Inspection·April 3, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, resident interview, staff interview, and review of the facility policy the facility failed to ensure residents were provided with a dignified dining experience. This affected two (Residents #81 and #102) of three residents reviewed for dining. The facility census was 110. Findings include: Review of the medical record for Resident #102 revealed an admission date of 12/28/22 with a diagnoses including Alzheimer's disease and dementia with behavior disturbance. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #102 was cognitively impaired and required supervision and set up assistance with eating. Review of the medical record for Resident #81 revealed an admission date of 08/30/22 with a diagnoses including eating disorder, cardiac arrhythmia, and dementia without behavioral disturbance. Review of the MDS assessment dated [DATE] revealed Resident #81 was cognitively impaired and was independent with eating with set up help only required. Observations on 03/29/23 from 12:57 P.M. to 1:25 P.M. revealed lunch trays were delivered to the dining room at 12:57 P.M. Residents #81, #96, and #102 were seated at a table together. At 1:00 P.M., Resident #96 received her tray and began feeding herself. At 1:15 P.M., Resident #81 stated she was upset because Resident #96 was almost done eating and she hadn't even been offered something to drink yet. At 1:17 P.M., State Tested Nursing Assistant (STNA) #715 brought a tray to Resident #81, and she began feeding herself. Resident #81 was done consuming her meal at the time Resident #81's tray was delivered and she left the dining room. STNA #715 then brought a tray to Resident #102 and began to feed Resident #102 from a standing position. Resident #102 started to get out of her chair and STNA redirected her to sit down and gave Resident #102 verbal cues to eat. STNA #715 was attempting to assist Resident #102 from a standing position for about two minutes. The Director of Nursing (DON) brought a chair to STNA #715 and encouraged STNA #715 to feed Resident #102 from a seated eye to eye position. Resident #102 then consumed the food and did not attempt to get up from the table. Interview on 03/29/23 at 1:23 P.M. with the DON confirmed all residents at a table should be served at the same time when possible for a more dignified dining experience. The DON confirmed meal trays were delivered to the floor at 12:57 P.M., and trays for Residents #81, #96, and #102 were all available on the cart at that time and could have been served together. The DON also confirmed it was considered a dignity issue to stand over a resident to feed them. Review of the facility policy titled Routine Resident Care, dated 01/19/22, revealed the facility (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 6 Event ID: 365734 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 365734 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Chamberlin Healthcare Center 3889 East Galbraith Road Cincinnati, OH 45236 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)