Inspection·January 18, 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 medical record review, staff interview, and policy review, the facility failed to notify the physician as ordered. This affected one (#28) resident of three reviewed for change in condition. The facility census was 73. Findings include: Medical record review for Resident #28 revealed an admission date of 10/29/23. Diagnoses included Alzheimer's disease, dementia with anxiety, chronic obstructive pulmonary disease, severe protein calorie malnutrition, heart failure, and depression. Review of the comprehensive Minimum Data Set (MDS) assessment dated [DATE] for Resident #28 revealed the resident was assessed with an intact cognition. Resident #28 required supervision for bed mobility, transfers, toileting and eating. Resident #28 weight was documented as 186 pounds. Review of the plan of care for Resident #28 dated 11/03/23 revealed the resident was at risk for malnutrition and dehydration related to chronic disease, advanced age, and potential for weight and intake decline related to disease progression. Interventions include to administer medication as ordered, provide diet as ordered and obtain weight at a minimum of monthly. Report significant changes of five percent or more in a month to the physician and the dietician. Review of the physician orders for Resident #28 revealed an order dated 12/12/23 for weekly weights every Tuesday, and to notify the physician if weight gain was greater than five pounds for congestive heart failure. Review of the electronic health record for Resident #28 revealed the resident weighed 186 pounds (lbs.) on 11/02/23, 190.4 lbs. on 11/29/23, 189.3 lbs. on 12/05/23, 190.2 pounds on 01/02/24 at 4:13 A.M., and 206.6 lbs. on 01/02/24 at 2:51 P.M. Review of the progress notes and medical record for Resident #28 dated 01/01/24 through 01/18/24 was silent for any physician notification of a weight gain greater than five pounds after 01/02/24. Interview on 01/11/23 at 11:30 A.M. with Licensed Practical Nurse (LPN) #1 verified Resident #28's medical record did not contain any documentation that the physician was notified of the significant weight gain and should have been. Interview on 01/11/23 at 3:30 P.M. with Director of Nursing (DON) #17 verified Resident #28's (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: 365558 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 365558 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Laurels of Hamilton 2923 Hamilton Mason Road Hamilton, OH 45011 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)