Inspection·March 21, 2019

F 0604 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 03/21/19 at 2:47 P.M., with Occupational Therapy Program Director (OTPD) #299 revealed she put the order in to discontinue Resident #39's seatbelt. OTPD #299 revealed the resident was being evaluated last week for new cushions for her custom wheelchair and it was noted the seatbelt was no longer necessary. OTPD further revealed she was unable to find where the resident had ever been assessed for the seatbelt use and/or safety. OTPD #299 stated she also reviewed the resident orders, including her discontinued orders, and was unable to find any order related to the use of the seatbelt. Review of the facility policy titled, Physical Restraints dated 01/03/06, revealed residents will be free from physical restraints that are not required to treat the resident's medical symptoms. When a restraint is used, an assessment shall identify the medical symptom that warrants it's use, risk and benefits of usage will be discussed with the resident and/or their representative, physician's order including type/medical reason/duration will be documented, care plan will be developed, and periodical assessments will be completed to reassess for continued use. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365445 If continuation sheet Page 2 of 10 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 365445 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/21/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beechwood Home for Incurables 2140 Pogue Avenue Cincinnati, OH 45208 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 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. 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, staff interview, resident interview, review of the facility Self Reported Incident(SRI), and review of facility policy, the facility failed to implement their abuse policy when an allegation of staff to resident verbal abuse was alleged. This affected one resident (#45) of one reviewed for abuse. The facility census was 78. Residents Affected - Few Findings include: Review of the medical record revealed Resident #45 was admitted to the facility on [DATE] with diagnoses including cerebrovascular disease, abnormal gait and mobility, and the need for assistance with personal care. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident was cognitively intact with no noted behaviors. Review of the SRI revealed investigation statements were collected from State Tested Nursing Assistant (STNA) #100, Registered Nurse (RN) #101, and Resident #45, regarding the allegation of abuse made by Resident #45's wife. The SRI revealed no evidence the facility had conducted interviews of other staff and residents that STNA #100 had come into contact with that day. Review of the SRI statement from RN #101 revealed she was the nurse providing care for the resident the day of the alleged incident, and Resident #45 only told her STNA #100 wasn't nice to him and didn't make his bed correctly. Review of the SRI statement from the Director of Nursing (DON) revealed Resident #45 had reported STNA #100 was verbally abusive when she asked him, can't you stand? The resident further revealed when he asked the STNA to take him to the dining room, the STNA revealed she had seen him in the halls in the wheelchair and asked him if he was able to do it by himself. Review of STNA #100's statement revealed she was rushing to pull Resident #45's pants up in the morning of 03/18/19 because he was shaky and unsteady on his feet. STNA #100 noted Resident #45 requested assistance to the dining room and she asked him if he was pulling her leg because she had witnessed the resident be independently mobile in his wheelchair. The STNA told the resident she would assist him to the dining room after providing care for another resident. Interview on 03/18/19 at 2:36 P.M., with Resident #45 revealed during his morning care a STNA was providing care to him and the STNA started accusing him of not trying to assist her. He felt the STNA did not treat him in a dignified manor. Resident #45 was unable to identify the STNA by name, however he stated he did inform his nurse of the situation that morning after the incident. Interview on 03/20/19 at 12:36 P.M., with the Administrator and DON revealed they submitted a SRI related to the alleged verbal abuse between STNA #100 and Resident #45. The Administrator stated Resident #45's wife had notified the facility on 03/18/19 around 4:00 P.M., that she felt the resident had been verbally abused by the STNA, when she was rushing the resident though personal care. The resident had asked the STNA to assist him down to the dining room, and the STNA told him she had seen him take himself to lunch before and she did not assist him. The Administrator revealed the facility reviewed the allegation, filed an SRI, and concluded the incident was unsubstantiated. The (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365445 If continuation sheet Page 3 of 10 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 365445 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/21/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beechwood Home for Incurables 2140 Pogue Avenue Cincinnati, OH 45208 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 0607 Level of Harm - Minimal harm or potential for actual harm Administrator verified the investigation consisted of interviews with Resident #45 and STNA #100. The Administrator confirmed no other interviews with staff or other residents were completed. Review of the facility policy, Abuse Reporting and Investigation review dated 11/12/18 revealed the facility will report and thoroughly investigate any allegation of abuse. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365445 If continuation sheet Page 4 of 10 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 365445 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/21/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beechwood Home for Incurables 2140 Pogue Avenue Cincinnati, OH 45208 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 0610 Respond appropriately to all alleged violations. 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, staff interview, resident interview, review of the facility Self Reported Incident(SRI), and review of facility policy, the facility failed to thoroughly investigate an allegation of staff to resident verbal abuse. This affected one resident (#45) of one reviewed for abuse. The facility census was 78. Residents Affected - Few Findings include: Review of the medical record revealed Resident #45 was admitted to the facility on [DATE] with diagnoses including cerebrovascular disease, abnormal gait and mobility, and the need for assistance with personal care. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident was cognitively intact with no noted behaviors. Review of the SRI revealed investigation statements were collected from State Tested Nursing Assistant (STNA) #100, Registered Nurse (RN) #101, and Resident #45, regarding the allegation of abuse made by Resident #45's wife. The SRI revealed no evidence the facility had conducted interviews of other staff and residents that STNA #100 had come into contact with that day. Review of the SRI statement from RN #101 revealed she was the nurse providing care for the resident the day of the alleged incident, and Resident #45 only told her STNA #100 wasn't nice to him and didn't make his bed correctly. Review of the SRI statement from the Director of Nursing (DON) revealed Resident #45 had reported STNA #100 was verbally abusive when she asked him, can't you stand? The resident further revealed when he asked the STNA to take him to the dining room, the STNA revealed she had seen him in the halls in the wheelchair and asked him if he was able to do it by himself. Review of STNA #100's statement revealed she was rushing to pull Resident #45's pants up in the morning of 03/18/19 because he was shaky and unsteady on his feet. STNA #100 noted Resident #45 requested assistance to the dining room and she asked him if he was pulling her leg because she had witnessed the resident be independently mobile in his wheelchair. The STNA told the resident she would assist him to the dining room after providing care for another resident. Interview on 03/18/19 at 2:36 P.M., with Resident #45 revealed during his morning care a STNA was providing care to him and the STNA started accusing him of not trying to assist her. He felt the STNA did not treat him in a dignified manor. Resident #45 was unable to identify the STNA by name, however he stated he did inform his nurse of the situation that morning after the incident. Interview on 03/20/19 at 12:36 P.M., with the Administrator and DON revealed they submitted a SRI related to the alleged verbal abuse between STNA #100 and Resident #45. The Administrator stated Resident #45's wife had notified the facility on 03/18/19 around 4:00 P.M., that she felt the resident had been verbally abused by the STNA, when she was rushing the resident though personal care. The resident had asked the STNA to assist him down to the dining room, and the STNA told him she had seen him take himself to lunch before and she did not assist him. The Administrator revealed the facility reviewed the allegation, filed an SRI, and concluded the incident was unsubstantiated. The (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365445 If continuation sheet Page 5 of 10 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 365445 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/21/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beechwood Home for Incurables 2140 Pogue Avenue Cincinnati, OH 45208 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 0610 Level of Harm - Minimal harm or potential for actual harm Administrator verified the investigation consisted of interviews with Resident #45 and STNA #100. The Administrator confirmed no other interviews with staff or other residents were completed. Review of the facility policy, Abuse Reporting and Investigation review dated 11/12/18 revealed the facility will report and thoroughly investigate any allegation of abuse. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365445 If continuation sheet Page 6 of 10 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 365445 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/21/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beechwood Home for Incurables 2140 Pogue Avenue Cincinnati, OH 45208 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 0661 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on closed medical record review and staff interview, the facility failed to complete a recapitulation/discharge summary for a resident discharged from the facility. This affected one resident (#79) of one reviewed for discharge. The facility census was 78. Findings include: Review of the closed medical record revealed Resident #79 was admitted to the facility on [DATE], discharged on 02/14/19 to another facility. Diagnoses included cerebral palsy, abnormal posture, dysphagia, hypertension, benign neoplasm of colon, and gastro-esophageal reflux disease. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #79 was cognitively intact with no noted behaviors. Review of Section Q- Participation in Assessment and Goal Setting revealed the resident expected to remain in the facility with no active discharge planning occurring, and no interest in talking to someone about the possibility of leaving the facility. Review of the progress note dated 02/14/19 revealed Resident #79 was discharged to another facility and left the facility with their guardian. The note revealed the resident left with medication and an order summary. There was no evidence of a discharge summary for Resident #79. Interview on 03/21/19 at 4:17 P.M., with Social Worker (SW) #111 revealed she was the discharge planner for Resident #79. SW #111 stated Resident #79's discharge request was abrupt, and that the resident had only lived in the facility for a couple weeks. SW #111 stated the resident's discharge was initiated by his mother and she took control of everything. SW #111 stated she faxed over the information the mother had requested, and a couple days later he discharged . SW #111 stated she provided the items the facility requested, however she did not complete a recapitulation of stay. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365445 If continuation sheet Page 7 of 10 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 365445 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/21/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beechwood Home for Incurables 2140 Pogue Avenue Cincinnati, OH 45208 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 0759 Ensure medication error rates are not 5 percent or greater. 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, observations, review of manufacturer recommendations, staff interview, and facility policy review, the facility failed to ensure their medication administration error rate was five percent (%) or lower. There were 32 opportunities observed with two errors. This resulted in a medication administration error rate of 6.25%. This affected two residents (#3 and #8) of six observed during medication administration. The facility census was 78. Residents Affected - Few Finding include: 1. Medical record review revealed Resident #3 was admitted to the facility on [DATE] with diagnoses of hypertension (high blood pressure), diabetes, multiple sclerosis (MS), and unspecified osteoarthritis. Review of Resident #3's physician orders revealed orders for 10 milligrams (mg) of Baclofen (muscle spasms) and Lisinopril (high blood pressure), and 500 mg of Metformin (diabetes) through her gastrostomy tube (G-tube). Observation on 03/20/19 at 11:15 A.M., revealed Licensed Practical Nurse (LPN) #9 administered Resident #3's medications through her G-tube. LPN #9 flushed the G-tube with 10 milliliters (ml) of water and administered the three medications through the G-tube. She flushed the G-tube with 10 ml of water between each medication administration. LPN #9 then administered a final flush of 25 ml of water. Interview on 03/20/19 at 12:00 P.M., with LPN #9 revealed she flushed Resident #3's G-tube with 10 to 30 ml of water before and after medication administration. On 03/20/19 at 5:00 P.M., interview with the Director of Nursing (DON) verified the facility policy instructed the nurses to administer 30 ml of a water flush before and after medication administration. Review of the facility's policy for Administration of Medications via Feeding Tubes with a revision date of 09/08/17 revealed the nurse was to flush G-tubes with 30 ml of water to rinse the feeding tube before and after giving medications. 2. Medical record review revealed Resident #8 was admitted to the facility on [DATE] with diagnoses of heart failure, respiratory failure, acute and chronic respiratory failure with hypoxia. A review of Resident #8's physician orders revealed the resident was to receive two puffs of Mometasone Furo-Formoterol Fum (Dulera) Aerosol 200-5 mg (inhaler) for respiratory health. On 03/21/19 at 8:30 A.M., LPN #12 administered two puffs of the inhaler medication to Resident #8. LPN #12 did not offer or instruct Resident #8 to rinse and spit after inhaling the medication. Interview with LPN #12 verified she had forgotten to offer or instruct the resident to rinse and spit after inhaling the medication. Review of the Dulera manufacturer recommendations revealed the resident should rinse their mouth with water after each dose (two) puffs. This will help to lessen the chance of getting a yeast (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365445 If continuation sheet Page 8 of 10 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 365445 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/21/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beechwood Home for Incurables 2140 Pogue Avenue Cincinnati, OH 45208 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 0759 infection (thrush) in the mouth and throat. Level of Harm - Minimal harm or potential for actual harm A review of the facility's policy for Administration of Metered-Dose Inhalers (undated) revealed the resident should rinse their mouth and spit out the rinse water. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365445 If continuation sheet Page 9 of 10 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 365445 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/21/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beechwood Home for Incurables 2140 Pogue Avenue Cincinnati, OH 45208 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 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. 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, observation, food test tray, staff interview, resident interview, and review of facility policy, the facility failed to serve meals at appetizing temperatures. This affected two residents (#53 and #66) of 24 residents reviewed for food temperatures. The facility census was 78. Residents Affected - Few Findings include: 1. Review of the medical record revealed Resident #53 was admitted to the facility on [DATE] with diagnoses including muscle spasms, dysphagia, constipation, neuromuscular dysfunction of the bladder, type two diabetes, and multiple sclerosis. Review of the quarterly Minimum Data Set (MDS) assessment 02/06/19 revealed the resident was cognitively intact. Interview conducted on 03/18/19 at 3:08 P.M., Resident #53 revealed the food comes to the unit at 5:00 P.M., and the residents do not receive it until 5:30 P.M. Resident #53 stated she had voiced her concerns to the food committee, and said she was entitled to warm food. 2. Review of the medical record revealed Resident #66 was admitted the the facility on 06/14/17 with diagnoses including hypertension, multiple sclerosis (MS), depression and cognitive communication deficit. Review of the resident's MDS assessment dated [DATE] revealed her cognition was intact. Interview on 03/19/19 at 9:32 A.M., with Resident #66 revealed her food was sometimes cold when she received it. A meal test tray was completed on 03/21/19 11:49 A.M., with the Dietary Manager (DM) #27. The food was plated and taken to the third floor at 11:54 A.M., after all residents were served. The test tray was removed from the transportation cart at approximately 12:23 P.M. Temperatures were completed with DM #27. The potatoes were 119 degrees Fahrenheit (F), the BBQ ribs were 120 degrees (F), the cabbage was 127 degrees (F), and the pea soup was 116 degrees (F). Food was then tasted for temperature with verification by DM #27. The food was no longer hot, and at luke warm temperature. DM #27 revealed the plate warmer had been broken and plates were being heated in the oven prior to the food being plated. Review of the facility policy, Food Preparation and Consistencies dated 09/10/15 revealed foods are maintained at proper temperature both during preparation and at serving time. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365445 If continuation sheet Page 10 of 10