Inspection·September 10, 2025

F 0770 Provide timely, quality laboratory services/tests to meet the needs of residents. 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 laboratory (lab) values were completed as ordered by the physician. This affected two (#01 and #44) out of three residents reviewed for labs being completed as ordered by the physician. The facility census was 58. Findings include: 1. Review of Resident #01's chart revealed the resident was admitted to the facility on [DATE] with unspecified dementia unspecified severity without behavioral disturbance, psychotic disturbance, mood disturbance and anxiety, pressure ulcer to the left buttock unspecified stage, pressure ulcer to the right buttock unspecified stage, traumatic subdural hemorrhage without loss of consciousness, type two diabetes mellitus and cerebral atherosclerosis. Review of Resident #01's annual Minimum Data Set (MDS) assessment dated [DATE] revealed the resident was cognitively intact and Resident #01 required set up assistance with eating, and oral hygiene. Resident #01 required moderate assistance with toileting, upper body dressing, lower body dressing, putting on and taking off footwear, personal hygiene, rolling left and right, sitting to lying, sitting to standing, chair transfers, toilet transfers, tub transfers and walking ten feet and supervision with lying to sitting. Resident #01 required maximal assistance with showering. Review of Resident #01's care plan initiated on 07/21/25 revealed the facility will obtain and monitor lab and diagnostic work as ordered. Review of Resident #01's progress note dated 08/26/25 at 11:54 A.M. revealed the Wound Care Nurse Practitioner (WCNP) was in the facility to see Resident #01 and gave orders for a complete blood count (CBC), complete metabolic panel (CMP), albumin, prealbumin, transferrin and hemoglobin A1c labs. Resident #01 and Resident #01's responsible party were aware. Review of Resident #01's physician order dated 08/26/25 revealed Physician #800 created a telephone order that stated the WCNP was in the facility to see Resident #01 and gave orders for a CBC, CMP, albumin, prealbumin, transferrin and hemoglobin A1c labs. Review of Resident #01's chart from 08/26/25 to 09/10/25 revealed Resident #01's CBC, albumin, prealbumin, transferrin and hemoglobin A1c lab results ordered on 08/26/25 were not on file at the facility. Review of Resident #01's lab results report dated 08/28/25 revealed the Resident #01's CMP was completed. Interview with the Director of Nursing (DON) on 09/10/25 at 2:00 P.M. verified Resident #01 was ordered a CBC, CMP, albumin, prealbumin, transferrin and hemoglobin A1c labs on 08/26/25 by the WCNP. The DON verified the facility received Resident #01's CMP but Resident #01's CBC, CMP, albumin, prealbumin, transferrin and hemoglobin A1c labs ordered on 08/26/25 were not obtained. 2. Review of Resident #44's chart revealed Resident #44 admitted to the facility on [DATE] with unspecified pseudobulbar affection, attention and concentration deficit following cerebral infarction, depression, Alzheimer's disease, type two diabetes mellitus with unspecified complications, hyperlipidemia, hypertension, anxiety disorder, chronic kidney disease stage two and other cerebrovascular disease. Review of Resident #44's quarterly MDS assessment dated [DATE] revealed the resident was severely cognitively impaired and Resident #44 required set up assistance with eating. Resident #44 required moderate assistance with oral Residents Affected - Few (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 2 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 09/10/2025 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)