Health inspection·May 19, 2022

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the facility policy titled Nail Care, dated 08/24/10 revealed it was the facility policy to clean the nail bed, to keep nails trimmed and to prevent infections. It was the responsibility of the Registered Nurse (RN), Licensed Practical Nurse (LPN) and/or State Tested Nursing Assistant (STNA) to provide appropriate nail care as needed. 2. Review of Resident #60's medical record revealed an admission dated of 06/23/20 with diagnoses including Parkinson's disease, low back pain, diabetes mellitus, conversion disorder, psychosis, vovulus, hallucinations and kyphosis. Review of the resident's comprehensive Minimum Data Set (MDS) 3.0 assessment, dated 04/02/22 revealed the resident had clear speech, usually understands others, usually makes himself understood and had no cognitive deficit as indicated by a Brief Interview for Mental Status (BIMS) score of 15 of 15. The assessment revealed the resident required extensive assistance from one staff for personal hygiene, including nail care. Review of the plan of care, dated 04/06/22 revealed the resident had a self care deficit related to decreased mobility, weakness, aging process, Parkinson's disease and psychotic disorder. Interventions included anticipate needs, assist with activities of daily living (ADL), clothing protectors at meals per resident request, encourage resident to ask staff for assistance when needed, shave as needed per resident preference, pull up garments, task segmentation and therapies as needed. The care plan revealed the resident required extensive assistance as needed, haircut as needed, make sure call light was within reach, oral care twice daily and praise all efforts. On 05/16/22 at 2:25 P.M. observation of the resident's nails revealed they were long, jagged and and dirty with a brown substance under them. On 05/17/22 at 11:36 A.M. observation of the resident's nails revealed they were long, jagged and and dirty with a brown substance under them. On 05/18/22 at 10:25 A.M. observation of the resident's nails revealed they were long, jagged and and dirty with a brown substance under them. On 05/18/22 at 11:00 A.M. interview with Corporate Nurse # 154 verified the resident's nails were long jagged and dirty and the resident required assistance from staff with nail care. Review of the facility policy titled Nail Care, dated 08/24/10 revealed it was the facility policy to clean the nail bed, to keep nails trimmed and to prevent infections. It was the responsibility of the Registered Nurse (RN), Licensed Practical Nurse (LPN) and/or State Tested Nursing Assistant (STNA) to provide appropriate nail care as needed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365272 If continuation sheet Page 2 of 4 Printed: 05/15/2026 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 365272 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/19/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview 3710 Olentangy River Road Columbus, OH 43214 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 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. Based on observation, record review, facility policy and procedure review and interview the facility failed to ensure Resident #8's suprapubic urinary catheter collection bag was placed properly to prevent infection and promote proper flow/drainage of urine. This affected one resident (#8) of one resident reviewed for urinary catheters. The facility identified four residents with indwelling urinary catheters. Findings Include: Review of Resident #8's medical record revealed an initial admission date of 08/29/19 with the latest readmission of 07/26/21 and diagnoses including acquired absence of left leg above the knee, chronic kidney disease, hydronephrosis, diabetes mellitus, anemia, hyperlipidemia, disorders of the bladder, urogenital implants, hypertension, gastroesophageal reflux disease, insomnia, systemic lupus, obstructive and reflux uropathy and dysphasia. Review of the plan of care, dated 06/08/21 revealed the resident had the potential for infection related to suprapubic catheter related to hydronephrosis, obstructive uropathy, spasms and overactive bladder. Interventions included apply leg strap to secure tubing, assess urine for odor, color, clarity, amount and document, catheter care using soap and water, change catheter per order, encourage fluids of approximately 1500 to 2000 milliliters (ml) per day, flush suprapubic catheter per orders, instruct resident to notify staff of any burning or itching to peri-area, monitor intake and output as indicated, monitor pertinent labs, monitor vital signs as ordered, notify physician as needed, place Foley catheter bag in drain bag cover, position catheter tubing and bag to facilitate drainage and provide good personal and perineal care. Review of the resident's quarterly Minimum Data Set (MDS) 3.0 assessment, dated 04/20/22 revealed the resident had clear speech, usually understands others, usually makes herself understood and had a moderate cognitive deficit as indicated by a Brief Interview for Mental Status (BIMS) score of eight of 15. The resident assessment revealed the resident required extensive assistance of two staff for bed mobility, did not transfer and was non-ambulatory. The assessment indicated the resident had an indwelling urinary catheter. Review of the monthly physician's orders for May 2022 revealed an order (initiated 07/26/21) to cleanse catheter site with normal saline (NS), pat dry, cover with split gauze daily and as needed, an order (initiated 09/21/21) to empty suprapubic catheter collection bag every shift, change the suprapubic catheter monthly and suprapubic catheter to straight drain catheter. On 05/16/22 at 11:10 A.M. observation of the resident revealed the indwelling urinary catheter collection bag was attached to the bed frame at the head of the bed (above the resident's bladder). On 05/16/22 at 2:43 P.M. observation of the resident revealed the indwelling urinary catheter collection bag was attached to the bed frame at the head of the bed (above the resident's bladder). On 05/16/22 at 2:45 P.M. interview with Licensed Practical Nurse (LPN) #196 verified the resident's indwelling urinary catheter collection bag was not hanging below the resident's bladder to promote/facilitate urine drainage and prevent infection (from urine back flow). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365272 If continuation sheet Page 3 of 4 Printed: 05/15/2026 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 365272 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/19/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview 3710 Olentangy River Road Columbus, OH 43214 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 0690 Level of Harm - Minimal harm or potential for actual harm Review of the facility policy titled Catheter Care, dated 07/29/10 revealed it was the facility policy to manage the residents' with catheters per physician's orders. The policy indicated to check drainage tubing and bag to ensure the catheter was draining properly. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365272 If continuation sheet Page 4 of 4