Inspection visit
Health inspection
14 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 14 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0580
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room,
etc.) that affect the resident.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
medical record review, staff and resident interview, and review of the facility policy, the facility failed to notify
the physician of lab refusals for a resident. This affected one Resident (#29) of five reviewed for
unnecessary medications during the investigation phase of the annual survey. The facility census was 40.
Findings include:
Review of the medical record revealed Resident #29 was admitted to the facility on [DATE] with diagnoses
including diabetes mellitus with diabetic neuropathy, major depressive disorder, hypertension, heart
disease, gastroesophageal reflux (GERD), diarrhea, anemia, end stage renal disease, and anxiety
disorder.
Review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed the resident was cognitively intact
with rejection of care behaviors noted one to three days during the look back period. Review of Section GFunctional status revealed the resident required extensive two-person assistance with bed mobility, transfer,
toileting, extensive one-person assistance for locomotion, personal hygiene, limited one-person assistance
with dressing, and supervision with set up for eating. Review of Section N-medications revealed the
resident received antidepressants, hypnotics, and opioids seven of the seven days during the look back
period, no antipsychotics provided.
Review of Resident #29's physician orders revealed laboratory orders dated 08/09/18 for complete blood
count (CBC), renal, hemoglobin A1C(diabetes) and cholesterol to be drawn every three months.
Review of Resident #29's lab reports dated 08/10/18, 11/08/18, and 02/07/19 revealed the resident refused
lab work and for the facility to inform the resident's physician of the refusal.
Further review of the medical record was silent of verification the labs were completed as ordered, the
physician was notified of the residents refusal of the lab draws, and/or a other attempts/arrangements were
made to obtain to labs.
Interview conducted on 02/20/19 at 9:30 A.M., Resident #29 stated she goes out the facility three days a
week to hemodialysis and if labs needed to be taken they could take them there.
Interview conducted on 02/21/19 at 2:23 P.M., the Director of Nursing (DON) stated she would expect staff
to notify the physician of Resident #29's refusals of lab draws and request an order to coordinate care with
dialysis for labs to be drawn with her other labs. The DON verified Resident #29 had
(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 19
Event ID:
366256
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
366256
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/21/2019
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Parkview Northwest Healthcare Center
3875 East Galbraith Road
Cincinnati, OH 45236
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 0580
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
other labs done frequently at dialysis, however the facility was unable to provided verification of the
physician ordered labs that were completed, physician was notified of refusal, and/or other
arrangements/attempts were obtained to have labs done as ordered.
Review of the facility policy titled Change in a Resident's Condition or Status dated 05/2017 revealed the
nurse will notify the residents physician if there is a need to alter the resident's medical treatment and/or
refusal of treatment two or more times.
Event ID:
Facility ID:
366256
If continuation sheet
Page 2 of 19
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
366256
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/21/2019
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Parkview Northwest Healthcare Center
3875 East Galbraith Road
Cincinnati, OH 45236
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 0584
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
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.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, staff interview, review of the resident census and review of facility policy the facility failed to
maintain residents rooms in a clean and sanitary manner. Holes were noted on the walls with exposing dry
wall and wood, and window blinds were dirty. This affected three rooms (7, 12 and 13) of 15 rooms on the
lower level. The facility identified six Resident's (#1, #4, #20, #21, #22 and #190) who resided in the
affected rooms. The facility census was 40.
Findings include:
1. Observation and interview conducted on 02/20/19 at 11:21 A.M. Licensed Practical Nurse (LPN) #26
verified the wall in room [ROOM NUMBER] next to the bathroom had a quarter edge and dry wall missing,
exposing the wood. LPN #26 verified there was noted patch work completed on the wall that appeared to
be done sometime ago due to the patch work had new holes and scuff marks noted. LPN #26 stated she
was unsure how long the holes had been on the walls and/or when the patch work was completed.
Observation and interview conducted on 02/21/19 at 11:35 A.M., Maintenance Director(MD) #56 stated
when repairs were needed, staff would put work orders in the maintenance log at the nurses station. MD
#56 stated he was not made aware of the holes in the wall of room [ROOM NUMBER]. MD #56 verified the
drywall in the room appeared to be repaired and not repainted, however he was unsure of when the repairs
were conducted. MD #56 verified the repair work had since obtained scuff marks and new holes in it, the
corner trim was missing, and more holes were noted in the wall exposing the wood underneath.
2. Observation on 02/21/19 at 10:25 A.M., of room [ROOM NUMBER] revealed there were holes and
cracks in the drywall by the affixed heating unit, and by the wall behind the residents bed. The base board
was missing on the wall by the bathroom.
Interview on 02/21/19 at 11:40 A.M. with MD #56, verified room [ROOM NUMBER] had holes and cracks in
the drywall by the affixed heating unit, and the wall behind the residents bed. MD #56 also verified the base
board was missing on the wall by the bathroom. MD #56 stated he wasn't aware of the rooms being in
disrepair with the holes and cracks in the drywall and the base board missing on wall by the bathroom. MD
#56 further stated when repairs were needed, facility staff would put work orders in the maintenance log
kept at the nurses station. MD #56 stated maintenance was to check the rooms daily when they came in to
facility.
3. Observation on 02/21/19 at 11:44 A.M. of room [ROOM NUMBER], revealed the window blinds had
water stains on the cords Further observation revealed a black substance on two different spots on the
blinds.
Interview at the time of the observation with MD #56, verified the blinds had water stains on the cords and
there was a black substance on the blinds.
Review of the resident census revealed six Residents (#1, #4, #20, #21, #22 and #190) resided in the
above rooms.
Review of an undated policy/procedure titled Departmental (Maintenance) - work order, revealed the
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366256
If continuation sheet
Page 3 of 19
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
366256
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/21/2019
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Parkview Northwest Healthcare Center
3875 East Galbraith Road
Cincinnati, OH 45236
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 0584
facility staff shall document routine maintenance needs on a work order form and place requests in the
work order book. Maintenance staff will review the work order book on each unit daily and log the repair.
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366256
If continuation sheet
Page 4 of 19
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
366256
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/21/2019
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Parkview Northwest Healthcare Center
3875 East Galbraith Road
Cincinnati, OH 45236
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 0607
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
review of medical record, observations, staff interview, review of facility incident log and review of facility
policy the facility failed to implement their policies and procedures for residents with injuries of unknown
origin. The facility failed to investigate and report to the state agency. This affected one Resident (#22) of
one reviewed for accidents. Total census was 40.
Residents Affected - Few
Findings include:
Review of the medical record for Resident #22, revealed an admission date of 08/30/16. Diagnoses
included schizophrenia, anxiety, major depressive disorder, dementia, drug induced subacute dyskinesia,
obesity, muscle weakness, lack of coordination, bipolar, diabetes mellitus and hypertension.
Review of the quarterly Minimum Data Set (MDS) assessment, dated 01/08/19, revealed the resident was
cognitively intact. The resident required extensive assistance for bed mobility, transfer, locomotion off unit,
dressing and personal hygiene. Resident #22 required supervision for walking, locomotion on unit and
eating. Resident #22 was dependent for bathing.
Review of a smoking assessment dated [DATE], indicated the resident was not able to state the hazards of
smoking. The resident was to be supervised during scheduled smoke breaks and a staff member would
light the cigarettes for the resident.
Review of plan of care for Resident #22 dated 11/30/18, revealed the resident was a smoker and he would
follow the facilities smoking policy. Interventions included facility shall provide safe smoking equipment such
as smoke stick, filter and a smoking apron. Plan of care also noted the resident was designated as an
impaired smoker who needed observation and constant supervision while smoking.
Review of alteration in skin document dated 01/09/19, indicated Resident #22 had blisters on his index and
middle fingers on his left hand and middle finger on his right hand.
Review of the physicians orders dated 01/09/19, revealed orders to apply skin prep to the left hand index
and middle fingers and middle finger of right hand twice daily until healed.
Review of progress notes dated 01/09/19 at 7:44 P.M., revealed the resident had blisters on his left index
and left middle fingers and the middle finger of right hand. New orders were received to apply skin prep
twice daily until healed. Progress notes indicated the physician and guardian were made aware.
Record review of physician visit notes dated 01/11/19 revealed the notes were silent for any blisters or
lesions on the resident's fingers.
Review of the most recent smoking assessment dated [DATE], indicated the resident was not able to state
the hazards of smoking. The resident was to be supervised during scheduled smoke breaks and staff
member would light cigarettes for the resident.
Record review of physician visit notes dated 02/08/19 revealed the notes were silent for any blisters or
lesions on the resident's fingers.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366256
If continuation sheet
Page 5 of 19
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
366256
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/21/2019
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Parkview Northwest Healthcare Center
3875 East Galbraith Road
Cincinnati, OH 45236
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 0607
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Observation on 02/19/19 at 11:00 A.M., revealed Resident #22 lying in bed with two round approximately
one-half inch holes with blackened edges in the thigh area of his pants.
Observation on 02/19/19 at 11:35 A.M., revealed Resident #22 in the courtyard with a smoking apron on
and filter for cigarette in place. Further observations revealed the resident had lesions on his left index
finger and left middle finger both at the same location of the fingers.
Interview on 02/20/19 at 2:04 P.M. with the Director of Nursing (DON), verified Resident #22 had blisters to
his fingers. The DON further stated she was not aware of how the blisters appeared on the residents
fingers. The DON further stated the facilities wound nurse had not completed an evaluation on the residents
blisters due to the blisters were not being opened.
Follow up interview on 02/20/19 at 3:15 P.M. with the DON, verified the facility did not complete an
investigation or submit a Self Reported Incident (SRI) for Resident #22's injuries of unknown origin. The
DON also verified the facility abuse & neglect policy indicated injuries of unknown origin shall be promptly
and thoroughly investigated and reported to the Ohio Department of Health.
Interview on 02/20/19 at 4:37 P.M. with Licensed Practical Nurse (LPN) #60, stated he had not seen
Resident #22 for any skin issues on his fingers. LPN #60 further stated he was not aware Resident #22 had
any blisters on his fingers. LPN #60 further stated he would normally see a resident if they had blisters from
an unknown source.
Observation on 02/21/19 at 1:18 P.M. of LPN #27, revealed the residents left hand was washed with soap
and water, patted dry and LPN #27 applied skin prep via wipes to the lesions on the left index and left
middle fingers. Resident #27's lesions were noted as being red with no drainage. Resident #22 refused to
allow LPN #27 to measure the lesions.
Interview with LPN #27 at the time of the observation verified the lesions were red with no active drainage.
LPN #27 stated the left middle finger lesion was approximately 1.0 centimeter (cm) x 0.5 cm and the lesion
on the left index finger was approximately 0.5 cm x 0.5 cm.
Review of incident log from 11/19/18 to 02/19/19, revealed Resident #22 was not on the log for any new
skin issue or incidents.
Review of facility policy dated 08/16/16 titled Abuse & Neglect, indicated all reports of resident abuse,
neglect and injuries of unknown origin shall be promptly and thoroughly investigated by facility
management. The policy also indicated the person in charge of the investigation or the Administrator will
immediately submit a SRI.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366256
If continuation sheet
Page 6 of 19
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
366256
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/21/2019
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Parkview Northwest Healthcare Center
3875 East Galbraith Road
Cincinnati, OH 45236
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 0609
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper
authorities.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
review of medical record, observations, staff interview, review of facility incident log and review of facility
policy the facility failed to ensure an injury of unknown origin was reported to the state agency. This affected
one Resident (#22) of one reviewed for accidents. Total census was 40.
Findings include:
Review of the medical record for Resident #22, revealed an admission date of 08/30/16. Diagnoses
included schizophrenia, anxiety, major depressive disorder, dementia, drug induced subacute dyskinesia,
obesity, muscle weakness, lack of coordination, bipolar, diabetes mellitus and hypertension.
Review of the quarterly Minimum Data Set (MDS) assessment, dated 01/08/19, revealed the resident was
cognitively intact. The resident required extensive assistance for bed mobility, transfer, locomotion off unit,
dressing and personal hygiene. Resident #22 required supervision for walking, locomotion on unit and
eating. Resident #22 was dependent for bathing.
Review of a smoking assessment dated [DATE], indicated the resident was not able to state the hazards of
smoking. The resident was to be supervised during scheduled smoke breaks and a staff member would
light the cigarettes for the resident.
Review of plan of care for Resident #22 dated 11/30/18, revealed the resident was a smoker and he would
follow the facilities smoking policy. Interventions included facility shall provide safe smoking equipment such
as smoke stick, filter and a smoking apron. Plan of care also noted the resident was designated as an
impaired smoker who needed observation and constant supervision while smoking.
Review of alteration in skin document dated 01/09/19, indicated Resident #22 had blisters on his index and
middle fingers on his left hand and middle finger on his right hand.
Review of the physicians orders dated 01/09/19, revealed orders to apply skin prep to the left hand index
and middle fingers and middle finger of right hand twice daily until healed.
Review of progress notes dated 01/09/19 at 7:44 P.M., revealed the resident had blisters on his left index
and left middle fingers and the middle finger of right hand. New orders were received to apply skin prep
twice daily until healed. Progress notes indicated the physician and guardian were made aware.
Record review of physician visit notes dated 01/11/19 revealed the notes were silent for any blisters or
lesions on the resident's fingers.
Review of the most recent smoking assessment dated [DATE], indicated the resident was not able to state
the hazards of smoking. The resident was to be supervised during scheduled smoke breaks and staff
member would light cigarettes for the resident.
Record review of physician visit notes dated 02/08/19 revealed the notes were silent for any blisters or
lesions on the resident's fingers.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366256
If continuation sheet
Page 7 of 19
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
366256
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/21/2019
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Parkview Northwest Healthcare Center
3875 East Galbraith Road
Cincinnati, OH 45236
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 0609
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Observation on 02/19/19 at 11:00 A.M., revealed Resident #22 lying in bed with two round approximately
one-half inch holes with blackened edges in the thigh area of his pants.
Observation on 02/19/19 at 11:35 A.M., revealed Resident #22 in the courtyard with a smoking apron on
and filter for cigarette in place. Further observations revealed the resident had lesions on his left index
finger and left middle finger both at the same location of the fingers.
Interview on 02/20/19 at 2:04 P.M. with the Director of Nursing (DON), verified Resident #22 had blisters to
his fingers. The DON further stated she was not aware of how the blisters appeared on the residents
fingers. The DON further stated the facilities wound nurse had not completed an evaluation on the residents
blisters due to the blisters were not being opened.
Follow up interview on 02/20/19 at 3:15 P.M. with the DON, verified the facility did not complete an
investigation or submit a Self Reported Incident (SRI) for Resident #22's injuries of unknown origin. The
DON also verified the facility abuse & neglect policy indicated injuries of unknown origin shall be promptly
and thoroughly investigated and reported to the Ohio Department of Health.
Interview on 02/20/19 at 4:37 P.M. with Licensed Practical Nurse (LPN) #60, stated he had not seen
Resident #22 for any skin issues on his fingers. LPN #60 further stated he was not aware Resident #22 had
any blisters on his fingers. LPN #60 further stated he would normally see a resident if they had blisters from
an unknown source.
Observation on 02/21/19 at 1:18 P.M. of LPN #27, revealed the residents left hand was washed with soap
and water, patted dry and LPN #27 applied skin prep via wipes to the lesions on the left index and left
middle fingers. Resident #27's lesions were noted as being red with no drainage. Resident #22 refused to
allow LPN #27 to measure the lesions.
Interview with LPN #27 at the time of the observation verified the lesions were red with no active drainage.
LPN #27 stated the left middle finger lesion was approximately 1.0 centimeter (cm) x 0.5 cm and the lesion
on the left index finger was approximately 0.5 cm x 0.5 cm.
Review of incident log from 11/19/18 to 02/19/19, revealed Resident #22 was not on the log for any new
skin issue or incidents.
Review of facility policy dated 08/16/16 titled Abuse & Neglect, indicated all reports of resident abuse,
neglect and injuries of unknown origin shall be promptly and thoroughly investigated by facility
management. The policy also indicated the person in charge of the investigation or the Administrator will
immediately submit a SRI.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366256
If continuation sheet
Page 8 of 19
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
366256
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/21/2019
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Parkview Northwest Healthcare Center
3875 East Galbraith Road
Cincinnati, OH 45236
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
review of medical record, observations, staff interview, review of facility incident log and review of facility
policy the facility failed to ensure an injury of unknown origin was investigated. This affected one Resident
(#22) of one reviewed for accidents. Total census was 40.
Residents Affected - Few
Findings include:
Review of the medical record for Resident #22, revealed an admission date of 08/30/16. Diagnoses
included schizophrenia, anxiety, major depressive disorder, dementia, drug induced subacute dyskinesia,
obesity, muscle weakness, lack of coordination, bipolar, diabetes mellitus and hypertension.
Review of the quarterly Minimum Data Set (MDS) assessment, dated 01/08/19, revealed the resident was
cognitively intact. The resident required extensive assistance for bed mobility, transfer, locomotion off unit,
dressing and personal hygiene. Resident #22 required supervision for walking, locomotion on unit and
eating. Resident #22 was dependent for bathing.
Review of a smoking assessment dated [DATE], indicated the resident was not able to state the hazards of
smoking. The resident was to be supervised during scheduled smoke breaks and a staff member would
light the cigarettes for the resident.
Review of plan of care for Resident #22 dated 11/30/18, revealed the resident was a smoker and he would
follow the facilities smoking policy. Interventions included facility shall provide safe smoking equipment such
as smoke stick, filter and a smoking apron. Plan of care also noted the resident was designated as an
impaired smoker who needed observation and constant supervision while smoking.
Review of alteration in skin document dated 01/09/19, indicated Resident #22 had blisters on his index and
middle fingers on his left hand and middle finger on his right hand.
Review of the physicians orders dated 01/09/19, revealed orders to apply skin prep to the left hand index
and middle fingers and middle finger of right hand twice daily until healed.
Review of progress notes dated 01/09/19 at 7:44 P.M., revealed the resident had blisters on his left index
and left middle fingers and the middle finger of right hand. New orders were received to apply skin prep
twice daily until healed. Progress notes indicated the physician and guardian were made aware.
Record review of physician visit notes dated 01/11/19 revealed the notes were silent for any blisters or
lesions on the resident's fingers.
Review of the most recent smoking assessment dated [DATE], indicated the resident was not able to state
the hazards of smoking. The resident was to be supervised during scheduled smoke breaks and staff
member would light cigarettes for the resident.
Record review of physician visit notes dated 02/08/19 revealed the notes were silent for any blisters or
lesions on the resident's fingers.
Observation on 02/19/19 at 11:00 A.M., revealed Resident #22 lying in bed with two round
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366256
If continuation sheet
Page 9 of 19
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
366256
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/21/2019
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Parkview Northwest Healthcare Center
3875 East Galbraith Road
Cincinnati, OH 45236
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
approximately one-half inch holes with blackened edges in the thigh area of his pants.
Level of Harm - Minimal harm
or potential for actual harm
Observation on 02/19/19 at 11:35 A.M., revealed Resident #22 in the courtyard with a smoking apron on
and filter for cigarette in place. Further observations revealed the resident had lesions on his left index
finger and left middle finger both at the same location of the fingers.
Residents Affected - Few
Interview on 02/20/19 at 2:04 P.M. with the Director of Nursing (DON), verified Resident #22 had blisters to
his fingers. The DON further stated she was not aware of how the blisters appeared on the residents
fingers. The DON further stated the facilities wound nurse had not completed an evaluation on the residents
blisters due to the blisters were not being opened.
Follow up interview on 02/20/19 at 3:15 P.M. with the DON, verified the facility did not complete an
investigation or submit a Self Reported Incident (SRI) for Resident #22's injuries of unknown origin. The
DON also verified the facility abuse & neglect policy indicated injuries of unknown origin shall be promptly
and thoroughly investigated and reported to the Ohio Department of Health.
Interview on 02/20/19 at 4:37 P.M. with Licensed Practical Nurse (LPN) #60, stated he had not seen
Resident #22 for any skin issues on his fingers. LPN #60 further stated he was not aware Resident #22 had
any blisters on his fingers. LPN #60 further stated he would normally see a resident if they had blisters from
an unknown source.
Observation on 02/21/19 at 1:18 P.M. of LPN #27, revealed the residents left hand was washed with soap
and water, patted dry and LPN #27 applied skin prep via wipes to the lesions on the left index and left
middle fingers. Resident #27's lesions were noted as being red with no drainage. Resident #22 refused to
allow LPN #27 to measure the lesions.
Interview with LPN #27 at the time of the observation verified the lesions were red with no active drainage.
LPN #27 stated the left middle finger lesion was approximately 1.0 centimeter (cm) x 0.5 cm and the lesion
on the left index finger was approximately 0.5 cm x 0.5 cm.
Review of incident log from 11/19/18 to 02/19/19, revealed Resident #22 was not on the log for any new
skin issue or incidents.
Review of facility policy dated 08/16/16 titled Abuse & Neglect, indicated all reports of resident abuse,
neglect and injuries of unknown origin shall be promptly and thoroughly investigated by facility
management. The policy also indicated the person in charge of the investigation or the Administrator will
immediately submit a SRI.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366256
If continuation sheet
Page 10 of 19
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
366256
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/21/2019
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Parkview Northwest Healthcare Center
3875 East Galbraith Road
Cincinnati, OH 45236
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
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** Based on
medical record review, staff interview, and facility policy review the facility failed to notify the Ombudsman of
a residents' discharge. This affected one (#20) of two residents reviewed for hospitalization. The facility
census was 40 residents.
Findings include:
Review of Resident #20's medical record revealed the resident was admitted to the facility on [DATE] with
diagnoses that included hypertension, seizure disorder, manic depression, anxiety, psychotic disorder,
schizophrenia and ileostomy.
Review of Resident #20's quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed he was
severely impaired for cognitive daily decision making skills and required supervision to extensive assistance
of staff with his activities of daily living.
Further review of the medical record revealed Resident #20 was discharged to the hospital on [DATE],
11/11/18 and 12/18/18. The facility provided the resident with bed hold notice but did not notify the
Ombudsman of the discharges
On 02/20/19 at 9:42 A.M. during an interview with the Director of Nursing (DON), she affirmed the facility
had notified the resident's responsible party of the discharges but they had not notified the Ombudsman
when the resident was discharged to the hospital. The DON verified the facility policy on Transfer or
Discharge did not instruct the staff to notify the Ombudsman when a resident was discharged . She said
time got away from them and they were currently in the process of updating their policy.
Review of the facility's policy entitled Transfer or Discharge, Preparing a Resident revealed when a resident
was scheduled for transfer or discharge, the business office will notify nursing services of the transfer or
discharge so that the appropriate procedures could be implemented.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366256
If continuation sheet
Page 11 of 19
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
366256
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/21/2019
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Parkview Northwest Healthcare Center
3875 East Galbraith Road
Cincinnati, OH 45236
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 0655
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being
admitted
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
medical record review and staff interview, the facility failed to develop baseline care plan within the required
48 hour of admission. This affected one Resident (#29) of 13 reviewed during the investigation phase of the
annual survey. The facility census was 40.
Findings include:
Review of the medical record revealed Resident #29 was admitted to the facility on [DATE] with diagnoses
including diabetes mellitus with diabetic neuropathy, major depressive disorder, hypertension, heart
disease, gastroesphageal reflux (GERD), diarrhea, anemia, end stage renal disease, and anxiety disorder.
Review of the admission Minimum Data Set (MDS) dated [DATE] revealed the resident was cognitively
intact. Review of Section G- Functional Assessment revealed Resident #29 required extensive two-person
assistance with bed mobility, transfer, toileting, extensive one-person assistance with personal hygiene,
locomotion, dressing, and supervision setup with eating. Review of Section O-Special Treatments revealed
Resident #29 required Dialysis.
Review of Resident #29's admission Assessment and Baseline Care Plan dated 05/09/18 revealed Section
N- Medication/Community Coordination including medications, monitoring, medication reconciliation, and
community coordination-dialysis services/information assessment was not completed.
Interview conducted on 02/21/19 at 2:36 P.M. with Corporate MDS Registered Nurse (RN) #115 verified
admission care plans for Resident #29's dialysis and medication Section N were not completed. RN #115
stated all sections should be completed on resident admission, and the facility was unable to provide any
other 48 hour care plans for Resident #29 related to her admission medications and/or dialysis
treatments/services.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366256
If continuation sheet
Page 12 of 19
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
366256
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/21/2019
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Parkview Northwest Healthcare Center
3875 East Galbraith Road
Cincinnati, OH 45236
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 0657
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed,
and revised by a team of health professionals.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
medical record review, staff and resident interviews, and review of facility policy, the facility failed to provide
care conference/care planning quarterly for residents. This affected one Resident (#39) of one reviewed for
care conferences/care planning during the investigation phase of the annual survey. The facility census was
40.
Findings include:
Review of the medical record revealed Resident #39 was admitted to the facility on [DATE] with diagnoses
including type two diabetes, major depressive disorder, osteoarthritis, cerebral infarction, hemiplegia of left
side, and muscle weakness.
Review of the quarterly Minimum Data Set(MDS) dated [DATE] revealed the resident was cognitively intact,
with no behaviors noted. Review of Section G-Functional Status revealed the resident required extensive
two-person assistance with bed mobility, toileting, transfer, extensive one-person assistance with walking,
locomotion, dressing, personal hygiene, and supervision and setup with eating. Review of section KSwallowing/Nutritional Status revealed the resident had no swallowing concerns, and no unplanned weight
loss or weight gain noted during the look back period.
Further review of the medical record revealed Resident #39's last documented care conference was held
on 08/09/18, without noted attendance by the physician and/or physician representative.
Interview conducted on 02/19/19 at 11:47 A.M., Resident #39 stated he had not had a care conference with
the interdisciplinary team, since his admission.
Interview conducted on 02/20/19 at 3:28 P.M. with Social Worker (SW) #84 verified the last documented
care conference was held in 08/2018. SW #84 stated she tried to get the dietitian, activities, social services,
and nursing staff present for quarterly care conferences, however the physician and/or physician
representative rarely attended, only if requested.
Review of the facility policy titled Care Plans, Comprehensive Person-Centered dated 12/2016 revealed the
interdisciplinary team, consisting of the attending physician, registered nurse who has responsibility for the
resident, nurse aide who has responsibility for the resident, member of food and nutrition services, resident
and resident legal representative, and other appropriate staff, will review and update the care plan at least
quarterly. The resident has the right to refuse to participate, and such refusals will be documented in the
resident's clinical record.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366256
If continuation sheet
Page 13 of 19
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
366256
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/21/2019
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Parkview Northwest Healthcare Center
3875 East Galbraith Road
Cincinnati, OH 45236
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 0689
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to
prevent accidents.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, staff interview, review of resident list and review of facility policy the facility failed to ensure the
residents environment was free from accident hazards. This affected one room (12) of 15 rooms on the
secured lower level. room [ROOM NUMBER] had exposed wires. The facility identified 14 Residents (#3,
#5, #8, #11, #15, #17, #18, #20, #22, #27, #36, #37, #38 and #190) as being cognitively impaired and
ambulatory who resided on the secured lower level. Total census of facility was 40.
Findings include:
Observation on 02/21/19 at 10:25 AM, revealed exposed and uncapped wires sticking out from underneath
the affixed heating unit located inside room. 12.
Interview on 02/21/19 at 10:55 A.M. with Maintenance Director # 56, verified there were exposed,
uncapped wires sticking out from underneath the affixed heating unit in room [ROOM NUMBER].
Review of resident list identified 14 Residents (#3, #5, #8, #11, #15, #17, #18, #20, #22, #27, #36, #37, #38
and #190) as being cognitively impaired and ambulatory who resided on the secured lower level
Review of an undated policy/procedure titled Departmental (Maintenance) - work order, revealed the facility
staff shall document routine maintenance needs on a work order form and place requests in the work order
book. Further review of policy/procedure revealed the Maintenance staff will review the work order book on
each unit daily and log the repairs.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366256
If continuation sheet
Page 14 of 19
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
366256
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/21/2019
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Parkview Northwest Healthcare Center
3875 East Galbraith Road
Cincinnati, OH 45236
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 0727
Level of Harm - Potential for
minimal harm
Residents Affected - Many
Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on
a full time basis.
Based on review of nursing staffing schedules and staff interview the facility failed to have Registered
Nursing (RN) services eight consecutive hours a day seven days a week. This had the potential to affect all
residents in the facility. The facility census was 40.
Findings include:
Review of the nursing staffing schedules from 01/19/19 through 02/19/19 revealed there was no RN
scheduled for the following dates: 01/19/19, 01/20/19, 02/02/19, 02/03/19, 02/16/19 and 02/17/19.
During an interview with the Director of Nursing (DON) on 02/21/19 at 9:48 A.M., she verified only one floor
nurse on staff was a RN. The DON stated she would pop in on the weekends at times to complete checks
but generally she and the Assistant Director of Nursing (ADON) generally only worked during the
weekdays. The DON reported she and the ADON switch off every other weekend for on call but were not
present in the building. The DON verified every other weekend on there is no RN scheduled. She also
verified they do not have a waiver to allow for no RN coverage.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366256
If continuation sheet
Page 15 of 19
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
366256
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/21/2019
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Parkview Northwest Healthcare Center
3875 East Galbraith Road
Cincinnati, OH 45236
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 0755
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a
licensed pharmacist.
Based on observation, staff interview, review of the narcotic logs, and review of facility policy, the facility
failed to ensure a nurse documented in the narcotic log in a timely manner after administration of a
narcotic. The facility also failed to ensure administration of a narcotic when it was signed out of the narcotic
log. This affected two (#25 and #26) of 24 residents the facility identified as receiving medications from the
medication cart on floor two. The facility census was 40.
Findings include:
Observation of the Team 1 and Team 2 medication carts on the second floor and staff interview with
Registered Nurse (RN) #21 was conducted on 02/20/19 at 3:58 P.M. At the time of the observation a review
of the narcotic logs revealed Resident #25's Alprazolam (anxiety medication) 0.5 milligram (mg) count
sheet noted a count of nine tablets however there were only eight tablets noted in the packet. RN #21
stated he provided Resident #25 the alprazolam at 12:20 P.M. and forgot to sign it out on the narcotic log.
RN #21 then signed the medication out on the log. Further review of the narcotic logs revealed Resident
#26's Norco(pain medication) 5/325 mg documented 14 tablets left in the package, however observation of
the package container revealed there were actually 15 tablets noted. RN #21 stated he must of signed out
the medication and failed to pull it and provide it to the resident. RN #21 stated he would inform the Director
of Nursing (DON) and the residents physician the medication was not provided. RN #21 stated he was
supposed to sign the narcotic's out when he took them out to provide the medication to the resident. RN
#21 verified he did not sight the medications out as required.
Interview conducted on 02/21/19 at 1:53 P.M., Corporate Director of Nursing (CDON) #57 stated she would
expect staff to sign narcotic's out when that take them out to provide them to the resident.
Review of the policy titled Documentation of Medication Administration dated 04/2007 revealed
administration of medication must be documented immediately after (never before) it is given.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366256
If continuation sheet
Page 16 of 19
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
366256
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/21/2019
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Parkview Northwest Healthcare Center
3875 East Galbraith Road
Cincinnati, OH 45236
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 0761
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted
professional principles; and all drugs and biologicals must be stored in locked compartments, separately
locked, compartments for controlled drugs.
Based on medical record review, observation, staff interview, and review of facility policy, the facility failed to
remove/dispose of discontinued medication. This affected one of three medication carts observed during
the annual survey. This directly affected one Resident (#16) who had expired medications in the medication
cart. The facility census was 40.
Findings include:
Review of Resident #16's medical record revealed a physician order dated 12/09/18 for Risperdal Solution,
two times a day for dementia/behaviors mix with food or drink. Further review revealed the Risperdal
Solution was discontinued on 12/26/18.
Observation of the Team 2 medication cart on the second floor and staff interview with Registered Nurse
(RN) #21 was conducted on 02/20/19 at 3:58 P.M. Observation revealed a bottle of liquid Risperdal Solution
(antipsychotic) that belonged to Resident #16, noted in the side drawer of the medication cart. RN #21
stated the medication was discontinued and needed to be removed from the medication cart.
Interview conducted on 02/21/19 at 1:53 P.M. Corporate Director of Nursing (CDON) #57 stated
discontinued medications should be pulled from the medication cart within five days and either destroyed or
returned to the pharmacy.
Review of the facility policy Discontinued Medications dated 04/2007 revealed the facility staff shall destroy
discontinued medication or shall return them to the dispensing pharmacy.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366256
If continuation sheet
Page 17 of 19
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
366256
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/21/2019
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Parkview Northwest Healthcare Center
3875 East Galbraith Road
Cincinnati, OH 45236
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 0801
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Many
Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the
food and nutrition service, including a qualified dietician.
Based on review of Safe Serve and staff interview the facility failed to have any dietary staff certified in food
service management and safety. This had the potential to affect all residents in the facility. The facility
census was 40.
Findings include:
Review of documentation of certification for dietary staff revealed Registered Dietician (RD) #1 was Safe
Serv Level Two certified.
During an interview with RD #1 on 02/20/19 at 11:18 A.M., she verified she held a Safe Serv Level Two
certification and was in the facility on Wednesdays and Thursdays. At the same time, Dietary Manager (DM)
#1 stated he was scheduled for the January class for Safe Serv Level 2 but it was canceled due to the
weather. DM #1 stated he was scheduled for the class on 04/23/19. He further verified currently none of the
facility dietary staff have Safe Serv Level One or Level Two certification.
During an interview with DM #1 on 02/21/19 at 9:26 A.M., he stated he had an Associate degree in
Culinary Arts obtained from a local Technical College in 2000 and documentation was requested. On
02/21/19 at 10:12 A.M DM #1 reported he did not have an Associate degree but rather a certification in
Culinary Arts.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366256
If continuation sheet
Page 18 of 19
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
366256
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/21/2019
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Parkview Northwest Healthcare Center
3875 East Galbraith Road
Cincinnati, OH 45236
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 - Some
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and
the public.
Based on observation, staff interview, review of census list and review of facility policy the facility failed to
maintain the canopy over the courtyard on the lower level. This had the potential to affect 16 residents (#1,
#3, #4, #5, #8, #11, #15, #17, #18, #20, #22, #27, #36, #37, # 38 and #190) who resided on the secured
unit and used the courtyard. Total census of the facility was 40.
Observation on 02/19/19 at 11:32 A.M. of the lower level courtyard attached to the secured unit, revealed
the canopy was in disrepair. Further observation revealed several holes in the canopy and a large area
where the canopy was completely separated from the frame and hanging down.
Interview on 02/21/19 at 11:10 A.M. with the Director of Nursing (DON), verified the canopy over the
courtyard had several holes in it and a large area where the canopy was separated from the frame and
hanging down.
Review of census list revealed 16 residents (#1, #3, #4, #5, #8, #11, #15, #17, #18, #20, #22, #27, #36,
#37, # 38 and #190) resided on the secured unit.
Review of an undated policy/procedure titled Departmental (Maintenance) - work order, revealed the facility
staff shall document routine maintenance needs on a work order form and place requests in the work order
book. Maintenance staff will review the work order book on each unit daily and log the repair.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366256
If continuation sheet
Page 19 of 19
Reading this as a family member? Your long-term care ombudsman is a free advocate for residents and families.
Back to topCitations
14 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.
F657 - Comprehensive Care Plans
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
F761 - Labeling of Drugs and Biologicals
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
F801 - Staffing
Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician.
F921 - Other Environmental Conditions
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
F580 - Notification of Changes
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
F655 - Comprehensive Person-Centered Care Planning
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
F689 - Accidents
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
F727 - Except when waived under paragraph (f) or (g) of this section, the
Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.
F755 - Pharmacy Services
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
F584 - Safe Environment
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.
F607 - The facility must develop and implement written policies and procedures that:
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
F609 - The facility must develop and implement written policies and procedures that:
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
F610 - In response to allegations of abuse, neglect, exploitation, or mistreatment, the
Respond appropriately to all alleged violations.
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.
FAQ · About this visit
Common questions about this visit
What happened during the February 21, 2019 survey of PARKVIEW NORTHWEST HEALTHCARE CENTER?
This was a inspection survey of PARKVIEW NORTHWEST HEALTHCARE CENTER on February 21, 2019. The surveyor cited 14 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at PARKVIEW NORTHWEST HEALTHCARE CENTER on February 21, 2019?
Yes, 14 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a t..."
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 . If you believe any information is inaccurate, report it here.