Health inspection·July 18, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, review of maintenance orders, resident interview, staff interview, and review of the facility policy, the facility failed to ensure a safe and homelike environment for the residents. This affected Residents #20 and #21, the following 18 residents residing on the 100- unit (#1, #2, #3, #4, #5, #6, #7, #8, #9, #10, #11, #12, #13, #14, #15, #16, #17, #18), and the following 14 residents residing on the 400-unit (#58, #59, #60, #61, #62, #63, #64, #65, #66, #67, #68, #69, #70, #71) and had the potential to affect all of the residents residing in the facility . The facility census was 71 residents. Findings include: 1.Observations on 07/07/25 between 9:20 A.M. revealed the handrail next to elevator on the 100-nursing unit was not safely secured to the wall rendering it non-functional. The handrail was missing an end cap and was secured to the wall on one end by one screw and the other end was dangling. There was an end cap and a corner cap missing from the handrail near the 100-nursing unit utility closet. Observation on 07/08/25 at 8:30 A.M. revealed the handrail next to elevator on the 100-nursing unit was not safely secured to the wall rendering it non-functional. The handrail was missing an end cap and was secured to the wall on one end by one screw and the other end was dangling. There was an end cap and a corner cap missing from the handrail near the 100-nursing unit utility closet. Observation on 07/09/25 at 1:10 P.M. accompanied by Maintenance Director (MD) #200 revealed the handrail next to elevator on the 100-nursing unit was not safely secured to the wall rendering it non-functional. The handrail was missing an end cap and was secured to the wall on one end by one screw and the other end was dangling. There was an end cap and a corner cap missing from the handrail near the 100-nursing unit utility closet. Interview on 07/09/25 at 1:16 P.M. with MD#200 confirmed the handrail next to elevator on the 100-nursing unit was not safely secured to the wall rendering it non-functional. The handrail was missing an end cap and was secured to the wall on one end by one screw and the other end was dangling. There was an end cap and a corner cap missing from the handrail near the 100-nursing unit utility closet. 2. Observation on 07/07/25 at 11:00 A.M. of Resident #20 and #21's bathroom revealed the light fixture was partially attached at the ceiling and was dropping down on one side about four inches. At the ceiling level, above the fixture, there was dried material covering the light fixture opening of what appeared to be dried grass, indicative of a animal's nest. Interview on 07/09/25 at 12:15 P.M. with the Administrator confirmed the dried material in the ceiling above the light fixture in Resident #20 and #21's room bathroom. Interview on 07/09/25 at 12:22 P.M. with Activity Director (AD) #115 confirmed she had seen what looked like a nest in Resident #20 and #21's bathroom. Interview on 07/09/25 at 12:23 P.M. with Activity Assistants (AAs) #116 and #117 confirmed the presence of grasses in the light fixture of Resident #20 and #21's bathroom. Interview on 07/10/25 at 9:20 A.M. with MD #200 confirmed the material removed from bathroom of Resident #20 and #21's bathroom appeared to be that of an animal nest of some kind. 3.Review of the medical Page 1 of 8 366150 366150 07/18/2025 Astoria Place of Cincinnati 3627 Harvey Avenue Cincinnati, OH 45229

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some record for Resident #24 revealed an admission date of 04/08/25 with diagnoses including paranoid schizophrenia, hypertension and history of myocardial infarction. Review of the Minimum Data Set (MDS) assessment for Resident #24 dated 04/21/25 revealed the resident had intact cognition, was occasionally incontinent of bowel and always continent of bladder, and required supervision with bathing and was independent with oral and personal hygiene, toileting, dressing, bed mobility and transfers. Interview on 07/07/25 at 10:30 A.M. with Resident #24 confirmed at night she frequently heard what she presumed to be animals making noise in her ceiling and it kept her awake and made her fearful the animals would come into her room through the ceiling. Resident #24 confirmed she heard banging, clawing, and running sounds starting at about 10:00 P.M., lasting for about one hour. Resident #24 confirmed she has heard these noises nearly every night since her admission on [DATE], and she has told the nursing staff, but no maintenance staff had assessed her concerns. Interview on 07/09/25 at 12:22 P.M. with AD #115 confirmed she had observed or heard noises indicative of animal noises during the past two years in the ceiling of her office and in the hallway of the 400 unit. In the fall of 2024, she heard and observed a squirrel in the ceiling when a ceiling tile had been temporarily removed. On 05/20/25 she reported to the former Administrator and MD #200 that she had observation an animal tail, claws and an eye looking down from the ceiling light fixture in her office. MD #200 stated he would contact the facility's pest control vendor. AD #115 stated the pest control never came to her office to assess the sighting. AD #115 stated she signed a statement and reported the animal sighting again on 06/16/25 to MD #20. MD #20 took down one tile and looked up in the ceiling, but did not observe an animal. AD #115 confirmed on 06/26/25 she heard apparent animal noise again and reported it to Assistant Maintenance (AM) #205. AM #205 told AD #115 that wildlife control or pest control had been contacted regarding the concern. AD #115 stated she had not seen or heard of any assessment from the pest control company or a wildlife control company. Interviews on 07/09/25 at 12:22 P.M. with AAs 116 and #117 confirmed they had heard what sounded like animal noises coming from the AD #115's office and in the resident hallway of the 400-unit. AAs #116 and #117 confirmed residents have made comments regarding hearing what sounded like running and clawing of animals in the ceiling. Interview on 07/09/25 at 2:30 P.M. with outside Pest Control Vendor (PCV) #5 confirmed the facility had made no requests regarding assessment of animals in the ceiling in the facility. PCV #5 confirmed they regularly provided pest control services but were unable to provide wildlife control services. PCV #5 confirmed the facility had called them to ask for wildlife assessment on 07/09/25 after the survey was entered. Interview on 07/10/25 at 9:20 A.M. with MD #200 confirmed he had received one report of animal noises which was a written report per AD #115 dated 06/16/25 indicating she heard what she presumed to be an animal in the ceiling of her office. Interviews on 07/07/25 through 07/09/25 from 10:45 A.M to 3:09 P.M. with Certified Nursing Assistants (CNAs) #523 and #521, Licensed Practical Nurses (LPNs) #401 and #411 and #406, and Housekeeping Aide (HA) #702 confirmed on multiple occasions for the past several months during the day and during the evenings they heard what sounded like animal noises from the hallway of the 400 unit short hall. Interviews confirmed the staff reported the animal noises to the former Administrator and the maintenance staff. Review of maintenance orders dated 04/01/25 through 07/09/25 revealed they did not include entries regarding staff concerns of animals in the 400-unit ceiling and no work orders completed related to the assessment of animals in the ceiling. Review of pest control service visit notes dated 04/01/25 through 07/03/25 revealed the company provided general insect control services and treatment of mice in the base on 05/12/25. There was no evidence pest control services assessed or treated for animals in the 400-unit ceiling. Review of the policy titled Housekeeping Policy - Safe, Clean, Comfortable Homelike Environment 366150 Page 2 of 8 366150 07/18/2025 Astoria Place of Cincinnati 3627 Harvey Avenue Cincinnati, OH 45229

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some revised 12/18/22 revealed it was the policy of the facility to provide a safe, clean, comfortable homelike environment in such a manner to acknowledge and respect resident rights. The facility must provide housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior. This deficiency represents noncompliance investigated under Master Complaint Number OH00167364 (1313526) and Complaint Number OH00167351 (1313529) and Complaint Number OH00166548 (1313528) and Complaint Number OH166287 (1313527) and is recite to the survey completed 05/19/25. 366150 Page 3 of 8 366150 07/18/2025 Astoria Place of Cincinnati 3627 Harvey Avenue Cincinnati, OH 45229

F 0600 Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, review of facility Self-Reported Incidents (SRIs), review of staff witness statements, review of hospital records, staff interview, resident interview, and review of the facility policy, the facility failed to ensure residents were free from resident-to-resident abuse. This resulted in Actual Harm on 07/01/25 to Resident #38 when Resident #43, a resident with a known history of aggressive behaviors towards other residents, struck Resident #38 in the face causing a nasal fracture. This affected one (Resident #38) of three residents reviewed for abuse. The facility census was 71 residents.Findings include: 1. 1.Review of the medical record for Resident #38 revealed an admission date of 05/13/25 with diagnoses including dementia without behavioral disturbance, hepatitis C, and atrioventricular heart block. Review of the Minimum Data Set (MDS) assessment for Resident #38, dated 05/22/25, revealed the resident had intact cognition and ambulated with a cane. Review of the census profile for Resident #38 revealed the resident was moved into a room with Resident #43 on 06/25/25 because Resident #38 was not getting along with his roommate. Review of the progress note for Resident #38, dated 07/01/25 at 6:06 P.M., revealed Resident #38 had been punched in the face by Resident #43. Upon entering the room, Resident #38 was sitting on his bed with blood and blood clots gushing out of his right nostril. The nose appeared to be injured. Emergency medical services (EMS) were called, and Resident #38 was sent to the hospital for evaluation. Review of the witness statement from Certified Nursing Assistant (CNA) #530 revealed the aide was coming back from a break and was passing Resident #38 and Resident #43's room when the aide noticed blood on the sheets. CNA #530 entered the room and Resident #38 told the aide that Resident #43 had hit him. CNA #530 then notified the nurse. Review of the Self-Reported Incident (SRI) regarding Resident #38 dated 07/01/25 revealed on 07/01/25 at 6:00 P.M., Resident #43 struck Resident #38 in the nose resulting in a bloody nose and a nasal fracture for Resident #38. The facility substantiated abuse had occurred by Resident #43 towards Resident #38. Review of the hospital note for Resident #38, dated 07/01/25 at 6:35 P.M., revealed the resident presented at the hospital due to blunt force trauma to the head and was diagnosed with a closed fracture of nasal bone, which was confirmed by a computerized tomography (CT) scans of the maxillofacial area and the head. Review of the hospital discharge instructions for Resident #38, dated 07/01/25 at 7:42 P.M., revealed the resident had a nasal bone fracture and should follow up with an ear, nose, and throat (ENT) physician for further examination and recommendation. Review of the progress note for Resident #38, dated 07/02/25 at 3:03 A.M., revealed the resident returned from the hospital with a fractured nasal bone. A report from the hospital nurse revealed the resident received tranexamic acid (a medication to help control bleeding) due to the resident's bloody nose. Resident #38 was to follow up with an ENT physician as soon as possible. Resident #38 was moved to a new room and was monitored frequently by staff. Review of the progress note for Resident #38, dated 07/03/25 at 2:43 P.M., revealed the resident returned to the facility after his ENT physician follow up visit with new orders for Amoxicillin 500 milligrams (mg), give one tablet by mouth two times a day for ten days for nasal swelling. The ENT physician's note indicated surgical repair of the nasal fracture was not indicated and staff should monitor the swelling to the resident's nose. 2. Review of the medical record for Resident #43 revealed an admission date of 04/23/25 with diagnoses including schizoaffective disorder (bipolar type), anxiety disorder, unspecified dementia with behavioral disturbance, chronic obstructive pulmonary disease (COPD), and hypertension. Review of the MDS assessment for Resident #43 dated 05/06/25 revealed the resident had severe cognitive impairment and was independently mobile. Review of Resident #38's medical record revealed 366150 Page 4 of 8 366150 07/18/2025 Astoria Place of Cincinnati 3627 Harvey Avenue Cincinnati, OH 45229

F 0600 Level of Harm - Actual harm Residents Affected - Few preadmission progress notes from the nursing home where Resident #43 had previously resided. The progress note dated 03/01/25 at 9:02 A.M., revealed the resident was involved in a physical altercation with another resident after Resident #43 had wandered into the other resident's room. Review of a preadmission progress note dated 03/18/25 at 6:20 P.M., revealed Resident #43 told the nurse he had gotten into a fight with his roommate. Resident #43's roommate had mistakenly laid down in the wrong bed and Resident #43 struck the roommate in the face with a closed fist. The other resident sustained a bruise and an abrasion to his forehead. Review of a preadmission progress note, dated 03/25/25 at 10:27 A.M., revealed Resident #43 was propelling himself in his wheelchair through the common area when he stopped behind another resident who was eating breakfast and punched the other resident twice in the back. Review of a preadmission progress note, dated 03/27/25 at 11:37 A.M., revealed social services spoke with Resident #43's guardian regarding finding alternate placement of the resident due to physically aggressive behaviors. Resident #43's guardian said he was agreeable to alternate placement to any facility able to accept Resident #43. Review of the note revealed Resident #43 had three physical altercations with other residents since his admission to the facility on [DATE]. Resident #43 was physically aggressive to other residents without provocation. Staff noted Resident #43 was cooperative with care and did not exhibit aggression towards staff members but was only physically aggressive with other residents. Review of the one to one observation form for Resident #43 form initiated on 06/25/25 revealed the resident was placed on one-on-one monitoring from 06/25/25 at 7:00 P.M. to 06/27/25 at 7:00 P.M. The one-on-one observation was discontinued for Resident #43 as the resident remained calm and did not appear to want to harm self or others. Review of a progress note for Resident #43, dated 06/25/25 at 5:05 A.M., revealed Resident #43 was observed engaged in a physical altercation with Resident #41. Resident #43 had no injuries and Resident #41 sustained scratches on his face. The staff moved Resident #41 to another room and placed Resident #43 on one to one supervision. Review of the facility SRI dated 06/25/25 revealed Resident #43 was involved in a physical altercation with Resident #41, in which Resident #41 received facial abrasions. The facility did not substantiate abuse, because the investigation revealed Resident #41 was in Resident #43's face and there was no intent to cause harm, just an effort for the residents to be clear of each other. Review of the care plan for Resident #43, initiated on 06/25/25 after the incident involving Resident #41, revealed the resident had the potential to be physically aggressive related to dementia and poor impulse control. Interventions included the following: administer medications as ordered, assess and address contributing sensory deficits, assess and anticipate resident's needs, assess resident's understanding of the situation and allow time for the resident to express self and feelings toward the situation, monitor/document/report as needed any signs/symptoms of resident posing danger to self and others, psychiatric/psychogeriatric consultation as indicated, review for triggers and patterns at scheduled behavior meeting, when physical aggression occurs, remove individuals to a controlled environment, when the resident becomes agitated, intervene before agitation escalates and guide away from source of distress, engage calmly in conversation, if resident is aggressive, staff to walk calmly away and approach later. Review of the census profile for Resident #43 revealed the resident was moved to a private room on 07/01/25 before being sent to the hospital for a psychiatric evaluation. Review of a hospital note for Resident #43 dated 07/01/25 at 6:30 P.M. revealed the resident should be admitted as he represented a substantial risk of physical harm to others as manifested by evidence of recent homicidal or other violent behavior, evidence of recent threats that place another in reasonable fear of violent behavior and serious physical harm, or other evidence of present dangerousness. Resident #43 had exhibited worsening agitation and aggression and had been hitting other 366150 Page 5 of 8 366150 07/18/2025 Astoria Place of Cincinnati 3627 Harvey Avenue Cincinnati, OH 45229

F 0600 Level of Harm - Actual harm Residents Affected - Few residents. Resident #43 was admitted to the psychiatric unit of the hospital on [DATE] and was readmitted to the facility on [DATE]. Review of the progress note for Resident #43, dated 07/02/25 at 8:35 P.M., revealed it was reported to the nurse on 07/01/25 that Resident #43 had punched Resident #38 in the nose. When the nurse asked Resident #43 why he had punched Resident #38, Resident #43 shrugged his shoulders and did not otherwise respond to the nurse. The nurse notified Resident #43's physician who gave orders to send the resident to the hospital for a psychiatric evaluation. Review of the progress note for Resident #43 dated 07/03/25 at 6:41 A.M. revealed the resident was admitted to the hospital's geriatric psych unit. Review of the progress note for Resident #43 dated 07/11/25 at 12:42 P.M. revealed the resident returned from the hospital with no new orders. During an interview on 07/16/25 at 8:13 A.M., CNA #530 stated he was the first person to respond to the incident on 07/01/25 between Residents #43 and #38. CNA #530 stated on 07/01/25 at approximately 6:00 P.M. he returned to the unit after supervising the 5:30 P.M. smoking session when he saw bloody sheets on Resident #38's nightstand. CNA #530 entered Resident #38's room and saw the resident in bed in a fetal position and there was blood everywhere. Resident #38 told the aide he had been resting in bed when Resident #43 wheeled over in his wheelchair and hit him in the face. Resident #43 was sitting in the room in his wheelchair while Resident #38 spoke to the aide regarding the incident. CNA #530 left the room and notified Licensed Practical Nurse (LPN) #401 of the incident. During an interview on 07/16/25 at 8:20 A.M., Resident #38 stated he was lying in bed on 07/01/25 when Resident #43 wheeled up in his wheelchair next to the bed and hit the resident in the face. Resident #38 said his nose hurt after he got hit but it felt better now. An interview with Resident #43 was attempted on 07/16/25 at 8:35 A.M. but was unsuccessful as Resident #43's responses to questions were unintelligible. During an interview on 07/16/25 at 8:42 A.M., LPN# 401 stated on 07/01/25 at approximately 6:00 P.M. she was in the nursing station when CNA #530 notified her Resident #43 had hit Resident #38. LPN #401 said she immediately went to Resident 38's room and observed the resident sitting on the side of the bed with blood gushing out of his nose. LPN #410 stated there was blood on the resident, on the sheets, and on the floor, and Resident #38's nose was crooked. LPN #401 notified the physician who gave orders to send Resident #38 to the hospital emergency room for evaluation and treatment and to send Resident #43 to the hospital for a psychiatric evaluation. During an interview on 07/16/25 at 9:32 A.M., the Director of Nursing (DON) stated Resident #38 was moved into the room with Resident #43 on 06/25/25, which was the same day of the incident between Residents #41 and #43. The DON stated she had heard the previous DON and Administrator had been reluctant to admit Resident #43 to the facility due to the resident's history of aggression towards other residents at his previous nursing home. The DON stated she believed Resident #43 should have been placed in a private room due to the resident's known history of physical aggression towards other residents. During an interview on 07/16/25 at 10:05 A.M., the Administrator stated he was not employed at the facility when Resident #43 was accepted for admission in April 2025. The Administrator stated the DON had the responsibility to screen residents and determine appropriateness for admission, but the Administrator had the final say regarding admissions. The Administrator stated he was unaware the previous Administrator and DON had not wanted to admit Resident #43. The Administrator verified Resident #43 had not had any altercations since being placed in a private room upon return from the hospital. The Administrator could not explain why Resident #38 was moved into a room with Resident #43 on 06/25/25. Review of the facility policy titled Abuse and Neglect Protocol, revised 06/13/21, revealed residents have the right to be free from abuse, neglect, misappropriation or resident property, exploitation, corporal punishment, physical or chemical restraints imposed for purposes of discipline or convenience, and not required to 366150 Page 6 of 8 366150 07/18/2025 Astoria Place of Cincinnati 3627 Harvey Avenue Cincinnati, OH 45229

F 0600 Level of Harm - Actual harm treat the resident's medical symptoms, and involuntary seclusion. This deficiency represents noncompliance investigated under Complaint Number OH00166548 (1313528) and Complaint Number OH00166287 (1313527). Residents Affected - Few 366150 Page 7 of 8 366150 07/18/2025 Astoria Place of Cincinnati 3627 Harvey Avenue Cincinnati, OH 45229

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on medical record review, observation, staff interview, and review of the facility policy, the facility failed to implement Enhanced Barrier Precautions (EBP) while providing incontinence and wound care and failed to change gloves and perform appropriate hand hygiene during incontinence care. This affected one (Resident #10) of three residents reviewed for infection control. The facility census was 71 residents. Findings include: Review of the medical record for Resident #10 revealed an admission date of 04/22/25 with diagnoses including dementia, hypertension and chronic kidney disease. Review of the Minimum Data Set (MDS) assessment for Resident #10 dated 05/05/25 revealed the resident had intact cognition, was frequently incontinent of bowel and occasionally incontinent of bladder, was independent for eating and bed mobility, required set up assistance with oral hygiene, required supervision with toileting, and required moderate assistance with personal hygiene, dressing, bathing, and transfers. Review of the physician's orders for Resident #10 revealed an order dated 06/16/25 for the resident to be placed in Enhanced Barrier Precautions (EBP). Review of the physician's orders for Resident #10 revealed an order dated 07/02/25 to cleanse the right heel with normal saline, apply Hydrogel, and cover with dry dressing daily. Observation on 07/10/25 at 10:40 A.M. revealed there was a sign on the door of Resident #10's room indicating the resident was on EBP. The sign indicated that everyone must clean their hands, including before entering and when leaving the room, and providers and staff must also wear gloves and gown for the following high-contact resident care activities: dressing, bathing/showering, transferring, changing linens, providing hygiene, changing briefs or assisting with toileting, central line care, urinary catheter care, feeding tube care, tracheostomy care, wound care, and care of any skin opening requiring a dressing. Personal Protective Equipment (PPE) was available in a cart in the corridor adjacent to Resident #10's room door. Observation of incontinence care for Resident #10 on 07/10/25 at 10:40 A.M. per Certified Nursing Assistant (CNA) #506 with assistance from Registered Nurse (RN) #314 revealed the staff did not don gowns prior to providing care. CNA #506 cleansed feces from Resident #10's buttocks with gloved hands. CNA #509 did not remove her gloves, perform hand hygiene, and don new gloves after cleansing the resident's buttocks. CNA #506 then touched the resident's clean brief, the resident's pajama bottoms, the resident's sheets, and the outside of the resident's wash basin. Observation of wound care for Resident #10 on 07/10/25 at 10:58 A.M. per Registered Nurse #314 with CNA #506 assisting revealed the staff did not don gowns prior to providing care. Interview on 07/10/25 at 11:13 P.M. with RN #314 and CNA #506 confirmed they should have donned gowns during incontinence care and wound care for Resident #10 and CNA #506 should have doffed gloves, performed hand hygiene, and donned clean gloves after cleansing feces from Resident #10's buttocks. Interview on 07/10/25 at 12:38 P.M. with the Director of Nursing (DON) confirmed Resident #10 had orders for EBP, and RN #314 and CNA #506 should have donned gowns prior to providing incontinence care and wound care. The DON confirmed CNA #506 should have doffed gloves, performed hand hygiene, and donned clean gloves after cleansing feces from Resident #10's buttocks. Review of the facility policy titled Infection Control dated 02/04/21 revealed it was the facility's policy to ensure appropriate infection control prevention and control measures were taken to prevent the spread of communicable diseases, and to change gloves after handling infected material (fecal material, urine, wound drainage, vomit, sputum). Residents Affected - Few 366150 Page 8 of 8