Health inspection·July 19, 2023

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, resident representative interview, staff interview, and review of the facility policy, the facility failed to notify the resident's representative of the onset of two new unstageable pressure ulcers (slough and/or eschar: known but not stageable due to coverage of wound bed by slough and/or eschar). This affected one (Resident #106) of three residents reviewed for notification of change in condition. The facility census was 104. Findings include: Review of the medical record for Resident #106 revealed an original admission date of 02/19/18. Diagnoses included hemiplegia and hemiparesis following cerebral infarction, chronic kidney disease, diabetes mellitus (DM), vascular dementia without behavioral disturbance. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #106 was cognitively impaired and was coded negative for the presence of pressure ulcers. The MDS assessment dated [DATE] revealed Resident #106 was coded for the presence of two unstageable pressure ulcers which were not present upon admission to the facility. Review of the power of attorney (POA) paperwork revealed Resident #106 had designated Resident Representative (RR) #610 to serve as her durable POA for healthcare on 12/19/14. Review of the nursing progress note dated 05/18/23 revealed Resident #106 had an open area to her upper right thigh and all parties were made aware of the new area. Review of the wound nurse practitioner (NP) note dated 05/24/23 revealed the NP assessed Resident #106 for new unstageable pressure ulcers to the sacrum and right buttock. The unstageable pressure area to the sacrum measured eight centimeters (cm) in length by four cm in width by 0.1 cm in depth and had 25-59 percent (%) slough noted to the wound bed. The unstageable pressure ulcer to the right buttock measured five cm in length by 2.5 cm in width by 0.2 cm in depth and had one to 24 % slough and one to 24 % eschar noted to the wound bed. Review of the nurse progress notes for Resident #106 dated 05/24/23 to 06/01/23 revealed there was no documentation of notification to Resident #106's representative, RR #610, of the newly developed unstageable pressure ulcers to the resident's sacrum and buttocks. The nurse progress note dated 06/01/23 revealed Resident #106 was sent to the hospital for altered mental status and was admitted to the hospital. (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 4 Event ID: 365375 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 365375 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Meadowbrook Care Center 8211 Weller Road Cincinnati, OH 45242 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)