Inspection·September 19, 2024

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Based on medical record review, staff interview, and review of the facility policy, the facility failed to report an allegation of misappropriation of resident funds to the Ohio Department of Health (ODH.) This affected one (Resident #33) of three residents reviewed for misappropriation. The facility census was 47 residents. Findings include: Review of the medical record for Resident #33 revealed an admission date of 01/26/24 with diagnoses including chronic obstructive pulmonary disease (COPD), traumatic compartment syndrome of left lower extremity, and major depressive disorder. Review of the Minimum Data Set (MDS) assessment for Resident #33 dated 07/06/24 revealed the resident had intact cognition and required supervision with activities of daily living (ADLs.) Review of the progress note for Resident #33 dated 09/01/24 timed at 4:03 P.M. per Licensed Practical Nurse (LPN) #20 revealed Resident #33 reported he had two hundred dollars in his room, and someone had stolen it. LPN #20 documented Resident #33's allegation of misappropriation of money would be reported to administration. Review of the facility Self-Reported Incidents (SRIs) dated 08/31/24 to 09/19/24 revealed the facility did not complete an SRI regarding Resident #33's allegation of misappropriation of money. Interview on 09/19/24 at 10:10 A.M. with the Director of Nursing (DON) confirmed the facility should have completed an SRI regarding Resident #33's allegation of stolen money made to staff on 09/01/24. The DON confirmed the Assistant Director of Nursing (ADON) was not available for interview. Interview on 09/19/24 at 10:58 A.M. with the Administrator confirmed the staff reported Resident #33 had made an allegation of missing money, but the facility did not report the allegation to ODH via an SRI. Interview on 09/19/24 at 11:12 A.M. with LPN #20 confirmed a staff member reported that Resident #33 alleged on 08/31/24 or 09/01/24 that someone had stolen two hundred dollars from him. LPN #20 further confirmed she reported the allegation to the Administrator and the ADON on 08/31/24 or 09/01/24. Review of the facility policy titled Abuse, Neglect, Exploitation, and Misappropriation Prevention Program dated April 2021 revealed residents had the right to be free from misappropriation of (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 4 Event ID: 365529 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 365529 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garden Park Health Care Center 3536 Washington Ave Cincinnati, OH 45229 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)