Inspection·October 24, 2019

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** 3. Medical record review for Resident #27 revealed the resident was admitted to the facility on [DATE] with a re-entry date of 05/24/19. Diagnosis included congestive heart failure and chronic obstructive pulmonary disease. Review of the 30-day MDS assessment revealed the resident had intact cognitive skills for daily decision making. Review of the nursing progress notes revealed Resident #27 was admitted to the hospital on [DATE] and was discharged from the hospital on [DATE]. The resident was transferred back to the hospital on [DATE]. Further review of the medical record revealed there was no evidence of written notice to the resident and/or resident's representative for the reason for transfer to the hospital. Interview on 10/23/19 at 11:01 A.M. with the Director of Nursing (DON) reported the facility did not notify residents or their representatives in writing of reasons for transfer to the hospital. Interview on 10/24/19 at 9:27 A.M. with admission Coordinator (AC) #300 reported the floor nurse would contact the family via telephone and inform them when a resident was transported to the hospital. The facility did not provide written notification to the resident or resident's representative about the reason for the transfer. Based on medical record review and staff interview, the facility failed to provide written transfer notification to the resident and/or resident's representative when they were hospitalized . This affected three (#27, #30 and #43) of four residents reviewed for hospitalization. The facility census was 61. Findings include: 1. Review of Resident #30's medical record revealed an admission date of 08/12/19. Diagnoses included psychotic disorder, metabolic encephalopathy, anoxic brain damage, atherosclerotic heart disease of native coronary artery without angina pectoris and paroxysmal atrial fibrillation. Review of the Minimum Data Set (MDS) assessment, dated 09/04/19, revealed Resident #30 was severely cognitively impaired. Review of the progress note, dated 08/03/19, indicated Resident #30 was sent to the hospital and admitted for a hip fracture. Further review of the medical record revealed there was no evidence of written notice to the resident and/or resident's representative for the reason for transfer to the hospital. Interview on 10/23/19 at 5:45 P.M. with admission Coordinator (AC) #300 verified the facility did not issue any transfer notifications. AC #300 reported she provides notifications when residents return to the facility. 2. Review of Resident #43's medical record revealed the resident was admitted to the facility on [DATE]. Diagnoses included cerebrovascular disease and dementia with behavioral disturbance. Review of the MDS assessment, dated 10/17/19, revealed Resident #43 was moderately cognitively impaired. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365277 If continuation sheet Page 2 of 9 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 365277 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/24/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Place Care Center 1302 Millville Avenue Hamilton, OH 45013 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 FORM CMS-2567 (02/99) Previous Versions Obsolete Review of the progress note, dated 10/17/19, revealed Resident #43 was sent to the hospital on [DATE] and admitted for altered mental status. Further review of the medical record revealed there was no evidence of written notice to the resident and/or resident's representative for the reason for transfer to the hospital. Interview on 10/23/19 at 5:45 P.M. with AC #300 verified the facility did not issue any transfer notifications. AC #300 reported she provides notifications when residents return to the facility. AC #300 was unable to provide a policy for transfer notification. Event ID: Facility ID: 365277 If continuation sheet Page 3 of 9 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 365277 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/24/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Place Care Center 1302 Millville Avenue Hamilton, OH 45013 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 0625 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. Medical record review for Resident #27 revealed the resident was admitted to the facility on [DATE] with a re-entry date of 05/24/19. Diagnosis included congestive heart failure and chronic obstructive pulmonary disease. Review of the 30-day MDS assessment revealed the resident had intact cognitive skills for daily decision making. Review of the nursing progress notes revealed Resident #27 was admitted to the hospital on [DATE] and was discharged from the hospital on [DATE]. The resident was transferred back to the hospital on [DATE]. Further review of the medical record revealed there was no evidence of written bed hold notice to the resident and/or resident's representative when the resident was transferred to the hospital. Interview on 10/23/19 at 11:01 A.M. with the Director of Nursing (DON) reported the facility bed hold policy was provided to the family upon admission to the facility. Bed hold information was not provided upon each hospitalization. Interview on 10/24/19 at 9:27 A.M. with admission Coordinator (AC) #300 reported after a resident returned to the facility following a hospitalization, the family was verbally informed of remaining bed hold days which was documented on the Medicaid Bed Hold Authorization Form. No written documentation was provided to the resident or representative regarding bed hold days. Review of the facility's Medicaid Bed Hold Authorization form revealed Resident #27 used six bed hold days out of 30 and had 24 remaining bed hold days left for the calendar year 2019. The resident's representative was verbally notified and granted permission on 07/15/19 for the hospitalization which began on 07/08/19. On 08/07/19, Resident #27's representative was verbally notified seven bed hold days out of 24 were used with 17 bed hold days remaining for 2019, for the hospitalization which began on 07/30/19. Review of the facility's bed hold policy, dated 11/01/16, revealed before the facility transfers a resident to a hospital or the resident goes on therapeutic leave, the facility shall provide the resident or his or her representative the facility's bed hold policy. Based on record review, staff interview, and review of facility policy, the facility failed to provide written bed hold information to the resident and/or resident's representative when the resident was hospitalized . This affected three (#27, #30 and #43) of four residents reviewed for hospitalization. The facility census was 61. Findings include: 1. Review of Resident #30's medical record revealed an admission date of 08/12/19. Diagnoses included psychotic disorder, metabolic encephalopathy, anoxic brain damage, atherosclerotic heart disease of native coronary artery without angina pectoris and paroxysmal atrial fibrillation. Review of the Minimum Data Set (MDS) assessment, dated 09/04/19, revealed Resident #30 was severely cognitively impaired. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365277 If continuation sheet Page 4 of 9 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 365277 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/24/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Place Care Center 1302 Millville Avenue Hamilton, OH 45013 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 0625 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the progress note, dated 08/03/19, indicated Resident #30 was sent to the hospital and admitted for a hip fracture. Further review of the medical record revealed no evidence of the facility's bed hold policy being provided to the resident's representative when the resident was hospitalized . Interview on 10/23/19 at 5:45 P.M. with admission Coordinator (AC) #300 verified the facility did not issue bed hold notifications when transferred to the hospital. 2. Review of Resident #43's medical record revealed the resident was admitted to the facility on [DATE]. Diagnoses included cerebrovascular disease and dementia with behavioral disturbance. Review of the MDS assessment, dated 10/17/19, revealed Resident #43 was moderately cognitively impaired. Review of the progress note, dated 10/17/19, revealed Resident #43 was sent to the hospital on [DATE] and admitted for altered mental status. Further review of the medical record revealed no evidence of the facility's bed hold policy being provided to the resident's representative when the resident was hospitalized . Interview on 10/23/19 at 5:45 P.M. with AC #300 verified the facility did not issue bed hold notifications when residents were transferred to the hospital. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365277 If continuation sheet Page 5 of 9 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 365277 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/24/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Place Care Center 1302 Millville Avenue Hamilton, OH 45013 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on staff interview and medical record review, the facility failed to ensure a resident was monitored and gradual dose reductions were conducted for psychotropic medications. This affected one (Resident #21) of five residents reviewed for unnecessary medications. The facility census was 61. Findings include: Medical record review for Resident #21 revealed the resident was admitted to the facility on [DATE]. Diagnoses included Alzheimer's disease, major depressive disorder, single episode, severe with psychotic features and unspecified dementia with behavioral disturbance. Review of the quarterly Minimum Data Set (MDS) assessment, dated 08/28/19, revealed the resident had moderately impaired cognitive skills for daily decision making, wandering behaviors occurred one to three days during the assessment, and antipsychotic medications were received on a routine basis only. Review of the hospital discharge orders, dated 12/26/18, revealed Resident #21 was diagnosed with major depressive disorder with psychosis and dementia with behavioral disturbances. Medication orders included Risperidone 0.25 mg. by mouth twice daily and Lexapro five mg. by mouth daily. Review of the physician orders, dated 12/26/18, revealed Resident #21 was prescribed Risperidone, a antipsychotic medication, 0.25 milligrams (mg.) by mouth twice a day along with Lexapro, a antidepressant medication, five mg. by mouth one time a day for major depressive disorder, single episode, severe with psychotic features. Further medical record review revealed a gradual dose reduction (GDR) had not been attempted for Risperidone or Lexapro. Review of all the physicians and nurse practitioner progress notes, dated 01/04/19, 01/08/19, 02/13/19, 04/24/19, 07/30/19, 08/16/19, and 09/06/19, revealed there was no documentation to indicate Resident #21 was even prescribed Risperidone or Lexapro. Interview on 10/24/19 at 3:03 P.M. with the Director of Nursing (DON) reported she had contacted the pharmacy consultant whom reported a GDR for Risperidone and Lexapro had been recommended on 06/22/19 and again on 08/27/19 without any response from the physician. The DON confirmed other than the physician order, the medical record did not contain any documentation by the physician or nurse practitioners to indicate Resident #21 was even prescribed Risperidone or Lexapro. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365277 If continuation sheet Page 6 of 9 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 365277 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/24/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Place Care Center 1302 Millville Avenue Hamilton, OH 45013 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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. Based on observation, resident and staff interview, record review, review of drug manufacturer instructions, and facility Self Administering Medications Policy, the facility failed to store medications securely, dispose of expired medications, and properly label medications. This affected two of fours medication carts. This affected five residents (#20, #27, #43, #54 and #59) on the four north medication cart. The facility identified one resident prescribed insulin and five residents prescribed inhalers on the four north medication cart. The facility census was 61. Findings include: 1. Observation on 10/21/19 at 2:53 P.M. revealed Resident #27 had the following eye medications: two bottles of Dorzolamide Timolol maleate ophthalmic solution 22.3 milligrams (mg.)/6.8 mg per milliliter (ml.), one bottle of Brimonidine tartrate ophthalmic solution 0.2 percent (%), one bottle of prednisolone acetate one %, one bottle of Xalatan 0.005 %, and one tube of neomycin polymyxin b sulfates and Dexamethasone ointment 3.5 grams located on the residents tray table and in the unlocked cabinet beside the bed. Interview with Resident #27, at the time of the observation, reported she kept and administered all but one eye drop, which was administered by the nurse. Review of Resident #27s medical record revealed no assessment or physician order for the resident to self administer medications. Interview on 10/24/19 at 3:07 P.M. with the Director of Nursing (DON) reported there wasn't any resident at the facility whom had been assessed or had a physician order to self administer medications. Observation of Resident #27's room with the DON verified two bottles of prednisolone acetate ophthalmic solution one %, three bottles of Dorzolamide Timolol maleate ophthalmic solution 22.3 mg./6.8 mg. per ml., one tube of neomycin polymyxin b sulfate and Dexamethasone ophthalmic ointment, and one bottle of Latanoprost 0.005 % solution all unsecured in the resident's possession in her room. Review of the facility's Self Administering Medications Policy revealed the facility should assess and determine, with respect to each resident, whether self-administration of medications was safe and appropriate and should ensure that orders for self-administration list the specific medication the resident may self-administer. 2. Observation on 10/24/19 at 7:45 A.M. of the four north medication cart with Licensed Practical Nurse (LPN) #47 revealed one Humulin R insulin vial dated as opened on 09/09/19 and one Humulin N insulin vial opened, but not dated with an open date, for Resident #59. One Basaglar KwikPen with opened date of 08/02/19, another one dated as opened on 08/17/19, and another one without a date for Resident #43. Review of Humulin R insulin manufacturer instructions revealed if stored at room temperature, below 86 degrees Fahrenheit (F) the vial must be discarded after 40 days. Review of Humulin N insulin manufacturer instructions revealed if stored at room temperature, below 86 degrees F the vial must be discarded after 31 days, even if the vial still contains Humulin N. Review of Basaglar KwikPen manufacturer instructions revealed the pen stored at room temperature (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365277 If continuation sheet Page 7 of 9 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 365277 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/24/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Place Care Center 1302 Millville Avenue Hamilton, OH 45013 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 (below 86 degrees F) should be thrown away after 28 days, even if it still has insulin left in it. Level of Harm - Minimal harm or potential for actual harm 3. Further observation on 10/24/19 at 7:45 A.M. of the four north medication cart with Licensed Practical Nurse (LPN) #47 revealed there was one Advair diskus 100-50 micrograms (mcg.) inhaler with opened date of 09/12/19 for Resident #54. The Advair diskus box revealed to discard one month after opening the foil pouch or when the counter reads zero. Residents Affected - Some There was one Breo Ellipta 200 mcg./25 mcg. inhaler, opened and not dated for Resident #20. Review of the Breo Ellipta box revealed to discard the inhaler six weeks after opening the moisture-protective foil tray or when the counter read zero. There was one Breo Ellipta 100 mcg./25 mcg. dated as opened on 08/27/19 and another one dated opened on 08/26/19 for Resident #27. All observations were verified by LPN #47. Review of Advair Diskus manufacturer information revealed it should be stored inside the unopened moisture-protective foil pouch and only removed from the pouch immediately before initial use. Discard Advair Diskus one month after opening the foil pouch or when the counter reads zero, whichever comes first. Review of Breo Ellipta manufacturer information revealed safely throw away Breo Ellipta in the trash six weeks after the foil tray was opened or when the counter reads zero, whichever comes first. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365277 If continuation sheet Page 8 of 9 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 365277 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/24/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bradford Place Care Center 1302 Millville Avenue Hamilton, OH 45013 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 and procedure review, the facility failed to label and date items in the freezer. The facility also failed to keep daily temperatures in the refrigerator on the third floor and failed to keep the freezer clean. This had the potential to affect all 61 residents residing in the facility. Findings include: On 10/21/19 from 9:10 A.M. to 9:30 A.M., an initial tour of the kitchen was conducted with Registered Dietician (RD) #200. During the observation the following concerns were observed, and all concerns were verified by RD #200. In the freezer, there was a box of chicken strips, a pepperoni pizza, a bag of vegetables, a bag of peas and a box of fish sticks that were unsealed and no opened date. Observation on 10/22/19 at 10:29 A.M. on the third floor revealed the refrigerator's last recorded temperature was dated on 10/20/19. The freezer was dirty and filled with blue and red stains throughout the freezer. Interview on 10/22/19 at 10:33 A.M. with Licensed Practical Nurse (LPN) #57 and State Tested Nursing Assistant (STNA) #103 reported the kitchen was responsible for taking daily temperatures and cleaning both refrigerator and freezer. LPN #57 and STNA #103 verified the findings of the dirty freezer and daily temperatures not maintained. Review of facility policy titled, Food Storage, dated 08/01/12, revealed opened frozen food will be properly bagged, dated and labeled in an additional sealed container. Every freezer will be equipped with a visible thermometer. Temperatures should be documented daily. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365277 If continuation sheet Page 9 of 9