Inspection visit

Health inspectionMarch 28, 2019

HOME AT HEARTHSTONE, THECMS #3662516 citations on this visit

6 citations recorded

Inspector’s narrative

What the inspector wrote

This survey cited 6 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.

F 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Review of Resident #25's medical record revealed an admission date of 09/01/18 with diagnoses including Alzheimer's disease, anxiety disorder, osteoporosis, anemia, and major depressive disorder. Review of the quarterly MDS dated [DATE] revealed the resident had severe cognitive impairment and extensive assistance of one was required for all activities of daily living with the exception of eating, which required only limited assistance. Review of the medical record census revealed Resident #25 was transferred out of the facility to the local hospital on [DATE]. Further review of the medical record revealed no documented evidence the facility provided notification to the ombudsman for the transfer. Interview conducted on 03/28/19 at 10:38 A.M., the DON verified the facility had not provided Ombudsman notification when residents were transferred to the hospital and/or out of the facility due to the facility did not have an established social worker. Based on medical record review and staff interview, the facility failed to provide notification to the ombudsman when residents were transferred from the facility. This affected two Residents (#9 and #25) of five reviewed for hospitalizations. The facility census was 93. Findings include: 1. Review of Resident #9's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses including Parkinson's disease, metabolic encephalopathy, altered mental status, multiple fractures of ribs, chronic obstructive pulmonary disease, limitation of activities due to disability, muscle weakness, dysphagia, dementia, polyosteoarthritis, hallucinations, unspecified fall, major depressive disorder, gastro-esophageal reflux disease, patients noncompliance with medical treatment and regimen, malaise, and post traumatic stress disorder. Review of the medical record census revealed Resident #9 was transferred out of the facility to the local hospital on [DATE] and again on 11/25/18. Further review of the medical record revealed no documented evidence the facility provided notification to the ombudsman for either transfer. Review of the quarterly Minimum Data Se t(MDS) assessment dated [DATE] revealed the resident was moderately cognitively impaired with no behaviors. The resident required extensive two-person assistance with bed mobility, transfers, toileting, extensive one person assistance with personal hygiene, dressing, locomotion, supervision setup with eating, and one person assistance with walking. The (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 11 Event ID: 366251 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 366251 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Home at Hearthstone, The 8028 Hamilton Avenue Cincinnati, OH 45231 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 0623 resident resident had falls with fracture related to a fall in the six months prior. Level of Harm - Minimal harm or potential for actual harm Interview conducted on 03/28/19 at 10:38 A.M., the Director of Nursing (DON) verified the facility had not provided the Ombudsman with notification when residents were transferred to the hospital and/or out of the facility due to the facility did not have an established social worker. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366251 If continuation sheet Page 2 of 11 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 366251 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Home at Hearthstone, The 8028 Hamilton Avenue Cincinnati, OH 45231 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, staff, resident and family interviews and policy review, the facility failed to apply appliances as ordered and care planned to prevent contractures. This affected two (Resident #7 and Resident #24) of two residents reviewed for appliances. The facility identified ten residents (Residents #59, #29, #37, #73, #24, #47, #10, #7, #18 and #69) as having appliances ordered in a facility census of 93. Findings include: 1. Review of Resident #7's medical record revealed an admission date of 04/12/17 with diagnoses including degenerative disc disease, pulmonary embolism, dementia, depression, hypothyroidism, Alzheimer's disease, atrial fibrillation, deep vein thrombosis, and dementia. Review of Resident #7's annual Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #7 was cognitively impaired and required extensive assistance of one to two for all activities of daily living (ADL)s. Review of a care plan with a revision date of 03/09/19 revealed the resident was to have a soft collar on for meals as tolerated at the following times: Breakfast, 8:00 A.M., to 8:30 A.M., Lunch,12:00 P.M. to 12:30 P.M., and Dinner, 5:00 P.M. to 5:30 P.M Check the skin integrity before and after placement (dated 03/21/19) and resident to wear right hand cone splint and left resting hand splint from 10:00 A.M. to 2:00 P.M. as tolerated to prevent further contractures or skin breakdown that may result, check skin before and after application. Interview with Therapist #203 revealed Resident #7 was evaluated on 03/04/19. She stated at the time Resident #7 was found with increased tone in both hands and the appliances were ordered. She also reported the neck collar was ordered for neck positioning and the collar's use was decreased to only 30 minutes three times per day on 03/08/19. Observation on 03/25/19 at 12:55 P.M., revealed State Tested Nurse Assistant (STNA) #83 was spoon feeding Resident #7 who was sitting up in wheelchair without a neck collar, hand cone, or splint in place. Interview with STNA #83 at that time verified Resident #7 did not have the neck collar, hand cone, or splint on and stated she had forgotten. Observation on 03/27/19 at 10:40 A.M. revealed Resident #7 lying in bed with neck collar on. Interview on 03/27/18 at 11:00 A.M. with STNA #108 verified Resident #7 was wearing the neck collar since she was getting everyone ready for lunch and she was unaware of any time limit for the collar to be worn. 2. Review of Resident #24's medical record revealed an admission date of 09/13/13 with diagnoses including anoxic brain damage, cerebral infarction, hemiplegia and hemiparesis, aphasia and muscle wasting. Review of Resident #24's plan of care dated 12/31/18 revealed resident required, Appliances applied as ordered for bilateral hand and feet contractures. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366251 If continuation sheet Page 3 of 11 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 366251 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Home at Hearthstone, The 8028 Hamilton Avenue Cincinnati, OH 45231 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the resident's Minimum Data Set (MDS) assessment dated [DATE] revealed severe cognitive deficits. The resident was assessed being totally dependent for all activities of daily living (ADL). Review of Resident #24's physician order dated 03/05/19 revealed, left and right wrist splints were to be put on at 9:00 A.M. and off at 1:00 P.M. every Tuesday, Thursday and Saturday as tolerated. Resident #24's physician order dated 03/06/19 revealed left and right elbow splints were to be put on at 9:00 A.M. and off at 1:00 P.M. every Monday, Wednesday and Friday as tolerated. Review of Resident #24's electronic March 2019 Treatment Administration Record (TAR) revealed no documented evidence the residents left and right elbow splints were applied on 03/25/19. Review of Resident #24's nursing progress notes revealed no documentation as to why the splints were not applied as ordered. Interview on 03/25/19 at 12:02 P.M., with Occupational Therapist (OT) #202, related to Resident #24's restorative care, revealed the resident had a schedule of left and right wrist and elbow splints ordered to reduce further contractures and/or the tightening that may cause pain. Observation and interview on 03/25/19 at 12:15 P.M., with Resident #24 and the residents family member confirmed the resident did not have either left or right elbow splints in place. Resident #24's family member denied knowledge of Resident #24 ever refusing splints and denied there was any reason why the splints were not on as ordered. Interview with the Director of Nursing (DON) on 03/25/19 at 12:47 P.M., confirmed Resident #24 did not have the elbow splints on as ordered. Review of the facility policy titled, Restorative Nursing Programs, dated August 2016, revealed residents would be provided with maintenance and restorative services to maintain or improve their highest practicable level. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366251 If continuation sheet Page 4 of 11 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 366251 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Home at Hearthstone, The 8028 Hamilton Avenue Cincinnati, OH 45231 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 0695 Provide safe and appropriate respiratory care for a resident when needed. 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, observation, and staff interview, the facility failed to provide monitoring of residents response to oxygen administration. This affected one (Resident #74) of two residents reviewed for respiratory care. The facility census was 93. Residents Affected - Few Findings include: Review of Resident #74's medical record revealed an admission date of 01/02/19 with diagnoses including heart failure, diabetes, hypertension, dementia, depression, and asthma. Review of Resident #74's plan of care dated 01/16/19 with interventions that included to titrate to keep oxygen (O2) saturations greater than or equal to 92% via nasal cannula, assess for signs and symptoms of respiratory infection: elevated temperature, changes in level of consciousness, malaise, sputum color, consistency, odor, auscultate lung sounds as ordered and monitor for edema. Administer oxygen as ordered and as needed to relieve shortness of breath. Review of Resident #74's Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #74 had cognitive impairment and required extensive assistance of two for bed mobility, transfers, toileting. The resident required extensive assistance of one for dressing, hygiene, and supervision for eating. Review of Resident #74's physician orders dated March 2019 included oxygen continuous, titrate to keep oxygen saturations greater than or equal to 92 percent via nasal cannula. Review of Resident #74's oxygen saturation tracking revealed the last entry was dated 03/13/19. Observation of Resident #74 on 03/26/19 at 8:45 A.M., revealed the resident was lying in bed with a nasal cannula on, connected to an oxygen concentrator set at five liters of oxygen per minute. Observation on 03/26/19 at 10:38 A.M., revealed Resident #74 lying in bed without any oxygen on. Observation of Resident #74 on 03/27/19 at 11:44 A.M., revealed the resident was in bed eating lunch with the O2 set at two liters per minute. Interview on 03/26/19 at 5:20 P.M., with Licensed Practical Nurse (LPN) #7 revealed Resident #74 does not always require oxygen and usually wears it at night only. He denied knowing the amount of oxygen the resident was on during the prior shift and stated he did not remove the oxygen from her. LPN #7 reported he does check oxygen saturations when he signs off oxygen orders since the system would not allow him to sign unless he enters a saturation number. LPN #7 reviewed Resident #74's orders during the interview and verified Resident #74's orders were not on the resident's electronic records to be signed off as administered but stated he checked her oxygen levels when providing 9:00 A.M. medications. LPN #7 acknowledged he did not chart the saturation result he received, although reporting it was 93 percent. Observation of Resident #74 on 03/27/19 at 10:52 A.M. revealed her lying in bed receiving oxygen at two liters per minutes. Interview with LPN #30 at time of observation stated Resident #74 wore oxygen at all times and saturation levels should be recorded in the electronic record and upon checking (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366251 If continuation sheet Page 5 of 11 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 366251 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Home at Hearthstone, The 8028 Hamilton Avenue Cincinnati, OH 45231 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 0695 verified the oxygen order had not been brought forward. LPN #30 verified the medical record did not contain documentation of oxygen levels being checked since 03/13/19. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366251 If continuation sheet Page 6 of 11 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 366251 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Home at Hearthstone, The 8028 Hamilton Avenue Cincinnati, OH 45231 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Review of Resident #25's medical record revealed an admission date of 09/01/18 with diagnoses including but not limited to Alzheimer's disease, anxiety disorder, osteoporosis, anemia, and major depressive disorder. Review of Resident #25's physician orders revealed on 09/01/18 Resident #25 had an order for Ativan 0.5 milligrams (mg) every four hours PRN for agitation/anxiety and the order was discontinued during her hospitalization on 03/10/19. Review of Psychiatric visit note dated 12/13/18 indicated reliance on benzodiazepine (Ativan) may increase residents fall risk and consider increasing Depakote medication. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed severe cognitive impairment and extensive assistance of one for all activities of daily living except eating which required only limited assistance. Review of Resident #25's Medication Administration Record (MAR) revealed the PRN Ativan was administered on an as needed basis in September, October, November, and December of 2018 and in January, February, March of 2019. Review of Resident #25 Monthly Medication Review (MMR) records revealed no documented evidence of recommendations from pharmacy related to the as needed Ativan. Interview with the DON on 03/27/19 at 12:42 P.M., verified Resident #24's PRN Ativan order exceeded 14 days and the medical record did not have documentation of a physician addressing the continued use. Review of the facility policy titled, Medication Regimen Review dated 06/21/17 revealed resident medication regimen was reviewed by a licensed pharmacist according to Federal, State, and Local regulations, report any irregularities to the Attending Physician, and irregularity reports must be acted upon in a manner that meets the needs of the residents. Based on medical record review, staff interview, and review of facility policy, the facility failed to have pharmacy medication irregularities addressed by the physician in a timely manner. This affected two Residents (#14, and #25) of five reviewed for unnecessary medications. The facility census was 93. Finding include: 1. Review of Resident #14's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses including chronic obstructive pulmonary disease, hypertension, muscle weakness, unspecified abnormalities of gait and mobility, lack of coordination, cerebrovascular disease, phlebitis and thrombophlebitis of lower extremity, chronic kidney disease, anxiety disorder, hypokalemia, major depressive disorder, and chronic pain. Review of the Resident #14's physician orders revealed on 09/12/18, the resident was ordered Lorazepam (Ativan, for anxiety) 0.5 milligram, twice daily, as needed (PRN). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366251 If continuation sheet Page 7 of 11 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 366251 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Home at Hearthstone, The 8028 Hamilton Avenue Cincinnati, OH 45231 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 0756 Level of Harm - Minimal harm or potential for actual harm Review of Resident #14 Monthly Medication Review (MMR) dated 09/27/18 revealed the pharmacist recommendation noted, per regulations, PRN anxiolytic orders are limited to 14 days. Review the order for Ativan and document a duration of treatment and support the use of the medication beyond 14 days. Further review of the MMR revealed the physician did not sign and/or review the PRN medication until 03/22/19, six months after the recommendation was made. Residents Affected - Few Review of Resident #14's quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #14 was cognitively intact, with no noted behaviors. The resident required limited one-person assistance with bed mobility, transfers, walking, toileting, personal hygiene, and supervision with setup for dressing, eating, and locomotion. The resident received antianxiety, antidepressant, anticoagulant,diuretics, and opioid medications seven of the seven days during the look back period. Interview conducted on 03/27/19 at 3:40 P.M., with the Director of Nursing (DON) verified Resident #14's MMR recommended on 09/27/18 had not been addressed by the physician until 03/22/19. The DON stated the facility had some changes in staffing and unfortunately some MMR's were not addressed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366251 If continuation sheet Page 8 of 11 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 366251 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Home at Hearthstone, The 8028 Hamilton Avenue Cincinnati, OH 45231 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 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Review of Resident #25's medical record revealed an admission date of 09/01/18 with diagnoses including Alzheimer's disease, anxiety disorder, benign paroxysmal vertigo, stable burst fracture of thoracic vertebra, hypotension, osteoporosis, anemia, and major depressive disorder. Residents Affected - Few Review of the quarterly MDS assessment dated [DATE] revealed the resident was severely cognitively impaired and required extensive assistance of one for all activities of daily living except eating which required limited assistance. Review of Resident #25's physician orders dated 03/18/19 revealed an order for Midodrine 2.5 milligrams (mg) one tablet with meals for hypotension. The order was updated on 03/21/19 with parameters for administration added - Hold for systolic blood pressure greater than 120. This order was discontinued on 03/26/19. Review of Resident #25's MAR for March 2019 revealed the Midodrine was administered once on 03/18/19 and three times a day on 03/19/19 through 03/26/19. Review of the MAR and progress notes revealed no documented evidence of blood pressure monitoring related to Midodrine administration. Interview with the DON on 03/27/19 at 12:42 P.M., verified Resident #25 received Midodrine without her blood pressure being monitored as ordered. Based on medical record review, staff and physician interview, and Medscape pharmacy information, the facility failed to provide blood pressure monitoring to ensure a medication was necessary for a resident. This affected two (Resident #60 and #25) of three residents prescribed Midodrine. The facility census was 93. Findings include: 1. Review of Resident #60's medical record revealed an admission date of 12/29/18 with diagnoses including Dementia with Lewy Bodies, orthostatic hypotension, osteoporosis and major depressive disorder. Review of Resident #60's physician order dated 12/29/18 revealed, Midodrine HCL 2.5 mg., give one tablet by mouth two times a day for blood pressure (BP). Review of Resident #60's plan of care dated 12/31/18 revealed the resident had postural hypotension identified as a risk factor related to falls. The plan of care did not identify any interventions related to the resident's Midodrine (medication to elevate blood pressure) that was administered for the postural hypotension. The care plan did not identify any interventions including monitoring the blood pressure or monitoring side effects for the Midodrine. Review of Resident #60's Minimum data set (MDS) assessment dated [DATE] revealed the resident was assessed with severe cognitive impairment. The resident required one person physical extensive assistance for bed mobility, transfers, toileting and personal hygiene. Review of Resident #60's progress notes from 01/23/19 thru 03/24/19 revealed no documented evidence related to monitoring of blood pressure to determine if Resident #60's blood pressure required the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366251 If continuation sheet Page 9 of 11 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 366251 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Home at Hearthstone, The 8028 Hamilton Avenue Cincinnati, OH 45231 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 0757 Midodrine. Level of Harm - Minimal harm or potential for actual harm Review of Resident #60's electronic medical record from 01/24/19 thru 03/24/19 revealed no documented evidence of blood pressure monitoring to determine if Resident #60's blood pressure required the Midodrine. Residents Affected - Few Review of Resident #60's Medication Administration Record (MAR) from 02/01/19 through 03/25/19 revealed Resident #60 received Midodrine 2.5 milligrams (mg.) twice daily. Further review of the MAR revealed no documented evidence of blood pressure monitoring, refusals or indication the medication was held for any reason. There was no evidence on the MAR to determine if Resident #60's blood pressure required the Midodrine. Interview on 03/26/19 at 5:35 P.M. with the Director of Nursing (DON) revealed her expectation was blood pressure should be monitored at least monthly by nursing. The DON confirmed there was no evidence nurses monitored the blood pressures for Resident #60 since 01/23/19. Interview on 03/27/19 at 1:58 P.M., with Physician #200, revealed his expectation was Resident #60's blood pressure should be obtained every shift and the midodrine only given if the pressure was below 100 systolic. Review of the web pharmacy resource, Medscape revealed a black box warning for Midodrine. Midodrine may cause elevation of supine blood pressure. Reserve use for patients whose lives are considerably impaired despite standard clinical care for orthostatic hypotension. It is essential to monitor supine and sitting blood pressure in patients receiving therapy. Uncontrolled hypertension increases the risk of cardiovascular events, particularly stroke. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366251 If continuation sheet Page 10 of 11 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 366251 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Home at Hearthstone, The 8028 Hamilton Avenue Cincinnati, OH 45231 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to evaluate psychotropic medications administered beyond 14 days. This affected one (Resident #25) of five residents reviewed for unnecessary medications. The facility census was 93. Findings include: Review of Resident #25's medical record revealed an admission date of 09/01/18 with diagnoses including but not limited to Alzheimer's disease, anxiety disorder, osteoporosis, anemia, and major depressive disorder. Review of Resident #25's physician orders revealed on 09/01/18 Resident #25 had an order for Ativan 0.5 milligrams (mg) every four hours PRN for agitation/anxiety and the order was discontinued during her hospitalization on 03/10/19. Review of Psychiatric visit note dated 12/13/18 indicated reliance on benzodiazepine (Ativan) may increase residents fall risk and consider increasing Depakote medication. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed severe cognitive impairment and extensive assistance of one for all activities of daily living except eating which required only limited assistance. Review of Resident #25's Medication Administration Record (MAR) revealed the PRN Ativan was administered on an as needed basis in September, October, November, and December of 2018 and in January, February, March of 2019. Review of Resident #25 Monthly Medication Review (MMR) records revealed no documented evidence of recommendations from pharmacy related to the as needed Ativan. Interview with the DON on 03/27/19 at 12:42 P.M., verified Resident #24's PRN Ativan order exceeded 14 days and the medical record did not have documentation of a physician addressing the continued use. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366251 If continuation sheet Page 11 of 11

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Citations

6 citations recorded^*CMS

What do CMS severity letters mean?

Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.

General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.

Each letter combines severity with scope: how many residents the deficiency affected.

0623GeneralS&S Dpotential for harm
F623 - Transfer and discharge-
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
0688GeneralS&S Dpotential for harm
F688 - Mobility
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
0695GeneralS&S Dpotential for harm
F695 - Respiratory care, including tracheostomy care and tracheal suctioning
Provide safe and appropriate respiratory care for a resident when needed.
0756GeneralS&S Dpotential for harm
F756 - Drug Regimen Review
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
0757GeneralS&S Dpotential for harm
F757 - Unnecessary Drugs—General
Ensure each resident’s drug regimen must be free from unnecessary drugs.
0758GeneralS&S Dpotential for harm
F758 - Medication Errors
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.

FAQ · About this visit

Common questions about this visit

What happened during the March 28, 2019 survey of HOME AT HEARTHSTONE, THE?

This was a inspection survey of HOME AT HEARTHSTONE, THE on March 28, 2019. The surveyor cited 6 deficiencies, recorded on the federal Form 2567 statement of deficiencies.

Were any deficiencies cited at HOME AT HEARTHSTONE, THE on March 28, 2019?

Yes, 6 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before tran..."

What type of survey was this?

This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.

SourceView on CMS Care Compare

Next steps

Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.

Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.

Data from CMS Care Compare public records. Dataset last refreshed June 22, 2026. If you believe any information is inaccurate, report it here.

Health inspection·March 28, 2019