Health inspection·February 14, 2024

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff and physician interviews, the facility failed to notify the physician of abnormal laboratory (lab) results in a timely manner which resulted in a delay of treatment. This affected two (#84 and #162) of four residents reviewed for timely care and treatment. The facility census was 147. Findings include: 1. Review of medical record for Resident #84 revealed admission date of [DATE]. The resident was admitted with diagnoses including contracture of right ankle and foot, hemiparesis following stroke, and stroke, depression and anxiety. The resident remains in the facility. The quarterly Minimum Data Set (MDS) dated [DATE] Resident #84 had a Brief Interview Mental Status (BIMS) score of 13 indicating intact cognition. Resident #84 required supervision for eating, maximum assistance for bed mobility bed mobility and toileting transfers were not documented. Record review revealed a positive urinalysis result was collected on [DATE], reported on [DATE] and reviewed by staff on [DATE]. Record review of the progress notes revealed no notification of the urinalysis result to a medical provider. Record review of the progress note dated [DATE] was for a new order from the on-call nurse practitioner for Macrobid (antibiotic) 100 milligrams twice daily for five days for a urinary tract infection. Interview on [DATE] at 9:15 A.M. with Regional Clinical Nurse (RCN) #128 acknowledged the late notification of the positive urinalysis result which resulted in delayed treatment of Resident #84's UTI. RCN #128 shared the missed notification was discovered during chart audits for lab notifications, and noted there was no negative outcome. 2. Review of medical record for Resident #162 revealed admission date of [DATE]. Diagnoses include stroke, hemi paresis affecting right dominant side, and depression. The was sent to the emergency room and expired on [DATE]. The significant change MDS dated [DATE] revealed Resident #162 had a BIMS score of 11 indicating impaired cognition. Resident #162 required supervision for eating, maximum assistance for bed mobility, toileting hygiene and no documentation for transfers. Page 1 of 5 365209 365209 02/14/2024 Majestic Care of Middletown LLC 6898 Hamilton Middletown Road Middletown, OH 45044

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident #162's provider progress note dated [DATE] revealed the resident had continued loose stools. An abdominal x-ray on [DATE] documented mild to moderate colonic stool burden with a nonobstructive bowel gas pattern. The plan was to check for fecal calprotecting, ova/parasites and fecal leukocytes and discontinue Bisacodyl (laxative) and Docusate (stool softener). Review of the medical records for Resident #162 revealed a positive C-diff result which was collected on [DATE], resulted on [DATE], reported on [DATE] and reviewed by staff on [DATE]. Further review of Resident #162's medical record revealed no documentation of the positive C-diff results were provided to any medical provider and no treatment for the C-diff was initiated. Interview on [DATE] at 10:11 A.M. with the Director of Nursing and Regional Clinical Nurse (RCN) #128 revealed the Certified Nurse Practitioner was doing a chart review after Resident #162 was sent to the hospital and discovered the positive C-diff result. An investigation revealed the unit manager had marked the lab as reviewed but did not notify the provider. Interview on [DATE] at 2:32 P.M. with Physician #119 revealed no provider in the physician's practice was notified by the facility of Resident #162's positive C-diff results which resulted in the resident's C-diff going untreated. This deficiency represents non-compliance under the Complaint Number OH00150450. 365209 Page 2 of 5 365209 02/14/2024 Majestic Care of Middletown LLC 6898 Hamilton Middletown Road Middletown, OH 45044

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. 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, observations, resident and staff interviews the facility failed to ensure residents received timely incontinence care. This affected two (#20 and #154) of three residents reviewed for incontinence care. The facility census was 147. Residents Affected - Few Findings include: 1. Review of medical record for Resident #20 revealed admission date of 01/10/21. Diagnoses include late onset Alzheimer's Disease, diabetes mellitus type two, bipolar disease and Parkinson's disease. The quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #20 had a Brief Interview Mental Status (BIMS) score of 12 indicating impaired cognition. Resident #20 was dependent for toileting hygiene and transfers. Documentation revealed she was frequently incontinent of bowel and bladder. 2. Review of medical record for Resident #154 revealed admission date of 01/7/23. Diagnoses including chronic obstructive pulmonary disease (COPD), anxiety and congestive heart failure. The annual Minimum Data Set (MDS) dated [DATE] revealed she required supervision for eating and dependent for mobility, transfers, and toileting hygiene. She was documented as always incontinent of bowel and bladder. Observation on 02/08/24 at 9:30 A.M. revealed Resident #20 requested assistance transferring from her wheelchair to her bed. Licensed Practical Nurse (LPN) #105 entered Resident #20's room to assist her and upon standing her up her incontinence brief was noted to be saturated and a strong urine odor filled the room. LPN #105 assisted Resident #20 into the bathroom where she removed her brief, provided peri care and dressed her in clean pants and a shirt. Interview on 02/08/24 at 9:43 A.M. with Resident #20 revealed she had not been checked for incontinence, yet that morning and she was unsure when she had been checked the evening prior. Interview on 02/08/24 at 9:45 A.M. with LPN #105 verified Resident #20's incontinence brief was saturated with a strong urine smell and she was unsure the last time incontinence care had been provided. Interview on 02/08/24 at 9:48 A.M. with State Tested Nursing Assistant (STNA) #129 revealed she had checked Resident #20 just prior to breakfast and she was only slightly wet, and she had not checked on her since. Observation on 02/08/24 at 10:30 A.M. revealed STNA #109 leaving Resident #154's room with a clear bag full of soiled linens. Interview with STNA #109 at the time of observation revealed this was her first time on the unit and she verified this was the first time she had checked and changed Resident #154 since starting her shift at 7:00 A.M. This deficiency represents non-compliance investigated under Complaint Number OH00150126. 365209 Page 3 of 5 365209 02/14/2024 Majestic Care of Middletown LLC 6898 Hamilton Middletown Road Middletown, OH 45044

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 record review and staff and physician interviews, the facility failed to timely notify the physician of abnormal laboratory (lab) results which resulted in a delay of treatment for a resident's positive Clostridioides difficile (C-diff) results. This affected one (#162) of four residents reviewed for timely care and treatment. The facility census was 147. Residents Affected - Few Findings include: Review of medical record for Resident #162 revealed admission date of [DATE]. Diagnoses include stroke, hemi paresis affecting right dominant side, and depression. The was sent to the emergency room and expired on [DATE]. The significant change Minimum Data Set (MDS) dated [DATE] revealed Resident #162 had a Brief Interview Mental Status (BIMS) score of 11 indicating impaired cognition. Resident #162 required supervision for eating, maximum assistance for bed mobility, toileting hygiene and no documentation for transfers. Review of Resident #162's provider progress note dated [DATE] revealed the resident had continued loose stools. An abdominal x-ray on [DATE] documented mild to moderate colonic stool burden with a nonobstructive bowel gas pattern. The plan was to check for fecal calprotecting, ova/parasites and fecal leukocytes and discontinue Bisacodyl (laxative) and Docusate (stool softener). Review of the medical records for Resident #162 revealed a positive C-diff result which was collected on [DATE], resulted on [DATE], reported on [DATE] and reviewed by staff on [DATE]. Further review of Resident #162's medical record revealed no documentation of the positive C-diff results were provided to any medical provider and no treatment for the C-diff was initiated. Interview on [DATE] at 10:11 A.M. with the Director of Nursing and Regional Clinical Nurse (RCN) #128 revealed the Certified Nurse Practitioner was doing a chart review after Resident #162 was sent to the hospital and discovered the positive C-diff result. An investigation revealed the unit manager had marked the lab as reviewed but did not notify the provider. Interview on [DATE] at 2:32 P.M. with Physician #119 revealed no provider in the physician's practice was notified by the facility of Resident #162's positive C-diff results which resulted in the resident's C-diff going untreated. This deficiency represents non-compliance under the Complaint Number OH00150450. 365209 Page 4 of 5 365209 02/14/2024 Majestic Care of Middletown LLC 6898 Hamilton Middletown Road Middletown, OH 45044

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interviews, the facility failed to notify the physician of abnormal laboratory (lab) results in a timely manner which resulted in a delay of treatment for a resident's urinary tract infection (UTI). This affected one (#84) of four residents reviewed for timely care and treatment. The facility census was 147. Findings include: Review of medical record for Resident #84 revealed admission date of 08/02/23. The resident was admitted with diagnoses including contracture of right ankle and foot, hemiparesis following stroke, and stroke, depression and anxiety. The resident remains in the facility. The quarterly Minimum Data Set (MDS) dated [DATE] Resident #84 had a Brief Interview Mental Status (BIMS) score of 13 indicating intact cognition. Resident #84 required supervision for eating, maximum assistance for bed mobility bed mobility and toileting transfers were not documented. Record review revealed a positive urinalysis result was collected on 01/08/24, reported on 01/11/24 and reviewed by staff on 01/12/24. Record review of the progress notes revealed no notification of the urinalysis result to a medical provider. Record review of the progress note dated 01/14/24 was for a new order from the on-call nurse practitioner for Macrobid (antibiotic) 100 milligrams twice daily for five days for a urinary tract infection. Interview on 02/12/24 at 9:15 A.M. with Regional Clinical Nurse (RCN) #128 acknowledged the late notification of the positive urinalysis result which resulted in delayed treatment of Resident #84's UTI. RCN #128 shared the missed notification was discovered during chart audits for lab notifications, and noted there was no negative outcome. This deficiency represents non-compliance under the Complaint Number OH00150450. 365209 Page 5 of 5