Health inspection·October 16, 2023

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 medical record review, staff interview and policy review, the facility failed to ensure a resident was provided with appropriate assistance and supervision during bed mobility which resulted in the resident having an avoidable fall from the bed. This affected one (#23) out of four residents reviewed for accidents. Facility census was 61. Findings Include: Review of Resident #23's medical record revealed the resident was admitted to the facility on [DATE]. Diagnoses include chronic obstructive pulmonary disease, mood disorder, dementia, unsteady feet, and lack of coordination. Review of the comprehensive Minimum Data Set, (MDS) assessment dated [DATE] revealed Resident #23 had severely impaired cognition and was required total staff assistance for bed mobility, transfers, locomotion, dressing, toileting and personal hygiene. Review of plan of care for Resident #23 dated 08/07/23 revealed the resident required total care. Review of Resident #23 plan of care revealed there was an update on 09/21/23 which instructed staff to use two assist for bed mobility. Review of nursing progress note dated 09/17/23 at 1:00 A.M. revealed the State Tested Nurse Aide, (STNA) #50 reported to Registered Nurse, (RN) #56 that Resident #23 fell in his/her room. RN #56 found Resident #23 on the floor between the window and the bed, with the resident head at the foot of the bed. Resident #23 was alert and able to speak. Resident #23 complained of pain on left side of the head and body. Blood was noted under left side of face. The emergency squad transported Resident #23 to the hospital at 1:20 A.M. Resident #23's guardian and Director of Nursing, (DON) were notified. On 09/17/23 at 5:00 A.M., Resident #23 returned from the hospital with a band-aid over superficial laceration measuring 0.5 centimeters by 0.5 centimeters (cm) by (x) 0.1 cm on the left zygoma, (cheekbone). There was no bleeding and no other injuries. Review of hospital records dated 09/17/23 at 2:00 A.M. revealed the Resident #23 arrived at the emergency room with a head laceration from a fall. Resident #23 was alert and had dried blood to the left anterior forehead. Wound care was completed, and the resident departed the emergency room at 3:56 A.M. There were no follow-up orders. Review of the Interdisciplinary Team documentation of 09/18/23 at 12:03 P.M., revealed the fall follow up investigation revealed the STNA #50 informed the RN #56 of the Resident #23 fall. STNA #50 (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: 366427 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 366427 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Liberty Nursing Center of Colerain Inc 8440 Livingston Road Cincinnati, OH 45247 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)