Inspection·October 10, 2024

F 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, resident and staff interviews and policy review, the facility failed to provide activities for a resident in isolation. This affected one (#22) out of one residents reviewed for activities. The facility census was 50. Residents Affected - Few Findings include: Review of the medical record for Resident #22 revealed an admission date of 04/26/24. Diagnoses include chronic obstructive pulmonary disease, chronic diastolic (congestive) heart failure, and dementia in other diseases classified elsewhere, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety. Review of the Quarterly Minimum Data Set (MDS) dated [DATE] revealed resident with moderate cognitive impairment. Resident required set-up assistance with eating, partial assistance for oral hygiene and bathing, substantial assistance with dressing, personal hygiene, bed mobility, and transfers, and was dependent on staff assistance with toileting hygiene. Review of Resident #22's care plan, dated 05/09/24 revealed the resident has the potential for reduced social interaction and/or reduced activity participation related to dementia and anxiety. With a goal to maintain involvement in cognitive stimulation and activities of choice three to five times weekly as desired/tolerated. Interventions include assist resident to modify / rearrange daily schedule, if possible, to accommodate activities of choice, and assist/direct resident to activity location(s) as needed, encourage and assist resident to choose leisure pursuits daily as needed. Further review of Resident #22's medical record revealed there was a lack of documentation regarding involvement in activities. Interview on 10/07/24 at 11:28 A.M. with Resident #22 revealed she attends bingo for activities but nothing else. Interview with Resident #22 also revealed the activities staff does not bring any activities to her room. Interview on 10/09/24 at 9:25 A.M. with Resident Lifestyle Coordinator #267 confirmed all residents are assessed on admission for likes and dislikes and their participation in community activities. Interview on 10/09/24 at 9:41 A.M. with Resident Lifestyle Coordinator #330 confirmed when a resident attends an activity, it is documented in the progress notes. Resident Lifestyle Coordinator #330 stated one-on-one (1:1) activities in the resident room is also documented in the progress notes. Interview with Resident Lifestyle Coordinator #330 also confirmed Resident #22 doesn't like to attend (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: 366232 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 366232 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westover Retirement Community 855 Stahlheber 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)