Health inspection·March 14, 2019

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review, review of facility policy and staff interviews, the facility failed to ensure staff provided a dignified dining experience while feeding Resident #56 during meal time. This affected one (#56) of four residents who were total dependent for assistance in eating on the fifth floor. The facility census was 69. Findings include: Medical record review revealed Resident #56 was admitted to the facility on [DATE]. Diagnoses included Alzheimer's Disease, major depressive disorder, anxiety disorder, dementia, macular degeneration, adult failure to thrive and pain. Review of the quarterly Minimum Data Set (MDS) assessment, dated 11/05/18, revealed Resident #56 was severely impaired and required extensive assistance with two people assistance for Activities of Daily Living (ADL). Resident #56 was unable to make daily decisions, had unclear speech, rarely understood others and vision was highly impaired. Observations on 03/12/19 at 5:55 P.M., revealed State Tested Nursing Assistant (STNA) #91 was texting on personal cell phone while feeding Resident #56 in bed. Interview on 03/12/19 at 6:00 P.M., revealed STNA #91 verified she was using her personal cell phone while feeding Resident #56 in bed and she reported she was not allowed to use personal cell phone while working with residents. Interview on 03/13/19 at 11:00 A.M., revealed the Administrator reported possession and use of personal electronic devices were prohibited and each employee signed a contract acknowledging the policy. Reviewed STNA #91 contract for not using personal electronic devices was signed on 02/05/19 by STNA #91. Reviewed policy titled, Social Media and Personal Electronic Device Policy dated 10/07/16 stated, Possession of cellular phones, tablets, other electronic recording devices, camera phones and push-to-talk phones within Christian Village Communities facilities is prohibited with the following approved exception; employees may keep their devices in a locker within the building and may use their devices only during designated break and meal times and in employee break areas or other designated areas. 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 3 Event ID: 366025 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 366025 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/14/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE MT Healthy Christian Home 8097 Hamilton Avenue 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)