Health inspection·February 14, 2022

F 0625 Level of Harm - Minimal harm or potential for actual harm Interview on 02/09/22 at 8:31 A.M. with COO #100 verified Resident #13 or representative did not receive a bed hold notice for her hospitalization on 02/05/22. Review of the facility's policy titled Bed-Holds and Returns, dated 03/2017, revealed prior to a transfer, the resident or resident representative will be informed in writing of the bed-hold and return policy. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366159 If continuation sheet Page 2 of 7 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 366159 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/14/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Birchwood Care Center 4070 Hamilton Mason Road Hamilton, OH 45011 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. Based on observation, record review, resident and staff interviews, review of the facility's policy, and review of the guidance from www.medlineplus.gov, the facility failed to provide routine catheter care. This affected one (Resident #39) of three residents reviewed for catheter care. The facility identified five residents with an indwelling or external catheter. The facility census was 69. Findings include: Review of the medical record for Resident #39 revealed an admission date of 05/06/19. Diagnoses included urinary tract infection, gross hematuria, and hydronephrosis with urethral stricture. Review of the plan of care dated 12/06/21 revealed Resident #39 had an indwelling catheter related to the history of hydronephrosis due to obstruction. Interventions included evaluating for urinary complaints, monitoring for signs/symptoms of a urinary tract infection (UTI), and providing catheter care per policy. Review of the quarterly Minimum Data Set (MDS) assessment for Resident #39, dated 12/22/21, revealed the resident had intact cognition. Resident #39 required total dependence for toileting. Resident #39 was identified to be continent of bladder and had an indwelling catheter. Review of the physician orders for Resident #39 for February 2022 revealed no orders for routine catheter care. Review of the facility's task documentation for Resident #39 for toileting dated 02/01/22 through 02/09/22 revealed no toileting was completed on 02/03/22 and 02/04/22. Interview on 02/09/22 at 9:17 A.M. with Resident #39 stated the staff has never done catheter care and I have been at the facility for over two years. Interview on 02/10/22 at 8:05 A.M. with Registered Nurse (RN) #63 stated that catheter care was defined as cleaning the perineal area from inside to the outside around the catheter at least every shift and as needed. RN #63 confirmed there was no order in the chart of Resident #39 for any type of catheter care. The nurse also confirmed no documentation was being completed on the output of Resident #39. RN #63 would expect the nurse aide staff to provide routine catheter care. Interviews on 02/10/22 from 8:13 A.M. to 8:25 A.M. with State Tested Nursing Aides (STNA) #12 and #38 revealed that catheter care was emptying the catheter bag. There was no mention by either staff member regarding cleaning the tubing or around the perineal area. The aides confirmed they do not document catheter care and outputs for Resident #39. Observation on 02/10/22 at 11:09 A.M. of catheter care for Resident #39 performed by STNA #12 cleaned the tubing with soap and water appropriately but cleansed the tube in an outward to inward motion towards the body. Interview on 02/10/22 at 11:29 A.M. with STNA #12 confirmed she incorrectly cleansed the catheter of Resident #39 while completing catheter care. STNA #12 stated she knows she was supposed to clean the tube starting at the body and going away from the body, but instead started away from the body (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366159 If continuation sheet Page 3 of 7 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 366159 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/14/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Birchwood Care Center 4070 Hamilton Mason Road Hamilton, OH 45011 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 0690 going towards the body. STNA #12 also stated that she never completed catheter care before. Level of Harm - Minimal harm or potential for actual harm Review of the guidance from the website www.medlineplus.gov revealed routine catheter care should be once a day, every day, or more often if needed. Residents Affected - Few Review of the facility's undated policy titled Urinary Catheter Care revealed urinary catheters should be evaluated every day for need and removed promptly when no longer necessary. Patients with urinary catheters will have intake and output recorded. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366159 If continuation sheet Page 4 of 7 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 366159 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/14/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Birchwood Care Center 4070 Hamilton Mason Road Hamilton, OH 45011 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on medical record review and staff interview, the facility failed to ensure the resident's blood pressure was obtained per physician orders and related to use of a as needed blood pressure medication. This affected two (#12 and #32) of five residents reviewed for unnecessary medications. The facility census was 69. Findings include: 1. Review of the medical record for Resident #12 revealed an admission date of 11/01/21. Diagnoses included essential (primary) hypertension, atrial fibrillation, acute on chronic systolic heart failure. Review of the comprehensive Minimum Data Set (MDS) assessment, dated 11/12/21, revealed Resident #12 had intact cognition. Review of the physician orders for February 2022 revealed an order dated 11/01/21 for Labeltalol HCl tablet (antihypertensive) give one tablet by mouth every 12 hours related to essential (primary) hypertension. The medication was to be for a systolic blood pressure (SBP) of less than 110 or a heart rate (HR) of less than 60. Review of the medication administration record (MAR) for January 2022 revealed the medication was administered without a blood pressure nor pulse reading for the 9:00 A.M. administrations on 01/01/22, 01/04/22, 01/07/22, 01/18/22, and 01/25/22. Review of the blood pressure and pulse readings for January 2022 revealed no evidence of either being checked on 01/01/22, 01/04/22, 01/07/22, 01/18/22, and 01/25/22. Interview on 02/09/22 at 12:26 P.M. with Licensed Practical Nurse (LPN) #50 stated, when administering a medication that has parameters, the required information (ie blood pressure (BP) and pulse) was entered directly on the MAR prior to administering the medication. LPN #50 further confirmed there was no BP nor pulse documented on the MAR when the medication was administered and stated entering NA (not applicable) was an option when administering the medication. Interview on 02/09/22 at 3:37 P.M. with the Director of Nursing (DON) verified there were no additional vitals documented at the time of administration for Resident #12 on 01/01/22, 01/04/22, 01/07/22, 01/18/22, and 01/25/22. 2. Review of medical record for Resident #32 revealed an admission date of 07/21/21. Diagnoses included stroke and hemiplegia affecting both left and right side. Resident#32 was admitted to hospice on 08/31/21 for cerebrovascular disease. Review of the quarterly Minimum Data Set (MDS) assessment, dated 12/07/21, revealed Resident #32 had short and long term memory problems with severely impaired cognition. Review of the care plan dated 07/16/21 revealed Resident #32 was at risk for an alteration in cardiac output related to hypertension. An intervention included to obtain vital signs every shift and as needed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366159 If continuation sheet Page 5 of 7 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 366159 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/14/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Birchwood Care Center 4070 Hamilton Mason Road Hamilton, OH 45011 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the physician orders, dated 02/05/22, revealed an order for Clonidine (blood pressure) 0.1 milligram every 24 hours as needed for hypertension for systolic blood pressure over 170 millimeters of mercury (mmHg). Review of the electronic medical record for Resident#32 revealed blood pressures were documented on 02/04/22. There were no other blood pressures documented in Resident #32's medical record from 02/05/22 to 02/08/22. Interview on 02/09/22 at 2:31 P.M. with the Director of Nursing (DON) revealed Resident #32 was on Clonidine as needed. Subsequent interview on 02/09/22 at 3:08 P.M. with the DON verified the facility had not been taking daily blood pressure for Resident#32 to monitor for the parameters on the as needed blood pressure (Clonidine) medication. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366159 If continuation sheet Page 6 of 7 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 366159 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/14/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Birchwood Care Center 4070 Hamilton Mason Road Hamilton, OH 45011 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, review of personnel files, and staff interview, the facility failed to properly handle food items while passing lunch trays to residents. The facility identified 67 residents that received food from the kitchen. The facility census was 69. Findings included: Observation on 02/07/22 at 12:50 P.M. of Housekeeper #74 revealed she was passing the lunch tray to Resident #15. Housekeeper #74 was noted opening the lid of the lunch tray and grabbing the sandwich from the tray with her bare hands. The housekeeper proceeded to cut the sandwich in half and put it back on the tray of Resident #15. Interview on 02/07/22 at 12:52 P.M. with Housekeeper #74 confirmed that she did grab the sandwich of Resident #15 with her bare hands and cut it in half. Housekeeper #74 stated that she washed her hands before passing trays. Observation on 02/08/22 at 12:08 P.M. of Housekeeper #69 revealed she was passing the lunch tray to Resident #37. Housekeeper #69 was noted opening the lid of the lunch tray and grabbing a piece of bread from the plate with her bare hands. The housekeeper then placed the piece of bread back on the tray of Resident #37. Interview on 02/08/22 at 12:11 P.M. with Housekeeper #69 confirmed that she did grab the piece of bread from the plate with her bare hands and set it back on the plate. Housekeeper #69 stated that she was never fully trained to pass trays to the residents. Review of the personnel files for Housekeepers #69 and #74 revealed no training related to the passing of trays to residents. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366159 If continuation sheet Page 7 of 7