Health inspection·May 16, 2023

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. Based on medical record review, observation, staff interview, and policy review, the facility failed to ensure resident bathrooms were maintained in a clean and sanitary manner. This affected four (Residents #16, #17, #18, and #19) of seven residents reviewed for a sanitary environment. The facility census was 47. Findings include: 1. Review of the medical record for Resident #16 revealed an admission date of 02/01/22. Diagnoses included unspecified dementia, Wernicke's encephalopathy, and unspecified conduct disorder. Review of the most recent Minimum Data Set (MDS) 3.0 assessment, dated 05/04/23, revealed Resident #16 had severely impaired cognition. Resident #16 required supervision assistance for toileting. 2. Review of the medical record for Resident #17 revealed an admission date of 03/20/22. Diagnoses included Parkinson's disease, unspecified dementia, and unspecified schizophrenia. Review of the most recent MDS 3.0 assessment, dated 04/07/23, revealed Resident #17 had both long and short term memory problems. Resident #17 required extensive assistance for toileting. 3. Review of the medical record for Resident #18 revealed an admission date of 01/24/22. Diagnoses included unspecified schizoaffective disorder. Review of the most recent MDS 3.0 assessment, dated 05/06/23, revealed Resident #18 had severely impaired cognition and required supervision assistance for toileting. 4. Review of the medical record for Resident #19 revealed an admission date of 08/20/21. Diagnoses included but were not limited to schizoaffective disorder bipolar type, type two diabetes, and unspecified dementia. Review of the most recent MDS 3.0 assessment, dated 04/05/23, revealed Resident #19 was cognitively intact and was independent with toileting. Observation on 05/15/23 at 3:49 P.M. revealed the bathroom shared by Residents #16, #17, #18, and #19 had the toilet seat up, a pile of brown substance at the base of the seat/tank, and a pile of paper towels covered in a brown substance on the floor in the corner beside the toilet. Interview on 05/15/23 at 3:49 P.M. with State Tested Nurse Aide (STNA) #185 verified the commode in the shared bathroom had feces and piles of feces-soiled paper towels on the floor. STNA #185 stated housekeepers had left for the day and the nursing staff was responsible to clean the unit as needed. Observation on 05/15/23 at 4:55 P.M. revealed the bathroom shared by Residents #16, #17, #18, and #19 still had a pile of brown substance at the base of the seat/tank, and a pile of paper towels covered in a brown substance on the floor in the corner beside the toilet. Interview on 05/15/23 at 4:55 P.M. with STNA #101 verified the bathroom was not clean. STNA #101 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366256 If continuation sheet Page 2 of 4 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 05/16/2023 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 stated she was not notified that the bathroom was dirty, and stated it was the responsibility of the nursing staff to clean the unit as needed after housekeepers had left for the day. Review of policy titled Resident Rights, undated, revealed residents were treated with dignity including providing a sanitary environment and attending to needs in a timely fashion. Residents Affected - Some This deficiency represents non-compliance investigated under Complaint Numbers OH00142659 and OH00141815. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366256 If continuation sheet Page 3 of 4 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 05/16/2023 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 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm Based on medical record review, staff interview, and policy review, the facility failed to ensure residents were free from significant medication errors. This affected one (Resident #50) out of four residents reviewed for medication administration. The facility census was 47. Residents Affected - Few Findings include: Review of the medical record for Resident #50 revealed an admission date of 02/15/23 and a discharge date of 04/07/23. Resident #50's diagnoses included Parkinson's disease, type two diabetes, and unspecified Alzheimer's disease. Review of the most recent Minimum Data Set (MDS) 3.0 assessment, dated 02/22/23, revealed Resident #50 had severely impaired cognition. Review of Resident #50's physician orders revealed an order, dated 04/05/23, for Rocephin (antibiotic) one gram solution, inject one gram intramuscularly daily in the afternoon. Review of Resident #50's progress notes revealed on 04/05/23 at 4:13 P.M. the Rocephin one gram solution was not administered to Resident #50 because it was on order. Review of the Medication Administration Record, dated April 2023, revealed Resident #50 did not receive any doses of the Rocephin one gram solution on 04/05/23 and 04/06/23. Interview on 05/15/23 at 5:40 P.M. with the Former Director of Nursing #25 verified Resident #50's Rocephin one gram solution was not available in the facility emergency drug supply, and there was no evidence the medication was administered to Resident #50 as ordered. Review of policy titled Medication Administration, undated, revealed medications were administered as prescribed by the provider. Medications that were not given were documented, and critical medications were followed up with physician contact. This deficiency represents non-compliance investigated under Complaint Number OH00141815 and is an example of continued noncompliance from the survey dated 03/30/23. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366256 If continuation sheet Page 4 of 4