Health inspection·March 13, 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, review of facility policy, and interview, the facility failed to ensure Resident #11's physician and guardian were notified timely following a fall with injury. This affected one resident (#11) of five residents reviewed for falls. The facility census was 63. Findings Include: Review of the medical record for Resident #11 revealed admission date of 09/12/11 with diagnoses including cerebral palsy (CP), schizophrenia, convulsion, moderate intellectual disabilities (ID), borderline personality disorder, type two diabetes mellitus, seizures, psychosis, dementia, peripheral vascular disease, impulse disorder, post-traumatic stress disorder (PTSD), and intermittent explosive disorder. Review of the Minimum Data Set (MDS) assessment dated [DATE], revealed Resident #11 was rarely understood and was dependent on staff for transfers and mobility. The resident had an unwitnessed fall on 03/11/24 at 6:00 A.M. On 03/11/24 at 3:25 P.M. review of Resident #11's medical record revealed there was no documented evidence the physician and the resident's guardian were notified at the time the resident sustained the fall on 03/11/24 at 6:00 A.M. Review a Nurse Practitioner (NP)'s note dated 03/11/24 at 3:45 P.M., for Resident #11 and authored by NP #150, revealed the resident was seen due to a request by the nursing staff for swelling and pain in the resident's right hand. The resident complained of pain in the right hand upon assessment and an x-ray was ordered. NP #150's note revealed no documentation regarding the resident having a recent unwitnessed fall or the provider being notified of the resident's fall at the time it occurred. Review of a nurse's progress note dated 03/11/24 at 6:29 P.M. and authored by Registered Nurse (RN) #51, revealed the resident had swelling and pain in right hand and an x-ray was ordered. A nurse's progress note at 8:27 P.M. revealed the x-ray was performed. Review of the x-ray report dated 03/11/24 at 7:29 P.M. for Resident #11, revealed the resident had a right hand x-ray due to pain/swelling. The findings indicated the resident had acute fracture base of the thumb metacarpal. Page 1 of 6 366150 366150 03/13/2024 Astoria Place of Cincinnati 3627 Harvey Avenue Cincinnati, OH 45229

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview with the Administrator and the Director of Nursing (DON) on 03/12/24 at 3:40 P.M., revealed Resident #11 was sent to the hospital on [DATE] for a fractured hand. The Administrator revealed the local Police Department had notified the facility the resident (after arriving to the hospital) had made an allegation of abuse against State Testing Nursing Assistant (STNA) #75. The Administrator and the DON initiated an investigation based on the abuse allegation and discovered Resident #11 had sustained an unwitnessed fall on 03/11/24 and was found on the floor by STNA #75. The DON verified Resident #11 had an unwitnessed fall on 03/11/24 at approximately 6:00 A.M. and the physician and the guardian were not notified. Interview with STNA #75 on 03/12/24 at 3:52 P.M., revealed she was assigned to care for Resident #11 on 03/10/24 from 7:00 P.M. to 03/11/24 at 7:00 A.M. STNA #75 stated she heard Resident #11 calling her name and she found Resident #11 on the floor at approximately 6:00 A.M. STNA #75 stated Resident #11 had an unwitnessed fall and was found lying next to her bed with the fall mat in place. Resident #11 reported the resident rolled out of the bed and fell on the ground. STNA #75 stated she notified LPN #47 of the fall and she and LPN #47 assisted Resident #11 from the floor back to her bed. STNA #75 stated she was unsure if LPN #47 notified the physician and the resident's guardian. On 03/12/24 at 4:00 P.M. an attempt to interview LPN #47 was unsuccessful as the LPN could not be reached. Review of the facility's transfer form dated 03/12/24 at 6:26 P.M. for Resident #11, revealed the resident was sent to the hospital for a fractured hand. Interview with NP #150 on 03/19/24 at 2:30 P.M. revealed she was at the facility doing her routine rounds when an aide brought Resident #11 to her and indicated the resident was having pain. NP #150 stated the resident's hand was swollen, bruised and the resident complained of pain. NP #150 reported she ordered an x-ay to rule out a fracture. NP #150 stated she was never notified of the resident's fall on 03/11/24 but would expect the facility to contact her. Review of facility policy titled Fall Policy dated 07/10/22 revealed after a resident's fall the physician and family/responsible party were to be notified. 366150 Page 2 of 6 366150 03/13/2024 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, review of facility policy, and interview, the facility failed to ensure adequate assessment and timely care and treatment were provided to Resident #11 following an unwitnessed fall with injury. This affected one resident (#11) of five residents reviewed for falls. The facility census was 63. Residents Affected - Few Findings Include: Review of the medical record for Resident #11 revealed admission date of 09/12/11 with diagnoses including cerebral palsy (CP), schizophrenia, convulsion, moderate intellectual disabilities (ID), borderline personality disorder, type two diabetes mellitus, seizures, psychosis, dementia, peripheral vascular disease, impulse disorder, post-traumatic stress disorder (PTSD), and intermittent explosive disorder. Review of a fall risk assessment dated [DATE] revealed Resident #11 was a high risk for falls. Review of the Minimum Data Set (MDS) assessment dated [DATE], revealed Resident #11 was rarely understood and was dependent on staff for transfers and mobility. Review of the most recent plan of care for Resident #11, revealed the resident was at risk for falls with the potential for injury related to impaired balance, impaired mobility, seizure disorder, cognitive deficits, cataracts, and diabetes. Interventions were to ensure a fall mat was on the right side of the bed, and to provide the necessary assistance with transfer. The resident had an unwitnessed fall on 03/11/24 at 6:00 A.M. On 03/11/24 at 3:25 P.M. review of Resident #11's medical record revealed there was no documented evidence the physician and the resident's guardian were notified at the time the resident sustained the fall on 03/11/24 at 6:00 A.M. Review a Nurse Practitioner (NP)'s note dated 03/11/24 at 3:45 P.M., for Resident #11 and authored by NP #150, revealed the resident was seen due to a request by the nursing staff for swelling and pain in the resident's right hand. The resident complained of pain in the right hand upon assessment and an x-ray was ordered. NP #150's note revealed no documentation regarding the resident having a recent unwitnessed fall or the provider being notified of the resident's fall at the time it occurred. Review of a nursing progress note dated 03/11/24 at 5:00 P.M. and recorded as a late entry on 03/13/24 by the Director of Nursing (DON) revealed Resident #11 screamed out for the State Tested Nursing Aide (STNA) (identified as STNA #75). The resident was noted on the floor on the right side of her bed on 3/11/24 at 6:00 AM. The resident stated she rolled out of the bed. The STNA and the nurse (identified as Licensed Practical Nurse [LPN] #47) assisted the resident off floor and the resident complained of right-hand pain. Tylenol was administered. Review of a nurse's progress note dated 03/11/24 at 6:29 P.M. and authored by Registered Nurse (RN) #51, revealed the resident had swelling and pain in right hand and an x-ray was ordered. A nurse's progress note at 8:27 P.M. revealed the x-ray was performed. 366150 Page 3 of 6 366150 03/13/2024 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 Review of the x-ray report dated 03/11/24 at 7:29 P.M. for Resident #11, revealed the resident had a right hand x-ray due to pain/swelling. The findings indicated the resident had acute fracture base of the thumb metacarpal. Interview with the Administrator and the Director of Nursing (DON) on 03/12/24 at 3:40 P.M., revealed Resident #11 was sent to the hospital on [DATE] for a fractured hand. The Administrator stated the local Police Department notified the facility regarding an allegation of abuse made by Resident #11 against State Testing Nursing Assistant (STNA) #75 (after the resident arrived to the hospital). The Administrator and DON initiated their investigation after receiving the notification of the allegation of abuse and discovered Resident #11 had been found on the floor from an unwitnessed fall by STNA #75 on 03/11/24. The DON verified Resident #11 had an unwitnessed fall on 03/11/24 at 6:00 A.M. and neither the physician or the guardian were notified at that time. At the time of the interview, the Administrator and DON revealed STNA #75 provided a statement to them that she made LPN #47 aware of the fall and did not move Resident #11 until LPN #47 was present in the resident's room. The DON verified there was no documentation related to Resident #11's fall with injuries, no assessment completed, nor neurological (neuro) checks being initiated by LPN #47 at the time of the fall. The DON verified that the facility's policy was to assess a resident after a fall and perform neuro checks for any unwitnessed falls. Interview with STNA #75 on 03/12/24 at 3:52 P.M., revealed she was assigned to care for Resident #11 on 03/10/24 from 7:00 P.M. to 03/11/24 at 7:00 A.M. STNA #75 stated she heard Resident #11 calling her name and she found Resident #11 on the floor (on 03/11/24) at approximately 6:00 A.M. STNA #75 stated Resident #11 had an unwitnessed fall and was found lying next to her bed with the fall mat in place. Resident #11 reported the resident rolled out of the bed and fell on the ground. STNA #75 stated she notified LPN #47 of the fall and she and LPN #47 assisted Resident #11 from the floor back to her bed. STNA #75 stated she was unsure if LPN #47 did an assessment on the resident or if she documented the fall. The STNA also revealed she was unsure if LPN #47 notified the physician and the resident's guardian of the fall. On 03/12/24 at 4:00 P.M. an attempt to interview LPN #47 was unsuccessful as the LPN could not be reached. Review of the facility's transfer form dated 03/12/24 at 6:26 P.M. for Resident #11, revealed the resident was sent to the hospital for a fractured hand (approximately 12 hours after she sustained the fall). Review of a nurse's progress note dated 03/13/24 at 3:42 A.M. revealed the nurse called the hospital and was updated that the resident had been admitted to the hospital with the diagnosis of fracture. Interview with NP #150 on 03/19/24 at 2:30 P.M. revealed she was at the facility doing her routine rounds when an aide brought Resident #11 to her and indicated the resident was having pain. NP #150 stated the resident's hand was swollen, bruised and the resident complained of pain. NP #150 reported she ordered an x-ay to rule out a fracture. NP #150 stated she was never notified of the resident's fall on 03/11/24 but would expect the facility to contact her. NP #150 revealed that had she been notified of the resident's fall at the time of the incident, she would have ordered the x-ray and proceeded with the same treatment plan. Review of the facility policy titled Fall Policy dated 07/10/22 revealed after a fall the 366150 Page 4 of 6 366150 03/13/2024 Astoria Place of Cincinnati 3627 Harvey Avenue Cincinnati, OH 45229

F 0684 Level of Harm - Minimal harm or potential for actual harm investigative procedure included to check resident for injuries; vital signs; and neuro-checks for head injuries of unwitnessed falls. The policy also included the physician and family/responsible party were to be notified. Residents Affected - Few 366150 Page 5 of 6 366150 03/13/2024 Astoria Place of Cincinnati 3627 Harvey Avenue Cincinnati, OH 45229

F 0851 Level of Harm - Potential for minimal harm Residents Affected - Many Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data. Based on staff interviews, record review, and review of the Payroll-Based Journal (PBJ), the facility failed to submit complete and accurate staffing information for the PBJ report to the Centers for Medicare and Medicaid Services (CMS). This had the potential to affect all 63 residents in the facility. Findings Include: Review of the [NAME] PBJ staffing data report for the third quarter of 2023 revealed the facility triggered for no Registered Nurse (RN) hours and no licensed nursing coverage 24 hours/day for the entire quarter. Interview with the Administrator on 03/13/24 at 9:00 A.M. confirmed inaccurate data was sent in on the PBJ for the third quarter of 2023. The Administrator revealed she collected data for two facilities and sends the information to corporate. The Administrator revealed she had no access to verify the information was received by CMS. 366150 Page 6 of 6