Health inspection·March 28, 2024

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm Based on medical record, observation, staff interview, and review of the facility policy the facility failed to timely implement treatment orders for residents with skin breakdown. This affected one (Resident #17) of three residents reviewed for skin breakdown. The facility census was 46. Residents Affected - Few Findings include: Review of the medical record for Resident #17 revealed an admission date of 06/15/23 with diagnoses including dementia, chronic obstructive pulmonary disease (COPD), and major depressive disorder. Review of the Minimum Data Set (MDS) assessment for Resident #17 dated 12/22/23 revealed the resident had moderate cognitive impairment, required supervision with eating and was dependent on staff for toileting, bathing, and transfers. Review of the care plan for Resident #17 dated 02/07/24 revealed the resident had an arterial/ischemic ulcer between the right great toe and second toe. Interventions included the following: assess for pain and administer medications as ordered, staff to inspect feet daily and report any changes to the nurse, staff to monitor and document wound including size, depth, margins, and peri wound skin, staff to complete treatments per physician order, staff to keep feet clean and dry. Review of the wound assessment for Resident #17 dated 01/29/24 revealed the resident had an arterial ulcer on the right foot between the great toe and second toe. The ulcer measured 0.3 centimeters (cm) in length by 0.5 cm in width by 0.1 cm in depth. The plan was to apply Betadine moistened gauze between right great toe and second toe twice daily. Review of the physician order for Resident #17 dated 02/05/24 revealed an order to apply Betadine moistened and fluffed gauze to the ulcer between the right great and the second toe two times a day. Review of the physician order for Resident #17 dated 02/12/24 revealed an order to cleanse the area to great and second toe with soap and water, pat dry, apply Betadine fluffed gauze to ulcer between the right great toe and the second toe, and cover with gauze two times a day. Review of the January 2024 and February 2024 physician orders for Resident #17 revealed there was no treatment order initiated for the arterial ulcer between the resident's right great toe and second toe until 02/05/24. Review of the Treatment Administration Record (TAR) for Resident #17 dated February 2024 revealed the treatment order dated 02/05/24 was not documented in the TAR. There was no treatment documented for Resident #17's ulcer until 02/12/24. (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 03/28/2024 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)