Inspection visit
Health inspection
2 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 2 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0812
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Many
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve
food in accordance with professional standards.
Based on observation, interview, review of facility policy, and review of the 2022 Food Code, the facility
failed to ensure dietary staff performed hand hygiene as directed by the facility policy, and failed to ensure
milk was held on the tray line at 41 degrees Fahrenheit (F) or less. This had the potential to affect all
residents. The facility census was 102.
Findings include:
1. During an observation of the lunch tray line on 05/13/2025 from 12:09 P.M. to 12:12 P.M., Dietary Aide
(DA) #18, while waiting for the meal tray line to begin, scratched the left side of her head with her left hand,
scratched the right side of her head with her right hand, put her hands in her pockets, then touched a plate,
touched her face, and took a plate from the cook and put it on a meal tray. DA #18 proceeded to scratch her
face, touch her clothes, and then took a sandwich from the refrigerator next to the meal tray line, placed the
sandwich on plate on a meal tray. DA #18 did not perform hand hygiene during this time.
During a concurrent observation and interview on 05/13/2025 at 12:17 P.M., DA #18 touched her pants and
scratched her head and then continued to participate on the lunch line without completing hand hygiene.
The Dietary Manager (DM) #19 stated DA #18 should wash her hands.
During an observation of breakfast tray line on 05/15/2025 at 7:38 A.M., DA #18 touched her face and then
the top of a plate and put the meal tray with the plate on the cart. DA #18 did not wash her hands after
touching her face. At 7:41 A.M., DA #18 touched her pants and her hair and continued to prepare plates for
residents' breakfast meal and put the plates on a meal cart. At 8:01 A.M., DA #18 spooned cream of wheat
into a container, put a top on it, and then put it on a meal tray. DA #18 proceeded to wipe her hands on her
pants. DA #18 did not complete hand hygiene during the observation.
During an interview on 05/15/2025 at 7:24 A.M., DA #18 stated she should wash her hands if she stepped
away from the meal tray line or touched anything.
During an interview on 05/16/2025 at 11:49 A.M., the Director of Nursing stated he expected staff to
sanitize their hands after touching clothing and things of that nature.
During an interview on 05/16/2025 at 11:13 A.M., the Administrator stated she expected staff to complete
hand hygiene according to the policy.
Review of an undated facility policy titled, Handwashing Procedure for Dining Services revealed, hand
hygiene continues to be the primary means of preventing the transmission of infection. The
(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 4
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
05/16/2025
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)
F 0812
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Many
handwashing procedure revealed, the following is a list of some situations that require hand hygiene, which
included, after blowing your nose, coughing, sneezing, or touching your hair, face, or clothes.
2. During a concurrent interview and observation of the breakfast tray line on 05/15/2025 at approximately
8:18 A.M., Dietary Aide (DA) #18 poured lactose free milk into seven cups to be served to residents. DA
#18 placed the seven glasses on the tray line and did not hold cups of milk in ice to maintain the
temperature. At the request of the surveyor, at 8:28 A.M., the Dietary Manager took the temperature of the
milk of the lactose free milk in each of the seven cups. The DM stated the temperature of the milk was 43
degrees Fahrenheit (F). and further added the facility could not serve the milk.
During an interview on 05/16/2025 at 11:49 A.M., the Director of Nursing stated his expectation was the
food was adequately heated, and the milk was at an appropriate temperature.
During an interview on 05/16/2025 at 11:13 A.M., the Administrator stated her expectation was the food
and drink temperatures were kept within acceptable and required temperature ranges.
Review of the 2022 Food Code published by the United States Food and Drug Administration, indicated,
(3-501.16) temperature control for the safety and hot and cold holding stated hot food shall be maintained
at 135 degrees Fahrenheit or higher and cold food items at 41 degrees Fahrenheit or less.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366389
If continuation sheet
Page 2 of 4
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
05/16/2025
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)
F 0842
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in
accordance with accepted professional standards.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
record review, resident and staff interview, the facility failed to transcribe a change of an advance directive
order. This affected one Resident (#2) of three residents reviewed for advance directives. The facility census
was 102.
Findings include:
Review of the medical record for Resident #2 revealed an admission date of [DATE]. According to the
admission record, Resident #2's code status was listed as a full code, meaning the resident wanted
cardiopulmonary resuscitation (CPR).
A quarterly Minimum Data Set (MDS), dated [DATE], revealed Resident #2 had a Brief Interview for Mental
Status (BIMS) score of 12, which indicated the resident had moderate cognitive impairment.
Review of Resident #2's current orders as of [DATE], revealed Resident #2 had an order dated [DATE],
indicating the resident's code status was a full code.
Review of Resident #2's care plan included a focus area for code status initiated [DATE] and revised
[DATE], that indicated Resident #2's code status was Do Not Resuscitate (DNR), Comfort Care.
Interventions directed staff to obtain the medical provider order for the residents' code status.
Review of Resident #2's DNR] Order Form, dated [DATE], indicated the resident's code status was DNR
Comfort Care.
Interview on [DATE] at 11:01 A.M., Resident #2 stated they were their own responsible party and wished to
have a DNR code status. The resident stated they no longer wanted to have full code status.
Interview on [DATE] at 3:23 P.M., Registered Nurse (RN) #1 stated a change in a resident's code status
should be updated by the management staff immediately in the resident's electronic health record (EHR).
RN #1 stated when she would receive a change in code status order, she notified the nurse practitioner, the
Director of Nursing (DON), and changed the order in the resident's EHR.
Interview on [DATE] at 7:36 P.M., the Director of Social Services (DSS) stated advanced directives were
reviewed with each resident annually to determine if they were still accurate. She stated if a resident wished
to change from full code to DNR, she met with the resident, consulted with responsible parties, and sent
the form to the physician. She stated changing a resident's code status in the EHR should be completed by
the nurses. She stated the resident's code status was changed a couple of weeks before she started
employment at the facility. She stated she expected the change in code status to be documented by the
social worker who was responsible and the paperwork to be forwarded to the nursing staff and physician so
the residents' orders and medical record could be updated.
Interview on [DATE] at 8:57 A.M., the DON stated that he expected a resident's code status to be updated
in the resident's EHR when the resident decided to change it. He stated the DSS was responsible for
making sure any change in code status were given to the nursing staff after all the forms were completed.
He stated Resident #2 signed their DNR in June of 2024 when the facility did not have a DSS. He stated it
was signed a couple of weeks before the current DSS started, and Resident #2's
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
366389
If continuation sheet
Page 3 of 4
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
05/16/2025
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)
F 0842
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
change in code status was missed. He stated the former medical records nurse should have uploaded the
resident's DNR form and changed their status in the EHR at that time and was unsure why it was not
completed.
Interview on [DATE] at 8:26 A.M., the Administrator stated she expected any changes to a resident's code
status should be updated in the EHR at that time.
Event ID:
Facility ID:
366389
If continuation sheet
Page 4 of 4
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Back to topCitations
2 citations recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F842 - Resident-identifiable information
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
F812 - Food safety requirements
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
FAQ · About this visit
Common questions about this visit
What happened during the May 16, 2025 survey of FOREST HILLS HEALTHCARE CENTER.?
This was a inspection survey of FOREST HILLS HEALTHCARE CENTER. on May 16, 2025. The surveyor cited 2 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at FOREST HILLS HEALTHCARE CENTER. on May 16, 2025?
Yes, 2 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with..."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
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Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.