Health inspection·November 1, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. THE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NON-COMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Residents Affected - Few Based on medical record review, review of facility investigation, staff interviews and review of facility policy, the facility failed to ensure a resident was provided dignity and respect. This affected one (#62) of four residents reviewed for dignity and respect. The facility census was 65. Findings include: Review of the medical record for Resident #62 revealed and admission date of 08/01/23. Diagnoses included cerebral infarction (stroke), type II diabetes, Chronic Obstructive Pulmonary Disease (COPD), Alzheimer's disease, emotional lability, depression, and anxiety. Review of the quarterly Minimum Data Set (MDS) assessment, dated 10/18/23, revealed Resident #62 had severely impaired cognition. The resident required extensive assistance of one to two staff for bed mobility, transfers, and ambulation. Review of behavior and mood revealed Resident #62 had a behavior of yelling out, cursing, and crying. Review of the plan of care dated 10/18/23 revealed Resident #62 exhibited behaviors related to medical diagnoses; Alzheimer's disease, dementia with behavioral disturbance, depression, anxiety as evidenced by verbal behaviors of frequently yelling out, cursing at others, racial slurs, and inappropriate language. Other behaviors included spitting on staff, refusal of medications, and non-compliance with care. Interventions included to intervene as necessary to protect the rights and safety of others, approach/speak in a calm manner, divert attention, remove from situation and take to alternate location as needed, minimize potential for the resident's disruptive behaviors by offering tasks which divert attention, and, if reasonable, discuss the resident's behavior and explain/reinforce why behavior is inappropriate and/or unacceptable to the resident. Review of a nursing progress note dated 10/09/23 at 3:10 P.M. revealed a concern was brought to the Director of Nursing (DON) and Administrator on 09/30/23 related to the resident and caregivers working relationship and the relationships effect on resident's current behaviors. The concerned party alleged caregivers were laughing and mocking the resident during an episode of her behaviors, causing the resident to become hysterical. The concern was related to a belief that staff was not handling resident's behaviors appropriately. A call was placed to Resident #62's daughter. The resident's daughter confirmed many of the behaviors exhibited by the resident had been happening for years. Resident #62 had a long history of yelling and screaming during care and would make statements surrounding suicidal ideations with no active plan. Resident #62 had orders to follow-up with psychiatric Page 1 of 3 365277 365277 11/01/2023 Bradford Place Care Center 1302 Millville Avenue Hamilton, OH 45013

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few services. Resident #62 had been heard using inappropriate speech towards her caregivers, refusing care and combativeness during care. The resident's daughter believed the resident was in an adjustment period and needed more time to get familiar and accepting of her new environment. The resident's daughter shared some helpful tips with nursing management to help manage Resident #62's current behaviors. She also suggested taking the resident outside in the sunshine, or letting the resident sit and look out the window. The resident's daughter stated she would bring in a radio and resident's favorite music to help calm resident when agitation is noted. State Tested Nurse Aides (STNA)/Caregivers have been educated and in-serviced on ways of interacting and communicating with Alzheimer and dementia residents. Nursing management will continue to assess and monitor interactions between caregivers and residents. Interview on 10/31/23 at 11:30 A.M. with the Administrator and Director of Nursing (DON) confirmed they initiated an investigation immediately upon being made aware of an allegation of staff laughing at Resident #62. The Administrator confirmed staff were congregated at the nurse's station and laughing about Resident #62 calling them names but the staff denied laughing at Resident #62. Interview on 11/01/23 at 2:00 P.M. of Activities Director (AD) #166 revealed on 09/29/23, she exited the elevator onto the fourth floor of the facility, where Resident #62 resided. AD #166 stated she observed staff laughing and Resident #62 was crying. AD #166 stated she approached Resident #62, assisted her with calming down, and took the resident to her room. As a result of the incident, the facility took the following actions to correct the deficient practice by 10/09/23: • On 09/30/23, the DON and Administrator initiated an investigation based on reports staff were laughing at Resident #62. • Interviews of the residents on the unit were completed with no areas of concern identified. • Staff members were in-serviced on communicating and caring for dementia residents. • Staff members were required to complete on-line education for communicating and caring for dementia residents. • Resident #62's medication review was completed and medication adjustments were made. • Continuous monitoring is being done by the DON, with no new deficient practice identified. 365277 Page 2 of 3 365277 11/01/2023 Bradford Place Care Center 1302 Millville Avenue Hamilton, OH 45013

F 0550 This deficiency represents non-compliance investigated under Master Complaint Number OH00147436, Complaint Number OH00147434, and Complaint Number OH00147088. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 365277 Page 3 of 3