Inspection·February 18, 2025

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. 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, and policy review, the facility failed to follow physician orders for weekly weights and medication administration. This affected three residents (#36, #16, and #2) of eight residents reviewed for following physician orders. The census was 43. Residents Affected - Few Findings included: 1. Medical record review for Resident #36 revealed an admission date of 08/23/22. Medical diagnoses included cerebrovascular attack (CVA), dementia, and aphasic. Review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #36 was moderately cognitively impaired. Review of the physician orders dated 06/07/24 revealed to obtain weekly weights for Resident #36. Review of the care plan dated 06/07/24 revealed Resident #36 was at risk for weight loss and an intervention was for weekly weights. Review of the weights since 11/27/24 for Resident #36 revealed there were missing weights for 11/27/24, 12/11/24, 12/18/24, 12/28/24, 01/04/25, 01/18/25, and 01/28/25. Interview with the Registered Dietician (RD) #205 on 02/18/25 at 2:19 P.M. confirmed Resident #36 missed some weights. She stated at one point the weight order dropped off due to hospitalization and she had to enter the order again into the system. 2. Medical record review for Resident #16 revealed an admission date of 07/26/24. Medical diagnoses included diabetes, renal insufficiency, and dementia. Review of the quarterly MDS dated [DATE] revealed Resident #16 was cognitively intact. Review of the physician orders dated 12/08/24 for Resident #16 revealed to weigh the resident weekly. Review of weights since 12/08/24 for Resident #16 revealed weights for 12/18/24, 01/28/25, and 02/11/25 were missing. Review of the care plan for Resident #16 dated 01/31/25 revealed she was at risk for weight loss. (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 4 Event ID: 365812 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 365812 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wellspring Health Center 8000 Evergreen Ridge Drive Cincinnati, OH 45215 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)