Inspection·September 3, 2024

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, and review of facility policy, the facility failed to notify the resident's representative of a significant change in the resident's care and treatment. This affected one (Resident #34) of three residents reviewed for notification of change in condition. The census was 42. Findings include: Review of the medical record revealed Resident #34 was admitted on [DATE] with presence of prosthetic heart valve, cerebral infarction with left sided hemiplegia and hemiparesis, vascular dementia, atrial fibrillation, and obesity. Review of the Minimum Data Set (MDS) annual assessment dated [DATE] revealed Resident #34 had moderate cognitive impairment and was always incontinent of bowel and bladder. The resident required supervision with eating, maximal assistance with oral hygiene and was dependent for toileting, bathing, dressing, personal hygiene, bed mobility, and transfers. Review of the physician orders for Resident #34 revealed that on 06/17/24, Nurse Practitioner (NP) #1001 discontinued the order for Warfarin Sodium oral tablet 4 Milligrams (mg), give one tablet by mouth in the morning for clot prevention and on 06/13/24, ordered Eliquis oral tablet 5 mg. (Apixaban), give one tablet by mouth two times a day related to paroxysmal atrial fibrillation, coagulation defect, unspecified. Review of the care plan for Resident #34 revealed the facility is to notify the legal representative of new orders or changes in status (nursing or social services). Review of the progress notes for Resident #34 revealed no documentation that the facility notified the resident's representative of the change from Coumadin to Eliquis on 06/13/24. Interview on 08/29/24 at 1:10 P.M. with Licensed Practical Nurse (LPN) #403 revealed the physician changed the anti-coagulant for Resident #34 from Coumadin to Eliquis on 06/13/24 due to inconsistencies with the consulting laboratory's ability to obtain blood draws and provide PT-INR results needed for the physician to monitor the Coumadin dosing. Interview on 08/29/24 at 3:54 P.M. with Resident #34's family revealed the representative was not notified of the medication change from Coumadin to Eliquis until around 07/11/24. Interview on 08/29/24 at 5:10 P.M. with the Administrator and LPN #403 confirmed the facility (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 2 Event ID: 365462 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 365462 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/03/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgetown Nursing and Rehabilitation Centre 4307 Bridgetown Road Cheviot, OH 45211 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)