Health inspection·July 1, 2025

F 0579 Provide information about how to apply for and use Medicare and Medicaid benefits. Level of Harm - Minimal harm or potential for actual harm Based on medical record review, staff interview, resident interview, and review of the facility policy, the facility failed to provide residents with information regarding how to apply for Medicaid benefits. This affected one (Resident #53) of two residents reviewed for discharge. The facility census was 53. Residents Affected - Few Findings include: Review of the medical record for Resident #53 revealed an admission date of 11/20/24 with diagnoses including chronic respiratory failure with hypoxia, severe protein-calorie malnutrition, chronic obstructive pulmonary disease (COPD), opioid dependence, cocaine abuse, pulmonary hypertension, bipolar disorder and post-traumatic stress disorder and a discharge date of 04/02/25. Review of a notice of adverse determination from the Medicaid provider for Resident #53 dated 03/28/25 revealed the resident no longer needed daily nursing care and her care needs could be met in a lower level of care. The document also included information for the resident with the opportunity to file a grievance against the decision or appeal the decision. Review of a social services progress note for Resident #53 dated 04/01/25 at 2:34 P.M. and created 04/02/25 at 2:38 P.M. per Social Services Director (SSD) #343 revealed she and the Director of Nursing (DON) spoke with Resident #53 about immediate discharge due to non-payment. The resident was in her room packing saying she would be discharging with her brother. This note was struck out on 04/08/25 with the reason cited as inaccurate documentation. Review of the Minimum Data Set (MDS) assessment for Resident #53 dated 04/02/25 revealed the resident had intact cognition and had an unplanned discharge Interview on 06/30/25 at 10:08 A.M. with Business Office Manager (BOM) #450 confirmed Resident #53 had a skilled care Medicaid payor and payment was stopped because the resident no longer required a skilled nursing service. The BOM verified the facility had the opportunity to assist the resident in applying for long-term Medicaid services but did not do so. She had no explanation as to why the facility did not do so. Follow up interview on 06/30/25 at 10:51 A.M. with BOM #450 verified the facility did not provide Resident #53 the opportunity or assistance to apply for long-term Medicaid. Phone interview on 06/30/25 at 3:00 P.M. with Resident #53 verified she was not offered the opportunity or assistance to apply for long-term Medicaid. Page 1 of 15 365218 365218 07/01/2025 Blue Ash Care Center 4900 Cooper Road Cincinnati, OH 45242

F 0579 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the policy titled Transfer and discharge date d 10/17/22 revealed a facility-initiated transfer or discharge was a transfer or discharge to which the resident objects or did not originate through a resident's verbal or written request, and/or was not in alignment with the resident's stated goals for care and preferences. The facility would not initiate the discharge of a resident based solely on resident's payment source or change in the resident's payment source. If the resident continued to need long-term care services, the facility would offer the resident the ability to remain in the facility by providing the Medicaid-eligible residents with the necessary assistance to apply for Medicaid coverage. This deficiency represents noncompliance investigated under Complaint Number OH00164494. 365218 Page 2 of 15 365218 07/01/2025 Blue Ash Care Center 4900 Cooper Road Cincinnati, OH 45242

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on observation, staff interview, resident interview, review of facility documents, and review of the facility policy, the facility failed to ensure comfortable and safe temperatures were maintained throughout the facility in resident rooms and common areas. This had the potential to affect the 10 residents residing on the facility's A-hall (#03, #04, #07, #13, #16, #26, #36, #52, #204, and #206), the 13 residents residing on the facility's B-hall (#01, #02, #10, #17, #19, #24, #29, #35, #37, #39, #43, #47, and #50. The facility identified 16 residents who routinely ate meals in the dining room (#01, #02, #06, #11, #12, #15, #16, #20, #27, #30, #36, #37, #39, #40, #46, and #47). The facility census was 53 residents. Findings include: Observation on 06/29/25 at 10:35 A.M. revealed the Administrator was taking air temperatures with an infrared laser digital thermometer with the following results: 86.9 degrees Fahrenheit (F) at the beginning of A-hall, closest to the entrance of the building, 81.7 degrees in the second half of A-hall adjacent to the nurses' station, 84.9 degrees F to the front of the nurses' station, 81.9 degrees F in the beginning of B-hall closest to the nurses' station, 83.1 degrees F in the back half of B-hall, 83.8 degrees F in Resident #24's room, 84.6 degrees F in the dining room, 86 degrees F in the television room. Interview 06/29/25 at 10:45 A.M. with the Administrator confirmed the air temperatures taken exceeded 81 degrees F. Interview on 06/29/25 at 9:15 A.M. with Resident #03 confirmed the building had been without air conditioning for a long time. Interview on 06/29/25 at 9:51 A.M. with Resident #204 reported he had been at the facility for two weeks, and although his room was quiet and private, the heat was unbearable. Interview on 06/29/25 at 10:04 A.M. Resident #19 confirmed the building was too hot and had been so for several days. Interview on 06/29/25 at 4:02 P.M. with Resident #24 confirmed it was too hot in the building, and the facility had provided her with a fan, but all the fan did was blow the hot air around. Interview on 06/30/25 at 8:21 A.M. with Resident #47 confirmed she spent more time in the dining room during the day because the air conditioning wasn't working and she thought it was slightly cooler in the dining room. Observation on 06/29/25 at 1:39 P.M. revealed the Administrator was taking air temperatures with an infrared laser digital thermometer with the following results: 82.9 degrees F in Resident #03's room, 84.9 degrees F in Resident #204's room. Interview on 06/29/25 at 1:45 P.M. with the Administrator confirmed the air temperatures in Resident #03 and #204's room exceeded 81 degrees F. Interview on 06/29/25 at 2:08 P.M. with the Administrator confirmed he air conditioning had stopped 365218 Page 3 of 15 365218 07/01/2025 Blue Ash Care Center 4900 Cooper Road Cincinnati, OH 45242

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some working approximately two weeks prior. The Administrator confirmed the facility rented portable air conditioning units and utilized two units on the A-hall, two units on the B-hall, and one unit in the dining area. The Administrator confirmed the portable air conditioning units on the A-hall did not seem to be cooling the areas as desired and the facility staff was checking air temperatures on a random basis. Observation on 06/30/25 at 11:09 A.M. revealed the Administrator was taking air temperatures with an infrared laser digital thermometer with the following results: 85.9 degrees F in the dining room, 84.9 degrees F in the television room, 84.6 degrees F in Resident #03's room, 83.8 degrees F in Resident #204's room, 82.9 degrees F in Resident #07's room, 84.7 degrees F in Resident #16's room, 85.3 degrees F in Resident #26's room, 83.1 degrees F in Resident #206's room. The facility's air conditioning was not working and the facility had portable air conditioning units in the hallways and fans in all resident rooms. Interview on 06/30/25 at 11:29 A.M. with the Administrator confirmed the air temperatures taken on 06/30/25 exceeded 81 degrees F. The Administrator stated the air conditioning had been out for approximately one week and he had no idea when the compressor would be delivered. Review of a local heating and cooling vendor estimate dated 05/21/25 revealed the compressor needed to be replaced with an estimated cost of $7,467.84. The estimate was signed on 06/24/25. Handwritten information on the estimate indicated the part was ordered 06/26/25 and a delivery date was not known. Review of the facility plan titled Plan for Extreme Heat undated revealed the facility had taken the following actions as a response to the air conditioning outage in the facility: rented portable air conditioning units and placed throughout the facility to aid in cooling of the halls, admissions were halted until all resident rooms could maintain a consistent temperature within the compliance range of 71-81 degrees F, contacted vendors were to obtain quotes for repair, offered room changes to all residents on the A-hall and B-hall to C-hall and D-hall or to another facility with some residents accepting room changes, provide fans to residents, monitored residents for signs and symptoms of heat-related illness, add hydration stations and routine ice pass were added, passed out popsicles to residents twice per day, added water to all meal trays, encouraged residents to drink more water during medication administration, altered the menu to include more cold foods, restricted opening of windows to aid in maintaining temperatures, encouraged residents to keep blinds closed and wear lighter clothing, provide lighter clothing if residents did not have such items). Review of the facility policy titled Extreme Heat dated 2024 revealed if indoor temperatures increased and sustained at 81 degrees F or greater, leadership would determine the possibility of moving residents to alternate locations within the facility or outside of the facility. 365218 Page 4 of 15 365218 07/01/2025 Blue Ash Care Center 4900 Cooper Road Cincinnati, OH 45242

F 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm Based on review of Self-Reported Incidents (SRIs), review of personnel files, review of the Bureau of Criminal Investigation (BCI) background check logs, staff interview, and review of the facility policy, the facility failed to implement their policy by failing to conduct criminal background checks. This affected two (Residents #08 and #156) of three residents reviewed for abuse. The facility census was 53 residents. Residents Affected - Few Findings include: Review of the facility SRI dated 01/31/25 revealed the facility substantiated an allegation of misappropriation of funds from Resident #08 and #156's resident fund accounts per Business Office Manager (BOM) #410. The facility contacted the local police who investigated the allegation, BOM #410, was terminated, and the facility replaced the residents' funds. Review of the personnel file for BOM #410 revealed a hire date of 12/16/24 and a termination date of 02/03/25. The file did not include a criminal background check completed upon hire for BOM #410. Review of the facility BCI log revealed BOM #410 was hired on 12/16/24, but BCI checks were not obtained. Interview on 07/01/25 at 2:10 P.M. with BOM #451 confirmed BOM #410's personnel file did not contain a criminal background check. BOM #451 confirmed newly hired employees were expected to complete a criminal background check within five days of hire. Interview on 07/01/25 at 2:58 P.M. with the Administrator confirmed the facility did not ensure a background check was completed for BOM #410. The Administrator further confirmed BOM #410 had informed him she had a clear record. Review of the facility policy titled Abuse, Neglect, Exploitation & Misappropriation of Resident Property dated 2016 revealed the facility would conduct criminal background checks in accordance with state law and facility policy and retain on file the applicable records of employees regarding such checks. 365218 Page 5 of 15 365218 07/01/2025 Blue Ash Care Center 4900 Cooper Road Cincinnati, OH 45242

F 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge. Based on medical record review, staff interview, resident interview, and review of the facility policy, the facility failed to ensure a safe and orderly discharge. The affected one (Resident #53) of two residents reviewed for discharge. The facility census was 53 residents. Findings include: Review of the medical record for Resident #53 revealed an admission date of 11/20/24 with diagnoses including chronic respiratory failure with hypoxia, severe protein-calorie malnutrition, chronic obstructive pulmonary disease, opioid dependence, cocaine abuse, pulmonary hypertension, bipolar disorder and post-traumatic stress disorder. The resident was discharged from the facility on 04/02/25. Review of the physician's orders for Resident #53 revealed an order dated 01/27/25 for oxygen at three liters per minute via nasal cannula every shift. Review of a notice of adverse determination from the Medicaid provider for Resident #53 dated 03/28/25 revealed the resident no longer needed daily nursing care and that her care needs could be met at a lower level of care. The document also provided the resident with the opportunity to file a grievance against the decision or appeal the decision. Review of a social services progress note for Resident #53 dated 04/01/25 at 2:34 P.M. and created 04/02/25 at 2:38 P.M. per Social Services Director (SSD) #343 revealed she and the Director of Nursing (DON) spoke with Resident #53 about immediate discharge due to non-payment. The resident was in her room packing saying she would be discharging with her brother. This note was struck out on 04/08/25 with the reason cited as inaccurate documentation. Review of the Minimum Data Set (MDS) assessment for Resident #53 dated 04/02/25 revealed the resident had an unplanned discharge. Resident #53 had intact cognition, was always continent of bowel and bladder was independent for eating, required supervision for oral and personal hygiene, bed mobility and toileting, and required moderate assistance for bathing, dressing and transfers. Interview on 06/30/25 at 10:14 A.M. with SSD #343 confirmed Resident #53 was discharged to the community without home health and oxygen services in place and the exact location of the discharge was unknown. Interview on 06/30/25 at 10:27 A.M. with the DON confirmed she was involved in the discharge of Resident #53 and the resident was not offered the opportunity to appeal the noncoverage of services decision. The DON confirmed the facility had not made arrangements for home health or oxygen services for Resident #53 prior to discharge and these services should have been arranged at the time of discharge. Phone interview on 06/30/25 at 3:00 P.M. with Resident #53 confirmed the SSD and the DON told her she had to leave the facility because Medicaid stopped paying. Resident #53 confirmed the facility staff told her she had 12 hours to leave, or they would call the police. Resident #53 confirmed the facility did not offer home health services or ongoing oxygen services. Resident #53 confirmed the facility discharged her with a four-hour oxygen tank and she had to take the oxygen nasal cannula she used while at the facility to receive the oxygen from the tank. Resident #53 confirmed after the 365218 Page 6 of 15 365218 07/01/2025 Blue Ash Care Center 4900 Cooper Road Cincinnati, OH 45242

F 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few oxygen tank ran out, she went to the hospital and remained there for 24 hours. After the hospitalization Resident #53 confirmed she was living on the street. Resident #53 confirmed she was currently staying with her mother and was trying to be admitted to a local homeless shelter. Phone interview on 06/30/25 at 4:30 P.M. with the Ombudsman confirmed there was a meeting with Resident #53 at the hospital discussing the resident's discharge. The Ombudsman confirmed Resident #53 did not want to remain a resident of the facility long-term, but the facility did not make the proper arrangements needed for a safe discharge such as a safe destination and provision of home health and oxygen services. Phone interview on 07/01/25 at 10:13 A.M. with Medical Director (MD) #405 for Resident #53 confirmed she was not involved in Resident 53's discharge and had no knowledge of where the resident's discharge location. MD #405 confirmed Resident #53 needed continuous oxygen due to her compromised respiratory status and should never have been discharged without home health services and an adequate supply of oxygen and oxygen supplies. Review of the facility policy titled Transfer and discharge date d 10/17/22 revealed a facility-initiated transfer or discharge was a transfer or discharge to which the resident objects or which did not originate through a resident's verbal or written request and/or was not in alignment with the resident's stated goals for care and preferences. Orientation for transfer or discharge would be provided and documented to ensure safe and orderly transfer or discharge from the facility, in a form and manner that the resident could understand. Depending on the circumstances, the orientation might be provided by various members of the interdisciplinary team. This deficiency represents noncompliance investigated under Complaint Number OH00164494. 365218 Page 7 of 15 365218 07/01/2025 Blue Ash Care Center 4900 Cooper Road Cincinnati, OH 45242

F 0628 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, resident interview, and review of the facility policy, the facility provide an accurate notice of discharge to a resident before discharge and failed to provide a copy of the discharge notice to the Ombudsman. This affected one (Resident #53) of two residents reviewed for discharge. The facility census was 53 residents. Findings include: Review of the medical record for Resident #53 revealed an admission date of 11/20/24 with diagnoses including chronic respiratory failure with hypoxia, severe protein-calorie malnutrition, chronic obstructive pulmonary disease, opioid dependence, cocaine abuse, pulmonary hypertension, bipolar disorder and post-traumatic stress disorder. The resident was discharged from the facility on 04/02/25. Review of the Minimum Data Set (MDS) assessment for Resident #53 dated 04/02/25 revealed the resident had an unplanned discharge. Resident #53 had intact cognition, was always continent of bowel and bladder was independent for eating, required supervision for oral and personal hygiene, bed mobility and toileting, and required moderate assistance for bathing, dressing and transfers. Review of the medical record for Resident #53 revealed the record did not include information regarding a formal discharge from the facility and there was no documentation per the physician regarding the resident's discharge. Interview on 06/30/25 at 10:27 A.M. with the Director of Nursing (DON) confirmed Resident #53 was discharged from the facility to the community on 04/02/25, and the facility did not provide the resident with a written discharge notice. Interview on 06/30/25 at 10:39 A.M. with Social Services Director (SSD) #343 confirmed Resident #53 was discharged to the community on 04/02/25 without home health and oxygen services in place and the exact location of the discharge was unknown. SSD #343 verified Resident #53 was not provided with a thirty-day discharge notice. Phone interview on 06/30/25 at 3:00 P.M. with Resident #53 confirmed the SSD and the DON told her she had to leave the facility because Medicaid stopped paying. Resident #53 confirmed the facility staff told her she had 12 hours to leave, or the police would be called. The resident said the facility did not offer her the opportunity to appeal the decision, and she did not learn about the appeal process until she met with the Ombudsman at the hospital on [DATE]. Resident #53 confirmed the facility did not issue her a written discharge notice. Phone interview on 06/30/25 at 4:30 P.M. with the Ombudsman confirmed there was a meeting with Resident #53 at the hospital discussing the resident's discharge and the facility did not provide a notice of the resident's discharge to the Ombudsman's office. Phone interview on 07/01/25 at 10:13 A.M. with Medical Director (MD) #405 confirmed she was not involved with the facility's decision to discharge Resident #53 and had no knowledge of the resident's discharge location. MD #405 confirmed did not sign a written discharge notice nor did she document in the resident's medical record regarding the discharge. 365218 Page 8 of 15 365218 07/01/2025 Blue Ash Care Center 4900 Cooper Road Cincinnati, OH 45242

F 0628 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the policy titled Transfer and discharge date d 10/17/22 revealed the facility's transfer/discharge notice would be provided to the resident and the resident's representative in a language and manner in which the resident could understand. Generally, the notice must be provided at least 30 days prior to a facility-initiated transfer or discharge of the resident. Exceptions to the 30-day requirement applied when the transfer or discharge was affected because the health and/or safety of individuals in the facility would be endangered due to the clinical or behavioral status of the resident, resident's health improved sufficiently to allow a more immediate transfer or discharge, an immediate transfer or discharge was required by the resident's urgent medical needs, or the resident had not resided in the facility for 30 days. A written discharge notice must be provided to the resident, resident's representative if appropriate, and the Ombudsman as soon as practicable before the transfer or discharge. The facility would maintain evidence that the notice was sent to the Ombudsman. This deficiency represents noncompliance investigated under Complaint Number OH00164494. 365218 Page 9 of 15 365218 07/01/2025 Blue Ash Care Center 4900 Cooper Road Cincinnati, OH 45242

F 0697 Provide safe, appropriate pain management 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, staff, resident and physician interviews and record review, the facility failed to conduct pain assessments and administer pain medication as ordered. This affected one (#36) of the two residents reviewed for pain medication administration. The facility census was 53. Residents Affected - Few Findings include: Review of the medical record for Resident #36 revealed the resident was admitted on [DATE]. Diagnoses included anxiety disorder, type two diabetes mellitus with diabetic peripheral angiopathy, hypertension, arthritis and schizophrenia. Review of the care plan for Resident #36 dated 04/28/25, revealed the resident was at risk for increase in behaviors of irritability, agitation, restlessness, grimacing, hyperventilation, groaning or crying without relief of pain. Interventions included administering medication as ordered and notify the physician if interventions were unsuccessful or unable to be fulfilled. Review of the Minimum Data Set (MDS) assessment for Resident #36 dated 06/10/25, revealed the resident had intact cognition, was independent with toileting and transfers, and required only moderate assistance with bathing and dressing. Review of a physician order for Resident #36 dated 06/26/25, revealed the resident was ordered to receive oxycodone with Acetaminophen tablet 7.5-325 milligrams (mgs) four times a day routinely for pain and an order for Tylenol 325 mgs ordered to give one tablet by mouth every eight hours as needed (PRN) for pain. Review of June 2025 medication administration record (MAR) for Resident #26, revealed no documented evidence of any pain assessments completed from 06/27/25 through 06/30/25. There was also no documented evidence oxycodone with Tylenol was administered to the resident on 06/27/25 through 06/30/25. The July 2025 MAR could not be provided to the surveyor for review. Observation of Resident #36 on 07/01/25 at 11:00 A.M., revealed the resident was lying on his side with his legs up on his wheelchair grimacing and moaning I am not happy. Interview at the same time with the resident stated he was unhappy. The resident stated he had not received his pain medicine for two days, and reported he was having pain all over. Interview with Licensed Practical Nurse (LPN) #326 on 07/01/25 at 11:02 A.M., verified Resident #36 had not been given Oxycodone with Tylenol yesterday or today because it was not supplied to the facility during the pharmacy supplier transition which took place on 06/30/25. LPN #326 also stated she had not informed the Director of Nursing (DON), the prescribing physician, or the new pharmacy vendor about the missing order. Interview with the DON on 07/01/25 at 11:29 A.M., revealed she had just been informed by Resident #36 he has not gotten his oxycodone with Tylenol the last few days. The DON reported she reached out to the prescribing physician and the pharmacy. A subsequent interview with LPN #326 on 07/01/25 at 11:52 A.M., revealed conflicting information. LPN #326 now stated she informed the DON first thing this morning that Resident #36's oxycodone with 365218 Page 10 of 15 365218 07/01/2025 Blue Ash Care Center 4900 Cooper Road Cincinnati, OH 45242

F 0697 Tylenol was missing and LPN #326 also shared the information in report yesterday evening with LPN #311. Level of Harm - Minimal harm or potential for actual harm Interview with Assistant Director of Nursing (ADON) #359 on 07/01/25 at 12:28 P.M., revealed oxycodone with Tylenol 7.5-325 mg was not available in the emergency supply box (E-box). Residents Affected - Few Interview via telephone with Physician #405 on 07/01/25 at 12:30 P.M., revealed she was notified today at 11:00 A.M. by the DON regarding the missing medication for Resident #36. She verified she had no knowledge of a call being made to her regarding the missing oxycodone with Tylenol for Resident #36. Interview via phone with LPN #311 on 07/01/25 at 2:15 P.M., revealed she did not receive information regarding the missing medication for Resident #36 during shift change report from LPN #326 on 06/30/25. LPN #311 stated she was unable to check in the E-box supply because there were no keys to get into it. She also confirmed she did not notify the physician or the DON during her overnight shift about the resident's missing oxycodone with Tylenol. LPN #311 stated she reported the information about the missing medications to the DON and LPN #326 when they arrived around 07:00 A.M. LPN #311 also verified she did not make a progress notes regarding the missing medications and document Resident #36's pain. Interview with the DON on 07/01/25 at 2:35 P.M., verified Resident #326 was missing pain assessments from 06/27/25 through 06/30/25 and Resident #36 did not receive his ordered oxycodone with Tylenol 7.5-325 mg from 06/27/25 through 06/30/25. The DON stated she was unable to provide a July 2025 MAR. Review of a facility policy titled Unavailable Medications, revealed the facility shall use uniform guidelines for unavailable medications. The facility maintains a contract with a pharmacy provider to supply the facility with routine, prn and emergency medications. A STAT (immediate need) supply of commonly used medications will be maintained in-house for the timely initiation of medications. The facility shall follow established procedures for ensuring residents have a sufficient supply of medications. Medications may be unavailable to a number of reasons; however the staff shall take immediate action when it is known that the medication is unavailable by determining the reason for the unavailability, length of time medication is unavailable, and what efforts have been attempted by the facility or the pharmacy to obtain the medication, notify the physician, obtain an alternative treatment orders and or specific orders for monitoring the resident while the medication is on hold and if the facility allows, determine if resident has a home supply and obtain orders to use the home supply. If a resident misses a scheduled dose of the medication, staff shall follow procedure for medication errors, including physician/family notification, completion of a medication error report and monitoring the resident for adverse reactions to the omission of the medication. 365218 Page 11 of 15 365218 07/01/2025 Blue Ash Care Center 4900 Cooper Road Cincinnati, OH 45242

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, staff interviews, and review of the facility policy, the facility failed to ensure insulin vials were properly labeled and stored. This affected one (#29) of the five residents who received Insulin stored in the A/B medication cart and of the 24 residents with medications stored in the A/B medication cart. The facility census was 53. Findings include: Review of the medical record revealed Resident #29 was admitted to the facility on [DATE] with diagnoses of diabetes mellitus type II, cerebral infarction and atrial fibrillation. Review of the Minimum Data Set (MDS) quarterly assessment dated [DATE] revealed Resident #29 had moderate cognitive impairment and was dependent on staff for medications. Review of physician orders for Resident #29 revealed an order dated 05/22/25 for Lantus SoloStar subcutaneous solution pen-injector 100 unit/milliliter (ml) inject 10 units subcutaneously at bedtime related to diabetes mellitus type II with hyperglycemia. Review of the May 2025 and June 2025 Medication Administration Records (MARs) for Resident #29, revealed Lantus Solostar was administered daily as ordered. Observation on 07/01/25 at 9:29 A.M. of the A/B medication cart with Licensed Practical Nurse (LPN) #326 revealed the Lantus SoloStar subcutaneous solution pen-injector for Resident #29 to be undated. Interview on 07/01/25 at 9:29 A.M. with LPN #326 verified the Lantus SoloStar pen-injector for Resident #29 was undated and should have been dated when removed from refrigerated storage and placed in the medication cart. Interview on 07/01/25 at 4:26 P.M. with the Director of Nursing (DON) verified insulin, in any form, is to be dated when removed from refrigerated storage and placed in the medication cart. The DON reported there was no policy and procedure for Medication Storage and Labeling. Review of the Manufacture's Insulin Products Expiration Guidelines revealed insulin products are to be labeled with the date when taken from the refrigerator or put into the medication cart. 365218 Page 12 of 15 365218 07/01/2025 Blue Ash Care Center 4900 Cooper Road Cincinnati, OH 45242

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 a sanitary environment for preparing and serving food and failed to ensure staff wore hair restraints while in the kitchen. This had the potential to affect all 53 residents who resided in the facility as the facility identified all residents received food from the kitchen. Findings include: Observation on 06/29/25 at 9:36 A.M., of the steam table in the kitchen with Dietary Supervisor (DS) #354, revealed a wooden panel of compressed wood, nailed to the side of the steam table. The top of the wooden panel, located even with the surface of the steam table, and extending the depth of the steam table, was observed to be significantly deteriorated and porous, with a beige fibrous material. Interview with DS #354 at the same time, verified the wooden panel was deteriorated, porous, and was not able to be cleaned. DS #354 stated the wooden panel had been in the stated condition when he started approximately three months prior. Observation on 06/30/25 at 10:26 A.M. with DS #354, revealed a fan, which was powered on, and blowing, facing the steam table. The fan was observed coated in a gray and fuzzy substance. Interview with DS #354 at the same time, verified the fan was coated in a gray and fuzzy substance and facing the food that was on the steam table. DS #354 stated the fan needed to be cleaned. Observation on 06/30/25 at 10:30 A.M. with DS #354, revealed the steam table wells contained brown debris floating in the water and had dark brown stains. Interview at the same time with DS #354, verified the steam table wells contained brown debris and dark brown stains. DS #354 stated the steam table wells should be cleaned daily and were last cleaned approximately two nights prior. Interview on 06/30/25 at 10:48 A.M., the Administrator, verified the steam table wells did not appear clean. The Administrator stated DS #354 spent a lot of time trying to clean them; however, he felt the steam table just needed to be replaced. Observation on 06/30/25 at 10:34 A.M. with DS #354, revealed a vent, measuring approximately 18 inches by 18 inches, above the coffee maker, facing toward the steam table, was coated in a dark gray and fuzzy substance. The vent was observed blowing air into the kitchen. Interview with DS #354 at the same time, verified the vent was coated in a dark gray and fuzzy substance and blowing air toward the steam table and needed to be cleaned. Observation on 06/30/25 between 10:25 A.M. and 10:32 A.M., revealed DS #354 making pureed green beans for the lunch meal. DS #354 had a beard, and it was not covered by a hair restraint. Observation on 06/30/25 at 11:50 A.M., revealed DS #354 plating food from the steam table for the lunch meal. DS #354's beard remained uncovered. Concurrent observation revealed [NAME] #307 was taking the plated food, covering it, and placing it on meal trays. [NAME] #307 was observed with facial hair that was not restrained. Continuous observation on 06/30/25 from 11:50 A.M. to 12:08 P.M., revealed DS #354 continued to plate food from the steam table without a facial hair restraint and [NAME] #307 continued to cover the 365218 Page 13 of 15 365218 07/01/2025 Blue Ash Care Center 4900 Cooper Road Cincinnati, OH 45242

F 0812 plated food and place it on the meal trays without his facial hair being restrained. Level of Harm - Minimal harm or potential for actual harm Interview on 06/30/25 at 12:08 P.M., DS #354, verified neither he nor [NAME] #307 wore facial hair restraints while in the kitchen and preparing food. DS #354 stated he did have facial hair restraints. Residents Affected - Many Observation on 06/30/25 at approximately 12:22 P.M., revealed the last meal tray was made and added to the cart for delivery. DS #354 and [NAME] #307 remained without facial hair restraints. Review of the facility policy titled, Maintaining a Sanitary Tray Line, undated, revealed, hair restraints would be worn when preparing or handling food. 365218 Page 14 of 15 365218 07/01/2025 Blue Ash Care Center 4900 Cooper Road Cincinnati, OH 45242

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on staff interview and record review, the facility failed to maintain a facility Tuberculosis (TB) Risk Assessment. This had the potential to affect all 53 residents who resided in the facility. The facility also failed to ensure all newly hired employees were tested for TB and employees employed by the facility for more than a year were screened annually for TB. This affected four (Business Office Manager [BOM] #410, Licensed Practical Nurse [LPN] #305, Certified Nursing Assistant [CNA] #361, and CNA #332) of the five personnel files reviewed. This had the potential to affect all 53 residents of the facility. Residents Affected - Many Findings Include: 1. Interview on 07/01/25 at 2:58 P.M. with the Administrator revealed the facility does not do a Tuberculosis Risk Assessment. Review of the facility provided documentation at the same time with the Administrator, revealed the facility had TB Risk Assessment. Review of the facility policy titled Tuberculosis Risk Assessment (not dated) states a Tuberculosis Risk Assessment shall be conducted annually. 2. Review of BOM #410's personnel file revealed BOM #410 was hired on 12/16/24. Further review of BOM #410's personnel file revealed BOM #410 did not receive a first or second step TB test upon hire. Review of LPN #305's personnel file revealed LPN #305 was hired on 01/29/20. Further review of LPN #305's personnel file revealed LPN #305 did not have an annual TB screen for 2024 or 2025. The last annual TB screen was completed on 01/26/23. Review of CNA #361's personnel file revealed CNA #361 was hired 11/17/23. Further review of CNA #361's personnel file revealed CNA #361 did not have an annual TB screen during 2024 or 2025. Review of CNA #332's personnel file revealed CNA #332 was hired 11/02/24. Further review of CNA #332's personnel file revealed CNA #332 did not receive a first or second step TB test upon hire. Interview on 07/01/25 at 2:30 P.M., BOM #451 verified BOM #410, and CNA #332 did not receive first or second step TB tests upon hire and LPN #305 and CNA #361 did not complete an annual TB screening. BOM #451 verified all employees should receive a first and second step TB test upon hire and complete annual TB screens thereafter. Interview on 07/01/25 at 3:52 P.M., the Administrator verified all employees should receive a first and second step TB test upon hire and complete annual TB screens thereafter. 365218 Page 15 of 15