Health inspection·January 31, 2025

F 0573 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Let each resident or the resident's legal representative access or purchase copies of all the resident's records. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, and facility policy review, the facility failed to provide copies of resident records as requested and per requirements. This affected one (Resident #110) of three residents reviewed for medical records request. The census was 108. Findings Include: Resident #110 was admitted to the facility on [DATE]. Her diagnoses were other specified fracture of left pubis, unspecified fall, anemia, hypertension, cognitive communication deficit, hypothyroidism, hyperlipidemia, syncope and collapse, osteoporosis, vitamin D deficiency, osteoarthritis, hypotension, and muscle weakness. Review of her minimum data set (MDS) assessment, dated 07/31/24, revealed she was cognitively intact. Review of Resident #110 progress notes, dated 07/25/24 to 08/21/24, revealed she was discharged from the facility on 08/21/24. There was no documentation to support a request of medical records. Review of facility Authorization for the Release of Health Information form, dated 01/13/25, revealed Resident #110 signed this document to request a copy of her complete medical records. The records were to be sent to an attorney's office. There was no documentation to support this request had been addressed and/or completed. Interview with Administrator on 01/31/25 at 2:50 P.M. confirmed the request had not been completed. She confirmed the facility received a request for Resident #110's complete medical records, which was signed by Resident #110, on 01/13/25. She confirmed the facility's typical process was to receive a written request for medical records, have the request sent to their legal department to verify the authenticity of the request/signature(s), and then within 30 days, start processing the medical records request. Review of facility Releasing Clinical Records procedures, undated, revealed the facility will only release confidential information to authorized persons/entities, and only in accordance with facility policy, federal, and state laws. The procedure includes the following: a written request if required, requires a properly executed authorization unless not required by law, complete the Authorization for Release of Health Information form, and the requested documents are produced and released in compliance with HIPAA regulations. The Authorization for Release of Health Information form is to be completed and emailed back to the facility. The resident may access his/her electronic record. A staff member is to accompany the resident during the inspection process. If a resident requests a copy of his/her record, the record will be provided in compliance with regulations. If a family member is (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: 366389 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 366389 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Forest Hills Healthcare Center. 8700 Moran Road Cincinnati, OH 45244 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)