Inspection·September 13, 2023

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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 record review, observations, staff interview, and review of the facility policy, the facility failed to ensure medications were stored safely and not left unattended. This affected Resident #3 and had the potential to affect nine additional facility-identified residents (#2, #5, #8, #9, #17, #19, #20, #22, and #23) residing on the second floor who were cognitively impaired and independently mobile. The facility census was 49 residents. Findings include: Review of the medical record for Resident #3 revealed an admission date of 03/01/23 with diagnoses including dementia without behavioral disturbance, chronic kidney disease (CKD), peripheral vascular disease (PVD), osteoarthritis (OA), and cerebral infarction. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #3 was cognitively impaired and required limited assistance of one staff with activities of daily living (ADLs.) Review of the monthly physician orders for Resident #3 revealed orders dated 10/28/22 for multivitamin one tablet in the morning for constipation and Mirabegron one tablet in the morning for overactive bladder and an order dated 09/01/23 for senna one tablet in the morning for constipation. Review of the monthly physician orders for Resident #3 revealed there were no orders for resident to self-administer medications. Observations on 09/13/23 at 9:49 A.M. revealed Resident #3 and #8 were sitting next to one another in the common area and conversing. Licensed Practical Nurse (LPN) #755 was in the nurses' office working on the computer. LPN #755 was not observing Resident #3. On 09/13/23 at 9:59 A.M. revealed LPN #755 approached Resident #3 and told her she needed to take the pills from the resident if she wasn't going to take them. LPN #755 then took a plastic cup containing two pills out of the resident's hand and discarded the pills. LPN #755 then returned to the nurses' office and sat in front of the computer. Observation on 09/13/23 at 10:00 A.M. revealed State Tested Nursing Assistant (STNA) #920 approached Resident #3 and spoke to the resident and then came to nurses' office with a red tablet in her hand which she reported had been in Resident #3's hand. STNA #920 gave the pill to LPN #755 who then discarded the red tablet. Interview on 09/13/23 at 10:01 A.M. with STNA #920 confirmed she noticed Resident #3 had a red pill in her hand and when she asked the resident if she could take the pill to the nurse, the resident (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 3 Event ID: 366316 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 09/13/2023 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)