Inspection·May 30, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 05/29/25 at 3:36 P.M., with the Executive Director (ED) stated the temperatures in the facility were a high priority. The ED stated when there were complaints of AC units were not working; the facility ensured the residents were comfortable and offered a fan or room change until the AC unit could be repaired or replaced. Review of the undated policy titled, Resident Rights, indicated it is the policy of this facility to provide resident centered care that meets the psychosocial, physical and emotional needs and concerns of the residents. This deficiency represents noncompliance investigated under Complaint Number OH00164412. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 2 of 6 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 05/30/2025 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, and policy review, the facility failed to identify a potential elopement and take action for finding a resident, when a resident's empty wheelchair was found on the facility curb in the rain. This affected one (#34) of one resident reviewed for potential elopement. The facility census was 82. Findings included: Review of the medical record revealed Resident #34 was admitted on [DATE] with diagnoses including peripheral vascular disease, manic depression, and psychotic disorder. Review of the discharge Minimum Data Set (MDS) assessment, dated 09/09/24, revealed Resident #34 had independent cognitive skills for daily decision-making and had no short-term memory problems per a staff assessment of mental status (SAMS). The MDS indicated the resident utilized a manual wheelchair for mobility and independently mobilized the wheelchair 150 feet in a corridor or similar space. Review of the quarterly MDS, dated [DATE], revealed Resident #34 had a Brief Interview for Mental Status (BIMS) score of 14, which indicated the resident had intact cognition. The MDS indicated the resident utilized a wheelchair for mobility and required staff assistance to mobilize the wheelchair 150 feet in a corridor or similar space. Review of Resident #34's Care Plan Report included a focus area, revised on 12/12/24, that indicated the resident was known to leave the building without signing out despite provided education. Interventions directed staff to encourage the resident to maintain as much independence and control/decision making as possible and praise any indication of progress with behaviors. Review of nursing Progress Note, dated 09/30/24 at 7:05 PM, revealed Resident #34 left the facility without notifying staff or signing out at approximately 2:45 P.M. that day. Per the note, the resident's (empty) wheelchair was discovered on a facility curb while it was raining outside. The note indicated staff brought the wheelchair inside the facility and notified the Executive Director (ED) and Resident #34's guardian. Per the note, the resident returned to the facility that day at 6:25 P.M. as a passenger in another resident's vehicle. The note revealed staff notified the driving resident of the dangers of having other residents in the vehicle with them. The note indicated staff assisted Resident #34 out of the vehicle and into the facility. Per the note, Resident #34 refused an assessment of their vital signs and expressed a desire to leave the facility again to see a family member. Review of physician Progress Note, dated 09/30/24 at 7:00 P.M., revealed a physician was notified that Resident #34 left the facility without signing out or notifying anyone and returned with no apparent injuries. The Progress Note further indicated the facility ED was aware. Interview on 05/28/25 at 1:02 P.M., with Certified Nurse Aide (CNA) #10 stated they had not previously known Resident #34 to leave the facility without notification. CNA #10 stated if a resident was not in their room, they would notify the nurse and then begin looking for the resident in the facility. CNA #10 stated residents were to sign out when they left the building. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 3 of 6 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 05/30/2025 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 05/28/25 at 1:15 P.M., with Licensed Practical Nurse (LPN) #11 stated if they identified a resident who was missing, they would search the building grounds and call the ED and the Director of Nursing. LPN #11 stated they would also check to see if the resident had signed out. Interview on 05/28/25 at 3:42 P.M., with the ED stated she remembered calling Resident #34's guardian after the incident wherein the resident did not notify staff they were leaving the facility. The ED stated they reminded Resident #34 to sign out before and after the incident in question. The ED stated that, on the day of the incident in question, it was raining outside, and staff identified a wheelchair belonging to Resident #34 was on the curb of the property. The ED stated Resident #34 was unable to walk. The ED stated she expected a resident to sign out if leaving the facility and, if a resident was unaccounted for, she expected the elopement process to be initiated. Interview on 05/30/25 at 12:29 P.M., with the ED stated she expected residents to sign out if they were leaving the property and for the facility to have no elopements. Review of the undated policy titled Elopement Prevention and Management Overview, indicated, Elopement is defined as when a resident/patient leaves the premises or a safe area without authorization and/or any necessary supervision and places the resident at risk for harm or injury. A situation in which a resident with decision-making capacity leaves the facility intentionally would generally not be considered an elopement unless the facility is unaware of the resident's departure and/or whereabouts. This deficiency represents non-compliance investigated under Complaint Number OH00164628. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 4 of 6 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 05/30/2025 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 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, resident interview, staff interview, record review, and policy review, the facility failed to ensure there was ongoing communication and collaboration with the dialysis center regarding dialysis care and service. This affected one (#37) of one sampled resident reviewed for dialysis. The facility census was 82. Residents Affected - Few Findings included: Review of the admission record revealed Resident #37 was admitted on [DATE], with diagnosis including end stage renal disease (ESRD). Review of the admission Minimum Data Set (MDS) assessment, with an Assessment Reference Date (ARD) of 02/23/25, revealed Resident #37 had a Brief Interview for Mental Status (BIMS) score of 13, which indicated the resident had intact cognition. Review of Resident #37's Care Plan Report, included a focus area revised 04/28/25, that indicated the resident received dialysis therapy related to ESRD by way of a port/catheter in their right upper chest wall. Interventions directed staff to communicate with the dialysis center regarding medications, vital signs, weights, any restrictions, diet orders, nutritional/fluid needs, laboratory results, and who to notify with concerns; coordinate resident's care in collaboration with dialysis center (initiated 04/01/25); evaluate resident following dialysis treatment and report abnormal findings to medical provider, nephrologist/dialysis center, and resident/resident representative (initiated 04/01/25). Interview on 05/28/25 at 9:34 A.M., with Registered Nurse (RN) #5 stated they only sent a resident's face sheet to dialysis with a resident. Per RN #5, the dialysis center called when a resident was sent to the emergency department or if they had any problems. Observation on 05/28/25 at 2:27 P.M., revealed Resident #37 returned from dialysis with no papers or forms. Observation on 05/28/25 at 2:29 P.M., revealed RN #4 provided Resident #37's medication and obtained their blood pressure. No papers or forms were provided by the resident to the staff from dialysis. Interview on 05/28/25 at 2:49 P.M., with Resident #37 stated they had not taken or returned with information, written or verbal, for communication between the facility and the dialysis center. Interview on 05/29/25 at 11:29 A.M., with the Director of Nursing (DON) stated the facility will call the dialysis center for any concerns. The DON denied having any type of formal communication with the dialysis center regarding pre and post dialysis treatment. The DON said she expected nursing staff to assess the fistula site or central venous catheter (CVC) site upon the resident's return and complete the pre- and post-dialysis assessments in the electronic medical record (EMR). Interview on 05/29/25 at 11:39 A.M., with the Executive Director stated they relied on clinical staff regarding dialysis care and services but expected that the policy be followed. Review of the undated policy titled, Hemodialysis Care and Monitoring, revealed the section titled, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365196 If continuation sheet Page 5 of 6 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 05/30/2025 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 0698 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete XI. Shared Communication, included, b. The care of the residents receiving dialysis services will include ongoing communication, coordination and collaboration between the dialysis center and the facility that may include but is not limited to i. Telephonic communication ii. Providing pre and post documentation of resident assessment to evaluate the resident response to dialysis and update care plan in collaboration with dialysis recommendations. The policy revealed, c. The facility will provide a copy of the current MAR [medication administration record], and the pre-evaluation for dialysis from the electronic medical record to the dialysis center. Event ID: Facility ID: 365196 If continuation sheet Page 6 of 6