT. Interventions included the following: family providing additional food in room to assist resident in meeting calorie needs, identify resident food/ beverage preferences, monitor meal intake, notify medical provider and resident representative of unplanned significant weight changes, nutrition related medications per order, nutritional consult on admission, quarterly, and as needed, offer substitutions if provided meal is declined, provide meals per diet order, and obtain weight per facility order. There was no refusal of care plan related to weights. Review of the nutrition progress note for Resident #67 dated 06/22/23, revealed the resident's current body weight was 132 pounds based on the weight obtained on 04/07/23. There were no recommendations to prevent weight loss. Review of the weight record for Resident #67 dated 07/05/23, revealed the resident weighed 102.3 pounds which indicated a 29.7-pound weight loss (22.5 percent) since the last recorded weight on 04/07/23. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 22 of 36 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 365196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Healthcare Center 5501 Verulam Cincinnati, OH 45213 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0692 Level of Harm - Actual harm Review of the nutrition progress notes for Resident #67 dated 07/07/23 authored by Registered Dietitian (RD) #525, revealed the resident's weight on 07/05/23 was 102.3 pounds and the resident's BMI was 15.1 (underweight.) RD #525 made a recommendation for Ensure plus supplement twice daily to prevent further weight loss. Residents Affected - Few Review of the Minimum Data Set (MDS) assessment 3.0 for Resident #67 dated 07/12/23, revealed the resident was cognitively impaired and required supervision and set up help with eating. The resident was assessed as being 69 inches tall, 102 pounds and coded positive for unplanned weight loss. The resident was assessed as not rejecting any care. Observation of Resident #67 on 08/07/23 at 2:29 P.M., revealed the resident was very thin in appearance and was edentulous. Interview with Resident #67 on 08/07/23 at 2:29 P.M., revealed the resident confirmed he had lost weight recently. The resident confirmed he was not able to eat everything he wanted to eat due to being edentulous and he was awaiting new dentures. Interview with the Director of Nursing (DON) on 08/09/23 at 2:39 P.M., confirmed Resident #67 was edentulous and was awaiting dentures through the facility's dentist. The DON confirmed resident's weight was 132 pounds on 04/07/23. The DON further confirmed all residents should be weighed at least monthly unless there is an order to do otherwise. The DON confirmed the facility did not obtain a monthly weight for Resident #67 in May or June of 2023 and when he was weighed on 07/05/23 his weight was 102.3 pounds which showed a 29.7-pound weight loss. The DON confirmed the facility had no documentation regarding refusals of weight for Resident #67. The DON indicated the facility did not have a policy regarding weight loss or obtaining weights. The DON indicated the facility had no policy on weights or obtaining weights and /or weight loss. Review of email correspondences from the Regional Director of Clinical Operations (RDCO) #510 dated 08/15/23 at 9:40 A.M. and 08/16/23 at 7:02 A.M., indicated the facility did not have a weight loss policy. Interview with RD #525 on 08/10/23 at 11:10 A.M. confirmed the residents should be weighed upon admission, then weekly for four weeks, then monthly thereafter unless ordered more frequently. RD #525 confirmed Resident #67 was weighed on 04/07/23 at 132 pounds and was underweight. RD #525 confirmed the facility did not obtain weights for May and June 2023 and the previous RD based the resident's nutritional assessment on the weight obtained 04/07/23. RD #525 confirmed the facility did not implement interventions to prevent a severe weight loss of 22.5 percent for Resident #67 from 04/07/23 to 07/05/23. Review of the facilities undated timeline for Resident #67, revealed Resident #67 had a diagnosis of adult failure to thrive, CHF, convulsions, and Diabetes. A weight was recorded on 04/07/23 at 132.0 pounds. On 04/27/23, the Dietitian offered supplements and the resident refused. From 05/19/23 to 05/26/23, the resident was on an antibiotic and had decreased appetite. From 06/29/23 to 07/06/23, the resident was on an antibiotic and had a decreased appetite. On 07/05/23, the resident weighed 102.3 pounds and on 08/14/23, ensure for resident was increased to four times daily. The timeline revealed no documented evidence the resident refused to be weighed from 04/07/23 and 07/05/23. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 23 of 36 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 365196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Healthcare Center 5501 Verulam Cincinnati, OH 45213 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 0745 Provide medically-related social services to help each resident achieve the highest possible quality of life. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, resident interview, staff interview, review of the facility policy, and review of Social Worker (SW) job description, the facility failed to provide medically related social services including provision of written notification of Medicare non-coverage to residents, notification to the Ombudsman of resident transfers to the hospital, arrangement of care conferences, and arranging for the provision of dental services. This affected two residents (#48 and #65) of three residents reviewed for notice of Medicare non-coverage (NOMNC), two (Residents #48 and #88) of two residents reviewed for Ombudsman notification of resident transfers to the hospital, four (Residents #24, #41, #44, and #67) of four residents reviewed for care conference, and two (Residents #24 and #49) of four residents reviewed for dental services. The facility census was 86. Residents Affected - Some Findings include: 1) Review of the medical record for Resident #48 revealed an admission date of 01/17/23 with diagnoses including paraplegia and pyogenic arthritis. Review of the Minimum Data Set (MDS) assessment 3.0 for Resident #48 dated 07/11/23 revealed resident was cognitively intact and required extensive assistance with activities of daily living (ADLS.) Review of the form completed by the facility titled Skilled Nursing Facility (SNF) Beneficiary Notice Review revealed Resident #48 had Medicare Part A service episode starting on 06/13/23 and was discharged from Medicare Part A services on 07/25/23 with Medicare days remaining. Further review of the form revealed the facility did not provide Resident #48 with CMS Form 10055 nor with CMS Form 10123, NOMNC, due to the facility did not have a social worker. Review of the medical record for Resident #65 revealed an admission date of 04/13/23 with diagnoses including chronic kidney disease (CKD) depression, osteoarthritis, and hypothyroidism. Review of the MDS assessment for Resident #65 dated 06/30/23, revealed the resident was cognitively intact and required supervision with ADLs. Review of the form completed by the facility titled SNF Beneficiary Notice Review revealed Resident #48 had Medicare Part A service episode starting on 04/13/23 and was discharged from Medicare Part A services on 06/29/23 with Medicare days remaining. Further review of the form revealed the facility did not provide Resident #65 with CMS Form 10055 nor with CMS Form 10123, NOMNC, due to the facility not having a social worker. Interview on 08/09/23 at 9:08 A.M. with Resident #65 revealed resident was discharged from therapy and her Medicare part A services were stopped in June 2023 but she did not receive anything in writing. Resident #65 confirmed she believed she could have benefited from more therapy and wished she had been given the opportunity to appeal the decision. Interview on 08/10/23 at 1:43 P.M. with the Administrator, confirmed Residents #48 and #65 did not receive required notices regarding Medicare non-coverage due to the facility not having a social worker to perform the task. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 24 of 36 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 365196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Healthcare Center 5501 Verulam Cincinnati, OH 45213 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 0745 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 2) Review of the medical record of Resident #48 revealed an admission date of 01/17/23. Diagnoses included paraplegia, moderate protein-calorie malnutrition, osteomyelitis of vertebra, sacral, and sacrococcygeal region, generalized anxiety disorder, schizophrenia, major depressive d/o, post-traumatic stress disorder, psychosis, and cachexia. Review of the 5-day MDS assessment 3.0 dated 07/11/23 revealed the resident had intact cognition. The resident did not exhibit behaviors during the assessment period. The resident required extensive assistance of one for bed mobility, transfers, and toileting and was independent with eating. Review of the medical record for Resident #48 revealed the resident discharged to the hospital on [DATE] and readmitted to the facility on [DATE]. There was no documentation to indicate the ombudsman was notified of the resident's discharge. Interview on 08/10/23 at 9:19 A.M., Regional Director of Clinical Operations (RDCO) #510 verified the ombudsman was not notified of Resident #48's transfer to the hospital and stated the notification was not completed because the facility did not have a social worker. Review of the medical record for Resident #88 revealed an admission date of 03/21/23 and a discharge date of 07/05/23. Diagnoses included chronic viral hepatitis-C, Chronic Obstructive Pulmonary Disease (COPD), panic disorder, altered mental status, and opioid dependence. Review of the MDS assessment 3.0 for Resident #88 dated 06/22/23 revealed the resident had intact cognition as evidenced by a Brief Interview for Mental Status (BIMS) score of 13. This resident was assessed to require one-person limited assistance with transfers, independent with dressing, eating, toileting, and supervision with bathing. Review of the transfer form for Resident #88 dated 06/30/23, revealed the resident went out to the hospital per a change in condition. Review of the medical record for Resident #88 revealed there was no documentation for a notification of the Ombudsmen related to the hospitalization. Interview on 08/09/23 04:02 PM with RDCO #510 verified there was no documentation regarding notification of the Ombudsman related to Resident #88's hospitalization because the facility did not have a social worker. 3) Review of the medical record for Resident #24 revealed an admission date of 05/18/19 with diagnoses including chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM), atherosclerotic heart disease, atrial fibrillation, anxiety disorder, polyosteoarthritis, hyperlipidemia, and hypertension (HTN.) Review of the Minimum Data Set (MDS) for Resident #24 dated 06/04/23 revealed resident was cognitively impaired and required extensive assistance of one staff with ADLs. Review of the medical record for Resident #24 revealed it did not include documentation of care conferences for resident from August 2022 to August 2023. Interview on 08/07/23 at 11:29 A.M. of Resident #24 confirmed the facility did not offer regular care conferences for her to offer input and discussion of her plan of care. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 25 of 36 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 365196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Healthcare Center 5501 Verulam Cincinnati, OH 45213 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 0745 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Interview on 08/09/23 at 2:00 P.M. with Registered Nurse (RN) #510 confirmed the facility had not held care conferences for Resident #24 from August 2022 to August 2023. Review of the medical record for Resident #44 revealed an admission date of 11/29/22 with diagnoses including cerebral infarction, hemiplegia, and hemiparesis, right and left above the knee amputation, and atherosclerotic heart disease. Review of the MDS for Resident #44 dated 04/26/23 revealed resident was cognitively intact and required supervision with ADLs. Review of the medical record for Resident #44 revealed it did not include documentation of care conferences for resident from November 2022 to August 2023. Interview on 08/08/23 at 8:53 A.M. with Resident #44 confirmed he had never been invited to a care conference since his admission to the facility and he knew the facility was supposed to have regular conferences so he could discuss his care concerns. Interview on 08/09/23 at 2:00 P.M. with RDCO #510 confirmed the facility had not held care conferences for Resident #44 from November 2022 to August 2023. Review of the medical record for Resident #67 revealed an admission date of 01/04/22 with diagnoses including metabolic encephalopathy, osteomyelitis, chronic pulmonary edema, DM, atherosclerotic heart disease, congestive heart failure, and adult failure to thrive. Review of the MDS for Resident #67 dated 07/12/23 revealed resident was cognitively impaired and required extensive assistance of one to two staff with ADLs. Review of the medical record for Resident #67 revealed it did not include documentation of care conferences for resident from August 2022 to August 2023. Interview on 08/07/23 at 2:30 P.M. with Resident #67 confirmed he did not recall having a care conference since his admission to the facility. Interview on 08/09/23 at 2:00 P.M. with RDCO #510 confirmed the facility had not held care conferences for Resident #67 from August 2022 to August 2023. RDCO #510 further confirmed care conferences should be held upon admission, quarterly, with a significant change in resident status, and upon resident/resident representative request. Review of the medical record for Resident #41 revealed an admission date of 05/21/23. Diagnoses included Guillian-Barre syndrome, atrial fibrillation, DM, depression, chronic kidney disease, and hypertension. Review of the MDS assessment 3.0 dated 07/17/23 revealed Resident #41 had intact cognition. This resident was assessed to require independent with transfers, dressing, eating, toileting, and bathing. Review of the medical record for Resident #41 for care conferences revealed there was no documentation of care conferences provided by the facility. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 26 of 36 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 365196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Healthcare Center 5501 Verulam Cincinnati, OH 45213 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 0745 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Interview on 08/09/23 at 2:02 P.M. with RDCO #510 confirmed there were no care conferences or documentation to confirm Resident #41 had a care conference completed since admission. Interview on 08/10/23 at 1:43 P.M. with the Administrator confirmed the facility had not arranged care conferences as required (upon admission, quarterly, significant change, and resident/representative request) because they did not have a social worker. 4) Review of the medical record for Resident #24 revealed an admission date of 05/18/19 with diagnoses including chronic obstructive pulmonary disease, DM, atherosclerotic heart disease, atrial fibrillation, anxiety disorder, polyosteoarthritis, hyperlipidemia, and hypertension. Review of the MDS for Resident #24 dated 06/04/23 revealed resident was cognitively impaired and required extensive assistance of one staff with ADLs. Review of physician's orders for Resident #24 revealed an order dated 05/17/19 for resident to be seen by the dentist. Review of the care plan for Resident #24 updated 11/01/22, revealed the resident was at risk for oral/dental health problems and needed assistance and set up for oral care. The resident was edentulous and wanted full upper and lower dentures because she had trouble chewing. Interventions included the following: diet as ordered, consult with dietitian and change if chewing/swallowing problems are noted, monitor for any difficulties with chewing/swallowing, monitor for proper fit and placement of dentures, use denture adhesive as needed, monitor/document/report as needed any signs and symptoms of oral/dental problems needing attention, offer and encourage fluids, set up/assist with oral/dentures care as needed due to no natural teeth. Review of dentist visit note for Resident #24 dated 11/16/22, revealed the resident was examined and was noted to be edentulous and denied mouth pain. The note did not include documentation regarding any dentures. Review of the annual MDS for Resident #24 dated 03/04/23, revealed the resident was assessed as being edentulous. Further review of the MDS 06/04/23 revealed the resident was cognitively impaired and required extensive assistance of one staff with activities of daily living (ADLs.) Observation of Resident #24 on 08/07/23 at 11:29 A.M., revealed the resident was edentulous. Interview with Resident #24 on 08/07/23 at 11:29 A.M. confirmed the resident did not have teeth and had never been offered dentures. Resident #24 confirmed she did not remember being seen by the facility dentist and she would like to have dentures. Interview on 08/09/23 at 2:00 P.M. with RDCO #510 confirmed Resident #24 was edentulous and wanted to receive dentures. RDCO #510 confirmed Resident #24 was last seen by the facility dentist on 11/16/22 and the dentist's note did not include documentation regarding dentures for resident. RDCO #510 confirmed she was unsure why dentist note did not include documentation regarding dentures. Interview on 08/10/23 at 10:55 A.M. of RDCO #510 confirmed she called the dentist and asked why the dentist note for Resident #24 dated 11/16/22 did not include documentation regarding dentures. RDCO #510 confirmed the dentist said the resident never requested dentures, so he did not offer them. RDCO #510 confirmed Resident #24 was cognitively impaired and the facility social worker was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 27 of 36 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 365196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Healthcare Center 5501 Verulam Cincinnati, OH 45213 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 0745 responsible for coordinating care with the dentist. Level of Harm - Minimal harm or potential for actual harm Review of the medical record for Resident #49 revealed an admission date of 05/20/22 with diagnoses including cerebral infarction, viral hepatitis, chronic obstructive pulmonary disease, DM, hypertension, and depression. Residents Affected - Some Review of the care plan for Resident #49 dated 05/26/22 revealed resident had oral/dental problems related to resident was edentulous. Interventions included the following: dental consult as needed, observe for signs and symptoms of infection: abscess, swelling, fever, pain, redness, observe for weight loss secondary to dental issues. Review of the MDS for Resident #49 dated 05/26/23 revealed the resident was cognitively intact and was independent with activities of daily living ADLs. Review of the medical record for Resident #49 revealed it did not include documentation of dental visits for resident. Interview on 08/10/23 at 2:00 P.M. with the Administrator confirmed Resident #49 was edentulous and was admitted without dentures. Administrator confirmed Resident #49 was not seen by the facility dentist or any dentist during his stay at the facility. Review of the facility policy titled Dental Services undated revealed the facility would assist the resident in obtaining routine dental services and obtaining services to meet the needs of each resident. Review of the job description titled Social Services Director dated June 2019 revealed the position of Social Service Director provides planning, assessing, coordinating and implementation of services to enhance each resident's social and psychosocial well-being and assure that care standards are met, and the highest degree of quality resident care is provided at all times. The position must function as both a team member, team leader, and supervisor to ensure that work is accomplished, and quality care is delivered, supporting team members, and leading the way in celebrating team successes. While focusing on delivering quality care, the position must also manage the resources within their control and assist others in managing resources. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 28 of 36 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 365196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Healthcare Center 5501 Verulam Cincinnati, OH 45213 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. Based on record review, interviews, and policy review, the facility failed to have medications available for medication administration of scheduled medications. This affected one resident (#41) of the five residents reviewed for unnecessary medications. The facility census was 86. Findings include: Review of the medical record for Resident #41 revealed an admission date of 05/21/23. Diagnoses included Guillian-Barre syndrome, atrial fibrillation, type two diabetes mellitus (DM II), depression, chronic kidney disease, and hypertension. Review of the Quarterly Minimum Data Set (MDS) assessment 3.0 dated 07/17/23 revealed Resident #41 had intact cognition as evidenced by a Brief Interview for Mental Status (BIMS) score of 15. This resident was assessed to require independent with transfers, dressing, eating, toileting, and bathing. Review of the physician order dated 05/21/23 revealed Resident #41 was ordered Lyrica oral capsule 100 milligrams (mg), give one capsule by mouth every eight hours for pain. Review of the progress note dated 07/19/23 at 1:39 A.M. revealed Lyrica was not administered to Resident #41 related to pending pharmacy delivery. Review of the progress note dated 07/20/23 at 3:02 P.M. revealed Lyrica was not administered to Resident #41 related to pending pharmacy delivery. Review of the progress note dated 07/21/23 at 5:39 A.M. revealed Lyrica was not administered to Resident #41 related to pending pharmacy delivery. Review of the progress note dated 08/05/23 at 1:31 P.M. revealed Lyrica was not administered to Resident #41 related to pending delivery. Review of the progress note dated 08/07/23 at 1:52 P.M. revealed Lyrica was not administered to Resident #41 related to medication not available. Review of the medication administration record (MAR) dated July 2023 revealed Resident #41 did not receive Lyrica 100 mg capsule for five doses related to the medication was not available. Review of the medication administration record (MAR) dated August 2023 revealed Resident #41 did not receive Lyrica 100 mg capsule for six doses related to the medication was not available. Review of the controlled substance logs (daily log and accountability for narcotic administration) for Resident #41's Lyrica 100 mg medication revealed the facility did not have the documentation from 07/16/23 through 08/07/23 regarding the medication administration. Interview on 08/10/23 at 9:47 A.M. with Resident #41 revealed he had missed doses of Lyrica related to the facility not having the medication. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 29 of 36 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 365196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Healthcare Center 5501 Verulam Cincinnati, OH 45213 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 Review of an undated facility policy titled Medication Administration revealed the facility would provide resident centered care that meets the psychosocial, physical, and emotional needs and concerns of the residents and the facility would administer medications as ordered by the provider. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 30 of 36 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 365196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Healthcare Center 5501 Verulam Cincinnati, OH 45213 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 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm Based on medical record review, staff interview, and review of the facility policy, the facility failed to ensure residents were free from significant medication errors. This affected one resident (#27) of five residents reviewed for unnecessary medications. The facility census was 86. Residents Affected - Few Findings include: Review of the medical record of Resident #27 revealed an admission date of 03/22/23. Diagnoses included cerebral infarction, hemiplegia and hemiparesis, atrial fibrillation, essential hypertension (HTN), oropharyngeal dysphagia, and depression. Review of the quarterly Minimum Data Set (MDS) assessment 3.0 for Resident #27 dated 07/05/23, revealed the resident had intact cognition. The resident was not assessed as having any behaviors during the assessment period. The resident was independent with bed mobility and required supervision for transfers, eating, and toileting. Review of the physician orders for Resident #27 dated 03/23/23, revealed the resident was ordered to receive Metoprolol tartrate oral tablet 100 milligram (mg) tablet every morning (9:00 A.M.) and at bedtime (9:00 P.M.) for HTN, and hold for SBP (systolic blood pressure) less than 120 or heart rate less than 60 (normal 60-100). Review of the July 2023 medication administration record (MAR) revealed, on 07/21/23 at the 9:00 P.M. administration time, Resident #27 had a documented blood pressure of 117/68 and heart rate of 55. The Metoprolol Tartrate 100 mg was documented as being administered. On 07/23/23 at the 9:00 A.M. administration time, Resident #27 had a documented blood pressure of 118/68 and Metoprolol Tartrate 100 mg was documented as being administered. On 07/28/23 at the 9:00 P.M. administration time, Resident #27 had a documented blood pressure of 114/71, and the Metoprolol Tartrate was documented as being administered. Interview on 08/10/23 at 11:05 A.M., Regional Director of Clinical Operations (RDCO) #510 verified Resident #27 was documented as receiving Metoprolol Tartrate despite blood pressure and/or heart rate being outside of the parameters on 07/21/23, 07/23/23, and 07/28/23. Review of the facility policy titled, Medication Administration, undated, revealed medications will be administered only as prescribed by the provider. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 31 of 36 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 365196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Healthcare Center 5501 Verulam Cincinnati, OH 45213 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, resident interview, staff interview, and review of the facility policy, the facility failed to arrange for resident dental services. This affected two residents (#24 and #49) of six residents reviewed for dental services. The facility census was 89. Residents Affected - Few Findings include: 1) Review of the medical record for Resident #24 revealed an admission date of 05/18/19 with diagnoses including chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM), atherosclerotic heart disease, atrial fibrillation, anxiety disorder, polyosteoarthritis, hyperlipidemia, and hypertension (HTN.) Review of the Minimum Data Set (MDS) assessment 3.0 for Resident #24 dated 06/04/23, revealed the resident was cognitively impaired and required extensive assistance of one staff with activities of daily living (ADLs.) Review of physician's orders for Resident #24, revealed an order dated 05/17/19 for resident to be seen by the dentist. Review of the care plan for Resident #24 updated 11/01/22, revealed the resident was at risk for oral/dental health problems and needed assistance and set up for oral care. The resident was edentulous (without teeth) and wanted full upper and lower dentures because she had trouble chewing. Interventions included the following: diet as ordered, consult with dietitian and change if chewing/swallowing problems are noted, monitor for any difficulties with chewing/swallowing, monitor for proper fit and placement of dentures, use denture adhesive as needed, monitor/document/report as needed any signs and symptoms of oral/dental problems needing attention, offer and encourage fluids, and set up/assist with oral/dentures care as needed due to no natural teeth. Review of the dentist visit note for Resident #24 dated 11/16/22, revealed resident was examined and was noted to be edentulous and denied mouth pain. The note did not include documentation regarding dentures. Review of the annual Minimum Data Set (MDS) for Resident #24 dated 03/04/23 revealed resident was coded as being edentulous. Review of the MDS dated [DATE] revealed resident was cognitively impaired and required extensive assistance of one staff with activities of daily living (ADLs.) Observation of Resident #24 on 08/07/23 at 11:29 A.M. revealed the resident was edentulous. Interview with Resident #24 on 08/07/23 at 11:29 A.M. confirmed the resident did not have teeth and had never been offered dentures. Resident #24 confirmed she did not remember being seen by the facility dentist and she would like to have dentures. Interview on 08/09/23 at 2:00 P.M. with Regional Director of Clinical Operations (RDCO) #510 confirmed Resident #24 was edentulous and wanted to receive dentures. RDCO #510 confirmed Resident #24 was last seen by the facility dentist on 11/16/22 and the dentist's note did not include documentation regarding dentures for resident. RDCO #510 confirmed she was unsure why dentist note did not include documentation regarding dentures. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 32 of 36 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 365196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Healthcare Center 5501 Verulam Cincinnati, OH 45213 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 Interview on 08/10/23 at 10:55 A.M. of RDCO #510 confirmed she called the dentist and asked why the dentist note for Resident #24 dated 11/16/22 did not include documentation regarding dentures. RDCO #510 confirmed the dentist said resident never requested dentures, so he did not offer them. RDCO #510 confirmed Resident #24 was cognitively impaired and the facility social worker was responsible for coordinating care with the dentist. Residents Affected - Few 2) Review of the medical record for Resident #49 revealed an admission date of 05/20/22 with diagnoses including cerebral infarction, viral hepatitis, COPD, DM, HTN, and depression. Review of the care plan for Resident #49 dated 05/26/22 revealed the resident had oral/dental problems related to the resident being edentulous. Interventions included the following: dental consult as needed, observe for signs and symptoms of infection: abscess, swelling, fever, pain, redness, observe for weight loss secondary to dental issues. Review of the MDS for Resident #49 dated 05/26/23 revealed the resident was cognitively intact and was independent with activities of daily living ADLs. Review of the medical record for Resident #49 revealed it did not include documentation of dental visits for resident. Interview on 08/10/23 at 2:00 P.M. with the Administrator confirmed Resident #49 was edentulous and was admitted without dentures. The Administrator confirmed Resident #49 was not seen by the facility dentist or any dentist during his stay at the facility. Review of the facility policy titled Dental Services undated revealed the facility would assist the resident in obtaining routine dental services and obtaining services to meet the needs of each resident. This deficiency represents non-compliance investigated under Complaint Number OH00144856. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 33 of 36 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 365196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Healthcare Center 5501 Verulam Cincinnati, OH 45213 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 - Few 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** Based on record review, staff interviews, and policy review, the facility failed to provide double portions as ordered. This affected one resident (#81) of the 22 residents reviewed for diet orders. The facility census was 86. Findings include: Review of the medical record for Resident #81 revealed an admission date of 04/07/23. Diagnoses included displaced intertrochanteric fracture of left femur, DM II, major depressive disorder, osteomyelitis, and HTN. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] Resident #81 had intact cognition as evidenced by a Brief Interview for Mental Status (BIMS) score of 14. This resident was assessed to require supervision with transfers, dressing, eating, toileting, and bathing. Review of the care plan dated 04/26/23 revealed Resident #81 had diabetes and was insulin dependent. Interventions included to administer insulin injections per orders and rotate sites. Staff to administer medications per physician orders. Staff to offer bedtime snacks. Staff to provide diet as ordered and offer substitutes per preference. Review of the physician order dated 07/18/23 revealed Resident #81 was ordered a regular diet, dysphagia advance texture, thin liquids consistency, and double portions. Observation on 08/09/23 at 1:45 P.M. of lunch tray served to Resident #81, which revealed Resident #81 did not receive double portions. Interview on 08/09/23 at 1:48 P.M. with State Tested Nurse's Aide (STNA) #470 verified Resident #81 did not receive double portions for lunch. Interview on 08/09/23 at 3:31 P.M. with Culinary Director #285 verified Resident #81 was to receive double portions for all meals. Culinary Director #285 confirmed Resident #81 should have received a double portion of ravioli and four pieces of garlic bread, which he did not. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 34 of 36 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 365196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Healthcare Center 5501 Verulam Cincinnati, OH 45213 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, staff interview, and policy review, the facility failed to ensure foods were stored in a manner to prevent the potential spread of foodborne illness. This had the potential to affect all 86 residents in the facility. Findings include: Observation on 08/07/23 at 9:25 A.M. of the facility's walk-in cooler revealed two unlabeled metal pans covered in foil. Culinary Director (CD) #285 present at the time of the observation and identified one pan as pureed eggs and the other as pureed sausage. CD #285 verified neither pan was labeled or dated and stated all foods should be labeled and dated. Observation on 08/07/23 at 9:27 A.M. of the facility's walk-in freezer revealed the following: a. Two boxes of shakes stored directly on the floor. b. A bag of corn open and not sealed nor dated. c. A bag of hamburger patties open and not sealed nor dated. d. A bag of cheese omelets open and not sealed nor dated. e. A plastic pitcher of unidentifiable yellow frozen substance without a label nor date. Interview at the time of the observations, CD #285 verified the two boxes of shakes stored directly on the floor and affirmed no food should ever be stored directly on the floor, the open and unlabeled bags of corn, hamburger patties, and cheese omelets, and the plastic pitcher of an unidentifiable yellow frozen substance without a label or date. CD #285 stated all opened foods should be labeled and dated and further stated she was unsure what the yellow frozen substance was. Review of the facility policy titled, Food Storage: Cold Foods, dated 04/2018, revealed all food items will be stored six inches above the floor and all foods will be stored wrapped or in covered containers, labeled, and dated. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 35 of 36 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 365196 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Ridge Healthcare Center 5501 Verulam Cincinnati, OH 45213 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interviews, and policy review, the facility failed to maintain a controlled substance record. This affected one resident (#41) reviewed for medication administration. The facility census was 86. Findings include: Review of the medical record for Resident #41 revealed an admission date of 05/21/23. Diagnoses included Guillian-Barre syndrome, atrial fibrillation, type two diabetes mellitus (DM II), depression, chronic kidney disease, and hypertension. Review of the Quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #41 had intact cognition as evidenced by a Brief Interview for Mental Status (BIMS) score of 15. This resident was assessed to require independent with transfers, dressing, eating, toileting, and bathing. Review of the physician order dated 05/21/23 revealed Resident #41 was ordered Lyrica oral capsule 100 milligrams (mg), give one capsule by mouth every eight hours for pain. Review of the medication administration record (MAR) dated July 2023 revealed Resident #41 did not receive Lyrica 100 mg capsule for five doses related to the medication was not available. Review of the medication administration record (MAR) dated August 2023 revealed Resident #41 did not receive Lyrica 100 mg capsule for six doses related to the medication was not available. Review of the controlled substance logs (daily log and accountability for narcotic administration) for Resident #41's Lyrica 100 mg medication revealed the facility did not have the documentation from 07/16/23 through 08/07/23 regarding the medication administration. Interview on 08/10/23 at 3:04 P.M. with Regional Director of Clinical Operations (RDCO) #510 verified the facility could not provide controlled substance record to verify if Resident #41 had received his prescribed medications as ordered. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 36 of 36

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Citations

39 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.

0692SeriousS&S Gactual harm
F692 - Assisted nutrition and hydration
Provide enough food/fluids to maintain a resident's health.
0745GeneralS&S Epotential for harm
F745 - The facility must provide medically-related social services to attain or
Provide medically-related social services to help each resident achieve the highest possible quality of life.
0760GeneralS&S Dpotential for harm
F760 - Residents are free of any significant medication errors
Ensure that residents are free from significant medication errors.
0561GeneralS&S Dpotential for harm
F561 - Self-determination
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
0578GeneralS&S Dpotential for harm
F578 - The right to request, refuse, and/or discontinue treatment, to participate in or
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
0582GeneralS&S Dpotential for harm
F582 - The facility must—
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
0623GeneralS&S Dpotential for harm
F623 - Transfer and discharge-
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
0644GeneralS&S Dpotential for harm
F644 - Coordination
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
0655GeneralS&S Epotential for harm
F655 - Comprehensive Person-Centered Care Planning
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
0656GeneralS&S Dpotential for harm
F656 - Comprehensive Care Plans
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
0657GeneralS&S Epotential 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.
0661GeneralS&S Dpotential for harm
F661 - Quality of life
Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge.
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.
0680GeneralS&S Epotential for harm
F680 - The activities program must be directed by a qualified professional
Ensure the activities program is directed by a qualified professional.
0688GeneralS&S Dpotential for harm
F688 - Mobility
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
0689GeneralS&S Dpotential for harm
F689 - Accidents
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
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 Dpotential 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.
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.
0842GeneralS&S Dpotential for harm
F842 - Resident-identifiable information
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
0791GeneralS&S Dpotential for harm
F791 - Dental Services
Provide or obtain dental services for each resident.
0039GeneralS&S Cno actual harm
Conduct testing and exercise requirements.
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.
0223GeneralS&S Epotential for harm
Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector.
0271GeneralS&S Epotential for harm
Have exits that are accessible at all times.
0291GeneralS&S Fpotential for harm
Install emergency lighting that can last at least 1 1/2 hours.
0321GeneralS&S Epotential for harm
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
0324GeneralS&S Epotential for harm
Provide properly protected cooking facilities.
0344GeneralS&S Epotential for harm
Have an alternate power supply for its alarm system.
0345GeneralS&S Fpotential for harm
Have approved installation, maintenance and testing program for fire alarm systems.
0346GeneralS&S Fpotential for harm
Follow proper procedures when the fire alarm was out of service for more than 4 hours.
0351GeneralS&S Fpotential for harm
Install an approved automatic sprinkler system.
0353GeneralS&S Fpotential for harm
Inspect, test, and maintain automatic sprinkler systems.
0354GeneralS&S Fpotential for harm
Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours.
0511GeneralS&S Epotential for harm
Have properly installed electrical wiring and gas equipment.
0712GeneralS&S Fpotential for harm
F712 - Frequency of physician visits
Have simulated fire drills held at unexpected times.
0741GeneralS&S Epotential for harm
F741 - The facility must have sufficient staff who provide direct services to
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
0914GeneralS&S Fpotential for harm
F914 - Be designed or equipped to assure full visual privacy for each
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.
0918GeneralS&S Fpotential for harm
F918 - Bathroom Facilities
Have generator or other power source capable of supplying service within 10 seconds.

FAQ · About this visit

Common questions about this visit

What happened during the August 16, 2023 survey of PLEASANT RIDGE HEALTHCARE CENTER?

This was a inspection survey of PLEASANT RIDGE HEALTHCARE CENTER on August 16, 2023. The surveyor cited 39 deficiencies, recorded on the federal Form 2567 statement of deficiencies.

Were any deficiencies cited at PLEASANT RIDGE HEALTHCARE CENTER on August 16, 2023?

Yes, 39 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Provide enough food/fluids to maintain a resident's health."

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·August 16, 2023