Inspection·September 18, 2024

F 0880 Provide and implement an infection prevention and control program. 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 interviews, observations, review of online resources from the Centers for Disease Control (CDC), and policy review, the facility failed to ensure staff followed hand hygiene procedures when providing incontinent care. This affected one (#24) resident of three residents reviewed for incontinent care. The facility census was 106. Residents Affected - Few Findings include Review of the medical record for Resident #24 revealed an admission on [DATE] with diagnoses including but not limited to spinal stenosis, Alzheimer's disease, and dementia. Review of the most recent quarterly Minimum Data Set (MDS) assessment for Resident #24 dated 07/19/24 revealed an impaired cognition. Resident #24 required set up for eating, maximum assistance for bed mobility and was dependent on staff for toileting, toileting hygiene and transfers. Resident #24 was assessed as incontinent of bowel and bladder. Observation of incontinence care for Resident #24 on 09/18/24 at 2:09 P.M., with State Tested Nursing Assistant (STNA) #159 revealed the STNA gathered washcloths, two trash bags, and an incontinent garment. STNA #159 went into the resident's bathroom and returned with the washcloths and placed them on the resident's bed side table without a barrier between the two surfaces. Three of the washcloths were in wads and two were opened and laid to the end of the table. STNA #159 instructed the resident of the task, applied gloves and removed the bed sheets. STNA #159 unfastened the incontinent garment rolling it to the center of the perineum and pushed to down towards the bed, exposing the front of the perineal area. STNA #159 used one corner of the washcloth to wipe down the front center of the labia. STNA #159 then noted fecal material on the end of the washcloth. STNA #159 flipped the washcloth over her hand using a clean area to make multiple passes over the inner thighs on both sides without moving washcloth to separate areas. STNA #159 placed the used washcloth into a plastic bag on chair and using a second opened washcloth to make multiple passes over the same perineal area without using a clean area of the washcloth. STNA #159 then asked the resident to roll to her left side exposing the rectal area. Using the third washcloth, the STNA #159 used an upward movement to remove a large portion of the fecal matter from the area and placing it into the trash bag. STNA #159 using a fourth wash cloth that was wadded up wiped the rectal area in multiple passes using different sections of the washcloth by flipping it over her right hand. Resident #24 moaned when STNA #159 cleansed over the right outer sacral area. STNA #159 stating the area was reddened and would apply barrier cream. STNA #159 used the fifth opened washcloth to wipe the rectal area and buttocks without repositioning the washcloth to a clean unused portion. STNA #159 placed the washcloth into the trash bag. STNA #159 then rolled the incontinent garment up and pulled it from underneath the resident and placed it into the second bag on the chair. STNA #159 then opened the nightstand drawer with her gloved (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 09/18/2024 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)