Health inspection·December 16, 2025

F 0805 Level of Harm - Actual harm Residents Affected - Few called for assistance with CPR initiated and 911 called. He was subsequently transferred to the hospital. The facility took corrective actions but did not substantiate neglect. Review of the hospital discharge paperwork for Resident #1 dated 12/09/25 revealed he was admitted from 12/04/25 through 12/09/25 with a diagnosis of cardiac arrest and pneumonitis to due inhalation of food and vomit. He was released with a diet order of a regular diet with pureed texture and moderately thick liquids. During an interview on 12/15/25 at 1:30 P.M., the Administrator and Director of Nursing (DON) confirmed all staff were trained on 11/20/25 verifying diet orders prior to serving meals in anticipation of the upcoming holiday dinner. On 12/04/25 the facility had a holiday dinner which included turkey and mashed potatoes. SW #303 heard staff state Resident #1 had not yet received a plate and she thought he would enjoy the garlic mashed potatoes, so she made him a plate and provided it without checking his diet order. About two minutes later she brought him a napkin and he was fine. About six minutes later an aide brought the correct diet to him not knowing he had been provided the wrong diet and found him unresponsive. She called for the nurse who began CPR and he was sent out to the hospital where he was on a ventilator in the intensive care unit (ICU) a couple of days and then returned to the facility with his diet downgraded to pureed. There were no other residents provided the wrong diet texture during this holiday meal on 12/04/25. During an interview on 12/15/25 at 3:38 P.M., Registered Nurse (RN) #168 stated revealed they were having a holiday dinner, and the social worker was assisting with ensuring all residents received a meal so she brought Resident #1 a plate of food without checking his diet order. A few minutes later CNA #125 brought Resident #1 a plate with the correct diet texture unaware he had already been provided a plate and found him unresponsive. CNA #125 immediately contacted RN #168 who assisted her with lowering Resident #1 to the floor. She assessed him found he was choking on food and assisted with clearing his airway. She was then not able to find a pulse and began CPR which she continued until EMS arrived. She stated EMS reported he had regained a pulse when they were leaving. During an interview on 12/15/25 at 4:02 P.M. CNA #125 stated as she was preparing a plate for Resident #1 with his correct diet, the social worker brought him a plate with a regular texture. She stated she was not aware he had been given the incorrect plate of food until she took him the food and found him unresponsive. She immediately called for the nurse and assisted with lowering him to the floor so the nurse could begin CPR while she called 911. Review of the policy titled Neighborhoods Diet, revised 12/02/21, revealed that a minced and moist diet consisted of a regular diet with textured altered for those with difficulty swallowing and/or chewing. Food can be eaten with fork or spoon, scooped or shaped onto the plate in a ball, soft and moist with no separate thin liquids, minimal chewing. Meat is finely minced or chopped. Fruit mashed or drained of excessive juice, vegetables finely minced or chopped or mashed, cereal very thick and smooth, and no regular dry bread. The deficient practice was corrected on 12/05/25 when the facility implemented the following corrective actions: - - On 12/04/25 Resident #1 was immediately assessed by RN #168 and CPR was initiated and he was sent to the hospital - - On 12/04/25 RN #151and Assistant Director of Nursing (ADON #168) conducted an audit and assessment of all residents either through interview or physical assessment with no concerns. - - -On 12/04/25 Education was sent by the Administrator to all staff via an email system and in-person training was completed by the Administrator, the Assistant Administrator (AA #181) and the DON with all staff regarding how to verify diet orders and the importance of following them. Staff not trained by 12/05/25 was not permitted to work until education was completed. - -On 12/04/25 All resident records were audited by the [NAME] President of Operations (VPoO #306) and the DON to identify anyone who currently required any type of modified diet to ensure it was correctly listed and to clarify the level of supervision needed with meals for each (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366393 If continuation sheet Page 2 of 3 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 12/16/2025 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)

F 0805 Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete resident. No one else in the same house identified. - -On 12/05/25 A root cause analysis was completed by VPoO #306, AA #181 and the DON regarding the incident and statements were obtained from all staff present. The root cause analysis revealed Social Worker (SW) #303 had not reviewed the diet orders before serving the food. Staff present were RN #168, LPN #142, SW #303, and CNA #104 and #125. - - -On 12/05/25 A Quality Assurance Performance Improvement (QAPI) meeting was held with the Medical Director to discuss the incident and action plan. Members in attendance were the Medical Director, Administrator, DON, RN #168, SW #303 and the Director of Rehab/SLP #290. - -On 12/05/25, SW #303 was terminated from the facility. - -On 12/06/25, two random audits were conducted by the DON daily to ensure the diet books had the correct diet orders and residents received the correct orders and level of supervision needed. The audits consisted of two residents each day for two weeks, two residents a week for two weeks and then two residents a month for two months. This deficiency represents non-compliance investigated under Master Complaint Number 2690997 and Complaint Number 2689516. Event ID: Facility ID: 366393 If continuation sheet Page 3 of 3