Health inspection·April 9, 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 record review, observations, interviews with staff and Environmental Specialist, review of the facilities approved water management plan and timeline and policy review, the facility failed to timely implement their approved water management plan to potentially prevent a Legionella outbreak. This affected one (#84) out of three residents reviewed for Legionella and had the potential to affect all 68 residents residing in the facility. The facility census was 68. Residents Affected - Many Findings include: Review of the medical record for Resident #84 revealed the resident was originally admitted to the facility on [DATE] and was readmitted following a hospital stay on 10/24/23. Resident #84 left the faciity on [DATE], against medical advice. Diagnoses included diabetes mellitus, illicit drug use, history of respiratory failure, and pneumonia. Review of Resident #84's quarterly Minimum Data Set (MDS) assessment, dated 10/31/23, revealed the resident had intact cognition. Review of Resident #84's medical record revealed the resident went to the emergency room on [DATE] due to an issue that was not respiratory related and was admitted . Resident #84 was readmitted to the facility on [DATE]. Further review of the hospital documentation from the hospital stay from 10/12/23 to 10/24/23 revealed Resident #84 was diagnosed with Legionella pneumonia while at the hospital. Orders for treatment included an oral antibiotic. Review of Resident #84's nurses notes dated 10/24/23 revealed the hospital notes reflected the resident tested positive for Legionella while at the hospital. The facility called the facility physician, local health department and the Ohio Department of Health. Observation on 03/26/24 from 10:30 A.M. until 11:00 A.M. revealed 64 shower filters are in place throughout the facility. The observations revealed there were no sink filters noted. Interview on 03/26/24 at 11:00 A.M. with the Administrator revealed Resident #84 returned after a two week stay in the hospital and it was discovered the resident had a diagnoses of Legionella pneumonia. The Administrator stated the hospital did not inform the facility of Resident #84's positive Legionella test results. The Administrator stated Resident #84's Legionella test results were noted in the hospital records by the facility staff. The Administrator noted the facility immediately reported Resident #84's positive Legionella results to the local health department and the state agency. The facility began testing at the facility. The Administrator confirmed the facility submitted a plan to the Ohio Department of Health on 12/15/23 regarding the Legionella/water management plan. The (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: 365946 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 365946 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/09/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE St. Theresa Care Center 7010 Rowan Hill Drive Cincinnati, OH 45227 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)