Health inspection·March 11, 2024

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. 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, staff interviews, and review of the facility policy, the facility failed to ensure a resident's pressure ulcer was assessed and monitored and the treatment to the pressure ulcer was administered as physician ordered. This affected one (Resident #100) of three residents reviewed for pressure ulcer care. The facility census was 135 Residents Affected - Few Findings include: Review of the closed medical record for Resident #100 revealed an admission date of 02/15/24. Diagnoses included encephalopathy, lack of coordination, muscle weakness, dementia, chronic kidney disease, and sacrococcygeal Deep Tissue Injury (DTI) (Purple or maroon area of discolored intact skin due to damage of underlying soft tissue. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue). The resident was discharged on 02/24/24 to the hospital. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #100 had severe cognitive impairment. Resident #100 was dependent on staff for toileting, upper and lower body dressing, and personal hygiene. Review of resident's initial nursing assessment dated [DATE] revealed there was no assessment of Resident #100's DTI on the sacrococcygeal. There was no description or measurements of the wound during Resident #100's stay at the facility. Review of Resident #100's care plan dated 02/22/24 revealed support and interventions for self-care deficit and actual and potential for impaired skin integrity related to fragile skin and DTI. Interventions for potential and actual skin impairment included to follow facility protocols for treatment of injury, monitor, document location size, and treatment of skin injury. Review of Resident #100's physician orders dated 02/16/24 revealed an order for the sacrococcygeal DTI blister: paint with betadine-soaked gauze over blistered/open area then apply zinc-based barrier ointment to general area four times daily and as needed (PRN) and an order for lower thoracic- lumbar spine: hydrocolloid dressings to protect prominent spinal bones every shift for protection. Review of Resident #100's Treatment Administration Record (TAR) from 02/17/24 to 02/23/24, revealed the physician ordered treatment to the sacrococcygeal DTI blister was not documented as being completed (blank signatures) ten times out of 28 opportunities on 02/20/24 at 9:00 A.M., 1:00 P.M., 5:00 P.M., and 9:00 P.M.; on 02/21/24 at 9:00 A.M., 1:00 P.M., and 5:00 P.M. and 02/22/24 at 9:00 A.M., 1:00 P.M., and 5:00 P.M Further The physician ordered treatment to the lower thoracic-lumbar spine Page 1 of 6 365272 365272 03/11/2024 Riverview 3710 Olentangy River Road Columbus, OH 43214

F 0686 Level of Harm - Minimal harm or potential for actual harm was not documented as being completed (blank signatures) three times out of seven opportunities on 02/20/24, 02/21/24, and 02/22/24. Interview on 03/06/24 at 2:16 P.M. with the Director of Nursing, (DON) verified that blank signatures in the treatment administration record indicated a physician order was not completed per order. Residents Affected - Few Interview with Registered Nurse (RN) #3 on 03/07/24 at 3:10 P.M. verified Resident #100's medical record did not contain an admission skin assessment with measurements of skin areas and a weekly measurements of each skin issue. Review of the facility policy titled Skin Care Program, dated 01/24/23, revealed upon admission, resident will have their skin assessed from head to tie by a professional nurse. Each area will be documented by the professional nurse on the illustration of documentation and measurements of skin area form. Weekly, a professional nurse needs to measure each skin issue and enter into Point Click Care (electronic medical record). This deficiency represents non-compliance investigated under Master Complaint Number OH00151682 and Complaint Number OH00150932. This is an example of continued non-compliance from the survey dated 02/08/24. 365272 Page 2 of 6 365272 03/11/2024 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, resident and staff interview, and review of the facility policy, the facility failed to ensure a resident received the physician ordered catheter care. This affected one (Resident #200) of two residents reviewed for urinary catheter care. The facility census was 135. Findings include: Review of the medical record for Resident #200 revealed an admission date of 02/15/24. Diagnoses included muscle weakness, urinary tract infection, neuromuscular dysfunction of bladder with urinary stoma, and ileostomy. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #200 had intact cognition. Review of Resident #200's physician orders revealed an order dated 02/16/24 for straight catheter kits for self-catheterization every shift. Review of Resident #200's Treatment Administration Record (TAR) from 02/16/24 to 02/29/24 revealed straight catheter kits for self-catheterization every shift was not documented as provided on the following five days: 02/20/24, 02/21/24, 02/22/24, 02/23/24 and 02/29/24 for the 12-hour shift. Interview with Resident #200 on 03/05/24 at 10:00 A.M. revealed she had not received straight catheter kits the previous week, resulting in Resident #200 calling family to obtain personal supplies from home after Resident #100 had to utilize a used catheter to urinate. Interview on 03/06/24 at 2:16 P.M. with the Director of Nursing (DON) verified Resident #200's physician ordered colostomy care was not documented as being provided on 02/20/24, 02/21/24, 02/22/24, 02/23/24 and 02/29/2024 for the 12-hour shift. Review of the facility policy titled Catheter- Intermittent Catheterization, dated 08/24/23, revealed a sterile field and sterile catheter is to be utilized for intermittent catheterization. This deficiency represents non-compliance investigated under Complaint Number OH00151619. 365272 Page 3 of 6 365272 03/11/2024 Riverview 3710 Olentangy River Road Columbus, OH 43214

F 0691 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate colostomy, urostomy, or ileostomy care/services for a resident who requires such services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, resident and staff interview, and review of the facility policy, the facility failed to ensure residents received the physician ordered care of their ostomy. This affected one (Resident #200) of two residents reviewed for ostomy care. The facility census was 135. Findings include: Review of the medical record for Resident #200 revealed an admission date of 02/15/24. Diagnoses included neuromuscular dysfunction of bladder with urinary stoma and ileostomy. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #200 had intact cognition. Review of Resident #200's physician orders revealed an order dated 02/16/24 to empty colostomy bag as needed every shift for colostomy care. Review of Resident #200's Treatment Administration Record (TAR) from 02/16/24 to 02/29/24 revealed empty colostomy bag as needed every shift for colostomy care was not documented as provided on the following four days: 02/20/24, 02/21/24, 02/22/24 and 02/23/24 for the 12-hour shift. Interview with Resident #200 on 03/05/24 at 10:00 A.M. revealed she had not received ostomy care including having supplies for the ostomy care the previous week, resulting in the stool overflowing out of the bag. Interview on 03/06/24 at 2:16 P.M. with the Director of Nursing (DON) verified Resident #200's physician ordered colostomy care was not documented as being provided on 02/20/24, 02/21/24, 02/22/24 and 02/23/24 for the 12-hour shift. Review of the facility policy titled Colostomy-Ileostomy Care, revision date 06/03/19 revealed the registered nurse or licensed practical nurse will manage the colostomy and ileostomy care appropriately. This deficiency represents non-compliance investigated under Complaint Number OH00151619. 365272 Page 4 of 6 365272 03/11/2024 Riverview 3710 Olentangy River Road Columbus, OH 43214

F 0694 Provide for the safe, appropriate administration of IV fluids for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, resident and staff interview, observation, and review of the facility policy, the facility failed to ensure residents received care and services for their intravenous catheter (IV). This affected one (Resident #200) of two residents reviewed for IV care. The facility census was 135. Residents Affected - Few Findings include: Review of the medical record for Resident #200 revealed an admission date of 02/15/24. Diagnoses included hypotension, urinary tract infection, severe protein calorie malnutrition, depression, nd acute kidney failure. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #200 had intact cognition. Review of Resident #200's physician orders revealed an order dated 02/23/24, ok to put in peripheral IV one time only for one day. Resident #200 physician orders was silent for care of the peripheral IV, including maintaining patience and function and dressing changes. Review of Resident #200's Medication Administration Record (MAR) for February 2024, revealed documentation of a peripheral IV had been placed on 02/23/24. Review of Resident #200 progress notes from 02/24/24 though 03/05/24 was silent for assessment, or care provided for peripheral IV place on 02/23/24. Interview and subsequent observation of Resident #200 on 03/05/24 at 10:00 A.M. revealed the appearance of an IV catheter tubing hanging down from left upper arm with a clear non-dated dressing over insertion cite. Resident #200 stated they put the IV in a week and a half ago, gave her some fluids for a day, and the nurses had not provided any care or even looked at it since. Resident #200 stated she had brought the IV to the nurse's attention several times with no avail. Interview with Director of Nursing (DON) on 03/06/24 at 2:16 P.M. revealed the facility had no policy for peripheral IV care. The DON stated the staff would refer to the center for disease infection control standards for the prevention of intravascular catheter related infections dated (2011), which stated to evaluate the catheter insertion site daily. The DON verified there was no documentation of daily evaluations of Resident #200's peripheral IV per standard of IV care, documented assessments including maintaining patency, site care and assessment were part of standard nursing care. This deficiency represents non-compliance investigated under Complaint Number OH00151280. 365272 Page 5 of 6 365272 03/11/2024 Riverview 3710 Olentangy River Road Columbus, OH 43214

F 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, resident interview, staff interview, and review of the facility policy, the facility failed to ensure residents were free from significant medication errors. This affected one (Resident #200) of one resident reviewed for significant medication errors. The facility census was 135. Residents Affected - Few Findings include: Review of the medical record for Resident #200 revealed an admission date of 02/15/24. Diagnoses included urinary tract infection. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #200 had a Brief Interview Mental Status (BIMS) score of 15 indicating intact cognition. Review of Resident #200's physician orders revealed an order dated 02/26/24 for Ceftriaxone sodium (antibiotic) injection two gram intramuscularly one time only for pneumonia. A physician order dated 02/27/24 for Ceftriaxone sodium (antibiotic) injection one gram intramuscularly one time a day for pneumonia for six days. Review of Resident #200's Medication Administration Record (MAR) for February 2024 revealed the Ceftriaxone sodium injection one gram was not documented as administered on 02/26/24 and Ceftriaxone sodium injection one gram was not documented as administered on 02/27/24 and 02/28/24. Resident #200 had three missed doses of her antibiotic Ceftriaxone sodium injection. Interview with Resident #200 on 03/05/24 at 10:00 A.M. revealed she had not correctly received an antibiotic medication as ordered by her physician for her pneumonia. Interview on 03/06/24 at 2:16 P.M. with the Director of Nursing, (DON) verified Resident #200 did not receive her scheduled dose of Ceftriaxone sodium injection two gram on 02/26/24 as scheduled and ordered by the physician, nor did she receive her scheduled dose of Ceftriaxone sodium injection one gram on 02/27/24 and 02/28/24. Review of the facility policy titled Administering Medications, dated 08/07/23, revealed medications must be administered in accordance with frequency prescribed by physician and standards of practice. This deficiency represents non-compliance investigated under Complaint Number OH00151280 and Complaint Number OH00151026. 365272 Page 6 of 6