Inspection·October 16, 2023

F 0622 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged. Based on medical record review and staff interview, the facility failed to coordinate care with the home health agency to ensure a smooth and safe resident discharge. This affected one (#90) of three residents reviewed for discharge planning. The facility census was 89. Findings include: Review of the medical record for Resident #90 revealed an admission date of 09/21/23, with diagnoses including chronic osteomyelitis, atherosclerotic heart disease, presence of cardiac pacemaker, atrial fibrillation, epilepsy, anxiety disorder, and major depressive disorder. Review of the Minimum Data Set (MDS) for Resident #90 dated 10/06/23 revealed resident was discharged to home with a return not anticipated. Review of MDS revealed resident was cognitively intact and required supervision and touching assistance with activities of daily living. Review of the discharge paperwork for Resident #90 with home health services revealed the resident was discharged with an order dated 09/21/2, for Vancomycin once daily via intravenous (IV) for 36 days and an order for a Vancomycin level to be drawn every Friday. The paperwork did not include when Resident #90 last received a dose of IV Vancomycin or her most recent Vancomycin level laboratory results. Interview on 10/16/23 at 1:52 P.M., with Registered Nurse (RN) #123 confirmed she was the nurse who discharged resident on 10/06/23. RN #123 confirmed she was unable to send IV Vancomycin because she was awaiting the vancomycin level results and the pharmacy would not send the medication without the results. RN #123 confirmed she asked the resident to wait until they had this information and could order the Vancomycin, but the resident was anxious to leave and told the nurse she would follow up with her home health nurse about continuing the Vancomycin. RN #123 further confirmed she did not notify the home health agency regarding the pending Vancomycin laboratory results and that Vancomycin and IV supplies were not sent home with resident upon discharge. RN #123 confirmed the discharge paperwork did not include information regarding Resident #90's most recent dose of Vancomycin received. This deficiency represents non-compliance investigated under Complaint Number OH00147320. 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: 365423 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 365423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mount Washington Care Center 6900 Beechmont Avenue Cincinnati, OH 45230 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)