Inspection·August 24, 2023

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, staff interview, review of the facility investigation, and review of the facility policy, the facility failed to ensure residents who were dependent on staff for bathing received adequate bathing to promote proper hygiene. This affected one (Resident #15) of three residents reviewed for activities of daily living (ADLs.) The facility census was 68. Residents Affected - Few Findings include: Review of the medical record for Resident #15 revealed the resident was admitted on [DATE]. Diagnoses included hemiplegia/hemiparesis, tracheostomy, gastrostomy, encephalopathy, and acute and chronic respiratory failure. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #15 required total dependence with all ADLs. Review of the care plan dated 02/23/23 revealed Resident #15 had an ADL self-care performance deficit related to disease process. Resident #15 required staff assist to complete ADL tasks daily. Fluctuations were expected related to diagnosis. At risk for decline in physical function, activity intolerance, confusion, disease process, hemiplegia, and limited mobility due to stroke. Review of a nursing note dated 08/14/23 for Resident #15, revealed the Administrator, Assistant Director of Nursing (ADON) #30, and the nurse were notified that during care, Resident #15 was noted to have what appeared to be a maggot underneath her on the mattress. The Administrator instructed for Resident #15 to be bathed and have the mattress cleaned. The nurse and ADON #30 assessed Resident #15 and the resident was noted to have increased oral secretions with moist tracheostomy (trach) ties. Upon rolling Resident #15 over, what appeared to be maggots, were on the back of Resident #15's head in her hairline. There were no wounds noted to the back of the resident's head or the back of the neck. Staff assisted Resident #15 up to a chair and gave Resident #15 a shower and washed her hair. The nurse and ADON #30 assessed Resident #15 again with no signs and symptoms of maggots or open areas to back of head or neck. The nurse practitioner (NP) was notified of the situation and ordered the resident Atropine drops to decrease the oral secretions and assist with cutting down on the moisture. The resident's family was informed of the findings and the new orders. Review of the facility's timeline dated 08/15/23, revealed on 08/10/23 a bed bath was given to Resident #15 with no abnormalities noted. On 08/11/23, a skin assessment was completed on Resident #15 with no abnormalities noted. On 08/13/23, Resident #15 was given a bed bath with no abnormalities. On 08/14/23, the night shift nurse discovered a maggot on Resident #15's mattress and noted maggots to be on the right side of the resident's hair line. A skin assessment was completed, and a new area to right inner thigh was noted related to brief and no other skin issues noted. On 08/14/23, after the resident's shower, the trach ties were changed, and trach care was administered. On 08/14/23, a new order was obtained for Resident #15 to have atropine to assist with the increased oral secretions. On 08/14/23, a whole house audit and skin assessments were completed with no abnormalities noted. On 08/15/23, new orders were obtained to have trach ties changed to every shift instead of every three days. Review of a witness statement dated 08/15/23 and authored by State Tested Nursing Assistant (STNA) #32, revealed STNA #32 was the aide for Resident #15 on 08/13/23 from 7:00 A.M. to 7:00 P.M. STNA (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365978 If continuation sheet Page 2 of 4 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 08/24/2023 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 0677 #32 gave Resident #15 a bed bath and there were no bugs were noted on Resident #15. Level of Harm - Minimal harm or potential for actual harm Review of the witness statement dated 08/15/23 and authored by ADON #30, revealed she received a message from Licensed Practical Nurse (LPN) #33 on 08/14/23 which indicated as the staff rolled Resident #15 and maggots were found on the mattress. Residents Affected - Few Review of a work order dated 08/15/23, revealed Resident #15's room was treated for flies. Review of the witness statement dated 08/16/23 and authored by LPN #31, revealed on Sunday 08/13/23, LPN #31 cared for Resident #15. Resident #15 appeared to be in the same condition that she typically was in, and the vital signs were within normal limits. LPN #31 reported that she had often seen small flies in the resident's room. All efforts to protect Resident #15 from the small flies had been made including a bed bath (according to the aide) and frequently drying the excessive saliva and mucus that Resident #15 tends to produce. Throughout the shift, LPN #31 did not notice any flies in her hair line or abnormalities in regards to her trach site. LPN #31 witnessed the aide provide care and a linen change to Resident #15's bed. Review of the physician order dated 08/17/23 for Resident #15, revealed the resident was ordered to receive a scopolamine transdermal patch every 72 hours one milligram (mg) for excessive secretions and remove per schedule. An interview with the Director of Nursing (DON) on 08/23/23 at 7:40 A.M. revealed she got a call on 08/14/23 around 6:30 A.M. from LPN #33, and reported the STNAs indicated when they were turning Resident #15, they found what appeared to be a maggot on the resident's mattress. The DON stated that she came into the facility to assess Resident #15 and found maggots in the resident's hairline. The DON stated they got Resident #15 into a chair and while waiting for the shower to be clear, they were removing the maggots from Resident #15's hair. The DON stated there were a fair number of maggots. The DON indicated after Resident #15 got her shower, she was re-assessed and there were no more maggots observed on Resident #15. Random observations of the facility on 08/23/23 and 08/24/23, revealed only one fly was noted in the stairwell, and no flies were noted on the resident's halls. Interview with STNA #35 on 08/24/23 at 6:33 A.M., revealed she was training an orientee on 08/13/23 during the night shift (7:00 P.M. to 7:00 A.M.) and they cared for Resident #15. STNA #35 stated they checked and changed Resident #15 every two hours along with repositioning Resident #15 and never seen any maggots all night, then on the last rounds at approximately 6:30 A.M. when they rolled the resident, they noticed maggots on the mattress and informed the nurse. Interview with LPN #33 on 08/24/23 at 6:37 A.M. revealed STNA #35 called her in to the resident's room and she saw approximately three maggots on the resident's mattress, so she reported it to the DON. LPN #33 stated she did not see any maggots during the 7:00 P.M. to 7:00 A.M. shift on 08/13/23 through 08/14/23. Interview with Maintenance Director #39 on 08/24/23 at 12:06 P.M., revealed the facility gets treated for pest control weekly; however, if there were identified issues, then they would be treated more often. Interview with STNA #38 on 08/24/23 at 1:08 P.M. revealed while they were waiting on the shower to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365978 If continuation sheet Page 3 of 4 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 08/24/2023 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 0677 Level of Harm - Minimal harm or potential for actual harm be cleared, she was helping the DON remove the maggots from Resident #15's hairline and by the time they could get Resident #15 into the shower, there were just a couple of maggots left and they were removed when Resident #15's hair was washed. STNA #38 stated the maggots in the resident's hair could have been prevented by providing more thorough care. STNA #38 stated that house flies come in through a door downstairs, but their main pest problem were the gnats that were everywhere. Residents Affected - Few Review of the facility policy titled Giving a Bed Bath (dated 10/2010), revealed staff were to wash the back from the hairline to the waist and to comb/brush resident's hair if he/she cannot do it. This deficiency represents non-compliance investigated under Complaint Number OH00145672 and Complaint Number OH00145287. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365978 If continuation sheet Page 4 of 4