Health inspection·February 13, 2025

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, and policy review, the facility failed to ensure resident records were updated to reflect a change in their advance directives. This affected one Resident (#52) of the eight residents reviewed for advance directives. The facility census was 66. Findings include: Review of the medical record for Resident #52 revealed an admission date of 10/29/24. Diagnoses included quadriplegia, cerebral infarction, congestive heart failure (CHF), paroxysmal atrial fibrillation, unspecified severe protein-calorie malnutrition, chronic obstructive pulmonary disease (COPD), anemia, insomnia, and anxiety disorder. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE], revealed Resident #52 had moderately impaired cognition. Resident #52 was assessed to be dependent on staff for eating, oral hygiene, toileting, bathing, dressing, personal hygiene, bed mobility, and transfer. Review of the physician orders in the electronic medical record (EMR) for Resident #52 dated 12/27/24 revealed the resident was to be a full code. Review of the completed Do Not Resuscitate (DNR) form dated 01/29/25, revealed Resident #52 had an advance directive of DNR Comfort Care - Arrest (DNR-CCA). Interview on 02/12/25 at 10:27 A.M. with Assistant Director of Nursing (ADON) #42, revealed she updated Resident #52's advance directive to reflect the DNR order. ADON #42 stated the hospice provider uploaded the DNR form into Resident #52's medical record, and the facility was unaware the change in advance directive had occurred. Review of the policy titled Advance Directives, revised 12/2016, revealed information about whether or not the resident has executed an advance directive shall be displayed prominently in the medical record. 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 3 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 02/13/2025 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)