Health inspection·May 19, 2022

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 Based on observation, record review, facility policy and procedure review and interview the facility failed to ensure Resident #4 and Resident #60, who required staff assistance with activities of daily living care received adequate and timely assistance with nail care to promote proper hygiene. This affected two residents (#4 and #60) of four residents reviewed for activities of daily living (ADL). Residents Affected - Few Findings Include: 1. Review of Resident #4's medical record revealed an initial admission date of 06/22/21 with the latest readmission of 01/28/22 and diagnoses including cerebrovascular accident (CVA) with left sided weakness, dysphasia, chronic obstructive pulmonary disease (COPD), diabetes mellitus, bipolar disorder, borderline personality disorder, viral hepatitis B, gastrostomy, anemia, major depressive disorder, insomnia, liver disease, alcohol dependence, hypertension and emphysema. Review of the plan of care, dated 06/30/21 revealed the resident had a self-care deficit related to CVA with left sided weakness, impaired cognition, bipolar disorder and dysphasia. Interventions included encourage/allow resident to participate in activities of daily living (ADL), encourage range of motion to all extremities, encourage (resident) to get out of bed for all meals, explain all procedures, oral care twice a day and as needed, partial bath on non-shower days and provide extensive assistance as needed, refer to therapy services as needed. The care plan revealed the resident's ADL abilities vary over the course of the day, provide restorative as ordered, shower as scheduled and as needed and task segmentation as needed. Review of the resident's comprehensive Minimum Data Set (MDS) 3.0 assessment, dated 04/14/22 revealed the resident had clear speech, understood others, made herself 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. On 05/16/22 at 10:43 A.M. observation of the resident's nails revealed they were long and jagged with a brown substance under them. On 05/17/22 at 11:16 A.M. observation of the resident revealed his nails remained long and jagged with a brown substance under them. On 05/17/22 at 11:20 A.M. interview with Licensed Practical Nurse (LPN) #196 verified the resident's nails were long, jagged and dirty and the resident required staff assistance with nail care. Page 1 of 4 365272 365272 05/19/2022 Riverview 3710 Olentangy River Road Columbus, OH 43214

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. 365272 Page 2 of 4 365272 05/19/2022 Riverview 3710 Olentangy River Road Columbus, OH 43214

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). 365272 Page 3 of 4 365272 05/19/2022 Riverview 3710 Olentangy River Road Columbus, OH 43214

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 365272 Page 4 of 4