Health inspection·July 11, 2023

F 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, review of the consult/communication sheet, review of the appointment sheet, and review of online medication prescribing information, the facility failed to ensure anticoagulant medication was held prior to a scheduled procedure resulting in the procedure having to be rescheduled. This affected one resident (#105) of three reviewed who received anticoagulant medication. The facility identified 31 residents currently received anticoagulant medications. The facility census was 101. Residents Affected - Few Findings include: Review of the medical record revealed Resident #105 was admitted to the facility on [DATE]. Diagnoses included heart failure, atrial fibrillation, and malignant neoplasm of the kidney. This resident was discharged from the facility on 06/19/23. Review of the discharge Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #105 received anticoagulation medication for seven days during the seven day review period. Review of the facility consult/communication sheet dated 05/24/23 revealed Resident #105 was ordered to have an Esophagogastroduodenoscopy (EGD) scheduled to screen for varices (abnormal veins in the lower part of the tube running from the throat to the stomach). Review of the appointment sheet revealed Resident #105 was scheduled to have the ordered EGD completed on 06/15/23 at 10:00 A.M. Instruction included to notify the office or prescribing provider if taking blood thinners. Review of the physicians orders dated 06/08/23 revealed Resident #105 was to have an EGD performed on 06/15/23 and was to have nothing by mouth after midnight on 06/15/23. Review of the Medication Administration Record (MAR) dated June 2023 revealed Resident #105 was documented to have been administered five milligrams (mg) of the medication Eliquis (an anticoagulant, blood thinning medication) at 9:00 A.M. and 9:00 P.M. on 06/13/23 and 06/14/23. Review of the progress note dated 06/14/23 and written by the Director of Nursing (DON), revealed a call was received from the daughter of Resident #105 regarding cancellation and rescheduling of EGD. The daughter sought clarification as to why the cancellation was necessary and blood thinner orders. The daughter was informed the resident took a blood thinner and would not be able to have the procedure so the office rescheduled the appointment. (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: 365693 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 365693 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Western Hills Retirement Village 6210 Cleves Warsaw Pike Cincinnati, OH 45233 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)