Health inspection·March 13, 2024

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 observations, staff interviews and policy reviews, the facility failed to provide assistance with activities of daily care for a resident dependent on staff for assistance. This affected two (#20 and #49) of three residents reviewed for assistance with care needs. The facility census was 137. Residents Affected - Few Findings include: 1. Review of medical record for Resident #20 revealed admission date of 12/04/17. The resident was admitted with diagnoses including congestive heart failure, stroke and Crohn's disease. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE], revealed he was rarely understood and had a long-term memory problem with modified independence cognition. He required maximum assistance for eating, and was dependent with bed mobility, transfers and toileting. He was always incontinent of bowel and bladder. Observation on 03/13/24 at 2:27 P.M., of Resident #20 revealed a layer of thick plaque to his top teeth and his nails were noted to extend approximately 0.6 centimeters beyond his fingertips. [NAME] material was also observed under his nails. Interview with the Director of Nursing, at the time of the observation, verified the observation. 2. Review of medical record for Resident #49 revealed admission date of 10/02/15 with a Brief Interview Mental Status (BIMS) score of 14 indicating intact cognition. The resident was admitted with diagnoses including peripheral vascular disease, dementia, bipolar disease and depression. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE], revealed she required set up assistance for eating, maximum assistance for bed mobility, toileting hygiene and not applicable for transfers. It was documented she was always incontinent of bowel and bladder. Observation was made on 01/13/24 at 9:27 A.M., of incontinence care for Resident #49. State Tested Nursing Assistant (STNA) #102 assisted Resident #49 onto her back and loosened the tape to both sides of the incontinence product. When she pulled down the product a strong smell of urine filled the room. The incontinence product was observed to be saturated with dark urine. Resident #49 was unsure about the last time she had been provided care. Interview immediately after incontinence care on 03/13/24 at 9:33 A.M., revealed STNA #102 did not receive report from the previous shift. She stated there was no STNA on the floor when she arrived at 7:00 A.M. She was unsure the last time Resident #102 had been provided incontinence care. She Page 1 of 3 365278 365278 03/13/2024 Troy Rehabilitation and Healthcare Center 512 Crescent Drive Troy, OH 45373

F 0677 Level of Harm - Minimal harm or potential for actual harm acknowledged the incontinence product of Resident #49 was saturated with dark colored urine with a strong odor. Review of the clock punch times revealed there were two STNAs working the unit on the night shift of 01/13/24 with one STNA leaving at 6:07 A.M. and the other at 7:14 A.M. The unit census was 45. Residents Affected - Few Review of the policy titled, Toileting Plans for Urinary Incontinence dated September 2021 documented a check and change strategy which involved checking the continence status of residents at regular intervals. Review of the undated policy titled, Activities of Daily Living documented appropriate care and services would be provided for residents who were unable to carry them out independently. Review of the undated policy titled, Care of Fingernails/Toenails documented nail bed was to be kept clean and the nails trimmed. This deficiency represents non-compliance investigated under Complaint Number OH00151247. 365278 Page 2 of 3 365278 03/13/2024 Troy Rehabilitation and Healthcare Center 512 Crescent Drive Troy, OH 45373

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observations, staff interviews and policy review, the facility staff failed to provide proper hand hygiene after providing incontinence care to a resident. This affected two (#17, and #18) residents of three residents observed. The facility census was 137. Residents Affected - Few Findings include: 1. Review of medical record for Resident #18 revealed admission date of 01/13/24 with a Brief Interview Mental Status (BIMS) score of 15 indicating intact cognition. The resident was admitted with diagnoses including malignant neoplasm to the palate, Parkinson's disease and sensorineural hearing loss bilateral. Observation on 03/13/24 at 9:57 A.M., of incontinence care provided by State Tested Nurse Assistant (STNA) #103 revealed Resident #18 was incontinent of bowel. After thoroughly cleaning the stool from Resident #18, STNA #103 placed a clean incontinence product and clothes on Resident #18. STNA #103 then removed her gloves and left the room without any hand hygiene. Interview on 03/13/24 at 10:03 A.M., STNA #103 verified she did not remove her gloves directly after providing incontinence care, and she did not implement hand hygiene when she later removed her gloves. 2. Review of medical record for Resident #17 revealed admission date of 04/03/13. T he resident was admitted with diagnoses including stroke and congestive heart failure. Observation on 03/13/24 at 10:32 A.M., of incontinence care provided by STNA #106 revealed Resident #17 was incontinent of urine. After providing incontinence care, STNA #106 placed Resident #17 in a clean incontinence product, adjusted his clothing and recovered him. She then removed her gloves and grabbed the bag soiled products and left the room without any hand hygiene. Interview on 03/13/24 at 10:37 A.M., STNA #106 verified she did not remove her gloves after providing incontinence care, and when she did not implement hand hygiene after removing her gloves. Review of the policy titled, Perineal Care dated 09/01/21, stated after providing care to remove gloves and wash hands thoroughly. This deficiency represents non-compliance investigated under Complaint Number OH00151247. 365278 Page 3 of 3