Inspection·April 28, 2022

F 0791 Provide or obtain dental services for each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Review of Resident #22's medical record revealed Resident #22 admitted to the facility on [DATE]. Diagnoses included osteoarthritis, chronic pain, and cognitive communication deficit. Review of the annual Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #22 was cognitively intact and Resident #22 had obvious or likely cavity or broken teeth. Residents Affected - Few Review of the dental care plan, last revised on 07/12/21, revealed Resident #22 had an alteration in dentition. Interventions included dental exams routinely and as needed by the dentist. Review of Resident #22's dental summary report dated 09/01/21 revealed an oral surgeon referral was made to extract all remaining teeth. Further review of the summary report revealed the resident, and the facility were advised the resident needed to be seen by an oral surgeon for extractions. Review of the dental oral surgery referral dated 09/01/21 revealed Resident #22's dentist completed referral form for Resident #22 to have all remaining teeth extracted. Further review of the oral surgery referral revealed the referral was not sent to the oral surgeon until 04/28/22. Review of Resident #22's medical record from 09/01/22 to 04/27/22 revealed no documentation that an appointment was made for Resident #22 to see the oral surgeon. There was also no documentation that Resident #22 was seen by an oral surgeon. Interview with Resident #22 on 04/25/22 at 8:30 P.M. revealed Resident #22 had not seen the dentist and all of her teeth were falling out. Interview with the Administrator on 04/28/22 at 9:38 A.M. verified Resident #22 was not seen by the oral surgeon and the oral surgeon referral was not sent until 04/28/22. Review of the facility's dental services policy dated 11/15/15 revealed the facility will promptly refer residents with lost or damaged dentures to a dentist. Based on resident and staff interview, review of the facility's policy, and record review, the facility failed to ensure residents received timely dental services. This affected two (#22 and #33) of two residents reviewed for dental services. The facility census was 71. Findings include: 1. Review of Resident #33's medical record revealed the resident was admitted on [DATE]. Diagnoses included cerebral palsy, polyarthritis, and chronic obstructive pulmonary disease. 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 3 Event ID: 365445 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 04/28/2022 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)