Health inspection·September 21, 2023

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **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 fall interventions were in place for a resident who was at risk for falls. This affected one (#20) of three reviewed for falls. Facility census was 62. Findings include: Review of medical record for Resident #20 revealed admission date of 06/19/23. Diagnoses include Cerebral Palsy, epilepsy and incontinence. A care plan initiated 06/20/23 revealed Resident #20 was a fall risk and interventions included Dycem (nonslip material) to wheelchair. The admission Minimum Data Set (MDS) dated [DATE] revealed Resident #20 had severe cognitive impairment. Resident #20 required extensive one person assistance for bed mobility, transfers, eating and toileting. Observation on 09/20/23 at 11:16 A.M. revealed Resident #20 had requested to go to the bathroom and was seated in a wheelchair. Further observations of Resident #20's wheelchair revealed there was no Dycem present. State Tested Nursing Assistant (STNA) #33 also present during the observation and verified Resident #20's wheelchair did not have Dycem. Interview on 09/20/23 at 1:41 A.M. with the DON revealed she was made aware the Dycem was not present on Resident #20's wheelchair. The DON confirmed Dycem is used as a fall risk intervention for Resident #20. Review of the facility policy titled Fall Prevention and Management Policy last revised 12/09/19 revealed individualized interventions would be implemented which may help to prevent further falls. This deficiency represents non-compliance investigated under Complaint Numbers OH00145970 and OH00146553. Page 1 of 4 365228 365228 09/21/2023 Wilmington Nursing & Rehab 75 Hale Street Wilmington, OH 45177

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, resident, Physician and Nurse Practitioner interviews, review of information from the Centers for Disease Control and Prevention (CDC) and policy review, the facility failed to implement their policy regarding reporting infectious diseases as required. This affected two (#13 and #14) of three resident reviewed for infections. Facility census was 62. Residents Affected - Few Findings include: 1. Review of medical record for Resident #14 revealed admission date of 01/09/18. Diagnoses include diabetes mellitus type 1, stage 4 kidney disease, depression and dementia. The resident remains in the facility. The quarterly Minimum Data Set (MDS) dated [DATE] revealed a Brief Interview Mental Status (BIMS) score of 10 indicating Resident #14 had impaired cognition. She required extensive two-person assistance for toileting, one person assistance for bed mobility, total dependence for transfer and supervision for eating. Record review of the 08/11/23 Dermatology office note for Resident #14 revealed no rash, scabies resolved return as needed. Record review of the physician orders for Resident #14 revealed an order for Ivermectin three milligrams, give six tablets daily with a start date of 06/30/23, Permethrin External Cream five percent (%) apply neck to feet at bedtime every Saturday with a start date of 06/23/23 and Hydrocortisone external cream 2.5 % apply to face at bedtime with a start date of 06/23/23. Observation and interview on 09/19/23 with Resident #14 at 10:25 A.M. in the courtyard revealed she had on a long sleeve sweatshirt during the interview her exposed hands revealed have several scabbed and open, superficial scratches. Resident #14 stated she scratches her hands in her sleep. Resident #14 acknowledged that she had a rash in the past but stated it had cleared up. Interview on 09/19/23 at 2:33 P.M. with the Assistant Director of Nursing (ADON) #9 and Director of Nursing (DON) revealed Resident #14 had a rash which was originally diagnosed as allergic dermatitis. The rash came and went, but subsided when she had dialysis during a hospitalization. An appointment was made for a dermatologist, but it took a few months for an available appointment. Resident #14's appointment was 06/23/23 and she was prescribed Permethrin cream (scabies), Ivermectin (scabies) and hydrocortisone (topical steroid). ADON #9 and DON were unable to answer why the medication was ordered if the rash was not present. ADON #9 stated they had tried to contact the office but were unable to and they were unable to produce the office note from the visit. They continued to share the wound physician had seen Resident #14 for her rash and believed it was attributed to elevated uric acid levels. They stated Resident #14 was seen by Certified Nurse Practitioner (CNP) #34 and originally treated for scabies but there was no improvement, and he was subsequently seen by Physician #32 who diagnosed him with atopic dermatitis. Interview on 09/20/23 at 12:38 P.M. with Physician #32 revealed he did not have concern of scabies at the facility. He stated Resident #14 had dialysis and her rash cleared, and he felt it was caused by an increase of Uric Acid in her system. He stated CNP #34 treated Resident #14 for what she felt was scabies but the rash did not go away. He added scabies was usually found in the folds of the 365228 Page 2 of 4 365228 09/21/2023 Wilmington Nursing & Rehab 75 Hale Street Wilmington, OH 45177

F 0880 skin, and no staff including himself have contacted anything therefore he felt it did not fit the criteria. Level of Harm - Minimal harm or potential for actual harm Interview on 09/22/23 at 10:55 A.M. with Dermatology CNP #35 revealed Resident #14 was seen on 06/23/23 and presented with signs and symptoms of scabies. Dermatology CNP #35 did not have the resource to perform a scaring for a definitive diagnosis, however she did have a rash, and accompanied redness and excoriation which was seen with scabies. For that reason, she prescribed Permethrin and Ivermectin as well as a topical steroid cream for treatment of scabies. The rash had resolved by her follow up visit in August. Residents Affected - Few 2. Review of medical record for Resident #13 revealed admission date of 10/28/22. Diagnoses include hypertension, heart failure and diabetes mellitus type II. The resident remains in the facility. The quarterly MDS dated [DATE] revealed a BIMS score of 15 indicating Resident #13 had intact cognition. He required extensive two-person assistance for toileting, one person assistance for bed mobility, transfers and independent for eating. Record review of the 08/30/23 skin assessment for Resident #13 revealed he presented with a red rash to upper extremities originally treated with Permethrin. The rash was documented as dry and fading upon assessment. Record review of the 09/12/23 CNP #34 note for Resident #13 revealed he had potential scabies exposure and had been treated with a dual round of Permethrin Cream. According to the documentation, nursing staff had informed CNP #34 his linens and room were treated per policy. Physician #36 was consulted, and the case was discussed for possible Permethrin resistant scabies. Given the symptoms had not worsened, further treatment was held, noting the itching and rash can linger for several weeks after Permethrin treatment. Review of the 09/13/23 Physician #32 note for Resident #13 revealed rash appeared as atopic dermatitis. Treatment for presumptive scabies for several weeks, rash remained with some improvements. Consult from Dermatology CNP #35 to determine if rash is scabies or dermatitis. No contagion noted and staff had not developed rash which was atypical for scabies. Dermatology CNP #35 had considered biopsy, but none scheduled at the time of visit. Interview on 09/21/23 at 1:30 P.M. with the Administrator, DON and ADON #9 revealed they did not report a potential scabies concern to the heath department as required regarding the potential scabies diagnoses for Resident #14 and #13. The DON revealed she was unaware of the details for Dermatology CNP #35's 09/13/23 for Resident #14. The DON restated the facility did not report the cases to the health department because they had conflicting diagnosis of scabies between the CNP's and Physicians. Review of information from the CDC at https://www.cdc.gov/parasites/scabies/health_professionals/control.html revealed the health department should be notified of any outbreak that may have community implications. In addition, an institution-wide information program should be implemented to instruct all management, medical, nursing, and support staff about scabies, the scabies mite, and how scabies is and is not spread. Epidemiologic and clinical data should be reviewed to determine the extent of the outbreak and risk factors for spread. Review of Ohio Administrative Code Chapter 3701-3 revealed scabies is listed as a Class C and 365228 Page 3 of 4 365228 09/21/2023 Wilmington Nursing & Rehab 75 Hale Street Wilmington, OH 45177

F 0880 should be reported by the end of the next business day. Level of Harm - Minimal harm or potential for actual harm Review of the facility policy for infection prevention and control last revised 05/11/23 revealed they would notify local, state and federal bodies of all reportable diseases. Residents Affected - Few This deficiency represents non-compliance investigated under Complaint Number OH00146217. 365228 Page 4 of 4