Health inspection·June 15, 2023

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. 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 and staff interview, the facility failed to ensure wounds were assessed regularly and dressing changes were completed as ordered. This affected one (Resident #38) out of three residents reviewed for skin conditions. The facility census was 92. Residents Affected - Few Findings include: Review of Resident #38's clinical record revealed Resident #38 was admitted to the facility on [DATE]. His diagnoses which included but was not limited to cellulitis, acquired absence of the right leg below the knee, local infection of the skin and subcutaneous tissue, bacteremia, type two diabetes with diabetic chronic kidney disease, acquired absence of the left toe, and unstageable pressure ulcer of the sacral region. Review of Resident #38's quarterly Minimum Data Set (MDS) assessment, dated 03/31/23, revealed he had a Brief Interview for Mental Status (BIMS) score of 12 indicating he had moderate cognitive impairment. Review of the physician note, dated 12/30/23, revealed Resident #38 was seen by the Medical Director. The history of his present illness revealed he had a history of noncompliance with medical treatment. The nurse reported the resident had been refusing medication and treatments. It noted Resident #38 was quite upset because nobody ever changed his dressing for his right below the knee amputation site since he was admitted to the facility. Under the summary of plans, nursing was to put a dry dressing on the right stump and change it every day. It also noted the resident was advised to let the nurse evaluate his wound and change the dressing to prevent infection. The note indicated Resident #38's right stump site was dressed. Review of the physician orders and Treatment Administration Records for December 2022 and January 2023 revealed no evidence of an order to apply a dry dressing to Resident #38's right BKA (below the knee amputation) wound and to change it every day. Review of Resident #38's medical record revealed no evidence Resident #38's wound to the right BKA stump site was assessed daily by staff in January 2023. Additionally, there was no evidence Resident #38's dressing change to the right BKA stump site was completed as ordered by the physician. Review of the Orthopedic note, dated 01/09/23, revealed Resident #38's wound to the right BKA stump site was healing. Interview with the Regional Registered Nurse #300 on 06/14/23 at 2:07 P.M. revealed there was no Page 1 of 5 365088 365088 06/15/2023 Englewood Health and Rehab 425 Lauricella Court Englewood, OH 45322

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few documentation to show the order on 12/30/23 for a daily dressing change to Resident #38's right BKA stump was implemented or completed. Interview with the Director of Nursing on 06/15/23 at 9:27 A.M. verified there was no order written on 12/30/22 for a dry dressing to Resident #38's right stump site daily and no documentation that the dressing was applied and the area was assessed daily. Interview with the Medical Director on 06/15/23 at 10:36 A.M. revealed Resident #38 complained to her that his dressing had not been changed since admission. She revealed she saw him on 12/30/22 and he had a dressing on the right stump which did not appear to be old or dirty. She said she did not look at Resident #38's right stump, and left the dressing intact. She stated she gave an order for a dry dressing to the right stump site to be completed daily. She said the expectation was that the nurse would change the dressing daily and observe the area. She stated she saw Resident #38 on 01/05/23 and he had multiple sores with drainage. This deficiency represents non-compliance investigated under Complaint Number OH00143480. 365088 Page 2 of 5 365088 06/15/2023 Englewood Health and Rehab 425 Lauricella Court Englewood, OH 45322

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. Based on medical record review, resident interview, and staff interview, the facility failed to ensure a hand splint and palm protector were applied as ordered. This affected one (Resident #53) out of two residents reviewed for position and mobility. The census was 92. Findings include: Review of Resident #53's medical record revealed an admission date of 08/16/22. Resident #53's diagnoses included muscle weakness, convulsions, hemiplegia, hypertension, major depressive disorder, and post-traumatic stress disorder. Review of Resident #53's annual Minimum Data Set (MDS) assessment, dated 04/19/23, revealed Resident #53 was moderately cognitively impaired with a Brief Interview for Mental Status (BIMS) score of 10, required extensive assistance with personal hygiene, and had an upper extremity impairment of the left side. Review of Resident #53's physician orders revealed an order, dated 05/12/23, for a left palm protector at all times except during personal hygiene. Monitor Resident #53's skin for any signs and symptoms of breakdown. Notify MD (physician) of changes. Further review of the orders revealed an order, dated 08/23/22, for 24 hour splint wearing with daily hygiene, doff and re-donn, every shift for splint and hygiene. Review of Resident #53's Treatment Administration Records revealed the splint and palm protector were signed off as being applied 06/11/23 through 06/14/23 on day shift. No refusals were documented. Observation of Resident #53 on 06/11/23 at 8:56 A.M. revealed Resident #53 had a left hand contracture. No splint or palm protector was in place. Observations on 06/14/23 at 7:54 A.M. and on 06/14/23 at 9:43 A.M. revealed no splint or palm protector were in place on Resident #53's left hand. During an interview on 06/14/23 at 9:43 A.M., Resident #53 stated staff were putting on her splint at one time, but haven't been putting it on recently. Observation of Resident #53 on 06/14/23 at 10:54 A.M. with the Director of Nursing (DON) revealed Resident #53 did not have a splint or palm protector on her left hand. The DON looked around Resident #53's room for the splint and palm protector. During an interview on 06/14/23 at 10:54 A.M., Resident #53 stated staff had not offered the splint or palm protector and Resident #53 denied refusing to wear the splint or palm protector. During an interview with the DON on 06/14/23 at 10:58 A.M., she confirmed Resident #53 was ordered to have a splint and palm protector on her left hand at all times except during personal care. The DON confirmed the splint and palm protector were not on Resident #53 and that they were signed off as having been applied on the TAR for dayshift on 06/14/23. 365088 Page 3 of 5 365088 06/15/2023 Englewood Health and Rehab 425 Lauricella Court Englewood, OH 45322

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, observation, and policy review, the facility failed to properly check a gastrostomy tube placement. This affected one (Resident #57) of three residents reviewed for enteral feeding. The census was 92. Findings include: Review of the medical record for Resident #57 revealed Resident #57 admitted to the facility on [DATE] with diagnoses including hemiplegia and hemiparesis following cerebral infarction affecting right dominant side, oropharyngeal dysphagia, and unspecified dementia. Review of Resident #57's care plan, dated 01/25/2023, revealed Resident #57 was dependent on tube feeding for intake due to diagnoses of cerebrovascular accident and dysphagia. Interventions included check tube feed placement every feeding, hold feedings if residual was above 100 ml, and provide enteral feedings as ordered. Observation on 06/13/2023 at 1:50 P.M. revealed Licensed Practical Nurse (LPN) #238 used a piston syringe to check the residual stomach contents for Resident #57's gastrostomy (G) tube. LPN #238 inserted an air bolus into the tube, removed the piston syringe, listened to the resident's abdomen with a stethoscope after she had removed the syringe, then poured medication and water directly into the G-tube. Interview on 06/13/2023 at 1:58 P.M. with LPN #238 revealed the process for checking G-tube placement was to insert air bolus in the G-tube, then remove the syringe, and then use the stethoscope to listen for air bubbles in the stomach. Review of the policy titled Verifying Placement of Feeding Tubes, dated 09/22/2022, revealed nurses check placement before administering enteral feeding or medications by placing a stethoscope over the left side of the abdomen and listening for a growl or rumbling/bubbling sound as air was injected through the G-tube. 365088 Page 4 of 5 365088 06/15/2023 Englewood Health and Rehab 425 Lauricella Court Englewood, OH 45322

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, and policy review, the facility failed to ensure medications were secured properly when left unattended. This had the potential to affect two (Residents #7 and #14) of 18 residents who resided on the [NAME] unit and were identified as cognitively impaired and ambulatory. The facility census was 92. Findings include: Observation on 06/13/2023 from 1:50 P.M. to 1:57 P.M. revealed the medication cart on the [NAME] unit was left unlocked and unsupervised while Licensed Practical Nurse (LPN) #238 and the Director of Nursing (DON) were administering medications to Resident #57. During an interview on 06/13/2023 at 1:57 P.M., the DON verified the medication cart on the [NAME] unit had been unlocked and was unsupervised while LPN #238 administered medications. Review of the policy titled Medication Storage, dated 09/29/2022, revealed during a medication pass, medications were under the direct observation of the person administering medications or locked in the medication cart. 365088 Page 5 of 5