Harrison Pavilion Care Center

F 0580

transfer the resident to a hospital/treatment center.This deficiency represents non-compliance investigated under Complaint Number 2622250.

Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Harrison Pavilion Care Center

2171 Harrison Avenue Cincinnati, OH 45211

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 0686 Level of Harm - Actual harm

prominences including the sacrum, ischial tuberosity, greater trochanters and heels and each time the patient was repositioned was an opportunity to conduct a brief skin assessment.This deficiency represents non-compliance investigated under Complaint Number 2622250.

Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Harrison Pavilion Care Center

2171 Harrison Avenue Cincinnati, OH 45211

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 0760

Ensure that residents are free from significant medication errors.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

record review, staff interviews, review of pharmacy records, and policy review, the facility failed to ensure residents were free from significant medication errors. This affected one (Resident #45) of three resident reviewed for medication administration. The facility census was 78.Findings include:Review of the medical

record for Resident #45 revealed an admission date of 03/19/24. Diagnoses included hyperosmolality and hypernatremia, major depressive disorder, and pressure ulcer of the sacral region.Review of the Quarterly Minimum Data Set (MDS) assessment dated [DATE REDACTED], revealed Resident #45 had moderate cognitive impairment as evidenced by a Brief Interview for Mental Status (BIMS) score of 10. Review of the physician order dated 11/11/25, revealed Resident #45 was ordered Meropenem (antibiotic) Intravenous (IV) Solution Reconstituted one gram (gm), use one gram intravenously every eight hours for infected sacral wound for 14 days.Review of the Pharmacy Delivery Receipt dated 11/11/25, revealed Resident #45 received 24 bags (an 8-day supply) of Meropenem IV solution.Review of the November 2025 medication administration

record (MAR), revealed Resident #45 did not receive IV Meropenem IV solution on 11/14/25 at 9:00 P.M., 11/15/25 at 5:00 A.M., 1:00 P.M., and 9:00 P.M., 11/16/25 at 5:00 A.M., 1:00 P.M., and 9:00 P.M., and 11/17/25 at 5:00 A.M.Review of the pharmacy progress note dated 11/15/25 at 4:55 A.M., revealed Resident #45 did not receive Meropenem IV solution because the medication was on order.Review of the pharmacy progress note dated 11/15/25 at 11:09 P.M., revealed Resident #45 did not receive Meropenem IV solution because the medication was on order. Review of the pharmacy progress note dated 11/16/25 at 5:11 A.M., revealed Resident #45 did not receive Meropenem IV solution because the medication was on order. Review of the pharmacy progress note dated 11/16/25 at 4:15 P.M., revealed Resident #45 did not receive Meropenem IV solution because the medication was on order. Review of the pharmacy progress note dated 11/16/25 at 8:41 P.M., revealed Resident #45 did not receive Meropenem IV solution because medication on order at pharmacy.Review of the pharmacy progress note dated 11/17/25 at 4:52 A.M., revealed Resident #45 did not receive Meropenem IV solution because the medication was on order.

Review pf the pharmacy delivery receipt dated 11/18/25, revealed Resident #45 received 21 bags (a seven-day supply) of Meropenem IV solution.During an interview on 11/26/25 at 8:07 A.M., Pharmacy Representative (PR) #100, stated an order was submitted on 11/11/25 for Meropenem IV solution. PR #100 reported a seven-day supply (24 bags) was sent on 11/11/25. PR #100 also reported a seven-day supply (21 bags) was sent on 11/18/25.During an interview on 11/26/25 at 9:27 A.M., the Director of Nursing (DON) verified Resident #45 missed doses of Meropenem on 11/14/25, 11/15/25, 11/16/25, and 11/17/25.During an interview on 11/26/25 at 1:05 P.M., the DON stated Resident #45 was not given IV Meropenem on the above days because an agency nurse was working and didn't ask where the IV medications were stored.Review of the facility policy titled, Administering Medications, revised April 2019, revealed medications were administered in a safe and timely manner, and as prescribed. Medications were administered within one hour of their prescribed time, unless otherwise specified.This deficiency represents non-compliance investigated under Complaint Number 2639823.

Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Harrison Pavilion Care Center

2171 Harrison Avenue Cincinnati, OH 45211

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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

observations, staff interviews, and policy review, the facility failed to ensure dishware was clean prior to serving pureed meal service. This affected one (Resident #11) of one resident who the facility identified as receiving pureed diets. The facility census was 78.Findings include:Record of the medical record for Resident #11 revealed an admission date of 05/06/24. Diagnoses included dysphagia, epilepsy, mood disorder, and hemiplegia and hemiparesis following cerebrovascular disease affecting right dominant side.Review of the Quarterly Minimum Data Set (MDS) assessment dated [DATE REDACTED], revealed Resident #11 had severe cognitive impairment as evidenced by a Brief Interview for Mental Status (BIMS) score of three.

Review of the physician order dated 11/21/25, revealed Resident #11 was ordered a regular diet, pureed texture, regular thin consistency.Observation on 11/25/25 at 11:46 A.M., revealed [NAME] #110 obtained a divided plate, which had food particles from previous meal on plate. [NAME] #110 went to sink and rinsed with water and then placed pureed pasta onto that divided plate.During an interview on 11/25/25 at 11:50 A.M. [NAME] #110 verified the divided plate was not clean and had food on it from previous meal. [NAME] #110 verified she rinsed off the plate with water and placed pureed pasta and placed onto lunch tray to be served.Review of the facility policy titled, Food Preparation and Service, revised October 2017 revealed food and nutrition services employees shall prepare and serve food in a manner that complied with safe food handling practices. Areas for cleaning dishes and utensils were located in a separate area from the food service line to ensure that a sanitary environment was maintained.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Harrison Pavilion Care Center

2171 Harrison Avenue Cincinnati, OH 45211

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 0880

Provide and implement an infection prevention and control program.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

record review, observations, staff interviews, and policy review, the facility failed to ensure infection control measures were implemented during wound care. This affected one (Resident #09) of three residents reviewed for wound care. The facility census was 78.Findings include:Review of the medical record of Resident #09 revealed an admission date of 10/20/25. Diagnoses included cellulitis, stage three pressure ulcer to sacrum, atrial fibrillation, and hemiparesis and hemiplegia to right dominant side.Review of the Five-Day Medicare Minimum Data Set (MDS) assessment dated [DATE REDACTED], revealed Resident #09 had impaired cognition evidenced by a Brief Interview for Mental Status (BIMS) score of 99. This resident was assessed to require dependent with toileting, bathing, dressing, and transfers.Review of the physician order dated 11/20/25, revealed Resident #09 was ordered to have right buttocks cleansed with normal saline, skin prep to peri-wound, and covered with border foam one time a day for wound care.During an

observation of wound care for Resident #09 on 11/26/25 at 10:05 A.M., by Licensed Practical Nurse (LPN) #23 with the assistance of Certified Nursing Assistant (CNA) #13, revealed LPN #23 did not remove her soiled gloves and perform hand hygiene after removing the old dressing from Resident #09. LPN #23 wore

the same gloves for the entirety of the dressing change.During an interview on 11/26/25 at 10:26 A.M., LPN #23 verified she did not remove her soiled gloves after removing Resident #09's old dressing. LPN #23 verified she should have removed her soiled gloves and performed hand hygiene prior to cleaning and placing a new dressing to Resident #09's wound.Review of the facility policy titled, Wound Care revised October 2010, revealed the purpose was to provide guidelines for the care of wounds to promote healing.

Wash and dry hands thoroughly and put on gloves. Loosen tape and remove dressing. Pull gloves over the dressing and discard into appropriate receptacle. Wash and dry hands thoroughly. Put on gloves and continue treatment.

Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet