Inspection·December 18, 2024

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, staff interview and policy review, the facility failed to ensure incontinence care was provided correctly. This affected one (#23) of three residents reviewed for incontinence. The census was 53. Findings included: Medical record review for Resident #23 revealed an admission date of 09/15/24. Medical diagnoses included Alzheimer's disease and dementia. Review of the care plan dated 09/15/23 for Resident #23 revealed he had bladder incontinence related to activity intolerance and dementia. Intervention was to cleanse the perineum (peri) area after each incontinence episode. Wash, rinse, and dry perineum after each episode. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #23 was moderately cognitively impaired. He was frequently incontinent with his bladder and always incontinent with his bowel. Observation of incontinence care on 12/17/24 at 8:50 A.M. revealed Certified Nursing Aide (CNA) #82 washed hands and placed gloves on. The resident was uncircumcised, and the resident had urinated and defecated in the brief. She tucked the brief to left side of the resident and took wipes and wiped in a downward motion on the right side, got another wipe and wiped down the left side of the resident and then got another wipe and brushed down the penis and then turned the resident over to cleanse the bottom area. Interview with the CNA #82 on 12/17/24 at 9:10 A.M. revealed she was trained in aide training to wipe the penis and the foreskin and the scrotum but when she was trained at the facility they didn't train her to do it that way. She said this wasn't her normal practice. Review of the policy entitled Perineal Care for a Male Resident revealed: a) wet the washcloth with warm water from a running spigot (or from a clean, disinfected bath basin) and apply mild soap. b) Hold the shaft of the penis in one hand. If the patient has an indwelling urinary catheter in place, use the other hand to clean the urethral meatus with the washcloth. (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: 366393 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 366393 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Otterbein at Maineville 201 Marge Schott Way Maineville, OH 45039 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)