Health inspection·November 9, 2022

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on resident and staff interview, observation, and record review, the facility failed to ensure a resident's care plan was developed related to dental needs and range of motion of the right upper extremity. This affected one (Resident #58) of 17 residents reviewed for care plans. The facility census was 69. Finding include: Review of the medical record for Resident #58 revealed an admission date of 09/03/21. Diagnoses included cerebral infarction, hemiplegia and hemiparesis, dysphasia, diabetes, cognitive communication deficit, hypertension and anxiety. Review of the annual Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #58 was cognitively intact. Resident #58 was noted to have an impairment on one side for upper and lower extremity. 1. Review of Resident #58's physician orders dated 03/04/22 revealed an order for the dentist may treat as needed. Review of the plan of care dated 08/10/22 revealed Resident #58 had impaired dentition and was at risk for oral problems of pain, infection, difficulty chewing or swallowing with interventions to complete oral assessment and refer to the dentist as needed. provide all necessary items for oral care as needed and provide oral care at least daily and more frequently as needed. The care plan had no mention of significant bleeding from the mouth. Review of the progress notes dated 10/04/22 revealed the nurse was notified by the aide regarding Resident #58 having bleeding from her mouth on her lips, chin and cheek. Resident #58 was assessed and found blood in her mouth. Resident #58 was referred to see the dentist and the nurse practitioner was informed. Observation and interview on 11/07/22 at 9:38 A.M. revealed Resident #58 had blood that had run down her face from the corner of her mouth down her chin and dripped on her chest, shirt and bedding. Resident #58 stated she had gum issues and at times will having increased bleeding of her mouth. Interview and observation on 11/07/22 at 9:43 A.M. with Registered Nurse (RN) #253 revealed Resident #58 had a history of bleeding from her mouth and Resident #58 was seen by the dentist. RN #253 then went to resident's bedside and asked Resident #58 if her mouth bleeding was common and if she saw the dentist. (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 4 Event ID: 366198 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 366198 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/09/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golden Years Nursing Center 2436 Old Oxford Road Hamilton, OH 45013 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)