Health inspection·August 19, 2022

F 0580 Level of Harm - Immediate jeopardy to resident health or safety 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 closed medical record review, review of the transportation service report, staff interviews, physician interview, and review of the facility policy regarding change in a resident's condition, the facility failed to timely notify the physician of a significant change of condition for one resident (#55). This resulted in Immediate Jeopardy and the potential for serious life-threatening harm, injury, and/or death when Resident #55 experienced abnormally low blood pressures over the course of four hours with no notification to the physician of the abnormal levels until Resident #55 was found unresponsive on [DATE] at 5:45 A.M. and subsequently expiring at the hospital later that evening. This affected one (#55) of four residents reviewed for a change in condition. The facility census was 57 residents. On [DATE] at 1:11 P.M., the Administrator, Director of Nursing (DON), and Regional Director of Clinical Services #500 were notified that Immediate Jeopardy began on [DATE] at 1:24 A.M. when Licensed Practical Nurse (LPN) #170 failed to notify a physician regarding a significantly low blood pressure for Resident #55. Resident #55's blood pressure on [DATE] at 1:24 A.M. was 77/47 millimeters of mercury (mm/Hg) (normal blood pressure is 120/80 mm/Hg). Documentation of the blood pressure at 5:45 A.M that morning revealed the blood pressure remained low at 73/39 mm/Hg and Resident #55 was unresponsive. Resident #55 was noted to be a Do-Not- Resuscitate Comfort Care Arrest (DNRCCA). The doctor gave the order to send the resident to the hospital for further evaluation and treatment related to her low blood pressure and unresponsive state. Resident #55 was taken to a local hospital where she was admitted with a diagnosis of sepsis. The resident died later that evening. The Immediate Jeopardy was removed on [DATE] when the facility implemented the following corrective actions: • On [DATE], Resident #55 ' s record was reviewed by the DON and Regional Director of Clinical Services #500. Resident #55 expired at the hospital on [DATE] at approximately at 8:00 P.M. with hospice services in place requested by her family. • On [DATE], all residents were assessed by the DON and/or designee that included vital signs and the resident's current condition. The nurse's focus is to determine the resident is within their normal baseline and if not, the Change in Condition Policy was followed. Findings included Resident #11 ' s blood pressure was out of the parameters and an order was in place for as needed hypertensive medication which was administered on [DATE] by LPN #166 with good results. (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 9 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 08/19/2022 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)