Inspection·May 30, 2024

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observations, staff interviews, and review of facility policy, the facility failed to provide timely incontinence care. This affected one resident (#04) out of three reviewed for incontinence care. The facility census was 98. Findings Included: Review of medical record for Resident #04 was admitted [DATE]. Diagnosis included Alzheimer's disease, dementia, epilepsy, hemiplegia, and hemiparesis. Review of the Bowel assessment dated [DATE] revealed Resident #04 was incontinent of bowel and required to be checked and changed every two hours. Review of the Urinary Incontinence assessment dated [DATE] revealed Resident #04 was incontinent with multiple episodes daily. Resident #04 wore an incontinent brief and was required to be checked and changed every two hours. Review of Minimum Data Set (MDS) assessment dated [DATE], revealed Resident #04 had a Brief Interview of Mental Status (BIMS) of 03 which indicated she was severely cognitively impaired. Resident #04 was dependent on staff for all activities of daily living (ADLs). Review of the plan of care dated 04/18/24 revealed Resident #04 was at risk for complications associated with episodes of urinary incontinence and was at risk due to self-care performance deficit related to dementia, Alzheimer's disease, and weakness. Interventions included two or more staff required for toileting, check the resident every two to three hours and as needed (PRN) for incontinent episodes, provide incontinence and perineum (peri) care after each incontinent episode, remind resident to go to bathroom every two to three hours, and report changes in bladder status to the physician. Numerous observations of Resident #04 on 05/29/24 starting at 9:56 A.M., revealed the resident was located in the lobby by herself and near the south hall nurses station dressed, covered in blanket and seated in a Geri-chair. At 10:20 A.M., Activity Aide #800 took the resident to the Music Hall dining room for activities. At 11:53 A.M., Activity Aide #800 took the resident to the dining room for lunch. At 12:22 P.M., Resident #04's daughter arrived and wheeled the resident to her room to assist with lunch. Interview with Resident #04's daughter on 05/29/24 at 12:25 P.M. revealed she visited the resident (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: 365892 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 365892 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Burlington House Rehab & Alzheimer's Care Center 2222 Springdale Road Cincinnati, OH 45231 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)