Inspection·July 12, 2023

F 0686 Level of Harm - Actual harm Residents Affected - Few to provide pressure relief, educate the resident/family/caregivers as to causes of skin breakdown; including: transfer/positioning requirements; importance of taking care during ambulating/mobility, good nutrition and frequent repositioning, heel boots as tolerated, inform the resident/family/caregivers of any new area of skin breakdown, keep shoe off right foot until the area is resolved, monitor nutritional status, serve diet as ordered, monitor intake and record, provide incontinence care after each incontinent episode, or per established toileting plan, resident requires a pressure reducing mattress to bed, and weekly treatment documentation to include measurement of each area of skin breakdown's width, length, depth, type of tissue and exudate. Review of a nurse progress note date 05/17/23 for Resident #37 and authored by the Assistant Director of Nursing (ADON) /Licensed Practical Nurse (LPN) #125, revealed the nurse on the unit notified LPN #125 that the resident had an area to his right heel. LPN #125 assessed the resident and noted the resident was lying in bed with his legs crossed and his heel on the mattress. An area to the right heel was noted measuring 2.5 centimeters (cm) in length by 2.4 cm in width by 0.1 cm in depth. The wound bed was noted with eschar (necrotic tissue that develops over wounds) with peri wound pink in color. Surrounding skin was pink and tender to touch. No drainage or odor noted. Wound Nurse Practitioner (NP) #575 was notified and gave treatment orders for the resident's wound to be treated with Medihoney fluffed gauze to the wound bed and cover with foam border gauze. An order was also given to apply heel boots to the resident's bilateral feet as tolerated. Review of the wound assessment dated [DATE] for Resident #37, completed by LPN #125 revealed the resident had a facility- acquired unstageable right heel pressure which measured 2.5 cm in length by 2.4 cm in width by 0.1 cm in depth. The wound bed was 100 percent (%) eschar. Treatment orders included Medihoney fluffed gauze to wound bed and cover with foam border gauze and heel boots as tolerated. Review of the NP #575 visit note dated 05/23/23 for Resident #37, revealed the resident had a facility-acquired unstageable pressure ulcer first identified on 05/17/23 to the right heel which measured 2.5 cm in length by 2.5 cm in width by 0.1 cm in depth. The wound bed was 100% covered with slough. Review of the NP #575 visit note dated 07/06/23 for Resident #37, revealed the resident's right heel pressure ulcer now presented as a stage III pressure ulcer (full thickness tissue loss. Subcutaneous fat may be visible, but bone, tendon, or muscle is not exposed) which measured 1.5 cm in length by 1.0 cm in width by 0.1 cm in depth. The wound bed was 25-49% slough. Observation of wound care on 07/11/23 at 1:03 P.M. for Resident #37, with LPN #580, revealed the resident was resting on a pressure reduction mattress and was compliant with wearing heel protectors. Observation revealed the resident had a dime-sized pressure ulcer to his right heel with the wound bed partially covered with slough tissue. Interview with NP #575 on 07/12/23 at 9:32 A.M., confirmed Resident #37 had no prior pressure ulcers on the right heel prior to 05/17/23. NP #575 confirmed facility notified her on 05/17/23 of a pressure ulcer to the resident's right heel which she first assessed on 05/23/23 and determined it was an avoidable facility-acquired pressure ulcer which was unstageable due to the wound bed was 100% obscured by slough/eschar tissue. NP #575 confirmed the etiology of the ulcer to the right heel was due to pressure from being in bed and she had ordered heel protectors on 05/17/23 after staff had notified her of the pressure ulcer. NP #575 confirmed with thorough assessment the facility could have identified the pressure ulcer before it had reached an advanced stage and possibly could have (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365978 If continuation sheet Page 2 of 6 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 365978 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scarlet Oaks Nursing and Rehabilitation Center 440 Lafayette Avenue Cincinnati, OH 45220 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)

F 0686 prevented it from developing into an unstageable pressure ulcer. Level of Harm - Actual harm Interview on 07/12/23 at 10:19 A.M. with the Director of Nursing (DON), LPN #125, and Regional Nurse (RN) #585, confirmed Resident #37 had a skin check on 05/13/23 which showed no skin abnormalities. LPN #125 confirmed she observed the pressure ulcer to Resident #37's right heel on 05/17/23 and determined it was an unstageable pressure ulcer which was covered 100% in slough/eschar. Residents Affected - Few Review of the facility policy titled Prevention of Pressure Ulcers Injuries dated July 2017 revealed nurses would assess skin weekly and would inspect the skin on a daily basis when performing and assisting with personal care and ADLs and would identify any signs of developing pressure injuries such as nonblanchable erythema and for darkly pigment individual signs such as changes in skin tone, temperature, and consistency. Skin inspection should include inspection of pressure points including the heels. Review of the NPUAP guidelines dated 2014 pages 70-71 at (https://npiap.com/general/custom.asp?page=2014Guidelines) revealed facilities should educate health professionals on how to undertake a comprehensive skin assessment that includes the techniques for identifying blanching response, localized heat, edema, and induration. Further review of the guidelines revealed ongoing assessment of the skin was necessary in order to detect early signs of pressure damage. Visual assessment for erythema (redness of the skin) was the first component of every skin inspection. Skin redness and tissue edema resulting from capillary occlusion was a response to pressure, especially over bony prominences. Staff should conduct a head-to-toe assessment with particular focus on skin overlying bony prominences including the sacrum, ischial tuberosities, greater trochanters and heels and each time the patient was repositioned was an opportunity to conduct a brief skin assessment. 2. Review of the medical record for Resident #04 revealed an admission date of 05/30/23 with diagnoses including acute respiratory failure with hypoxia, neuromuscular dysfunction of bladder, anxiety disorder, DM, and tracheostomy status. Review of the MDS assessment dated [DATE] for Resident #04, revealed the resident was cognitively impaired and required extensive assistance of one to two staff with ADLs. Review of the physician orders dated 06/13/23 for Resident #04, revealed the resident was ordered to have the left heel cleansed with wound cleanser, patted dry, calcium alginate applied to wound bed, then covered with an abdominal (ABD) pad and wrapped with Kerlix gauze every shift (twice daily). Review of the NP #575's wound visit note dated 07/06/23 for Resident #04, revealed the resident had a healing stage III pressure ulcer to the left heel which measured 1.0 cm in length by 1.8 cm in width by 1.0 cm in depth. Review of the nurse progress notes dated 07/09/23 for Resident #04, revealed the notes did not include any documentation of resident's refusal of treatment or any rationale for treatment to left heel not being completed as ordered. Review of the July 2023 Treatment Administration Record (TAR) for Resident #04 revealed the dayshift and nightshift treatments for 07/09/23 were not signed off as being completed. Observation of Resident #04 on 07/10/23 at 12:26 P.M. with RN #415, revealed the resident had a dressing to her left foot which was dated 07/08/23 and had a nurse's initials written on the dressing. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365978 If continuation sheet Page 3 of 6 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 365978 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scarlet Oaks Nursing and Rehabilitation Center 440 Lafayette Avenue Cincinnati, OH 45220 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)

F 0686 Level of Harm - Actual harm Interview on 07/10/23 at 12:26 P.M. with RN #415, confirmed Resident #04 had a stage III pressure ulcer to her left heel and the treatment was ordered every shift. RN #415 confirmed the dressing on resident's left foot was dated 07/08/23 and had the initials of RN #410. RN #415 confirmed she was orienting RN #410 and had observed the nurse apply the dressing to Resident #04's left heel on 07/08/23. Residents Affected - Few Interview on 07/12/23 at 10:19 A.M. with the DON, LPN #125, and RN #580, confirmed RN #415 had brought it to their attention on 07/10/23 that the Surveyor had observed an outdated dressing on Resident #04's foot. Interview confirmed the facility had investigated and determined the treatment for resident was not completed as ordered on 07/09/23. Review of the facility policy titled Wound Care dated October 2010 revealed the facility would ensure nurses provided wound care per physician's order. This deficiency represents non-compliance investigated under Complaint Number OH00143918. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365978 If continuation sheet Page 4 of 6 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 365978 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scarlet Oaks Nursing and Rehabilitation Center 440 Lafayette Avenue Cincinnati, OH 45220 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)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, review of the facility fall investigation and review of the facility's policy, the facility failed to ensure care was provided per the president's plan of care in order to prevent falls with injury. This affected one resident (#32) of three residents reviewed for falls. The facility census was 67. Findings include: Review of the medical record for Resident #32 revealed an admission date of 04/24/23 with diagnoses including hemiplegia and hemiparesis following cerebral infarction, chronic kidney disease, coronary artery disease, diabetes mellitus, and acute and chronic respiratory failure with hypoxia. Review of the care plan for Resident #32 dated 02/22/23 revealed the resident had an activities of daily living (ADL) self-care deficit related to disease process. Resident required staff assistance to complete ADL tasks daily. Resident was at risk for a decline in function related to activity intolerance, confusion, disease process, hemiplegia, limited mobility, and stroke. Interventions included the following: resident was totally dependence on the assistance of two staff with toileting, resident required a mechanical lift for transfers with assistance of two staff for transfers. the resident was totally dependent on staff for repositioning and turning in bed every two hours, and as necessary. Review of the Minimum Data Set (MDS) assessment dated [DATE] for Resident #32, revealed the resident was cognitively impaired and was totally dependent on the assistance of two staff with bed mobility, transfer, and toilet use. Review of the fall risk assessment dated [DATE] for Resident #32, revealed the resident was at high risk for falls. Review of the nurse progress note dated 06/23/23 for Resident #32, revealed an State Tested Nursing Assistant (STNA) reported while providing peri-care to resident, the resident's leg slid off mattress resulting in the resident falling from the bed to the floor. The STNA (identified as STNA #455) reported he called for assistance, and the nurse assessed the resident, and the staff assisted the resident back into bed. There was swelling noted to the left eye and active bleeding above the eye. The nurse applied pressure to the bleeding area, 911 was called and the resident was transferred to the hospital for an evaluation. Review of the hospital notes dated 06/23/23 for Resident #32, revealed the resident had a computerized tomography (CT) scan of her head to rule out injury and neurosurgery was consulted to evaluate the resident. Resident #32 underwent laceration repair and returned to the facility. Review of the facility post fall investigation for Resident #32 dated 06/23/23, revealed the resident had a witnessed fall out of bed on 06/23/23 resulting in swelling and bleeding above the left eye. An aide reported he was providing peri-care to the resident by himself, and the resident fell off of low air loss mattress onto the floor. Contributing factor to fall included staff not having a second person for assistance and root cause of the fall was only having one person to assist with ADLs. Interventions to prevent recurrence was staff education. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365978 If continuation sheet Page 5 of 6 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 365978 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scarlet Oaks Nursing and Rehabilitation Center 440 Lafayette Avenue Cincinnati, OH 45220 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)

F 0689 Level of Harm - Minimal harm or potential for actual harm Review of facility form titled Teachable Moment dated 06/26/23, completed per Assistant Director of Nursing (ADON)/Licensed Practical Nurse (LPN) #125 to State Tested Nursing Assistant (STNA) #455 revealed the STNA was educated on asking for assistance for any resident that required a two-person assist. All residents with air mattresses or who have tracheostomies (trachs), or ventilators (vents) should be a two-person assist for all care. Residents Affected - Few Review of the wound evaluation dated 06/28/23 for Resident #32, revealed the resident had a laceration to left eyebrow with steri-strips intact. Review of the wound nurse visit note dated 06/28/23 for Resident #32, revealed the resident had a laceration to the left eyebrow which measured 1.6 centimeters (cm.) The laceration was secured with steri-strips and staff were to leave laceration open to air and to monitor steri-strips until they fell off. Interview on 07/12/23 at 10:19 A.M. with the Director of Nursing (DON), LPN #125, and Regional Nurse (RN) #585, confirmed STNA #455 provided peri-care to Resident #32 by himself on 06/23/23 when resident fell out of bed sustaining a laceration to her left eyebrow. Interview confirmed Resident #32 was a two-person assist for toileting and bed mobility and the facility's investigation had determined the root cause of resident's fall was that the resident's care plan was not followed and only one staff (STNA #455) was assisting the resident when she fell out of bed. Interview confirmed Resident #32 was evaluated at the hospital following the fall and the CT scan to her head was negative for any injuries. Resident #32 sustained a laceration above her left eyebrow which was able to be secured with steri-strips. STNA #455 was provided with verbal education on following the resident's care plan regarding level of ADL assistance needed and also received written education on a Teachable Moment form regarding need for two-person assistance with care. Review of the facility policy titled Fall Risk Assessment dated December 2007, revealed the facility would assess residents for fall risk on admission, quarterly, and upon significant change. The facility would identify and address modifiable fall risk factors and interventions to minimize the consequences of risk factors that were not modifiable. Review of the facility policy titled Perineal Care dated October 2010, revealed prior to providing care staff should review the care plan to assess for any special needs of the resident. This deficiency represents non-compliance investigated under Complaint Numbers OH00144181, OH00143880, and OH00143792. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365978 If continuation sheet Page 6 of 6