Health inspection·December 10, 2025

F 0697 Level of Harm - Actual harm Residents Affected - Few Note: The nursing home is disputing this citation. long-term-care facility. Resident #64 was brought in complaining of left elbow pain and was brought to the ER by EMS. Resident #64 was assessed to have a pain level of nine out of 10 upon her arrival at the hospital. Work-up in the ER revealed a previous shoulder fracture and a new acute displaced transcondylar humerus fracture (serious break at the lower end of the upper arm near the elbow joint, where bone fragments have significantly shifted out of alignment) to her left elbow. Resident #64 was treated with nonsurgical interventions with a sling/immobilizer to her left arm. Resident #64 was discharged back to the facility on [DATE], with orthopedic follow up on 11/06/25 and a medication order for Norco 5-325 (narcotic pain medication to treat severe pain) mg by mouth every four hours as needed for pain control.The nursing note dated 10/31/25 at 3:30 A.M. revealed Resident #64 returned from the ER and records sent with no new orders for the right shoulder, with the right elbow showing the appearance of an acute displaced transcondylar humerus fracture and joint effusion. Recommend orthopedic consult. Review of the facility's fall investigation report dated 10/31/25 completed by the Director of Nursing (DON) revealed Resident #64 began complaining of pain to the left arm on 10/30/25 at approximately 7:30 P.M. The report revealed Resident #64 sustained an acute left displaced transcondylar humerus fracture to her left elbow and complained of left elbow pain after being sent to the hospital and returning on 10/31/25 around 4:00 A.M. Review of the e-mail statement provided by Certified Nursing Assistant (CNA) #590 dated 10/31/25 revealed CNA #590 had entered the resident's room to feed her dinner around 5:45 P.M. with the resident reporting no complaints of pain at that time. She stated she had returned to the resident's room around 6:30 P.M. to get her ready for bed. When she was hooking up the lift pad under the resident, she began screaming that her arm was hurting, with Resident #64 stating It was broken again. CNA #590 then finished hooking up the resident to the lift and moving her over to bed with Resident #64 still screaming in pain. CNA #590 then began rolling and changing the resident. Two additional CNAs entered Resident #64's room to respond to Resident #64's screaming during care provided by CNA #590. During an interview on 12/02/25 at 12:53 P.M., CNA #410 stated she had cared for Resident #64 on day shift of 10/30/25 and had encountered no problems moving the resident from her bed to the chair early in the shift that day (10/30/25) with the use of a mechanical lift. She stated the resident had asked throughout the day for a drink but had no complaints of pain. During an interview on 12/02/25 at 1:15 P.M., Licensed Practical Nurse (LPN) #800 stated she was the evening shift nurse that had come into work that day around 3:00 P.M. and was the nurse for Resident #64. She stated that around 7:30 P.M. she was alerted to the resident who was complaining about left arm pain, and during her assessment was unable to identify any dislocation or swelling to her left elbow region. She stated she had administered Acetaminophen 325 mg two tablets by mouth as ordered by the physician and would return to reassess. She stated around 10:30 P.M., she returned and reassessed the site of which the resident was still complaining of pain (no pain level obtained), so she notified the physician she provided an order for the resident to be sent to the hospital for evaluation. She then notified family, who stated they would meet the resident at the hospital. During an interview on 12/02/25 at 1:20 P.M., CNA #590 stated she was getting Resident #64 ready for bed on 10/30/25 and transporting her from her chair to her bed. She stated the resident began screaming that her arm was broken again, but she had always done that due to a previous fracture to the same shoulder. CNA #590 thought this was normal for Resident #64. She verified she was the only staff member in the room during the transfer until CNA #650 and CNA #340 responded to the room following the transfer due to the resident screaming in pain. She verified they responded after the resident had already been placed in bed and she was attempting to put on her nightgown. During an interview on 12/10/25 at 1:30 P.M., CNA #340 stated she was walking down the hall with CNA #650 as (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365444 If continuation sheet Page 2 of 3 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 365444 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hill View Retirement Center 1610 28th Street Portsmouth, OH 45662 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)

F 0697 Level of Harm - Actual harm Residents Affected - Few Note: The nursing home is disputing this citation. FORM CMS-2567 (02/99) Previous Versions Obsolete she had just come onto her shift at 6:30 P.M. CNA #650 and heard loud screaming coming from the resident's room. When they entered, Resident #64 was already in bed being changed by CNA #590. Resident #340 was screaming that her arm hurts and It's broken again. They assisted with care and the resident calmed down and they then left the room. The resident was no longer screaming, and she left the room around 6:45 P.M. During an interview on 12/10/25 at 1:45 P.M., CNA #650 stated she was walking down the hall and heard loud screaming from the resident's room. She stated she walked in with another aide and asked why Resident #64 was screaming like that. She stated she had never heard the resident scream in pain like that, and she was yelling my arm is broken. The resident would not say exactly what was hurting but pointed at her right shoulder, which had been previously broken. She told LPN #800 when she left the room that the resident was in pain and was told she would be administering Resident #64 Tylenol. She stated she did not see the nurse enter the room at all or after reporting it to her. CNA #650 left the room around 6:45 P.M. During a subsequent interview on 12/10/25 at 2:30 P.M., CNA #590 stated it was around 6:30 P.M. when she was transferring the resident and got her into bed. She stated the resident was screaming about her arm hurting when the other two aides entered the room. She stated she let the nurse know the resident was screaming and in pain, and the nurse stated she would check on her in a minute. During an interview on 12/10/25 at 3:00 P.M., the Director of Nursing she would expect the nurse to respond to complaints of pain within usually 30-45 minutes and maybe one hour depending on what they were involved in at the time. She stated she did not know how long it should take after a resident had been provided pain medication for reassessment to take place. She also verified that she was unaware of any follow-up.Review of the facility policy titled Pain Management, revised 02/24/25, revealed the CNAs will report any resident pain to the licensed nurse. The licensed nurse will medicate the resident per physician orders and will also follow-up after administration of the medication for effectiveness and adverse reactions. Documentation in the medical record to include time the as needed medication is administered, pre and post pain levels, the cite of pain, the non-pharmacological interventions attempted (at least three) and the effect on the resident.Review of Medscape guidance titled Acute Pain: Assessment and Treatment dated 01/03/11 found at https://www.medscape.com/viewarticle/735034 revealed Pain is defined by the International Association of the Study of Pain as an unpleasant sensory and emotional experience arising from actual or potential tissue damage. Acute pain is the normal, predicted physiologic response to an adverse chemical, thermal, or mechanical stimulus.associated with which included trauma. Acute pain plays the vital role of providing warning signal that something is wrong and in need of further examination. This deficiency represents non-compliance investigated under Complaint Number 2666893. Event ID: Facility ID: 365444 If continuation sheet Page 3 of 3