Inspection·August 3, 2023

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, staff interview, and policy review, the facility failed to ensure oxygen was administered as ordered. This affected three Residents (#11, #12, and #13) out of four residents reviewed for working oxygen concentrators. The census was 108. Residents Affected - Few Findings include: 1. Review of Resident #11's medical record revealed Resident #11 was admitted on [DATE] with diagnoses including congested heart failure, acute kidney failure, and chronic respiratory failure. Review of the Discharge Return Anticipated Minimum Data Set (MDS) assessment, dated 07/19/23, revealed Resident #11 had moderate cognitive deficits and required extensive assistance with activities of daily living (adl). Review of Resident #11's care plan, dated 07/13/23, revealed Resident #11 had oxygen therapy related to congestive heart failure and respiratory failure with interventions to monitor for respiratory distress and to give medicine as ordered by the physician. Review of Resident #11's physician order, dated 07/31/23, revealed an order for oxygen at two liters per minute via nasal cannula continuously due to shortness of breath. Observation on 08/02/23 at 9:37 A.M. during medication administration revealed Resident #11's oxygen concentrator was set to four liters per minute. Observation on 08/02/23 at 11:53 A.M. revealed Resident #11's oxygen concentrator was set to four liters per minute. Interview on 08/02/23 at 11:54 A.M. with Licensed Practical Nurse (LPN) #20 verified Resident #11's physician order was for two liters per minute and reported that Resident #11's oxygen concentrator was on the wrong setting. 2. Review of Resident #12's medical record revealed Resident #12 was admitted on [DATE] with diagnoses including chronic obstructive pulmonary disease (COPD), congestive heart failure, sleep apnea, asthma, and respiratory disorders. Review of Resident #12's Annual MDS assessment, dated 07/11/23, revealed Resident #14 was cognitively intact and required extensive assistance with adls. (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: 366432 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 366432 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sanctuary Pointe Nursing & Rehabilitation Center 11501 Hamilton Avenue Cincinnati, OH 45231 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)