Health inspection·February 22, 2024

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Based on medical record review, resident representative interview, staff interview, and review of facility policy, the facility failed to ensure staff made timely notification of changes in resident condition to the physician and resident representative. This affected one (Resident #78) of three residents reviewed for falls. The facility census was 63. Findings include: Review of the medical record for Resident #78 revealed an admission date of 08/31/22 with diagnoses including chronic obstructive pulmonary disease (COPD), major depressive disorder, and generalized anxiety disorder. Review of the Minimum Data Set (MDS) for Resident #78 dated 10/19/23 revealed the resident was cognitively intact. Review of the discharge return anticipated Minimum Data Set MDS assessment for Resident #78 dated 01/04/24 revealed the resident required partial/moderate assistance with toileting. Review of the nurse progress note for Resident #78 dated 01/04/24 timed at 5:44 A.M. per Licensed Practical Nurse (LPN) #205 revealed State Tested Nursing Assistant (STNA) #101 notified the nurse at 3:44 A.M. that Resident #78 requested pain medication due to a fall which had occurred earlier in the shift. The note did not include documentation regarding notification to the physician or the resident's representative of the fall. Review of the facility fall incident report for Resident #78 dated 01/04/24 revealed the resident had suffered a fall and was verbalizing complaints of pain. The incident report did not include documentation regarding notification to the physician or the resident's representative of the fall. Review of progress note for Resident #78 dated 01/04/24 timed at 1:00 P.M. revealed the nurse practitioner (NP) gave an order for resident to be sent to the emergency room for evaluation of right hip pain and possible fracture related to the fall in early morning hours of 01/04/24. Telephone interview on 02/20/24 at 9:41 A.M. with Representative #199 (Resident #78's representative) confirmed facility staff did not notify her of the resident's fall on 01/04/24. Telephone interview on 02/20/24 at 12:29 P.M. with LPN #205 confirmed he did not notify Resident #78's physician nor Representative #199 of the resident's fall. Page 1 of 16 366150 366150 02/22/2024 Astoria Place of Cincinnati 3627 Harvey Avenue Cincinnati, OH 45229

F 0580 Level of Harm - Minimal harm or potential for actual harm Review of the facility policy titled Change of Condition Process dated 11/30/22 revealed the facility would ensure staff responded promptly when a resident exhibited a change from baseline including resident falls. The licensed nurse was responsible for evaluating the resident's condition and notifying the resident's physician and the resident's representative. Residents Affected - Few This deficiency represents noncompliance investigated under Complaint Number OH00150869. 366150 Page 2 of 16 366150 02/22/2024 Astoria Place of Cincinnati 3627 Harvey Avenue Cincinnati, OH 45229

F 0602 Protect each resident from the wrongful use of the resident's belongings or money. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, review of resident banking records, review of review of facility grievance logs, review of facility investigative reports, review of facility Self-Reported Incidents (SRIs), resident representative interview, staff interview, and review of facility policy, the facility failed to ensure residents were free from misappropriation. This affected one (Resident #78) of three residents reviewed for misappropriation. The facility census was 63. Residents Affected - Few Findings include: Review of the medical record for Resident #78 revealed an admission date of [DATE] with diagnoses including chronic obstructive pulmonary disease (COPD), major depressive disorder, and generalized anxiety disorder. Review of the Minimum Data Set (MDS) for Resident #78 dated [DATE] revealed the resident was cognitively intact. Review of the resident fund account record for Resident #78 revealed the resident withdrew 30 dollars in cash from his account on [DATE]. Review of the discharge return anticipated MDS assessment for Resident #78 dated [DATE] revealed the resident required partial/moderate assistance with toileting. Review of progress note for Resident #78 dated [DATE] timed at 1:00 P.M. revealed the nurse practitioner (NP) gave an order for resident to be sent to the emergency room for evaluation of right hip pain and possible fracture related to a fall in early morning hours of [DATE]. Review of the facility grievance log dated [DATE] revealed on [DATE] Representative #199 (Resident #78's representative) reported the resident was missing approximately $140.00 from his drawer in his room at the facility. Further review of the log revealed the facility was unable to verify the resident had money because the resident had been discharged from the facility since [DATE]. The grievance was documented as resolved on [DATE]. Review of the facility investigation report dated [DATE] revealed on [DATE] Social Service Designee (SSD) #410 called Representative #199 regarding the disposition of Resident #78's belongings because the resident had expired in the hospital. Representative #199 informed SSD #410 that resident was missing approximately $140.00 in cash. Further review of the investigation revealed Resident #78 was sent to the hospital on [DATE] and had expired in the hospital on [DATE] and no one had reported resident was missing money until [DATE]. The investigation report included statements from four staff dated [DATE] indicating Resident #78 usually kept his money on his person and had never reported to them he had any missing money. Review of the facility Self-Reported Incidents (SRIs) for the month of [DATE] revealed there were no reports filed regarding the allegation of misappropriation of money for Resident #78. Telephone interview on [DATE] at 9:41 A.M. with Representative #199 revealed while she was in the hospital visiting Resident #78 on [DATE], the resident had asked her to go to the facility to retrieve $147.00 from the drawer in the resident's room at the facility. Representative #199 confirmed she 366150 Page 3 of 16 366150 02/22/2024 Astoria Place of Cincinnati 3627 Harvey Avenue Cincinnati, OH 45229

F 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few went to the facility on [DATE] and could not find the resident's money in the resident's drawer or other areas of the room. Representative #199 stated she informed a male nurse working on the unit regarding the missing money, and he stated he would look into it and get back with her. Representative #199 stated SSD #410 had called her on a later date, and she again reported the missing money. Representative #199 confirmed SSD #410 said someone would check into the concern and get back with her. Representative #199 stated she had not yet received an update regarding Resident #78's missing money, and she believed the money had been taken by someone at the facility while the resident was in the hospital. Interview on [DATE] at 9:52 A.M. with SSD #410 confirmed Representative #199 informed her on [DATE] Resident #78 was missing approximately $140.00 from his room at the facility. SSD #410 stated Representative #199 told her she had given the resident $40.00 or $50.00 and the resident had also pulled money out of his account. SSD #410 confirmed Representative #199 reported that she came to the facility on [DATE] to search for the money while the resident was in the hospital and the money was missing. SSD #410 revealed she sent an email to the Administrator dated [DATE] that Representative #199 had reported Resident #78's money as missing. SSD #410 stated facility staff had searched Resident #78's room for the money on [DATE] and were unable to locate it. Telephone interview on [DATE] at 1:48 P.M. with Licensed Practical Nurse (LPN) #307 confirmed on [DATE] while Resident #78 was in the hospital, Representative #199 had come to the facility and searched for money in the resident's room. LPN #307 confirmed Representative #199 reported to him that Resident #78's money was missing on this date. LPN #307 confirmed Resident #78 usually kept his cash on his person and occasionally asked staff for change for larger bills. LPN #307 confirmed he did not report Resident #199's allegation of Resident #78's missing money to anyone at that time. Interview with the Administrator on [DATE] at 2:45 P.M. confirmed the staff did not notify her of the allegation of misappropriation of Resident #78's money until [DATE]. The Administrator confirmed the facility did not initiate an SRI regarding Resident #78's missing money and were unable to determine what had happened to the resident's money. Interview with the Administrator on [DATE] at 9:05 A.M. confirmed the facility did not notify the police of Resident #78's missing money. Interview on [DATE] at 8:15 A.M. with Representative #199 revealed she had brought Resident #78 $100.00 in cash on [DATE] and he said he had also withdrawn cash from his account at the facility and the representative knew he got $50.00 per month. Representative #199 confirmed the resident told her on [DATE] when she went to visit him in the hospital, he had approximately $147.00 cash in his drawer in his room at the facility, because he had spent a little of the money as of that time. Representative #199 revealed Resident #78 usually kept money in his shirt or pants pockets except when he went to bed, and then would put the cash in the drawer in his room. Representative #199 revealed the resident told her he had gone to the hospital on [DATE] wearing just his underwear and blankets due to having fallen during the night and hurting his hip. Representative #199 confirmed she told Resident #78 she had gone to the facility on [DATE] to try to find the $147.00 but was unable to locate the money. Representative #199 confirmed again she told the male nurse on [DATE] the money was missing, and he said he would get back to her, but he never did. Representative #199 confirmed Resident #78 told her he would follow up on the issue of his missing money when he returned to the facility because he had money stolen from him while in the facility in the past. However, the resident did not return to the facility following the hospitalization; he passed away. 366150 Page 4 of 16 366150 02/22/2024 Astoria Place of Cincinnati 3627 Harvey Avenue Cincinnati, OH 45229

F 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the facility policy titled Abuse dated [DATE] revealed misappropriation of a resident's property meant the misplacement, exploitation, or wrongful, temporary, or permanent use of a resident's belongings or money without the resident's consent. Further review of the policy revealed residents had the right to be free from abuse and misappropriation and employees must always report any abuse or suspicion of abuse or misappropriation immediately to the Administrator. The facility would thoroughly investigate and report all allegations of abuse and misappropriation. All reports of suspected crimes should be reported to local law enforcement. This deficiency represents noncompliance investigated under Complaint Number OH00150869 and Complaint Number OH00151115. 366150 Page 5 of 16 366150 02/22/2024 Astoria Place of Cincinnati 3627 Harvey Avenue Cincinnati, OH 45229

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, review of resident banking records, review of review of facility grievance logs, review of facility investigative reports, review of facility Self-Reported Incidents (SRIs), resident representative interview, staff interview, and review of facility policy, the facility failed to ensure allegations of misappropriation were reported to the Ohio Department of Health (ODH) as required. This affected one (Resident #78) of three residents reviewed for misappropriation. The facility census was 63. Findings include: Review of the medical record for Resident #78 revealed an admission date of [DATE] with diagnoses including chronic obstructive pulmonary disease (COPD), major depressive disorder, and generalized anxiety disorder. Review of the Minimum Data Set (MDS) for Resident #78 dated [DATE] revealed the resident was cognitively intact. Review of the resident fund account record for Resident #78 revealed the resident withdrew $30.00 in cash from his account on [DATE]. Review of the discharge return anticipated MDS assessment for Resident #78 dated [DATE] revealed the resident required partial/moderate assistance with toileting. Review of progress note for Resident #78 dated [DATE] timed at 1:00 P.M. revealed the nurse practitioner (NP) gave an order for resident to be sent to the emergency room for evaluation of right hip pain and possible fracture related to a fall in early morning hours of [DATE]. Review of the facility grievance log dated [DATE] revealed on [DATE] Representative #199 (Resident #78's representative) reported the resident was missing approximately $140.00 from his drawer in his room at the facility. Further review of the log revealed the facility was unable to verify the resident had money because the resident had been discharged from the facility since [DATE]. The grievance was documented as resolved on [DATE]. Review of the facility investigation report dated [DATE] revealed on [DATE] Social Service Designee (SSD) #410 called Representative #199 regarding the disposition of Resident #78's belongings because the resident had expired in the hospital. Representative #199 informed SSD #410 the resident was missing approximately $140.00 in cash. Further review of the investigation revealed Resident #78 was sent to the hospital on [DATE] and had expired in the hospital on [DATE] and no one had reported resident was missing money until [DATE]. The investigation report included statements from four staff dated [DATE] indicating Resident #78 usually kept his money on his person and had never reported to them he had any missing money. Review of the facility Self-Reported Incidents (SRIs) for the month of [DATE] revealed there were no reports filed regarding misappropriation of money for Resident #78. Telephone interview on [DATE] at 9:41 A.M. with Representative #199 revealed while she was in the hospital visiting Resident #78 on [DATE], the resident had asked her to go to the facility to 366150 Page 6 of 16 366150 02/22/2024 Astoria Place of Cincinnati 3627 Harvey Avenue Cincinnati, OH 45229

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few retrieve $147.00 from the drawer in the resident's room at the facility. Representative #199 confirmed she went to the facility on [DATE] and could not find the resident's money in the resident's drawer or other areas of the room. Representative #199 stated she informed a male nurse working on the unit regarding the missing money, and he stated he would look into it and get back with her. Representative #199 stated SSD #410 had called her on a later date, and she again reported the missing money. Representative #199 confirmed SSD #410 said someone would check into the concern and get back with her. Representative #199 stated she had not yet received an update regarding Resident #78's missing money, and she believed the money had been taken by someone at the facility while the resident was in the hospital. Interview on [DATE] at 9:52 A.M. with SSD #410 confirmed Representative #199 informed her on [DATE] Resident #78 was missing approximately $140.00 from his room at the facility. SSD #410 stated Representative #199 told her she had given the resident $40.00 or $50.00 and the resident had also pulled money out of his account. SSD #410 confirmed Representative #199 reported that she came to the facility on [DATE] to search for the money while the resident was in the hospital and the money was missing. SSD #410 confirmed sent an email to the Administrator dated [DATE] that Representative #199 had reported Resident #78's money as missing. SSD #410 stated facility staff had searched Resident #78's room for the money on [DATE] and were unable to locate it. Telephone interview on [DATE] at 1:48 P.M. with Licensed Practical Nurse (LPN) #307 confirmed on [DATE] while Resident #78 was in the hospital, Representative #199 had come to the facility and searched for money in the resident's room. LPN #307 confirmed Representative #199 reported to him that Resident #78's money was missing. LPN #307 confirmed Resident #78 usually kept his cash on his person and occasionally asked staff for change for larger bills. LPN #307 confirmed he did not report Resident #199's allegation of Resident #78's missing money to anyone. Interview with the Administrator on [DATE] at 2:45 P.M. confirmed the staff did not notify her of the allegation of misappropriation of Resident #78's money until [DATE]. The Administrator confirmed the facility did not initiate an SRI regarding Resident #78's missing money and were unable to determine what had happened to the resident's money. Interview with the Administrator on [DATE] at 9:05 A.M. confirmed the facility did not notify the police of Resident #78's missing money. Interview on [DATE] at 8:15 A.M. with Representative #199 revealed she had brought Resident #78 $100.00 in cash on [DATE] and he said he had also withdrawn cash from his account at the facility and the representative knew he got $50.00 per month. Representative #199 confirmed the resident told her on [DATE] when she went to visit him in the hospital, he had approximately $147.00 cash in his drawer in his room at the facility, because he had spent a little of the money. Representative #199 revealed Resident #78 usually kept money in his shirt or pants pockets except when he went to bed, and then would put the cash in the drawer in his room. Representative #199 confirmed the resident told her he had gone to the hospital on [DATE] wearing just his underwear and blankets due to having fallen during the night and hurting his hip. Representative #199 confirmed she told Resident #78 she had gone to the facility on [DATE] to try to find the $147.00 but was unable to locate the money. Representative #199 confirmed again she told the male nurse on [DATE] the money was missing, and he said he would get back to her, but he never did. Representative #199 confirmed Resident #78 told her he would follow up on the issue of his missing money when he returned to the facility because he had money stolen from him while in the facility in the past. However, the resident did not return to the facility following the hospitalization; the resident had passed away. 366150 Page 7 of 16 366150 02/22/2024 Astoria Place of Cincinnati 3627 Harvey Avenue Cincinnati, OH 45229

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the facility policy titled Abuse dated [DATE] revealed misappropriation of a resident's property meant the misplacement, exploitation, or wrongful, temporary, or permanent use of a resident's belongings or money without the resident's consent. Further review of the policy revealed residents had the right to be free from abuse and misappropriation and employees must always report any abuse or suspicion of abuse or misappropriation immediately to the Administrator. The facility would thoroughly investigate all allegations of abuse and misappropriation and would report them to ODH. All reports of suspected crimes should be reported to local law enforcement. This deficiency represents non-compliance investigated under Complaint Number OH00150869 and Complaint Number OH00151115. 366150 Page 8 of 16 366150 02/22/2024 Astoria Place of Cincinnati 3627 Harvey Avenue Cincinnati, OH 45229

F 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, review of resident banking records, review of review of facility grievance logs, review of facility investigative reports, review of facility Self-Reported Incidents (SRIs), resident representative interview, staff interview, and review of facility policy, the facility failed to complete a timely and thorough investigation of misappropriation of resident property. This affected one (Resident #78) of three residents reviewed for misappropriation. The facility census was 63. Residents Affected - Few Findings include: Review of the medical record for Resident #78 revealed an admission date of [DATE] with diagnoses including chronic obstructive pulmonary disease (COPD), major depressive disorder, and generalized anxiety disorder. Review of the Minimum Data Set (MDS) for Resident #78 dated [DATE] revealed the resident was cognitively intact. Review of the resident fund account record for Resident #78 revealed the resident withdrew $30.00 in cash from his account on [DATE]. Review of the discharge return anticipated MDS assessment for Resident #78 dated [DATE] revealed the resident required partial/moderate assistance with toileting. Review of progress note for Resident #78 dated [DATE] timed at 1:00 P.M. revealed the nurse practitioner (NP) gave an order for resident to be sent to the emergency room for evaluation of right hip pain and possible fracture related to a fall in early morning hours of [DATE]. Review of the facility grievance log dated [DATE] revealed on [DATE] Representative #199 (Resident #78's representative) reported the resident was missing approximately $140.00 from his drawer in his room at the facility. Further review of the log revealed the facility was unable to verify the resident had money because the resident had been discharged from the facility since [DATE]. The grievance was documented as resolved on [DATE]. Review of the facility investigation report dated [DATE] revealed on [DATE] Social Service Designee (SSD) #410 called Representative #199 regarding the disposition of Resident #78's belongings because the resident had expired in the hospital. Representative #199 informed SSD #410 the resident was missing approximately $140.00 in cash. Further review of the investigation revealed Resident #78 was sent to the hospital on [DATE] and had expired in the hospital on [DATE] and no one had reported resident was missing money until [DATE]. The investigation report included statements from four staff dated [DATE] indicating Resident #78 usually kept his money on his person and had never reported to them he had any missing money. The investigation did not include resident interviews, interview with Licensed Practical Nurse (LPN) #307, or a follow up interview with Representative #199. Review of the facility Self-Reported Incidents (SRIs) for the month of [DATE] revealed there were no reports filed regarding misappropriation of money for Resident #78. Telephone interview on [DATE] at 9:41 A.M. with Representative #199 revealed while she was in the hospital visiting Resident #78 on [DATE], the resident had asked her to go to the facility to 366150 Page 9 of 16 366150 02/22/2024 Astoria Place of Cincinnati 3627 Harvey Avenue Cincinnati, OH 45229

F 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few retrieve $147.00 from the drawer in the resident's room at the facility. Representative #199 confirmed she went to the facility on [DATE] and could not find the resident's money in the resident's drawer or other areas of the room. Representative #199 stated she informed a male nurse working on the unit regarding the missing money, and he stated he would look into it and get back with her. Representative #199 stated SSD #410 had called her on a later date, and she again reported the missing money. Representative #199 confirmed SSD #410 said someone would check into the concern and get back with her. Representative #199 stated she had not yet received an update regarding Resident #78's missing money, and she believed the money had been taken by someone at the facility while the resident was in the hospital. Interview on [DATE] at 9:52 A.M. with SSD #410 confirmed Representative #199 informed her on [DATE] Resident #78 was missing approximately $140.00 from his room at the facility. SSD #410 stated Representative #199 told her she had given the resident $40.00 or $50.00 and the resident had also pulled money out of his account. SSD #410 confirmed Representative #199 reported that she came to the facility on [DATE] to search for the money while the resident was in the hospital and the money was missing. SSD #410 confirmed sent an email to the Administrator dated [DATE] that Representative #199 had reported Resident #78's money as missing. SSD #410 stated facility staff had searched Resident #78's room for the money on [DATE] and were unable to locate it. Telephone interview on [DATE] at 1:48 P.M. with LPN #307 confirmed on [DATE] while Resident #78 was in the hospital, Representative #199 had come to the facility and searched for money in the resident's room. LPN #307 confirmed Representative #199 reported to him that Resident #78's money was missing. LPN #307 confirmed Resident #78 usually kept his cash on his person and occasionally asked staff for change for larger bills. LPN #307 confirmed he did not report Resident #199's allegation of Resident #78's missing money to anyone. Interview with the Administrator on [DATE] at 2:45 P.M. confirmed the staff did not notify her of the allegation of misappropriation of Resident #78's money until [DATE]. The Administrator confirmed the facility did not initiate an SRI regarding Resident #78's missing money and were unable to determine what had happened to the resident's money. Interview with the Administrator on [DATE] at 9:05 A.M. confirmed the facility did not notify the police of Resident #78's missing money. Interview on [DATE] at 8:15 A.M. with Representative #199 revealed she had brought Resident #78 $100.00 in cash on [DATE] and he said he had also withdrawn cash from his account at the facility and the representative knew he got $50.00 per month. Representative #199 revealed the resident told her on [DATE] when she went to visit him in the hospital, he had approximately $147.00 cash in his drawer in his room at the facility, because he had spent a little of the ,money. Representative #199 confirmed Resident #78 usually kept money in his shirt or pants pockets except when he went to bed, and then would put the cash in the drawer in his room. Representative #199 confirmed the resident told her he had gone to the hospital on [DATE] wearing just his underwear and blankets due to having fallen during the night and hurting his hip. Representative #199 confirmed she told Resident #78 she had gone to the facility on [DATE] to try to find the $147.00 but was unable to locate the money. Representative #199 confirmed again she told the male nurse on [DATE] the money was missing, and he said he would get back to her, but he never did. Representative #199 confirmed Resident #78 told her he would follow up on the issue of his missing money when he returned to the facility because he had money stolen from him while in the facility in the past. However, the resident did not return to the facility; the resident subsequently passed away. 366150 Page 10 of 16 366150 02/22/2024 Astoria Place of Cincinnati 3627 Harvey Avenue Cincinnati, OH 45229

F 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the facility policy titled Abuse dated [DATE] revealed misappropriation of a resident's property meant the misplacement, exploitation, or wrongful, temporary, or permanent use of a resident's belongings or money without the resident's consent. Further review of the policy revealed residents had the right to be free from abuse and misappropriation and employees must always report any abuse or suspicion of abuse or misappropriation immediately to the Administrator. The facility would thoroughly investigate all allegations of abuse and misappropriation and would report them to ODH. All reports of suspected crimes should be reported to local law enforcement. The investigation of allegations of misappropriation should be started immediately should include the following: a review of the completed complaint or grievance form, an interview with the person or persons reporting the incident, interviews with any witnesses to the incident, a review of the resident medical record if indicated, a search of the resident room, an interview with staff members having contact with the resident during the relevant periods or shifts of the alleged incident, interviews with the residents family members and visitors, a root cause analysis of all circumstances surrounding the incident. This deficiency represents noncompliance investigated under Complaint Number OH00150869 and Complaint Number OH00151115. 366150 Page 11 of 16 366150 02/22/2024 Astoria Place of Cincinnati 3627 Harvey Avenue Cincinnati, OH 45229

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm Based on medical record review, staff interview, and review of facility policy, the facility failed to ensure Resident #78 was timely and adequately assessed and provided timely medical intervention following a fall with major injury. This affected one (Resident #78) of three residents reviewed for falls. The facility census was 63. Residents Affected - Few Findings include: Review of the medical record for Resident #78 revealed an admission date of 08/31/22 with diagnoses including chronic obstructive pulmonary disease (COPD), major depressive disorder, and generalized anxiety disorder. Review of the Minimum Data Set (MDS) assessment for Resident #78 dated 10/19/23 revealed the resident was cognitively intact. Review of the discharge return anticipated MDS assessment for Resident #78 dated 01/04/24 revealed the resident required partial/moderate assistance with toileting and had one fall with major injury since the prior assessment. Review of the nursing progress note for Resident #78 dated 01/04/24 timed at 5:44 A.M. per Licensed Practical Nurse (LPN) #205 revealed State Tested Nursing Assistant (STNA) #101 notified the nurse at 3:44 A.M. that Resident #78 requested pain medication due to a fall which had occurred earlier in the shift. STNA #101 stated the Resident #78 denied hitting his head and said he was fine following the fall. Further review of the note revealed LPN #205 took the resident's vital signs which were within normal limits and administered pain medications. The note did not include an assessment of Resident #78's condition including range of motion following the fall. Review of the facility fall incident report for Resident #78 dated 01/04/24 revealed the resident had fallen and STNA #101 had assisted the resident back into bed. STNA #101 reported the fall to LPN #205 after the resident was back in bed on 01/04/24 at approximately 3:44 A.M. Review of the incident report revealed the resident's vital signs were stable but did not include any further assessment of the resident's condition following the fall. Review of the neurological assessment flow sheet for Resident #78 dated 01/0/4/24 revealed neurological checks were initiated at 5:45 A.M. with checks done every 15 minutes times three and every 30 minutes times nine. The section of the flow sheet which assessed range of motion to the extremities was blank for all of the assessments. Review of the nursing progress note for Resident #78 dated 01/04/24 timed at 4:34 P.M. revealed the day shift nurse assessed the resident at 8:00 A.M. and noted the resident was unable to bear weight on his right leg. The nurse notified the nurse practitioner (NP) who gave an order of an x-ray to the resident's right leg. Resident #78 reported to the day shift nurse that he had fallen while trying to go to the bathroom during the night and the aide had helped get him off the floor and back into bed. Review of nurse practitioner (NP) progress note for Resident #78 dated 01/04/24 timed at 10:20 A.M. revealed the NP examined the resident because staff reported he had fallen during the night. Resident was unable to move his right leg and complained of pain. NP ordered an x-ray, and the findings 366150 Page 12 of 16 366150 02/22/2024 Astoria Place of Cincinnati 3627 Harvey Avenue Cincinnati, OH 45229

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few were pending. NP gave an order to send Resident #78 to the hospital for an evaluation of possible right hip fracture. Review of progress note for Resident #78 dated 01/04/24 timed at 1:00 P.M. revealed the nurse practitioner (NP) gave an order for resident to be sent to the emergency room for evaluation of right hip pain and possible fracture related to the fall in early morning hours of 01/04/24. Interview with the Administrator and Director of Nursing (DON) on 02/20/24 at 12:10 P.M. confirmed Resident #78's record did not include a post-fall assessment for the resident at the time of the fall. Interview confirmed Resident #78's range of motion was not assessed until the day shift nurse on 01/04/24 at approximately 8:00 A.M. following the resident's fall which had been reported by STNA #101 on 01/04/24 at 3:44 A.M. Further interview confirmed Resident #78 sustained a right hip fracture and was hospitalized as a result of the fall on 01/04/24 sometime before 3:44 A.M. Telephone interview on 02/20/24 at 12:29 P.M. with LPN #205 confirmed Resident #78 fell during the night of 01/04/24 and STNA #101 assisted the resident back into bed following the fall. LPN #205 confirmed STNA #101 did not notify him of the resident's fall until 3:44 A.M. when the resident requested pain medication. LPN #205 confirmed he did not conduct a post-fall assessment for Resident #78. Telephone interview on 02/20/24 at 7:20 P.M. with STNA #101 on 02/20/24 at 7:20 P.M. confirmed he found Resident #78 on the floor of his room and assisted the resident back into bed. STNA #101 confirmed he did not report the fall LPN #205 immediately and he did not wait to allow the nurse to assess the resident before assisting the resident back into bed. Review of the facility policy titled Post Fall Monitoring dated 07/10/22 revealed residents should receive adequate post fall monitoring. Physical assessments should be completed at the following intervals for all falls: at the time of the fall, every fifteen minutes for the first hour, every 30 minutes times four, every hour times four, then every eight hours times four. Post fall assessments should include vital signs, orientation, and skin assessment. Review of the facility policy titled Change of Condition Process dated 11/30/22 revealed the facility would ensure staff responded promptly when a resident exhibited a change from baseline including resident falls. The licensed nurse was responsible for evaluating the resident's condition and notifying the physician of the change. This deficiency represents noncompliance investigated under Complaint Number OH00150869 and OH00151115. 366150 Page 13 of 16 366150 02/22/2024 Astoria Place of Cincinnati 3627 Harvey Avenue Cincinnati, OH 45229

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. Based on medical record review, resident representative interview, staff interview, and review of facility policy, the facility failed to ensure resident falls were thoroughly investigated including identification of root cause of the fall, identification of hazards and risks associated with falls and evidence of implementation of appropriate interventions to prevent resident falls. This affected one (Resident #78) of three residents reviewed for falls. The facility census was 63. Findings include: Review of the medical record for Resident #78 revealed an admission date of 08/31/22 with diagnoses including chronic obstructive pulmonary disease (COPD), major depressive disorder, and generalized anxiety disorder. Review of the care plan for Resident #78 dated 08/31/22 revealed the resident was at risk for falls and injury related to falls. Interventions included the following: review information on past falls and attempt to determine cause of falls, record root cause of falls, alter and remove any potential causes, follow facility fall protocol. Resident #78's fall care plan was not updated following the resident's fall on 01/04/24. Review of the care plan for Resident #78 dated 08/31/22 revealed the resident had bowel incontinence. Interventions included observation of patterns of incontinence and initiation of toileting schedule if indicated. Resident #78's incontinence care plan was not updated following the resident's fall on 01/04/24. Review of the Minimum Data Set (MDS) assessment for Resident #78 dated 10/19/23 revealed the resident was cognitively intact. Review of the discharge return anticipated MDS assessment for Resident #78 dated 01/04/24 revealed the resident required partial/moderate assistance with toileting and had one fall with major injury since the prior assessment. Review of the nursing progress note for Resident #78 dated 01/04/24 timed at 5:44 A.M. per Licensed Practical Nurse (LPN) #205 revealed State Tested Nursing Assistant (STNA) #101 notified the nurse at 3:44 A.M. that Resident #78 requested pain medication due to a fall which had occurred earlier in the shift. STNA #101 stated the Resident #78 denied hitting his head and said he was fine following the fall. Further review of the note revealed LPN #205 took the resident's vital signs which were within normal limits and administered pain medications. Review of the facility fall incident report for Resident #78 dated 01/04/24 revealed the resident had fallen and STNA #101 had assisted the resident back into bed. STNA #101 reported the fall to LPN #205 after the resident was back in bed on 01/04/24 at approximately 3:44 A.M. The incident report did not include a thorough investigation of the resident's fall. Review of nurse progress note for Resident #78 dated 01/04/24 timed at 4:34 P.M. revealed the day shift nurse assessed the resident at 8:00 A.M. and noted the resident was unable to bear weight on 366150 Page 14 of 16 366150 02/22/2024 Astoria Place of Cincinnati 3627 Harvey Avenue Cincinnati, OH 45229

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few his right leg. The nurse notified the nurse practitioner (NP) who gave an order of an x-ray to the resident's right leg. Resident #78 reported to the day shift nurse that he had fallen while trying to go to the bathroom during the night and the aide had helped get him off the floor and back into bed. Review of nurse practitioner (NP) progress note for Resident #78 dated 01/04/24 timed at 10:20 A.M. revealed the NP examined the resident because staff reported he had fallen during the night. Resident was unable to move his right leg and complained of pain. NP ordered an x-ray, and the findings were pending. NP gave an order to send Resident #78 to the hospital for an evaluation of possible right hip fracture. Review of progress note for Resident #78 dated 01/04/24 timed at 1:00 P.M. revealed the nurse practitioner (NP) gave an order for resident to be sent to the emergency room for evaluation of right hip pain and possible fracture related to the fall in early morning hours of 01/04/24. Interview with the Administrator and Director of Nursing (DON) on 02/20/24 at 12:10 P.M. Resident #78 had an unwitnessed fall which State Tested Nursing Assistant (STNA) #101 reported to the nurse on 01/04/24 at 3:44 A.M. Further interview confirmed Resident #78 sustained a right hip fracture and was hospitalized as a result of the fall on 01/04/24 sometime before 3:44 A.M. Interview confirmed the facility had not completed a thorough investigation of Resident #78's fall to identify the root cause of the fall and if the resident's fall prevention measures were in place per the resident's plan of care. Interview confirmed the facility had not updated the resident's care plan following the fall or determined if the current care plan was sufficient to prevent recurrence. Telephone interview on 02/20/24 at 12:29 P.M. with LPN #205 confirmed Resident #78 fell during the night of 01/04/24 and STNA #101 assisted the resident back into bed following the fall. LPN #205 confirmed STNA #101 did not notify him of the resident's fall until 3:44 A.M. when the resident requested pain medication. LPN #205 confirmed he did not conduct a post-fall assessment, nor did he initiate an investigation of the fall for Resident #78. LPN #205 confirmed Resident #78 frequently attempted to use the bathroom without requesting or waiting for staff assistance. Telephone interview on 02/20/24 at 7:20 P.M. with STNA #101 on 02/20/24 at 7:20 P.M. confirmed he found Resident #78 on the floor of his room and assisted the resident back into bed. STNA #101 confirmed he did not report the fall LPN #205 immediately, and he did not wait to allow the nurse to assess the resident before assisting the resident back into bed. STNA #101 confirmed Resident #78 frequently attempted to go to the bathroom without requesting assistance from staff or waiting for staff assistance, so he checked on the resident frequently. STNA #101 confirmed Resident #78 told the aide he had fallen on 01/04/24 while trying to take himself to the bathroom and the resident had not used his call light or requested staff assistance prior to the fall. Telephone interview on 02/21/24 at 8:15 A.M. with Representative #199 (Resident #78's representative) confirmed Resident #78 was known by staff to frequently try to go to the bathroom without requesting assistance and felt the resident's fall may have been prevented if staff had offered assistance with toileting more frequently. Review of the facility policy titled Fall Policy dated 07/10/22 revealed all residents would receive adequate supervision, assistance and assistive devices to prevent falls. Each resident would be evaluated for safety risks, including falls and accidents. Care plans would be created and implemented based on the individual risk factors to aid in preventing falls. The facility staff would 366150 Page 15 of 16 366150 02/22/2024 Astoria Place of Cincinnati 3627 Harvey Avenue Cincinnati, OH 45229

F 0689 thoroughly investigate all resident falls. Level of Harm - Minimal harm or potential for actual harm This deficiency represents noncompliance investigated under Complaint Number OH00150869 and Complaint Number OH00151115. Residents Affected - Few 366150 Page 16 of 16