F0553

D

Failure to Conduct Care Conferences and Involve Residents in Care Planning

Cincinnati, Ohio Survey Completed on 03-17-2026

Penalty

No penalty information released

Summary

The facility failed to ensure residents were allowed to participate in the development and implementation of their person-centered plans of care by not conducting required care conferences. For one resident with chronic viral hepatitis C, polyneuropathy, dementia, manic episode without psychotic symptoms, bipolar disorder, depression, and venous insufficiency, record review showed admission and subsequent discharge against medical advice with no guardian at the time of discharge. The most recent MDS 3.0 assessment documented moderately impaired cognition with varying levels of assistance needed for ADLs, and a later BIMS score of 13 indicated the resident was cognitively intact. Review of this resident’s medical record with Social Services staff revealed no evidence of any care conferences, and the Social Services staff member confirmed that none had been conducted.

For another resident with diagnoses including mood disorder, bipolar disorder, cauda equina syndrome, catatonic schizophrenia, and major depressive disorder, the most recent MDS assessment showed severely impaired cognition and a need for assistance with ADLs. Review of this resident’s medical record with Social Services staff likewise revealed no documentation of any care conferences, and the Social Services staff member verified that none had been held. The facility’s Comprehensive Care Plans policy states that each resident’s comprehensive person-centered care plan must be consistent with the resident’s right to participate in the planning process, and that if resident or representative participation is not practicable, an explanation and the steps taken to include them must be documented in the medical record. Such documentation was not present for these residents. This deficiency was cited under Complaint Number 2691577.