Health inspection·February 7, 2024

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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. Based on medical record review, observation, and staff interview the facility failed to ensure residents' toilets were functioning properly. This affected two (Residents #58 and #63) of two residents reviewed for physical environment. The facility census was 102 residents. Findings include: 1. Review of the medical record for Resident #63 revealed an admission date of 01/24/23 with diagnoses including Alzheimer's disease with late onset and adult failure to thrive. Review of the Minimum Data Set (MDS) assessment for Resident #63 dated 12/26/23 revealed the resident had severe cognitive impairment and was dependent on staff for all activities of daily living (ADLs). Observation on 01/30/24 at 12:45 P.M. of Resident #63's bathroom revealed the bathroom floor was covered with water and pieces of toilet paper and paper towels. A large piece of clear plastic was on the bathroom floor beside the bathroom door which had been used to cover the toilet. The toilet was out of order and did not flush properly. Interviews on 01/30/24 at 12:55 P.M. with Licensed Practical Nurse (LPN) #163 and State Tested Nursing Assistant (STNA) #296 confirmed Resident #63's bathroom floor was covered with water and pieces of toilet paper and paper towel. LPN #163 and STNA #296 confirmed the resident's toilet was out of order and the large piece of plastic in the bathroom had been used to cover the toilet and indicate it was out of order. STNA #296 confirmed when she was Resident #63's assigned aide in December 2023 the resident's toilet was not working and had been covered with a large piece of clear plastic. 2. Review of the medical record for Resident #58 revealed an admission date of 12/20/23 with diagnoses including chronic obstructive pulmonary disease, osteoarthritis, schizoaffective disorder, and anxiety disorder. Review of the MDS for Resident #58 dated 12/06/23 revealed the resident had moderate cognitive impairment and required set up assistance, supervision, and verbal cues for all ADLs. Observation on 01/30/24 at 12:50 P.M. of Resident #58's room revealed the resident's bathroom was covered with water and pieces of toilet paper and paper towel. Water overflowed out of the bathroom and extended into the resident's bedroom. Interviews on 01/30/24 at 12:55 P.M. with LPN #163 and STNA #296 confirmed Resident #58's bathroom (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 3 Event ID: 366220 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 366220 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/07/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harmony Court Rehab and Nursing 6969 Glenmeadow Lane Cincinnati, OH 45237 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)