Health inspection·March 6, 2024

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview with the Administrator on 03/06/24 at 3:15 P.M. confirmed the facility did not report the allegation of neglect involving Resident #64 to the State Survey Agency on 02/16/24 or 02/17/24. The Administrator confirmed the allegation should have been reported. Review of the facility's policy titled Abuse, Neglect, Misappropriation and Reporting and Investigating revealed all reports of resident abuse (including injuries of unknown origin), neglect, exploitation, or theft/misappropriation of resident property are reported to local, state and federal agencies (as required by current regulations) and thoroughly investigated by facility management. Findings of all investigations are documented and reported. Upon receiving any allegations of abuse, neglect, exploitation, misappropriation of resident property or injury of unknown source, the Administrator is responsible for determining what actions (if any) are needed for the protection of residents. This was an incidental finding discovered during the complaint survey. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366175 If continuation sheet Page 2 of 6 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 366175 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/06/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carecore at the Meadows 11760 Pellston Court Cincinnati, OH 45240 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 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, staff and resident interview, review of a grievance form, and policy review, the facility failed to complete an investigation into a resident's allegation of neglect. This affected one (#64) of three residents reviewed for neglect. The facility census was 76. Residents Affected - Few Findings include: Medical record review for Resident #64 revealed an admission date of 01/04/24. Diagnoses included stroke, diabetes mellitus, and heart failure. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #64 was cognitively intact. Resident #64 was dependent on staff for toileting and was frequently incontinent for bowel and bladder. Review of her care plan dated 01/29/24 revealed she had urinary incontinence. Interventions included to check and change the resident every two hours to keep clean and dry. Review of the bladder incontinence form for Resident #64 dated 02/16/24 revealed the resident was changed at 2:48 P.M. and 9:26 P.M. Review of a Resident Concern/Grievance form dated 02/16/24 revealed Resident #64 complained about a negative interaction with a night shift aide on 02/16/24. The resident asked to be changed and the state tested nursing aide (STNA) turned off the light and left the room. The facility was unable to provide any documentation of an investigation to Resident #64's grievance and allegation of neglect. Interview with Resident #64 on 03/06/24 at 2:45 P.M. revealed on the morning of 02/16/24, her brief became soiled with urine about 12:00 A.M. but she waited because she would have to go again and didn't want to bother the staff so many times. So she waited until the staff member was back from her lunch break before she rang out her call light. She stated she rang the call light about 2:00 A.M. and an aide came into the room and the resident told the aide she needed changed and the STNA turned off her light and left the room and didn't change the resident. The resident stated she didn't call back out because she thought the STNA would come back, but she didn't. She stated she didn't get changed until about 8:00 A.M. when the day shift staff came into to change her. The resident said this incident aggravated her and thought it was neglectful. Interview with the Administrator on 03/06/24 at 3:15 P.M. confirmed the facility had nothing in writing to show the facility completed an investigation into Resident #64's allegation of neglect on 02/16/24. Review of the facility policy titled Abuse, Neglect, Misappropriation and Reporting and Investigating revealed all reports of resident abuse (including injuries of unknown origin), neglect, exploitation, or theft/misappropriation of resident property are reported to local, state and federal agencies (as required by current regulations) and thoroughly investigated by facility management. Findings of all investigations are to be documented. All allegations are thoroughly investigated. The Administrator initiates investigations. The Administrator provides supporting documents and evidence related to the alleged incident to the individual in charge of the investigation. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366175 If continuation sheet Page 3 of 6 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 366175 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/06/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carecore at the Meadows 11760 Pellston Court Cincinnati, OH 45240 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 0610 The individual conducting the investigation as a minimum: Level of Harm - Minimal harm or potential for actual harm a. reviews the documentation and evidence; Residents Affected - Few b. reviews the resident's medical record to determine the resident's physical and cognitive status at the time of the incident and since the incident; c. observes the alleged victim, including his or her interactions with staff and other residents; d. interviews the person(s) reporting the incident; e. interviews any witnesses to the incident; f. interviews the resident (as medically appropriate) or the resident's representative; g. interviews the resident's attending physician as needed to determine the resident's condition; h. interviews staff members (on all shifts) who have had contact with the resident during the period of the alleged incident; 1. interviews the resident's roommate, family members, and visitors; j. interviews other residents to whom the accused employee provides care or services; k. reviews all events leading up to the alleged incident; and l. documents the investigation completely and thoroughly. This was an incidental finding discovered during the course of the complaint investigation. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366175 If continuation sheet Page 4 of 6 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 366175 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/06/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carecore at the Meadows 11760 Pellston Court Cincinnati, OH 45240 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 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, medical record review, staff and resident interview, and policy review, the facility failed to ensure the toilets were in good working order. This affected one (#10) of one resident reviewed for toilets. The facility also failed to ensure the showers in the facility were safe. This had the potential to affect all of the residents who resided in the facility. The facility also failed to ensure the floors were clean and the smells of incontinence were eradicated on the memory care unit (MCU). This had the potential to affect 29 residents who resided on the MCU. The facility census was 76. Findings include: 1. Medical record review for Resident #10 revealed an admission date of 06/15/22. Diagnoses included heart failure and dementia. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #10 was moderately cognitively impaired. Interview with Resident #10 on 03/05/24 at 8:12 A.M. revealed her toilet had been stopped up for a few days and she hasn't been able to flush it and she has told everyone about it. Observation of the toilet on 03/05/24 at 8:15 A.M. revealed the hose going to toilet into the wall had been disconnected from the toilet and capped off. Inside the toilet there was an over abundance of waste in it, which made the room smell bad. Interview with the Maintenance Man (MM) #167 on 03/05/24 at 8:20 A.M. revealed the toilet overflowed on 03/03/24 in the evening sometime. He stated he had to cap off the toilet so the resident couldn't flush it until he could order the part, since the stores were already closed to buy a part for the toilet. He said the part came in on 03/04/24 but did not fix the toilet yet. At 9:00 A.M., MM #167 stated he was nervous when they spoke at 8:20 A.M. and wanted to say he had the part in the facility at the time of the toilet overflow but didn't fix it. MM #167 confirmed it was late getting the toilet fixed and admitted the smell was bad in the bathroom and in the resident's room. 2. Observation of the the MCU on 03/04/24 at 8:00 A.M., 1:55 P.M., on 03/05/24 at 8:08 A.M. and on 03/06/24 at 8:19 A.M. revealed the floors in the hall were sticky and shoes made a noise when they hit the floor. During the observations of the floor, there was a strong urine smell as you walked into the door of the MCU during these observations. Interview with the Housekeeper Aide (HA) #151 on 03/06/24 at 8:20 A.M. revealed she worked on the MCU unit and said the floors were sticky and thought it was because they hadn't been mopped in a while. She stated there was a resident who urinated on the floor sometimes all the way down the hall. There wasn't any wet spots on the floor at the time of the interview. She confirmed the unit smelled like urine when you walk into the door of the MCU and didn't know why. 3. Observations of the showers on 03/06/24 at 10:36 A.M. outside the door of the MCU revealed the Central Shower #2 had non-skid strips in the shower that were peeling up and were dirty. The floors in the shower room were dirty. Interview with State Tested Nursing Aide (STNA) #87 on 03/06/24 at 10:37 A.M. confirmed the non-skid strips in the shower were cracked and dirty and the floors were dirty in the room. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366175 If continuation sheet Page 5 of 6 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 366175 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/06/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carecore at the Meadows 11760 Pellston Court Cincinnati, OH 45240 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 0921 Level of Harm - Minimal harm or potential for actual harm Observation of Shower #2 on Hall #1 on 03/06/24 at 10:48 A.M. revealed before stepping into the shower, there were two cracks in the floor and black stirps on the floor that were dirty. Further observation of shower #1 on hall #1 revealed the floor was dirty, the walls were dented, and paint scraped off of the walls. There was a crack in the floor of the shower and the fiberglass was peeling off the bottom of the floor of the shower. The molding in the room was loose and coming apart and the fan and air duct were both rusted. Residents Affected - Many Interview with the Housekeeping Supervisor (HS) #148 on 03/06/24 at 10:50 A.M. confirmed the showers need work done on them and they were dirty. Review of the facility policy titled Cleaning and Disinfection of Environmental Services dated 02/01/21 revealed environmental surfaces will be cleaned and disinfected according to current Centers of Disease Control (CDC) recommendations for disinfection of healthcare facilities. Housekeeping surfaces (e.g., floors, tabletops) will be cleaned on a regular basis, when spills occur when these surfaces are visibly soiled. This deficiency represents non-compliance investigated under Complaint Number OH00151552 and OH00150955. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366175 If continuation sheet Page 6 of 6