Health inspection·May 2, 2023

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review, and policy review, the facility failed to notify family and physician timely after resident falls. This affected one (Resident #29) of three residents sampled for falls. The facility census was 96. Findings include: Review of the medical record for Resident #29 revealed an admission date of 03/24/2023. Diagnoses included but were not limited to stage II pressure ulcer of the sacral region, unspecified chronic obstructive pulmonary disease (COPD), and unspecified displaced fracture of the sixth cervical vertebra. Review of the most recent Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had severely impaired cognition, had no behaviors, did not reject care, and did not wander. Resident #29 was a one-person physical assist, required total assistance with toileting, and required extensive assistance with all other ADL's. Review of the care plan dated 03/24/23 revealed Resident #29 was at risk for falls related to actual fall. Interventions included one-to staff-supervision, bed in lowest position, initiate neuro checks if a fall is unwitnessed, medication review, move resident closer to the nurse's station, place call light in reach, and remind resident to use call light for assistance. Review of the medical record revealed on 03/26/23 at 5:30 P.M. Resident #29 fell in his room, sustaining a bleeding laceration and hematoma to the forehead. There was no documentation that the doctor was notified. The progress note documented the nurse cleaned the wound, applied an ice pack, and reported the fall to the oncoming nurse. Resident #29's vital signs were stable and the resident was not alert and oriented to respond on his behalf to what led to the fall. During a telephone interview on 05/01/23 at 4:31 P.M., Licensed Practical Nurse (LPN) #119 stated Resident #29 had only fallen once on her shift on 03/26/23 around 5:30 P.M. LPN #119 stated she initiated neurological (neuro)checks and cleaned the resident's head wound. LPN #119 confirmed she did not notify the physician or family of the fall. During an interview on 05/01/2203 at 4:18 P.M. the Director of Nursing verified there was no evidence that the physician or family had been notified of the fall with head injury, and Resident #29 was not sent to the hospital until 03/26023 at 11:30 P.M. Page 1 of 10 366389 366389 05/02/2023 Forest Hills Healthcare Center. 8700 Moran Road Cincinnati, OH 45244

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of policy titled Fall Prevention and Management, revised 06/01/22, revealed neuro checks were initiated if a resident hit their head or had an unwitnessed fall and both family and physician were to be notified after a fall. This deficiency represents non-compliance investigated under Complaint Numbers OH00141684 and OH00141751. 366389 Page 2 of 10 366389 05/02/2023 Forest Hills Healthcare Center. 8700 Moran Road Cincinnati, OH 45244

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review, and policy review, the facility failed to report allegations of abuse to the state agency in a timely manner. This affected two (Residents #23 and #53) of three sampled residents. The facility census was 96. Findings include: 1. Review of the medical record for Resident #23 revealed an admission date of 10/15/22. Diagnoses included chronic obstructive pulmonary disease (COPD), cognitive communication deficit, and unspecified anxiety disorder. Review of the most recent Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had moderately impaired cognition, had no behaviors, did not wander, and rejected care one to three out of seven days per week. Resident was a one to two-person physical assist and required extensive assistance with activities of daily living. During an interview on 04/27/23 at 1:49 P.M. the Administrator stated approximately five or six months ago Social Worker (SW) #241 reported to him concerns for abuse involving Resident #23 and a Promedica Hospice aide. The administrator stated he did not feel the facility needed to complete an self reported incident because Promedica Hospice completed their own internal investigation and did not substantiate abuse. 2. Review of the medical record for Resident #53, specified, revealed an admission date of 09/21/22. Diagnoses included unspecified fracture of T 9-T 10 vertebra, COPD, and generalized anxiety disorder. Review of the most recent MDS assessment dated [DATE] revealed the resident had moderately impaired cognition, had no behaviors, did not reject care, and did not wander. Resident #53 was a one-person physical assist and required limited to extensive assistance with activities of daily living. During an interview on 04/26/23 at 11:56 A.M., Resident #53 stated she had reported concerns of abuse last week to an unidentified female staff with long dark hair who wore black pants with black and white sweater. The resident stated last week, date not specified, a black male nurse on night shift grabbed her arm and bruised it then told her he would not give her any medications. The resident stated the lady with dark hair said she would take care of it but he was still working and she did not feel safe. During an interview on 04/27/23 at 1:49 P.M. the Administrator stated he had not received any allegations about Resident #53 regarding abuse, and identified the specified perpetrator as Licensed Practical Nurse (LPN) #108, the only staff on night shift who matched the resident's description. During an interview on 05/01/2023 at 1:18 P.M., the Administrator verified he had not reported allegations of abuse for Resident #23 and #53 until 05/01/23. Review of the facility policy titled Ohio Abuse, Neglect & Misappropriation, dated 04/01/19, revealed allegations of abuse would be reported timely to the state agency as required and would be 366389 Page 3 of 10 366389 05/02/2023 Forest Hills Healthcare Center. 8700 Moran Road Cincinnati, OH 45244

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few thoroughly investigated. Further review of the facility policy revealed employees alleged or accused of being a party of abuse would be immediately removed from the area(s) of resident care, interviewed by facility leadership for a written statement and not left alone. The employee would not be permitted to be alone in the facility at any time until the investigation is complete. In the event the alleged perpetrator is a staff member that staff member will be removed from areas of resident living and interviewed by nurse on duty. The staff member will be escorted off of the premises by another staff member. The accused staff member will be suspended by the Executive Director or designee pending the outcome of the investigation. Removing the staff member serves to protect the staff member from further accusation, the resident from additional, potential abuse, and the other residents from potential abuse. This deficiency represents non-compliance investigated under Complaint Numbers OH00141751 and OH00141684. 366389 Page 4 of 10 366389 05/02/2023 Forest Hills Healthcare Center. 8700 Moran Road Cincinnati, OH 45244

F 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review and policy review, the facility failed to investigate allegations of physical abuse. This affected two (Residents #23 and #53) of three residents reviewed. The facility census was 96. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #23 revealed an admission date of 10/15/22. Diagnoses included chronic obstructive pulmonary disease (COPD), cognitive communication deficit, and unspecified anxiety disorder. Review of the most recent Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had moderately impaired cognition, had no behaviors, did not wander, and rejected care one to three out of seven days per week. Resident was a one to two-person physical assist and required extensive assistance with activities of daily living. During an interview on 05/01/2023 at 2:11 P.M. Social Worker #241 stated 2:11 P.M. SW stated she was present in the conference room when former Administrator in Training (AIT) #210 reported to the Administrator that Promedica Hospice reported one of their aides had been rough with Resident #23 during care. SW #241 stated she scheduled a meeting on 03/17/23 with Promedica Hospice staff and invited AIT #210, the Administrator, Admissions #238, and Registered Nurse (RN) #236. SW #241 attended the meeting with Admissions #238 and RN #236; AIT #210 and the administrator were unable to attend. Promedica Hospice alleged their aide, unidentified was rough with Resident #23 during care around her scalp. They said something about bruising on her arms. Promedica sent a nurse out to investigate Resident #23 and two additional residents (#28 and #67) who received Promedica Hospice services. There were no significant findings to substantiate abuse, and they said Resident #23 had age-related bruising. Promedica investigated and asked if these residents had any concerns, but Forest Hills did not complete an investigation. 2. Review of the medical record for Resident #53, specified, revealed an admission date of 09/21/22. Diagnoses included unspecified fracture of T 9-T 10 vertebra, COPD, and generalized anxiety disorder. Review of the most recent MDS assessment dated [DATE] revealed the resident had moderately impaired cognition, had no behaviors, did not reject care, and did not wander. Resident #53 was a one-person physical assist and required limited to extensive assistance with ADL's. During an interview on 04/26/23 at 11:56 A.M. Resident #53 stated she had reported concerns of abuse last week to an unidentified female staff with long dark hair who wore black pants with black and white sweater. The resident stated last week, date not specified, a black male nurse on night shift grabbed her arm and bruised it then told her he would not give her any medications. The resident stated the lady with dark hair said she would take care of it but he was still working and she did not feel safe. During an interview on 04/27/23 at 1:49 P.M. the Administrator stated he had not received any allegations about Resident #53 regarding abuse, and identified the specified perpetrator ad LPN #108, the only staff on night shift who matched the resident's description. 366389 Page 5 of 10 366389 05/02/2023 Forest Hills Healthcare Center. 8700 Moran Road Cincinnati, OH 45244

F 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 05/01/23 at 1:18 P.M., the administrator verified he had not begun investigations for abuse concerning allegations regarding Resident #23 and #53 until 05/01/23. Review of the facility policy titled Ohio Abuse, Neglect & Misappropriation dated 04/01/19 revealed allegations of abuse would be reported timely to the state agency as required and would be thoroughly investigated. Further review of the facility policy revealed employees alleged or accused of being a party of abuse would be immediately removed from the area(s) of resident care, interviewed by facility leadership for a written statement and not left alone. The employee would not be permitted to be alone in the facility at any time until the investigation is complete. In the event the alleged perpetrator is a staff member that staff member will be removed from areas of resident living and interviewed by nurse on duty. The staff member will be escorted off of the premises by another staff member. The accused staff member will be suspended by the Executive Director or designee pending the outcome of the investigation. Removing the staff member serves to protect the staff member from further accusation, the resident from additional, potential abuse, and the other residents from potential abuse. This deficiency represents non-compliance investigated under Complaint Numbers OH00141751 and OH00141684. 366389 Page 6 of 10 366389 05/02/2023 Forest Hills Healthcare Center. 8700 Moran Road Cincinnati, OH 45244

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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 interview, record review, and policy review, the facility failed to ensure residents were given timely and appropriate care after falls. This affected one (Resident #29) of three residents sampled for falls. The facility census was 96. Findings include: Review of the medical record for Resident #29 revealed an admission date of 03/24/23. Diagnoses included stage II pressure ulcer of the sacral region, chronic obstructive pulmonary disease and displaced fracture of the sixth cervical vertebra. Review of the care plan dated 03/24/23 revealed Resident #29 was at risk for falls related to actual fall. Interventions included one-to staff-supervision, bed in lowest position, initiate neuro checks if a fall is unwitnessed, medication review, move resident closer to the nurse's station, place call light in reach, and remind resident to use call light for assistance. Additionally, Resident #29 had a behavior problem of trying to get out of bed resulting in two falls. Interventions included administer medications as ordered, monitor/document side effects/effectiveness of medications. Review of the most recent Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had severely impaired cognition, had no behaviors, did not reject care, and did not wander. Resident #29 was a one-person physical assist, required total assistance with toileting, and required extensive assistance with all other activities of daily living. Review of the medical record revealed Resident #29 had physician orders for apixaban, a blood thinner, 2.5 milligrams (mg) mg by mouth twice daily. Review of the progress note dated 03/26/23 at approximately 5:30 P.M. documented Resident #29 fell in his room sustaining a bleeding laceration and hematoma to the forehead. There was no documentation that the doctor was notified. Progress notes documented the nurse cleaned the wound, applied an ice pack, and reported the fall to the oncoming nurse. Resident #29's vital signs were stable and the resident was not alert and oriented to respond on his behalf to what led to the fall. Review of the progress note dated 03/26/2023 at 11:15 P.M. revealed the on-call provider documented Resident #29 was on Eliquis 5 mg and was confused, a change in baseline status post fall with head injury earlier in the day. New orders were given to send Resident #29 to the hospital for evaluation and treatment including a computed tomography (CT) scan of the head. The progress note dated 03/27/23 at 12:37 A.M. documented the night shift nurse stated Resident #29 had a fall on the day shift with a head injury. The nurse stated Resident #29 was normally very active and responsive, but he was acting tired. The provider was notified and gave new orders for Resident #29 to be evaluated at the emergency room. Resident #29 left the facility 03/26/23 at 11:30 P.M. Review of document titled Neuro Checks dated 03/26/23 revealed Resident #29 was assessed on 03/26/23 at 5:30 P.M., 5:45 P.M., 6:00 P.M. 6:15 P.M., and 7:15 P.M. During an interview on 04/27/23 at 2:29 P.M., State Tested Nursing Assistant (STNA) #276 stated 366389 Page 7 of 10 366389 05/02/2023 Forest Hills Healthcare Center. 8700 Moran Road Cincinnati, OH 45244

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident #29 had two falls in his room within two hours of each other on 03/26/23. The first time he fell trying to get out of bed and had no injury. The second time the resident fell, he had a small bleeding laceration with a hematoma forming to his left forehead. After the second fall, STNA #276 stated she and Licensed Practical Nurse (LPN) #119 put the resident in his wheelchair, cleaned his wound, and put the resident in the hallway near the desk between the units on rehab. Resident #29 was alert to himself with confusion at baseline, but the resident appeared more confused than usual after the second fall. During a telephone interview on 05/01/23 at 4:31 P.M., LPN #119 stated Resident #29 had only fallen once on her shift on 03/26/23 around 5:30 P.M. LPN #119 stated she initiated neuro checks and cleaned the resident's head wound. LPN #119 confirmed she did not notify the physician or family of the fall. During an interview on 05/01/23 at 4:18 P.M., the Director of Nursing (DON) verified the facility had no additional evidence that hourly neuro checks were completed for Resident #29 on 03/26/2023 after 7:15 P.M. until the resident was sent out to the hospital. The DON verified there was no evidence that the physician had been notified of the fall with a head injury, and Resident #29 was not sent to the hospital until 03/26/23 at 11:30 P.M. Review of policy titled Fall Prevention and Management, revised 06/01/22, revealed neuro checks were initiated if a resident hit their head or had an unwitnessed fall and both family and physician were to be notified after a fall. This deficiency represents non-compliance investigated under Complaint Numbers OH00141684 and OH00141751. 366389 Page 8 of 10 366389 05/02/2023 Forest Hills Healthcare Center. 8700 Moran Road Cincinnati, OH 45244

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observation, interview, record review, and policy review, the facility failed to have medications available to administer as ordered. This affected two (Residents #8 and #15) of four residents sampled for medications. The facility census was 96. Findings include: Review of the medical record revealed Resident #8 had physician orders for routine medications including quetiapine 25 mg by mouth three times daily. Review of the medical record revealed Resident #15 had physician ordered for routine medications including Januvia 25 mg by mouth once daily. During observation of medication administration on 04/27/23 from 8:59 A.M. to 10:16 A.M. revealed Resident #8's Seroquel 25 mg and Resident #15's Januvia 25 mg were unavailable and not administered during med pass. During an interview on 04/27/2023 at 10:16 A.M. LPN #101 verified Seroquel and Januvia medications were not available in the medication cart or in the emergency drug supply and would have to be reordered from pharmacy. Review of policy titled Medication Administration undated revealed medications should be administered per physician's orders. This deficiency represents non-compliance investigated under Complaint Numbers OH00142373, OH00142334, OH00142141, OH00141751 and OH00141684. 366389 Page 9 of 10 366389 05/02/2023 Forest Hills Healthcare Center. 8700 Moran Road Cincinnati, OH 45244

F 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure the medication error rate was less than five percent. 24 opportunities with two errors were observed for a medication error rate of 8.33 percent. This affected two (Residents #98 and #15) of five residents observed during medication administration. The facility census was 96. Residents Affected - Few Findings include: Review of the medical record revealed Resident #8 had physician orders for routine medications including Seroquel 25 mg by mouth three times daily. Review of the medical record revealed Resident #15 had physician ordered for routine medications including Januvia 25 mg by mouth once daily. Observation on 04/27/2023 from 8:59 A.M. to 10:16 A.M. revealed Licensed Practical Nurses (LPN's) #101 and #134 delivered twenty-two out of twenty-four ordered medications to five residents (Residents #5, #8, #15, #18, and #22). There were two medications not given because they were unavailable: Resident #8's Seroquel 25 mg and Resident #15's Januvia 25 mg, creating a medication error rate of 8.33%. During an interview on 04/27/2023 at 10:16 A.M., Licensed Practical Nurse (LPN) #101 verified Seroquel and Januvia medications were not available in the medication cart or in the emergency drug supply and would have to be reordered from pharmacy. Review of policy titled Medication Administration undated revealed medications should be administered per physician's orders. This deficiency represents non-compliance investigated under Complaint Numbers OH00142141, OH00141684, and OH00141751. 366389 Page 10 of 10