Inspection·December 12, 2023

F 0580 on weekends and he would not be called directly. An on-call physician would be called. Level of Harm - Minimal harm or potential for actual harm During an interview on [DATE] at 4:41 P.M. the Administrator confirmed the Hospice recommendation of a STAT chest X-ray was faxed to the physicians office. The Administrator confirmed the fax was sent on Sunday, [DATE] and would not be have been addressed until Monday, [DATE]. The Administrator confirmed Resident #110's physician was not called regarding her significant change in condition on [DATE]. Residents Affected - Few Review of the facility's policy titled Change in Resident Condition, Family and Physician Notification dated [DATE] revealed the physician and responsible party will be notified in a timely manner regarding any significant change in a resident's physical, mental, or psychosocial status (which warrants an alteration in treatment, possible transfer to an acute care setting, or discharge from the facility) regardless of code status. The nurse will notify the resident, the resident's attending physician and responsible party when there has been a significant change in the resident's physical, emotional or psychosocial status. A significant changes are defined as a decline or deterioration in health, mental or psychosocial status in either life-threatening situations or clinical complications. This deficiency represents non-compliance investigated under Complaint Number OH00148377. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366432 If continuation sheet Page 2 of 4 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 12/12/2023 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)

F 0849 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff and physician interviews and policy review, the facility failed to coordinate hospice care to ensure hospice recommendations were timely implemented. This affected one (#110) of three residents reviewed for death. The census was 108. Findings include: Review of Resident #110's closed medical record revealed an admission date of [DATE]. Diagnoses included diverticulosis, hypertension, atrial fibrillation, carotid stenosis, congestive heart failure, and chronic obstructive pulmonary disease. Resident #110 passed away in the facility on [DATE]. Review of a quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #110 had severe cognitive impairment and was receiving Hospice services. Review of progress notes dated [DATE] at 10:41 A.M. revealed Resident #110's oxygen (O2) level was ar 79 percent (%) on four liters upon waking. A breathing treatment was administered. Supervisor and Hospice were notified of the low O2 level. Review of progress notes dated [DATE] at 4:33 P.M. revealed Resident #110's Granddaughter was notified. Hospice nurse was in to see Resident #110. Hospice recommendations were STAT (urgent) chest X-ray and breathing treatment routinely every four hours. Order was faxed to physician and were awaiting a response. Review of a calender revealed [DATE] was a Sunday. Review of progress notes dated [DATE] at 5:49 A.M. revealed Resident #110 expired at 5:40 A.M. Director of Nursing (DON) and physician were made aware. Further review of Resident #110's closed medical record revealed no documentation of a chest X-ray being completed before Resident #110's death on [DATE]. No documentation was found of Resident #110's physician being notified of Resident #110's low O2 level or the Hospice recommendations on [DATE]. During a phone interview on [DATE] at 3:51 P.M. Physician #200 stated faxes to this office on weekends would not be addressed until Monday. Physician #200 stated an on-call physician service was used on weekends and he would not be called directly. An on-call physician would be called. During an interview on [DATE] at 4:41 P.M. the Administrator confirmed the Hospice recommendation of a STAT chest X-ray was faxed to the physicians office. The Administrator confirmed the fax was sent on Sunday, [DATE] and would not be have been addressed until Monday, [DATE]. The Administrator confirmed the physician was not called on [DATE]. Review of a facility policy titled Hospice Services, Coordination, revised [DATE] revealed when a resident chooses to receive hospice care and services, the facility will coordinate and provide care in cooperation with hospice staff in order to promote the resident ' s highest practicable physical, mental, and psychosocial well-being. The facility and hospice provider will coordinate a plan of care and will implement interventions in accordance with the resident ' s needs, goals, and recognized (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366432 If continuation sheet Page 3 of 4 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 12/12/2023 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)

F 0849 Level of Harm - Minimal harm or potential for actual harm standards of practice in consultation with the resident ' s attending physician/practitioner and resident ' s representative, to the extent possible. This deficiency represents non-compliance investigated under Complaint Number OH00148377. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366432 If continuation sheet Page 4 of 4