Health inspection·May 2, 2019

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 observation, record review, and staff interview, the facility failed to ensure fall interventions were in place. This affected on (#18) of four residents reviewed for accidents. The facility census was 50. Findings include: Medical record review revealed Resident #18 was admitted to the facility on [DATE] with diagnosis including fracture of the humerus, left arm, history of falling, osteoarthritis, generalized muscle weakness, insomnia, and difficulty walking. Review of care plan dated 02/10/19 and revised 02/16/19 revealed Resident #18 was at risk for falls due to status post fall with fracture, unsteady gait, use of psychotropic medications, incontinence, impaired safety awareness as resident attempts to transfer self. Interventions included to provide sensor alarm to bed to alert staff of attempted self transfers. Review of 30 day minimum data set (MDS) assessment dated [DATE] revealed severely impaired cognitive skills for daily decision making, extensive assistance was required with bed mobility, transfers, toileting, personal hygiene, and limited assistance with eating. A wheelchair was utilized for mobility. Review of physician orders dated 04/11/19 revealed Resident #18 was to have a sensor alarm to the bed to alert staff of attempts to transfer/ambulate unassisted. Observation on 04/29/19 at 3:26 P.M. revealed Resident #18 was awake in bed without a sensor alarm to the bed. Resident #18 was unable to be interviewed due to a confused mental status. Resident #18's wheelchair was located next to bed with an alarm located on the wheelchair. Observation on 04/29/19 at 3:33 P.M. revealed Resident #18 had self transferred to the wheelchair. Interview on 04/29/19 at 3:38 P.M. with State Tested Nursing Assistant (STNA) #11 reported Resident #18 was forgetful and self transferred from the bed to the wheelchair. STNA #11 confirmed Resident #18 did not have a sensor alarm in place to the bed to alert staff of attempted self transfers. 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: 365652 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 365652 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/02/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cottingham Retirement Community 3995 Cottingham Drive Cincinnati, OH 45241 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)