Health inspection·October 18, 2021

F 0685 Assist a resident in gaining access to vision and hearing services. Level of Harm - Minimal harm or potential for actual harm Based on record review, observation, interview and policy review, the facility failed to ensure residents were assisted with placement of hearing aids. This affected one (Resident #34) of three residents reviewed for hearing impairment. The census was 63. Residents Affected - Few Findings include: Review of the medical record for Resident #34 revealed an admission date of 01/26/21 with a diagnosis of acute congestive heart failure. Review of the Minimum Data Set (MDS) for Resident #34 dated 08/24/21 revealed the resident was cognitively intact and required extensive assistance of two staff with activities of daily living (ADL). She had a communication impairment and required the use of bilateral hearing aids to hear adequately. Review of the care plan dated 02/03/21 revealed resident had a communication impairment and required bilateral hearing aids to hear adequately. Interventions included the following: assist to wear hearing aids daily, maintain hearing aids in good working order, keep clean and replace batteries as needed, arrange for maintenance as needed. Review of the nurse aide assignment sheet for Resident #34 dated 10/13/21 revealed resident wore bilateral hearing aids. During observation on 10/13/21 at 11:15 A.M., Resident #34 revealed resident was not wearing hearing aids and exhibited difficulty hearing. During interview on 10/13/21 at 11:15 A.M., Resident #34 stated she was not wearing her hearing aids and was having difficulty hearing. She said her hearing aids were in her nightstand and staff were supposed to assist her with putting them in her ears when she woke up. During interview on 10/13/21 at 11:26 A.M., State Tested Nursing Assistant (STNA) #198 confirmed Resident #34 was not wearing hearing aids and was exhibiting difficultly hearing without them. STNA #198 confirmed the nurse aide assignment sheet for the resident said she was to wear bilateral hearing aids, but she thought the nurse was responsible for assisting resident with hearing aids. During interview on 10/13/21 at 11:27 A.M., Licensed Practical Nurse (LPN) #202 confirmed Resident #34 wore hearing aids, which she kept in her nightstand. LPN #202 stated she thought the resident managed her hearing aids independently and did not require staff assistance with them. During observation on 10/13/21 at 11:28 A.M. with LPN #202, a check of the resident's nightstand revealed one hearing aid was in the nightstand in a box and the other hearing aid was missing. Review of the facility policy titled Care of Hearing Aids, undated, revealed staff should review residents care plan to assess needs of the resident regarding hearing aids, assess resident's knowledge of operating the hearing aid, and should notify supervisor if hearing aid is lost or damaged. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366025 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 366025 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/18/2021 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)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, staff interview, review of facility policy, and review of online resources per the Centers for Disease Control (CDC) and the Centers for Medicare and Medicaid Services (CMS) the facility failed to ensure staff wore appropriate personal protective equipment (PPE) to prevent the spread of Coronavirus (COVID-19). This had the potential to affect 13 (Residents #4, #7, #10, #20, #21, #25, #31, #32, #34, #41, #44, #53 and #54)residing on the Five South Unit; and failed to ensure staff practiced appropriate hand hygiene during meal service. This affected three (Residents #3, #14 and #28) of 18 residents observed for meal service on the Four North Unit. The census was 63. Residents Affected - Some Findings include: 1. During observation on 10/12/21 at 11:30 A.M., State Tested Nursing Assistant (STNA) #98 was eating in the resident lounge area and was not wearing PPE. During interview on 10/12/21 at 11:30 A.M., STNA #98 confirmed she was not wearing PPE and was eating while in the resident area. During interview on 10/14/21 at 11:37 A.M., the Director of Nursing (DON) confirmed staff should wear a surgical mask and eye protection in resident at all times. Review of the facility policy titled COVID-19 Infection Control, undated, revealed staff should wear face masks and eye protection in resident areas. Review of an online resource from the CDC (https://www.cdc.gov/Coronavirus/2019-ncov/hcp/long-term-care-strategies.html) revealed the following guidance regarding facemasks: ensure all healthcare care personnel (HCP) wear a facemask while in the facility. 2. During observation on 10/13/21 at 8:58 A.M., STNA #189 revealed she was working in a resident area providing direct resident care and was not wearing proper eye protection. STNA #189 was wearing prescription eyeglasses with side pieces (eye glass wings). During interview on 10/13/21 at 8:58 A.M., STNA #189 confirmed she had brought the eye glass wings from home and thought they were a substitute for eye protection provided by the facility. During interview on 10/14/21 at 11:37 A.M., the DON confirmed staff should currently wear a face shield or goggles as eye protection in resident areas. Review of the facility policy titled COVID-19 Infection Control undated revealed staff should wear eye protection that covers the front and sides of the face. Review of an online resource from CMS titled COVID-19 Nursing Home data at https://data.cms.gov/stories/s/COVID-19-Nursing-Home-Data-Test-Positivity-Rates/q5r5-gjyu/ revealed the county in which the facility was situated was experiencing a moderate spread of COVID 19 with a positivity rate of 9.8 percent (%) for the week ending in 10/05/21. A review of an online resource per the CDC and NIOSH at https://www.cdc.gov/niosh/topics/eye/eye-infectious.html revealed prescription eyeglasses are not considered eye protection and while the use of prescription safety glasses with side protection are available, they do not provide protection (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366025 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 366025 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/18/2021 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)

F 0880 against splashes or droplets as goggles and/or face shields do. Level of Harm - Minimal harm or potential for actual harm 3. During observation on 10/12/21 at 12:43 P.M., STNA #250 served food to Resident #14 in the 4 North dining room, served a tray to Resident #28 in the resident's room, and served at tray to Resident # 3 in the residents room and did not perform hand hygiene between trays. Residents Affected - Some During interview on 10/12/21 at 12:46 P.M., STNA #250 confirmed she did not wash or sanitize hands between delivering meal trays to Residents #3, #14, and #28. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366025 If continuation sheet Page 4 of 4