Health inspection·May 8, 2024

F 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure a resident's pain was addressed. This affected one resident (#29) of one resident reviewed for pain. The facility census was 52. Residents Affected - Few Findings include: Review of the medical record revealed Resident #29 admitted to the facility on [DATE] with diagnoses including hypertensive heart disease with heart failure, pulmonary hypertension, congestive heart failure, type two diabetes mellitus with diabetic neuropathy, hyperlipidemia, bipolar disorder, gastro esophageal reflux disease without esophagitis, post traumatic stress disorder, anemia, asthma, restless legs syndrome, obstructive sleep apnea, and major depressive disorder. Review of Resident #29's annual Minimum Data Set (MDS) assessment dated [DATE] revealed the resident was cognitively intact. Resident #29 received opioid medication during the review period and rated her worst pain over the past five days as a four out of ten. Review of Resident #29's opioid medication care plan dated 04/08/24 revealed Resident #29 used opioid medication for treatment of chronic pain. Interventions included administer opioid medication as ordered by the physician and monitor for side effects and effectiveness, the physician to review medications for possible dose reduction and monitor, document, and report as needed any adverse reactions of medications. Review of Resident #29's pain care plan dated 03/19/24 revealed Resident #29 had chronic pain due to neuropathy, an old injury of the back from a fall, radiculopathy lumbosacral region, restless leg syndrome, arthropathy, diabetes mellitus neuropathy, and chronic headaches. Interventions included administer analgesia and medication for treatment of pain per orders, evaluate the effectiveness of pain interventions, monitor and document for side effects of pain medication, monitor and record pain characteristics and monitor and report to nurse any signs and symptoms of nonverbal pain. Review of Resident #29's physician order dated 05/26/23 and discontinued 04/22/24 revealed Resident #29 was ordered Oxycodone 10 milligrams (mg) give two tablets by mouth two times a day for pain and give two tablets by mouth every eight hours as needed for pain. Review of Resident #29's physician order dated 04/08/24 revealed Resident #29 was ordered Oxycodone 10 mg give two tablets by mouth two times a day for pain and give two tablets by mouth every eight hours as needed for pain. Review of Resident #29's physician order dated 03/09/23 revealed Resident #29 was ordered Lyrica (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 6 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 05/08/2024 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)