Inspection·April 29, 2021

F 0606 Level of Harm - Minimal harm or potential for actual harm dated 04/01/17, revealed it was the policy of the facility to screen employees and volunteers prior to working with resident. Screening components include verification of references, certification and verification of license and criminal background check. Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366316 If continuation sheet Page 2 of 5 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 366316 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/29/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seven Acres Senior Living at Clifton 476 Riddle Road Cincinnati, OH 45220 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 - Potential for minimal harm Residents Affected - Some 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 record review and interview, the facility failed to notify the Ombudsman when a resident was transferred to the hospital. This affected two (Residents #2 and #37) of four residents reviewed for hospitalizations. The in-house facility census was 40. Findings include: 1. Record review revealed Resident #2 was transferred to the hospital on [DATE] with a change in condition. Review of a nursing note dated 02/28/2021 at 11:51 P.M. revealed 911 was notified and Resident #2 was transported to lobby area where paramedics were awaiting. Resident #2 was assessed by medic and transported to hospital without incident. Power of Attorney notified. Bed hold notice given and signed. There was no evidence the Ombudsman was notified of the resident's transfer to the hospital. 2. Record review revealed Resident #37 was transferred to the hospital on [DATE]. Review of a nursing note dated 04/22/21 at 10:04 P.M. revealed Resident #37 left facility at 6:45 P.M. via 911. Bed hold notice given. There was no evidence the Ombudsman was notified of the resident's transfer to the hospital. During an interview on 04/28/21 at 11:43 A.M., Social Worker (SW) #48 stated she had not been notifying the Ombudsman about the transfer to the hospital for Resident #2 and #37. SW #28 stated she was unaware that Ombudsman was supposed to be notified. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366316 If continuation sheet Page 3 of 5 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 366316 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/29/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seven Acres Senior Living at Clifton 476 Riddle Road Cincinnati, OH 45220 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 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review, interview and policy review, the facility failed to address a slow weight loss, failed to provide the appropriate diet and failed to ensure supervision was provided during meals. This affected two (Residents #32 and #17) of six residents identified with significant weight loss. The facility census was 40. Residents Affected - Few Findings include: Record review for Resident #32 revealed an admission date of 11/21/17. Medical diagnoses included muscle weakness, overactive bladder, and hypertension. Review of the care plans dated 12/31/19 revealed to provide companionship at mealtime to encourage nutritional intake Review of the weights for Resident #32 revealed on 10/13/20, the resident weighed 153 pounds; 11/09/20, 149 pounds; 12/05/20, 146 pounds; 01/12/21, 145 pounds; 02/04/21, 143 pounds; 03/05/21, 141 pounds; and 04/05/21, 138 pounds. Review of the quarterly Minimum Data Set (MDS) assessment, dated 04/09/21, revealed Resident #32 was severely cognitively impaired. She was able to feed herself. She was not on a prescribed weight loss program. Review of the dietician note, dated 04/10/21, revealed the resident exhibited a slow weight loss. The resident had lost 15 pounds in the past six months, which was significant loss of 10.1%. The current weight was still within a healthy range with Body Mass Index (BMI) at 22.9. The resident was currently eating 50 to 75 percent of her meals. The recommendation was to offer a supplement of choice if the resident eats less than 50 percent of meals and to start weekly weights for four weeks. Review of the medical record revealed no weekly weights had been obtained. Observation of the lunch meal on 04/27/21 at 12:00 P.M. revealed Resident #32 did not have a companion sitting at the table encouraging her to eat. During interview with Licensed Dietician (LD) #76 on 04/28/21 at 2:05 P.M. revealed she was not aware the weights weekly weren't obtained. 2. Medical record review for Resident #17 revealed an admission date of 06/04/19. Medical diagnoses included renal insufficiency, coronary artery disease, cerebrovascular attack and dementia. Review of quarterly MDS assessment, dated 03/11/21, revealed Resident #17 was severely cognitively impaired. He needed supervision for eating with one-person physical assistance. Review of care plan dated 04/09/21 revealed one to one supervision to encourage Resident #17 with meals. Review of physician orders dated 04/14/21 revealed a mechanical soft to pureed diet with mechanical soft texture, and thin consistency due to difficulty chewing. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366316 If continuation sheet Page 4 of 5 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 366316 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/29/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seven Acres Senior Living at Clifton 476 Riddle Road Cincinnati, OH 45220 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 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Observation of Resident #17 on 04/27/21 at 12:00 P.M. revealed he was sitting outside of the dining area alone. He was served grilled chicken that was cut up into bite size pieces. During interview on 04/27/21 at 12:21 P.M., Dietary Aide (DA) #36 stated Resident #17's chicken was not mechanical soft to pureed. The resident won't eat the food if it is mechanical soft or pureed so the chicken was fixed regular for him. She confirmed someone was supposed to be sitting with him assisting him with eating, but there was only two aides and they were helping someone else eat. Review of the facility policy titled Weight, Loss or Gain, dated 07/01/09 revealed residents will be weighed every week for four weeks upon admission and monthly thereafter. If a 5% weight loss is noted the resident will be weighed weekly for four weeks for closer monitoring. This is an example of continued non-compliance from the survey dated 03/29/21. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366316 If continuation sheet Page 5 of 5