Health inspection·September 21, 2022

F 0567 Honor the resident's right to manage his or her financial affairs. Level of Harm - Minimal harm or potential for actual harm Based on review of personnel funds documentation, staff interview and policy review, the facility failed to ensure resident fund authorization forms contained an authorized signature. This affected one (#19) out of five resident accounts reviewed. The facility census was 51. Residents Affected - Few Findings include: Review of authorized representative form titled, Resident Fund Management Services, undated, for Resident #19 revealed there was no signature on the authorized representative form. Interview on 09/13/22 at 1:58 P.M. with the facility business office manager (BOM) #450 confirmed Resident #19's form did not contain an authorized signature for the facility to manage the residents funds. Review of the facility policy titled, Deposit Resident Funds, dated April 2017, revealed, Resident personal funds that are held and managed by the facility will be safeguarded. Page 1 of 17 365529 365529 09/21/2022 Garden Park Health Care Center 3536 Washington Ave Cincinnati, OH 45229

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, and policy review, the facility failed to ensure forms indicating advance directives were accurately completed. This affected two (#13 and #47) out of three residents reviewed for advance directives. The facility census was 51. Findings include: 1. Review of the medical record for Resident #13 revealed he was admitted to the facility on [DATE]. Diagnoses included type two diabetes mellitus without complications, unspecified dementia with behavioral disturbance, vitamin d deficiency, muscle weakness, and other abnormalities of gait and mobility. Review of the signed Do Not Resuscitate (DNR) Comfort Care form dated 05/24/22 revealed the box for DNR Comfort Care (CC) was checked. Review of the current physician orders revealed an order dated 05/26/22 for DNRCC Arrest. Review of the admission Minimum Data Set (MDS) 3.0 assessment, dated 06/06/22, revealed Resident #13 had severely impaired cognition evidenced by a Brief Interview for Mental Status (BIMS) score of three out of 15. This resident was assessed to require limited assistance for dressing, toileting, and personal hygiene as well as supervision for bed mobility, transfer, and eating. Interview on 09/07/22 at 4:45 P.M. with Regional Director of Clinical Operations #500 confirmed Resident #13 had a code status of DNRCC Arrest in the electronic health record. Interview on 09/08/22 at 10:56 A.M. with Regional Director of Clinical Operations #500 verified the signed DNR form was for DNRCC and should have been marked as DNRCC - Arrest. 2. Review of the medical record for Resident #47 revealed he was admitted to the facility on [DATE]. Diagnoses included chronic obstructive pulmonary disease, unspecified acquired deformity of left hand, anorexia nervosa, bulimia nervosa, other specified anxiety disorders, disorganized schizophrenia, vitamin d deficiency, chronic viral hepatitis c, and personality disorder. Review of the current physician orders revealed an order dated 08/09/18 for DNRCC Arrest. Review of the facility form titled Medical Directives, dated 01/06/20, revealed Resident #47 was identified with an advance directive for DNRCC - Arrest. Further review of the form revealed it had been signed only by two nurses at the facility. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 08/16/22, revealed this resident had severely impaired cognition evidenced by a Brief Interview for Mental Status (BIMS) score of zero. This resident was assessed to require supervision for bed mobility, transfer, dressing, eating, toileting, and personal hygiene. Interview on 09/07/22 at 4:45 P.M. with Regional Director of Clinical Operations #500 confirmed the form had been signed by two facility nurses and was not signed by an appropriate provider. 365529 Page 2 of 17 365529 09/21/2022 Garden Park Health Care Center 3536 Washington Ave Cincinnati, OH 45229

F 0578 Review of the facility policy titled Advance Directives, revised 12/2016, revealed advance directives would be respected in accordance with state law and facility policy. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 365529 Page 3 of 17 365529 09/21/2022 Garden Park Health Care Center 3536 Washington Ave Cincinnati, OH 45229

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observations, resident and staff interviews and policy review, the facility failed to provide a safe, clean, and homelike environment for residents. This affected three (#05, #08 and #23) out of three residents reviewed. The facility census was 51. Findings include: 1. Record review for Resident #05 revealed he was admitted to the facility on [DATE]. His diagnosis included paranoid schizophrenia, history of Coronavirus Disease 2019 (COVID-19), hyperlipemia, vascular dementia, psychotic disturbance, constipation, epileptic seizures, and anxiety disorder. Review of the quarterly minimum data set (MDS) assessment dated [DATE] for Resident #05 revealed he had intact cognition. Further review of the MDS assessment revealed Resident #05 was independent and required no assistance from staff with bed mobility, transfers, walking, dressing, toilet use, personal hygiene, and eating. Interview on 09/06/22 11:25 A.M. with Resident #05 revealed he had a concern with the gazebo outside his window. Observations revealed Resident #05 was pointing at the portion of the metal gazebo hanging to the ground. Resident #08 stated the hot water in his bathroom is cold. Resident #05 pointed at his doorway and stated the door knob is missing from his door. Interview on 09/07/22 at 11:09 A.M. with Maintenance Assistance (MA#59) confirmed the hot water temperature in Resident #05's room was 68 degrees Fahrenheit (F). MA #59 confirmed the vent over the bathroom toilet in Resident #05's bathroom was covered with plastic and in place with black electric tape. MA #59 confirmed the bathroom light over the sink in Resident #05's bathroom contained several bugs. Interview on 09/14/22 at 11:19 A.M. with the Maintenance Supervisor MS #54 confirmed Resident #05's room door is missing a door knob. MS #54 also confirmed the metal gazebo outside the window of Resident #05's room was broken and hanging down, and in need of repair. 2. Record review for Resident #08 was admitted ot the facility on 05/31/19. His diagnosis included chronic obstructive pulmonary disease, protein-calorie malnutrition, hemiplegia, cancer, altered mental status, epilepsy, history of COVID-19, vascular dementia, schizophrenia, vascular dementia, dysphasia, oropharyngeal phase, diabetes mellitus 2, squamous cell carcinoma of skin, dementia, chronic obstructive pulmonary disease, hyperlipemia. Review of the significant change MDS assessment for Resident #08 revealed he had impaired cognition. Further review of the MDS assessment revealed Resident #08 required extensive assistance from staff with transfer, and limited assistance from staff with bed mobility. However, Resident #08 was totally dependent on assistance from staff with dressing, personal hygiene and toilet use. Interview on 09/14/22 at 11:11 A.M. with MA #59 confirmed the hot water temperature in Resident #05's and Resident #08's room was 68 degrees F. 3. Record review for Resident #23 revealed was admitted to the facility on [DATE]. His diagnosis 365529 Page 4 of 17 365529 09/21/2022 Garden Park Health Care Center 3536 Washington Ave Cincinnati, OH 45229

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few included cerebral infarction, chronic obstructive pulmonary disease, history of COVID-19, dysphasia, insomnia, hyperlipidemia, diabetes mellitus 2, major depressive disorder, suicidal ideation, schizophrenia, bipolar disorder, and essential primary hypertension. Review of the quarterly MDS assessment revealed Resident #23 was milady cognitively impaired. Further review of the MDS assessment revealed he was totally dependent on staff with bed mobility, transfers, dressing, toilet use and personal hygiene. Resident #23 required supervision from staff with eating. Interview on 09/06/22 at 4:09 P.M. with the housekeeping supervisor (HS) #109 confirmed bathroom sink located in Resident #23's room was swarming with flying gnats. Review of the facility policy titled, Quality of Life - Homelike Environment, dated May 2017, revealed Residents are provided with a safe, clean, comfortable and homelike environment and encouraged to use their personal belongings to the extent possible. Review of the facility policy titled, Water Temperatures, Safety of, dated December 2009, revealed 1. Water heaters that service resident rooms, bathrooms, common areas, and tub/shower areas shall be set to temperatures of no more than 110 degrees F, or the maximum allowable temperature per state regulation. This deficiency substantiates Complaint Number OH00135455, Complaint Number OH00133502 and Complaint Number OH00110620. 365529 Page 5 of 17 365529 09/21/2022 Garden Park Health Care Center 3536 Washington Ave Cincinnati, OH 45229

F 0637 Assess the resident when there is a significant change in condition 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 and staff interview, the facility failed to ensure a significant change assessment was completed following discharge from hospice services. This affected one (#47) resident out of three residents reviewed for hospice services. The facility census was 51. Residents Affected - Few Findings include: Review of the medical record for Resident #47 revealed he was admitted to the facility on [DATE]. Diagnoses included chronic obstructive pulmonary disease, unspecified acquired deformity of left hand, anorexia nervosa, bulimia nervosa, other specified anxiety disorders, disorganized schizophrenia, vitamin d deficiency, chronic viral hepatitis c, and personality disorder. Review of the discontinued physician orders revealed an order dated 04/14/21 for admission to Hospice for Resident #47, which was discontinued on 03/19/22. Review of the plan of care, initiated 04/27/21 and resolved 03/18/22, revealed Resident #47 had a decline in condition and received hospice services. Interventions included allow resident to voice feelings, provide privacy, offer emotional support, involve family, validate concerns, offer reassurance, observe for pain, medicate per physician order, observe for effectiveness, notify hospice nurse and physician for necessary medication changes, observe for signs and symptoms of depression, and observe for signs and symptoms of anxiety. Review of the current physician orders revealed an order dated 03/15/22 for consult/enroll with Hospice Services. Further review of the completed MDS assessments for Resident #47 revealed the last significant change assessment was completed on 04/19/21. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 08/16/22, revealed this resident had severely impaired cognition evidenced by a Brief Interview for Mental Status (BIMS) score of zero. This resident was assessed to require supervision for bed mobility, transfer, dressing, eating, toileting, and personal hygiene. Interview on 09/12/22 at 4:11 P.M. with Corporate Director of Clinical Services #975 confirmed a significant change assessment was not completed following Resident #47's discharge from hospice. 365529 Page 6 of 17 365529 09/21/2022 Garden Park Health Care Center 3536 Washington Ave Cincinnati, OH 45229

F 0645 PASARR screening for Mental disorders or Intellectual Disabilities Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, and policy review, the facility failed to ensure a Preadmission Screening and Resident Review (PASARR) was completed as required following admission to the facility. This affected one resident (#44) out of three residents reviewed for PASARR. The facility census was 51. Residents Affected - Few Findings include: Review of the medical record for Resident #44 revealed he was admitted to the facility on [DATE]. Diagnoses included malignant neuroleptic syndrome, unspecified severe protein-calorie malnutrition, adult failure to thrive, subsequent encounter for suicide attempt, muscle wasting and atrophy, paroxysmal tachycardia, dietary folate deficiency anemia, catatonic schizophrenia, unspecified psychosis not due to a substance or known physiological condition, anxiety disorder, major depressive disorder, and autistic disorder. Review of the Hospital Exemption from Preadmission Screening Notification, dated 07/08/21 revealed Resident #44 was admitted to the facility from the hospital. Further review of the exemption revealed the nursing facility accepts responsibility for requesting a resident review (if required) prior to the 30th day following admission from the hospital. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 07/07/22, revealed this resident had moderately impaired cognition evidenced by a Brief Interview for Mental Status (BIMS) score of 10. This resident was assessed to require limited assistance for personal hygiene, toileting, and dressing as well as supervision for bed mobility, transfer, and eating. Further medical record review for Resident #44 revealed there was no further PASARR completed. Interview on 09/12/22 at 3:34 P.M. with Corporate Director of Clinical Services #975 confirmed Resident #44 did not have an updated PASARR completed within 30 days following admission to the facility. Review of the facility policy titled admission Criteria, revised 03/2019, revealed all new admissions and readmissions are screened for mental disorders (MD), intellectual disabilities (ID) or related disorders (RD) per the Medicaid Pre-admission Screening and Resident Review (PASARR) process. 365529 Page 7 of 17 365529 09/21/2022 Garden Park Health Care Center 3536 Washington Ave Cincinnati, OH 45229

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. Resident #25 was admitted to the facility on [DATE]. Her diagnosis included osteomyelitis, tachycardia, sepsis, pressure ulcer of sacral region, edema, anemia, and essential primary hypertension. Review of the quarterly MDS assessment, date 07/14/22, revealed Resident #24 had intact cognition. Further review of the MDS assessment revealed Resident #25 was totally dependent on staff with assistance with bed mobility, transfers and toilet use. Resident #25 required extensive assistance with personal hygiene, dressing, and supervision from staff with eating. The MDS assessment confirmed Resident #25 required an indwelling catheter. Review of Resident #25's orders revealed an order dated, 08/26/22 to change indwelling catheter/tubing/bag every month. Further review of the physician orders for Resident #25 revealed an order, dated 08/26/22, change indwelling catheter bag q (each) week. Review of Resident #25's nursing care plan revealed the document did not reveal any information regarding Resident #25 requiring a catheter or catheter care. Interview on 09/13/22 at 2:35 P.M. with Corporate Director of Clinical Services (DCS) #975 confirmed Resident #44 did not have a care plan to address suicidal ideation's/attempts. Corporate DCS #975 further confirmed Resident #16 did not have a care plan to address treatment and services for dementia and Resident #25's care plan did not include the use of her indwelling Foley catheter or catheter care. Review of the facility policy titled Comprehensive Person-Centered Care Plans, revised 03/2022, revealed a comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident. Based on record review, staff interview, and policy review, the facility failed to develop appropriate care plans based on resident needs. This affected three (#25, #16 and #44) out of three residents reviewed for care plans. The facility census was 51. Findings include: 1. Review of the medical record for Resident #44 revealed he was admitted to the facility on [DATE]. Diagnoses included malignant neuroleptic syndrome, unspecified severe protein-calorie malnutrition, adult failure to thrive, suicide attempt, subsequent encounter, muscle wasting and atrophy, paroxysmal tachycardia, dietary folate deficiency anemia, catatonic schizophrenia, unspecified psychosis not due to a substance or known physiological condition, anxiety disorder, major depressive disorder, and autistic disorder. Review of the nursing progress note dated 08/06/21 revealed Resident #44 contacted a suicide hotline using a tablet. The note indicated the police called and notified the Assistant Director of Nursing (ADON). Resident #44 was placed on one-to-one supervision, the psychiatric nurse practitioner was notified, and medication changes were made. 365529 Page 8 of 17 365529 09/21/2022 Garden Park Health Care Center 3536 Washington Ave Cincinnati, OH 45229

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the nursing progress note dated 08/19/21 revealed Resident #44 was transferred to the emergency room as he reported to the Assistant Director of Nursing (ADON) that he felt like committing suicide. Review of the nursing progress note dated 08/20/21 revealed Resident #44 returned to the facility from the hospital with no talk of suicide mentioned. Review of the nursing progress note dated 08/21/21 revealed Resident #44 had made threats towards his life, was trying to exit the facility, and reported to a nurse that he had consumed disinfecting supplies. The note indicated Resident #44's guardian had been contacted as well as the ADON and physician. Review of the nursing progress note dated 08/24/21 revealed Resident #44 returned to the facility from the hospital on this date. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 07/07/22, revealed this resident had moderately impaired cognition evidenced by a Brief Interview for Mental Status (BIMS) score of 10 out of 15. This resident was assessed to require limited assistance for personal hygiene, toileting, and dressing as well as supervision for bed mobility, transfer, and eating. Review of the plan of care for Resident #44 revealed there was no care plan related to suicidal ideation's or behaviors. 2. Review of the medical record for Resident #16 revealed she was admitted to the facility on [DATE]. Diagnoses included unspecified injury of head, subsequent encounter, unspecified psychosis not due to a substance or known physiological condition, dementia in other diseases classified elsewhere with behavioral disturbance, other asthma, opioid use, unspecified with unspecified opioid-induced disorder, cocaine use, unspecified with other cocaine-induced disorder, and nicotine dependence, unspecified with withdrawal. Review of the plan of care, dated 09/22/21, revealed there was no care plans with a focus on dementia. Review of the quarterly MDS 3.0 assessment, dated 06/30/22, revealed this resident had moderately impaired cognition evidenced by a BIMS score of 11. This resident was assessed to require supervision for bed mobility, transfer, dressing, toileting, and personal hygiene, and was independent for eating. 365529 Page 9 of 17 365529 09/21/2022 Garden Park Health Care Center 3536 Washington Ave Cincinnati, OH 45229

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, staff interview, and policy review, the facility failed to provide adequate supervision while residents were smoking. This affected three (#16, #23, and #25) out of three residents reviewed for smoking. The facility census was 51. Findings include 1. Review of the medical record for Resident #16 revealed she was admitted to the facility on [DATE]. Diagnoses included unspecified injury of head, subsequent encounter, unspecified psychosis not due to a substance or known physiological condition, dementia in other diseases classified elsewhere with behavioral disturbance, other asthma, opioid use, unspecified with unspecified opioid-induced disorder, cocaine use, unspecified with other cocaine-induced disorder, and nicotine dependence, unspecified with withdrawal. Review of the plan of care, dated 04/01/22, revealed the resident had the potential for injury related to smoking. Interventions included advise resident to wear smoking apron while smoking if indicated, complete smoking assessment quarterly and with significant change, observe clothing daily for burn holes, provide supervision during smoking, remind resident of scheduled smoking times, secure cigarettes/lighters at nurses' station, staff to check room regularly for cigarettes and lighters, staff to light resident's cigarette/pipe, ensure resident holds cigarette securely, and remind resident to use ash tray appropriately. Review of the CareCore Health Smoking Assessment, dated 04/13/22, revealed Resident #16 needed supervision for smoking. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 06/30/22, revealed this resident had moderately impaired cognition evidenced by a Brief Interview for Mental Status (BIMS) score of 11. This resident was assessed to require supervision for bed mobility, transfer, dressing, toileting, and personal hygiene, and was independent for eating. 2. Review of the medical record for Resident #23 revealed he was readmitted to the facility on [DATE]. Diagnoses included cerebral infarction, chronic obstructive pulmonary disease, other dysphagia, contracture of muscle, left hand, insomnia, hyperlipidemia, chronic pain syndrome, hemiplegia, unspecified affecting left non-dominant side, diabetes mellitus due to underlying condition without complications, schizophrenia, bipolar disorder, and hypertension. Review of the plan of care dated 03/15/22 revealed the resident had the potential for injury related to smoking. Interventions included assist to smoking area as needed, provide supervision during smoking, remind resident of scheduled smoking times, secure cigarettes/lighters at nurses' station, and staff to light resident's cigarette/pipe, ensure resident holds cigarette securely, and remind resident to use ash tray appropriately. Review of the CareCore Health Smoking Assessment, dated 04/13/22, revealed Resident #23 needed supervision for smoking. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 07/15/22, revealed this 365529 Page 10 of 17 365529 09/21/2022 Garden Park Health Care Center 3536 Washington Ave Cincinnati, OH 45229

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few resident had moderately impaired cognition evidenced by a Brief Interview for Mental Status (BIMS) score of 12. This resident was assessed to be totally dependent on staff for personal hygiene, toileting, dressing, transfer, and bed mobility as well as supervision for eating. 3. Review of the medical record for Resident #25 revealed she was admitted to the facility on [DATE]. Diagnoses included osteomyelitis, tachycardia, disorder of urea cycle metabolism, unspecified, pressure ulcer of sacral region, unspecified stage, unspecified open wound, right thigh, subsequent encounter, generalized edema, acute posthemorrhagic anemia, non-pressure chronic ulcer of back with unspecified severity, hypoglycemia, unspecified open wound, right lower leg, subsequent encounter, anemia, hypertension, and acute embolism and thrombosis of unspecified deep veins of unspecified lower extremity. Review of the CareCore Health Smoking Assessment, dated 05/23/22, revealed Resident #25 needed supervision when smoking. Review of the plan of care dated 05/24/22 revealed the resident had the potential for injury related to smoking. Interventions included assist to smoking area as needed, complete smoking assessment quarterly and with significant change, observe clothing daily for burn holes, provide supervision during smoking, remind resident of scheduled smoking times, secure cigarettes/lighters at nurses' station, staff to check room regularly for cigarettes and lighters, staff to light resident's cigarette/pipe, ensure resident holds cigarette securely, and remind resident to use ash tray appropriately. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 07/14/22, revealed this resident had intact cognition evidenced by a Brief Interview for Mental Status (BIMS) score of 14. This resident was assessed to be totally dependent on staff for toileting, transfer, and bed mobility, and required extensive assistance for dressing and personal hygiene as well as supervision for eating. Observation on 09/12/22 at 11:17 A.M. revealed Residents #16, #23, and #25 were outside during the scheduled smoke break. Resident #16 was sitting outside on a bench near the door to the smoking area and was sleeping while wearing a smoking apron. Residents #23 and #25 were actively smoking. No staff were observed outside in the designated smoking area with the residents. A staff member was observed sitting inside the facility in a common area that led to the doors for the smoking area and was looking at their cell phone at the time of the observation. Interview on 09/12/22 at 11:18 A.M. with Activity Aide #89 confirmed there were no staff outside with the residents while they were smoking and that she was unable to see the residents that were outside in the smoking area. Review of the undated facility policy titled RESIDENT SMOKING/USE OF ELECTRONIC CIGARETTE POLICY revealed all residents require monitoring of their smoking/electronic cigarette use and shall receive direct supervision in the designated smoking room. This deficiency substantiates Complaint Number OH00135455. 365529 Page 11 of 17 365529 09/21/2022 Garden Park Health Care Center 3536 Washington Ave Cincinnati, OH 45229

F 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 4. Record review for Resident #17 revealed an admission date of 05/10/21. His diagnosis included, sleep apnea, diabetes mellitus 2, hypoxemia, enchephalopathy, anxiety disorder, dementia, mood disturbance, paranoid schizophrenia, seborrheic dermatitis, dysphasia, major depressive disorder, and gastro-esophageal reflux disease. Review of the quarterly MDS assessment, dated 07/14/22, revealed Resident #17 was cognitively impaired. Further review of the MDS assessment revealed Resident #17 required limited assistance from staff with bed mobility. However, Resident #17 required extensive assistance from staff with transfers, personal hygiene, and toilet use. He required supervision from staff with eating. Review of Resident #17 physician orders revealed an order for, ativan tablet 0. 5 mg, give one tablet by mouth at bedtime related to adjustment disorder with mixed anxiety and depressed mood, clozapine tablet 250 mg by mouth-related to adjustment disorder with anxiety and depressed mood, other schizophrenia, escitalopram oxalate table 10 MG, give 20 mg by mouth one time a day related to major depressive disorder, and lithium carbonate 300 mg, give 300 mg by mouth every morning and bedtime related to schizophrenia. Review of the licensed pharmacist review for Resident #17 revealed a pharmacist reviewed his medications on the following months in the past year, 01/17/22, 03/17/22, and 05/18/22. Interview on 09/13/22 at 11:56 A.M. with the Director of Nursing (DON) confirmed the facility had several months where there was no evidence a licensed pharmacist had conducted medication regimen reviews. The DON expressed the facility was unable to locate any additional reviews and were also unable to obtain the reviews from the contracted pharmacy for Resident #16, #29, #17 and #44. Review of the facility policy titled Medication Regimen Reviews, revised 05/2019, revealed the Consultant Pharmacist performs a medication regimen review (MRR) for every resident in the facility receiving medication. Further review of the policy revealed the medication regimen reviews were to be done upon admission or close as possible to admission and at least monthly. Based on record review, staff interview, and policy review, the facility failed to ensure a medication regimen review was completed as required by a licensed pharmacist. This affected four (#16, #17, #29, and #44) out of four residents reviewed for medication review. The facility census was 51. Findings include: 1. Review of the medical record for Resident #16 revealed she was admitted to the facility on [DATE]. Diagnoses included unspecified injury of head, subsequent encounter, unspecified psychosis not due to a substance or known physiological condition, dementia in other diseases classified elsewhere with behavioral disturbance, other asthma, opioid use, unspecified with unspecified opioid-induced disorder, cocaine use, unspecified with other cocaine-induced disorder, and nicotine dependence, unspecified with withdrawal. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 06/30/22, revealed this resident had moderately impaired cognition evidenced by a Brief Interview for Mental Status (BIMS) score 365529 Page 12 of 17 365529 09/21/2022 Garden Park Health Care Center 3536 Washington Ave Cincinnati, OH 45229

F 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some of 11. This resident was assessed to require supervision for bed mobility, transfer, dressing, toileting, and personal hygiene, and was independent for eating. Review of the current physician orders for Resident #16 revealed orders for gabapentin capsule 600 milligrams (mg) two times a day for unspecified injury of head, initial encounter, Risperdal tablet one mg two times a day related to unspecified psychosis not due to a substance or known physiological condition, methadone hydrochloride solution 10 mg/milliliter with 210 mg by mouth one time a day related to opioid use, unspecified with unspecified opioid-induced disorder, citalopram hydrobromide tablet 20 mg with a dosage of two tablets once a day for depression, and Depakote tablet delayed release 500 mg with a dosage of two tablets one time a day for unspecified injury of head, initial encounter. Review of the completed medication regimen reviews provided by the facility for Resident #16 included reviews for the months of September 2021, March 2022, and June 2022. 2. Review of the medical record for Resident #29 revealed he was admitted to the facility on [DATE]. Diagnoses included other idiopathic peripheral autonomic neuropathy, other megaloblastic anemia's not elsewhere classified, unspecified dementia with behavioral disturbance, and other specified anxiety disorders. Review of the admission MDS 3.0 assessment, dated 07/22/22, revealed this resident had intact cognition evidenced by a Brief Interview for Mental Status (BIMS) score of 15. This resident was assessed to require limited assistance for dressing, and supervision for bed mobility, transfer, eating, toileting, and personal hygiene. Review of the current physician orders for Resident #29 revealed orders for buspirone hydrochloride tablet 10 mg with a dosage of one tablet by mouth three times a day for anxiety related to depression, unspecified and other specified anxiety disorders, cyclobenzaprine hydrochloride tablet 10 mg to be given three times a day related to scoliosis unspecified, low back pain, unspecified, and age-related osteoporosis without current pathological fracture, trazadone hydrochloride tablet 100 mg with a dosage of one tablet by mouth at bedtime for insomnia, pregabalin capsule 150 mg with a dosage of one tablet every 12 hours for low back pain, Effexor Extended Release capsule 75 mg with a dosage of one capsule once a day for depression, and Effexor Extended Release 37.5 mg with a dosage of one capsule once a day for depression. The facility was unable to provide any medication regimen reviews for Resident #29 since his admission to the facility on [DATE]. 3. Review of the medical record for Resident #44 revealed he was admitted to the facility on [DATE]. Diagnoses included malignant neuroleptic syndrome, unspecified severe protein-calorie malnutrition, adult failure to thrive, suicide attempt, subsequent encounter, muscle wasting and atrophy, paroxysmal tachycardia, dietary folate deficiency anemia, catatonic schizophrenia, unspecified psychosis not due to a substance or known physiological condition, anxiety disorder, major depressive disorder, and autistic disorder. Review of the quarterly MDS 3.0 assessment, dated 07/07/22, revealed this resident had moderately impaired cognition evidenced by a Brief Interview for Mental Status (BIMS) score of 10. This resident was assessed to require limited assistance for personal hygiene, toileting, and dressing as well as supervision for bed mobility, transfer, and eating. 365529 Page 13 of 17 365529 09/21/2022 Garden Park Health Care Center 3536 Washington Ave Cincinnati, OH 45229

F 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of the current physician orders for Resident #44 revealed orders for Risperdal tablet one mg with a dosage of one tablet two times a day related to schizophrenia, unspecified, sulindac tablet 150 mg to be given two times a day for pain, desvenlafaxine extended release tablet 50 mg with a dosage of one tablet every morning related to schizophrenia, unspecified, catatonic schizophrenia, and undifferentiated schizophrenia, Depakote tablet delayed release 500 mg with a dosage of one tablet every morning for schizophrenia, and Ativan tablet 0.5 mg with a dosage of one tablet four times a day for anti-anxiety. Review of the completed medication regimen reviews provided by the facility for Resident #44 included reviews for the months of August 2021, March 2022, and April 2022. Interview on 09/13/22 at 11:56 A.M. with the Director of Nursing (DON) confirmed the facility had several months where there was no evidence a licensed pharmacist had conducted medication regimen reviews. The DON expressed the facility was unable to locate any additional reviews and were also unable to obtain the reviews from the contracted pharmacy for Resident #16, #29 and #44. Review of the facility policy titled Medication Regimen Reviews, revised 05/2019, revealed the Consultant Pharmacist performs a medication regimen review (MRR) for every resident in the facility receiving medication. Further review of the policy revealed the medication regimen reviews were to be done upon admission or close as possible to admission and at least monthly. 365529 Page 14 of 17 365529 09/21/2022 Garden Park Health Care Center 3536 Washington Ave Cincinnati, OH 45229

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. Based on medical record review, staff interview review of medication information from Medscape, the facility failed to ensure a resident was free from unnecessary psychotropic medications when the facility failed to monitor a residents laboratory (lab) work in response to the use of a psychotropic medication. This affected one (#25) out of five residents reviewed for unnecessary medications. Facility census was 51. Findings include Record review for Resident #17 revealed an admission date of 05/10/21. His diagnosis included, sleep apnea, diabetes mellitus 2, hypoxemia, enchephalopathy, anxiety disorder, dementia, mood disturbance, paranoid schizophrenia, seborrheic dermatitis, dysphasia, major depressive disorder, and gastro-esophageal reflux disease. Review of the quarterly MDS assessment, dated 07/14/22, revealed Resident #17 was cognitively impaired. Further review of the MDS assessment revealed Resident #17 required limited assistance from staff with bed mobility. However, Resident #17 required extensive assistance from staff with transfers, personal hygiene, and toilet use. He required supervision from staff with eating. Review of Resident #17 physician orders revealed an order for, ativan tablet 0. 5 mg, give one tablet by mouth at bedtime related to adjustment disorder with mixed anxiety and depressed mood, clozapine tablet 250 mg by mouth-related to adjustment disorder with amenity anxiety and depressed mood, other schizophrenia, escitalopram oxalate table 10 mg, give 20 mg by mouth one time a day related to major depressive disorder, and lithium carbonate 300 mg, give 300 mg by mouth every morning and bedtime related to schizophrenia. Further review of the physician orders revealed an order dated, 06/25/21, Lithium Level in one week. Review of the licensed pharmacist review for Resident #17 revealed a pharmacist reviewed his medications on the following months in the past year, 01/17/22, 03/17/22, and 05/18/22. Review of the laboratory results revealed no results for the order requested on 06/25/21. Further review of the laboratory blood work results revealed no monitoring of the lithium ongoing. Interview on 09/13/22 at 11:55 A.M. with the Director of Nursing (DON) confirmed the facility is missing the lab work for Resident #17 and any further lithium lab draw and monitoring. Review of medication information from Medscape at https://reference.medscape.com/drug/eskalith-lithobid-lithium-342934#91, revealed lithium is Bipolar agent used to treat Bipolar disorder and Huntington's disease. According to Medscape, laboratory and/or medical tests (such as kidney function, thyroid function, lithium and calcium blood levels) should be performed periodically to monitor your progress or check for side effects related to Lithium usage. 365529 Page 15 of 17 365529 09/21/2022 Garden Park Health Care Center 3536 Washington Ave Cincinnati, OH 45229

F 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. 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, and staff interview, the facility failed to have properly working call lights in all resident rooms. This affected four (#11, #20, #24, and #31) out of 11 residents residing on the unit. The facility census was 51. Residents Affected - Some Findings include: A chart review revealed Resident #11 was admitted on [DATE] with diagnosis including paraplegia, diabetes, anemia, schizophrenia, altered mental status, adult failure to thrive, and hypertension. Review of the Quarterly MDS dated [DATE] revealed Resident #11 has severe cognitive deficits, requires limited to extensive assistance with activities of daily living, and is occasionally incontinent of bladder, and always continent of bowel. A chart review revealed Resident #20 was admitted on [DATE] with diagnosis including coronary artery disease, fall history, hyperglycemia, hypertension, dementia, peripheral vascular disease, benign prostatic hyperplasia, depression, and heart failure. Review of the Quarterly MDS dated [DATE] revealed Resident #20 has severe cognitive deficits, requires supervision with activities of daily living, and is always continent of bowel and bladder. A chart review revealed Resident #24 was admitted on [DATE] with diagnosis including nicotine dependence, dystonia, hypertension, glaucoma, antisocial personality disorder, dysphagia, COVID, schizoaffective disorder, embolism, diabetes, right hip fracture, diabetes, follicular disorder, and acute cystitis. Review of the Discharge Return Anticipated MDS dated [DATE] revealed Resident #24 had severe cognitive deficits, required limited assist with personal hygiene, supervision with all other activities of daily living, and was occasionally incontinent of bowel and bladder. A chart review revealed Resident #31 was admitted on [DATE] with diagnosis including traumatic subdural hemorrhage, huntington's disease, acute cystitis, conduct disorder, chorea, mental disorder, alcohol abuse, altered mental status, anemia, and thiamin deficiency. Review of the Quarterly MDS dated [DATE] revealed Resident #31 has severe cognitive deficits, requires supervision to limited assistance with activities of daily living, and is occasionally incontinent of bladder, and always continent of bowel. Observation and interview on 09/06/22 at 12:37 P.M. with State Tested Nursing Assistant (STNA) #73) confirmed the following call lights were no operational for Resident #11, #20, #24 and #31. This deficiency substantiates Complaint Number OH00135455, Complaint Number OH00133502 and Complaint Number OH00110620. 365529 Page 16 of 17 365529 09/21/2022 Garden Park Health Care Center 3536 Washington Ave Cincinnati, OH 45229

F 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. 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, staff interview and policy review, the facility failed to maintain an effective pest control program regarding the presence of gnats in a resident's room. This affected one (#23) out of one resident reviewed for effective pest control. The facility census was 51. Residents Affected - Few Findings include: Record review for Resident #23 revealed was admitted to the facility on [DATE]. His diagnosis included cerebral infarction, chronic obstructive pulmonary disease, history of COVID-19, dysphasia, insomnia, hyperlipidemia, diabetes mellitus 2, major depressive disorder, suicidal ideation, schizophrenia, bipolar disorder, and essential primary hypertension. Review of the quarterly Minimum Data Set (MDS) assessment revealed Resident #23 was mildly cognitively impaired. Further review of the MDS assessment revealed he was totally dependent on staff with bed mobility, transfers, dressing, toilet use and personal hygiene. Resident #23 required supervision from staff with eating. Interview on 09/06/22 at 4:09 P.M. with the housekeeping supervisor (HS) #109 confirmed bathroom sink located in Resident #23's room was swarming with flying gnats. Review of the facility policy titled, Quality of Life - Homelike Environment, dated May 2017, revealed Residents are provided with a safe, clean, comfortable and homelike environment and encouraged to use their personal belongings to the extent possible. This deficiency substantiates Complaint Number OH00135455, Complaint Number OH00133502 and Complaint Number OH00110620. 365529 Page 17 of 17