Inspection·March 12, 2024

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. Based on observations, medical record review, staff interviews and spread sheet review, the facility failed to serve the correct amount of puree food texture portions as listed on the menu spreadsheet. This affected four (#21, #35, #39 and #47) of four residents observed who required an ordered puree texture diet. The facility total census was 48. Findings include: Review of Residents #21, #35, #39 and #47's monthly March 2024 physician orders revealed the residents had physician orders for puree texture diets. Review of the lunch menu spreadsheet dated 03/07/24 revealed the puree texture diet should have received three ounces puree meat, four ounces of vegetable, and four ounces of starch. Review of the meal tickets of Residents #21, #35, #39 and #47 revealed no notation the residents preferred small food portions. Observation on 03/07/24 at 12:15 P.M., revealed Residents #21, #35, #39 and #47 were served by Diet Aides, (DA) #45 and #50, puree meat of two ounces, three ounces of vegetable and three ounces of starch. The serving utensils were not completely filled to an accurate measurement. There was no written food spreadsheet noted during the meal service. Interview on 03/07/24 at 12:17 P.M., of DA's #45 and #50 verified there was no written spreadsheet available for the staff to reference, and they knew what the food portions were supposed to be since they had worked at the facility so long. DA #50 verified she did not completely fill the serving utensils when measuring out the food, as some residents did not want that much food. DA #50 verified the meal ticket did not indicate small portions as a preference, but just knew the residents wanted less food. Interview on 03/07/24 at 12:40 P.M., Diet Manager (DM) # 40 verified the puree texture portions were incorrect for Residents #21, #35, #39 and #47 and the DA's #45 and #50 should have served the puree texture portions as listed on the menu spreadsheet. DM #40 verified there was no spreadsheet available for the staff to reference, and no serving portion chart available for portion control accuracy during the meal service. DM #40 confirmed the facility has spread sheets and staff were not utilizing them. Review of policy titled Portion Control, dated 2019, revealed the residents will receive the appropriate portions of food as outlined on the menu. Control at the point of service is necessary to (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 2 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 03/12/2024 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)