Health inspection·May 21, 2024

F 0624 Prepare residents for a safe transfer or discharge from the nursing home. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, review of the emergency medical services (EMS) run report, review of the hospital record review, staff interviews and policy review, the facility failed to ensure a resident was adequately prepared for a transfer by ensuring EMS and the hospital was provided with the resident's code status and other pertinent information. This affected one (#100) of three residents reviewed for hospitalization. Facility census was 70. Residents Affected - Few Findings include: Review of the medical record of Resident #100 revealed an admission date of 10/08/20. The resident transferred to the hospital on [DATE] and did not return to the facility. Diagnoses included spinal stenosis, type 2 diabetes mellitus, Alzheimer disease, dementia with mood disturbance, major depressive disorder, anxiety disorder, hyperlipidemia, and hypertension. Review of Resident #100's quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had severe cognitive impairment. Review of the medical record revealed a Change of Condition Evaluation was initiated on 02/23/24 but the form/evaluation was not completed. Review of physician orders revealed an order dated 10/20/21 (discontinued 02/26/24) for the resident to be a Do Not Resuscitate Comfort Care-Arrest (DNRCC-Arrest). Review of the care plan dated 01/25/22 revealed the resident had an advanced directive of a DNRCC-Arrest. Interventions included to follow the facility protocol for identification of code status. Review of a progress note dated 02/23/24 at 5:18 P.M. revealed Resident #100 was found in her room unresponsive to verbal and physical stimuli. Call was placed to nine-one-one (911) and assistance was received from other staff nurses. Vital signs were obtained-temperature was 98.4 degrees Fahrenheit, pulse was 86 beats per minute, respirations were 14 breaths per minute, blood pressure was 180/110, oxygen saturations were 97% on room air. The squad arrived and Resident #100 was transported to the hospital. Family and the Director of Nursing (DON) were notified. Report was called to the hospital, along with the resident's code status, DNRCC-Arrest. Review of the EMS run report, dated 02/23/24, revealed facility staff stated Resident #100 had a DNR but had no further information or documentation was provided. There was no DNR presented to EMS and the only medical history obtained from the facility was diabetes. (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 2 Event ID: 365277 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 05/21/2024 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)