Inspection·April 4, 2019

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, staff interview, resident interview and policy review, the facility failed to accurately assess a fall for one Resident (#34) and dental status for one Resident (#23) of 18 sampled. The facility census was 83. Residents Affected - Few Findings included: 1. Resident #34 was admitted to the facility on [DATE]. Diagnoses included heart failure, hypertension, major depression, insomnia, pulmonary embolism and dementia without behavioral disturbances. Review of the nurse notes dated 09/07/18 revealed the Resident #34 had an unwitnessed fall without major injury while she was attempting to transfer unassisted. Review of the quarterly Minimum Data Set (MDS) assessments dated 09/19/18 documented the resident had impaired cognition, she required extensive assistance of staff for bed mobility and transfers. She had no documented falls since admission/entry, reentry or prior assessment. Interview on 04/03/19 at 10:13 A.M., with MDS Coordinator Licensed Practical Nurse (LPN) #95 stated she only reviewed the fall assessment which did not capture the fall from 09/07/18 and so she did not code the quarterly assessment correctly. Interview on 04/02/19 at 2:45 P.M., Resident #34 stated she had a fall a few months ago but could not tell the exact dates. Review of the policy titled Fall Prevention Policy and Procedure revised 11/14/18 documented an interdisciplinary team meeting will be held after all falls to re-evaluate the plan of care and determine the need for further interventions or care plan adjustments. 2. Resident #23 was admitted to the facility on [DATE]. Diagnoses included bacterial meningitis, hydrocephalus, insomnia and spondylosis with myelopathy of the cervical region. Review of the admission assessment dated [DATE] documented nothing related to dental status. Review of the admission assessment dated [DATE] documented under dental status there were obvious or likely cavity or broken natural teeth. Review of the comprehensive MDS assessment dated [DATE] revealed the resident had intact cognition, he required extensive assistance of staff for bed mobility and transfer. He had no broken or loosely fitting full or partial denture, no mouth or facial pain or difficulty with chewing. Review of the (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: 365427 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 365427 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/04/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Loveland Health Care Center 501 North Second Street Loveland, OH 45140 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)