Health inspection·December 14, 2023

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on staff interview and record review, the facility failed to include all the mental health diagnoses on the preadmission screening and resident review (PASARR) for Resident #8. This affected one (#8) of three residents reviewed for PASARR. The facility census was 90. Findings include: Review of the medical record for Resident #8 revealed an admission date of 08/14/15. Diagnoses included paranoid schizophrenia, major depressive disorder, antisocial personality disorder, psychosis, mood disorder. and anxiety disorder. A diagnosis of dementia with agitation was added on 08/15/15. Review of the PASARR completed on 03/13/23, revealed Resident #8 received antipsychotic, antidepressant, antianxiety and mood stabilizer medications. Resident #8 did not have any indication of intellectual and developmental disability. The PASARR revealed Resident #8 had indications of serious mental illness including schizophrenia, mood disorder, delusional disorder and severe anxiety. The PASARR did not include the diagnosis of antisocial personality disorder or psychosis. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #8 had moderately impaired cognition with no behavior symptoms. Resident #8 exhibited feelings of down/depressed and tired with little energy. Resident #8 received antipsychotic medication, antidepressant and antianxiety medication seven of seven days during the look back period. An interview on 12/14/23 at 9:32 A.M. with Social Services Designee #200 verified she missed the diagnosis of antisocial personality and psychosis listed on Resident #8's medical diagnosis list. Social Service Designee #200 confirmed the PASARR was incomplete. Page 1 of 7 365313 365313 12/14/2023 Bridgeport Health Care Center 2125 Royce Street Portsmouth, OH 45662

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Review of the medical record for Resident #3 revealed an admission date of 02/17/23. Diagnoses included type two diabetes mellitus, neuromuscular dysfunction of the bladder, neuropathy, and peripheral vascular disease. Residents Affected - Few Review of the plan of care dated 06/15/23, last revised on 09/28/23, revealed Resident #3 had impaired skin integrity and was at risk for altered skin integrity. Interventions included to complete skin at risk assessment upon admission, quarterly and as needed along with weekly skin assessments, and float heels as tolerated. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #3 had mild to moderate cognitive impairment. Resident #3 required extensive assistance of two persons for personal care/hygiene and bathing. The assessment did not indicate any skin impairments and no treatments to altered skin integrity. Review of the weekly skin assessments dated 12/07/23 and 12/14/23, completed by a licensed nurse, revealed Resident #3 had no skin impairment to the bilateral lower extremities. Review of the physician orders dated 12/2023 revealed no orders to assess Resident #3 bilateral lower extremities or any treatment for the scabbed areas and large white dry scales to bilateral lower extremities. Interview and observation on 12/13/23 at 9:05 A.M. with Licensed Practical Nurse (LPN) #90 revealed she was not aware of any abnormal skin impairment to Resident #3's bilateral lower extremities. Observation of Resident #3's bilateral lower extremities with LPN #90 revealed Resident #3 had dark purple/black lower extremities with dry scaly raised areas and brown scabs. LPN #90 confirmed the areas and stated the State Tested Nursing Assistants (STNA) provided lotion to skin after bathing. LPN #90 confirmed there was not any documentation in the medical record regarding the areas to Resident #3's bilateral lower extremities. Review of the facility policy titled Skin Care and Wound Management Overview, dated 12/13/23, revealed facility staff strived to prevent resident/patient skin impairment and to promote the healing of existing wounds. Each resident/patient was assessed upon admission then weekly for any changes in skin condition. Based on observations, resident and staff interviews, record reviews, and review of the facility policy, the facility failed to identify and implement treatment for residents with skin alterations. This affected two (#3 and #20) of the two residents reviewed for non-pressure skin alterations during the annual survey. The facility census was 90. Findings include: 1. Record review for Resident #20 revealed the resident was admitted to the facility on [DATE]. Diagnoses included chronic heart failure, type two diabetes mellitus, weakness, and chronic obstructive pulmonary disorder. Review of the quarterly Minimum Data Set (MDS) assessment, dated 11/10/23, revealed Resident #20 had severely impaired cognition and required substantial to maximal assistance from staff for bed mobility, transfers, and toileting. 365313 Page 2 of 7 365313 12/14/2023 Bridgeport Health Care Center 2125 Royce Street Portsmouth, OH 45662

F 0684 Level of Harm - Minimal harm or potential for actual harm Review of the care plan, most recently revised on 09/15/23, revealed Resident #20 had or was at risk for impaired skin integrity. Interventions included to complete weekly skin checks. Review of the facility's Weekly Skin Check assessment, dated 12/12/23, revealed Resident #20 was documented to not have any skin alterations present. Residents Affected - Few Further record review for Resident #20 revealed no documentation of the presence of any skin alterations on the residents feet or toes. Interview with Resident #20 on 12/11/23 at 2:43 P.M. revealed the resident voiced concerns over needing to see the foot doctor due to being diabetic and having skin alterations on her toes. Observation on 12/11/23 at 2:47 P.M. revealed Resident #20 had small scabs present on the top of the second, third, and fourth toe on the residents right foot and reddened areas present to the tops of the second, third, and fourth toes on the left foot. No treatments were observed to be in place at the time of the observation. Observation and interview with Licensed Practical Nurse (LPN) #90 on 12/14/23 at 11:26 A.M. verified there were scabs and reddened areas present to the tops of the toes of Resident #20's left and right foot. LPN #90 additionally verified there was no treatment orders or documentation of the presence of the skin alterations on Resident #20's toes. 365313 Page 3 of 7 365313 12/14/2023 Bridgeport Health Care Center 2125 Royce Street Portsmouth, OH 45662

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on staff interview, record review, and facility policy review, the facility failed to ensure Resident #31 was provided a speech therapy screen or evaluation as recommended by the dietitian on admission. This affected one (Resident #31) of three residents reviewed for nutrition. The facility census was 89. Residents Affected - Few Findings include: Review of the medical record for Resident #31 revealed an admission date of 11/06/23. Diagnoses included encephalopathy, end stage renal disease, type two diabetes mellitus, and dementia. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #31 had impaired cognition and was dependent on staff for assistance with activities of daily living. The assessment indicated Resident #31 had no problems with swallowing or chewing, and no weight loss. Resident #31 had no documentation of therapy services during the look back period. Review of the admission dietary nutritional assessment dated [DATE] revealed Resident #31's meal intakes had been fair and the current nutritional plan of care met the resident's estimated needs. The dietitian recommended a speech therapy screen related to Resident #31 had stated she had difficulty swallowing. Review of the physician orders dated 12/2023 revealed Resident #31 was ordered a renal diet, regular texture with thin liquids. Review of the medical record for Resident #31 revealed no evidence of a speech/swallowing screen or evaluation. An interview on 12/14/23 at 3:26 P.M. with the Administrator verified Resident #31 was not screened or evaluated by speech therapy since admission. Review of the facility policy titled Nutritional Assessment and Recommendations revealed the facility had 14 days to implement a recommendation. 365313 Page 4 of 7 365313 12/14/2023 Bridgeport Health Care Center 2125 Royce Street Portsmouth, OH 45662

F 0695 Provide safe and appropriate respiratory care 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 observations, staff interviews, and record review, the facility failed to ensure physicians orders were in place for the administration of oxygen therapy. This affected one (Resident #9) of two residents reviewed for respiratory care during the annual survey. The facility census was 90. Residents Affected - Few Findings include: Record review for Resident #9 revealed the resident was admitted to the facility on [DATE]. Diagnoses included dementia with other behavioral disturbances, pulmonary fibrosis, and chronic obstructive pulmonary disease (COPD). Review of the five-day Minimum Data Set (MDS) assessment, dated 11/19/23, revealed Resident #9 had mildly impaired cognition. Review of the care plan, dated 11/16/23, revealed Resident #9 had COPD with shortness of breath while lying flat. Interventions included oxygen therapy as ordered. Review of the physicians orders for Resident #9 dated from 11/16/23 to 12/11/23 revealed there was no order for the administration of oxygen. Observations on 12/11/23 at 3:23 P.M. and on 12/12/23 at 9:15 A.M. revealed Resident #9 was sitting up in her recliner and had oxygen being administered by nasal cannula with the oxygen concentrator set to administer two liters per minute. Observation and interview with Licensed Practical Nurse (LPN) #100 on 12/12/23 at 2:11 P.M. verified Resident #9 had oxygen being administered by nasal cannula at a rate of two liters per minute. LPN #100 additional verified Resident #9 did not have physicians orders in place for the administration of oxygen. Interview with LPN #90 on 12/12/23 at 2:39 P.M. revealed physicians orders should be in place for all residents receiving oxygen therapy to determine the amount of oxygen to be administered. 365313 Page 5 of 7 365313 12/14/2023 Bridgeport Health Care Center 2125 Royce Street Portsmouth, OH 45662

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on staff interview and record review, the facility failed to ensure there was an appropriate diagnosis for the administration of an antipsychotic medication for Resident #52. This affected one (#52) of five residents reviewed for unnecessary medications. The facility census was 90. Findings include: Review of the medical record for Resident #52 revealed an admission date of 05/10/23. Diagnoses included anxiety, depression, visual and auditory hallucinations, and dementia with psychotic disturbance. Review of the plan of care dated 07/24/23 revealed Resident #52 used antipsychotic medication related to dementia with psychotic disturbances. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #52 was cognitively intact and received an antipsychotic medication seven of seven days during the look back period. Review of the progress note dated 11/06/23 revealed the Psychiatric Nurse Practitioner (NP) #22 was in the facility and ordered to increase the olanzapine 2.5 milligrams (mg) by mouth from daily to two tablets by mouth at bedtime for dementia with psychotic disturbance. The nursing progress notes were silent on reason for increase in olanzapine. Review of the physician order dated 11/06/23 revealed Resident #52 had an order for olanzapine (antipsychotic) 2.5 mg two tablets at bedtime for diagnosis of dementia with psychotic disturbance. An interview on 12/14/23 at 10:18 A.M. with the Director of Nursing confirmed Resident #52 received an antipsychotic medication for the diagnosis of dementia with behavioral disturbance and this was not an appropriate diagnosis for the use of the antipsychotic medication. 365313 Page 6 of 7 365313 12/14/2023 Bridgeport Health Care Center 2125 Royce Street Portsmouth, OH 45662

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and staff interviews, the facility failed to ensure resident's bathroom tiles remained in good repair. This affected one bathroom that was shared by three residents in two rooms (rooms [ROOM NUMBERS]). The facility identified the three residents in rooms [ROOM NUMBERS] who were ambulatory and used the bathroom. The facility census was 90. Findings include: Observation on 12/11/23 at 9:35 A.M. of the secured memory care unit revealed three floor tiles located in the bathroom shared by rooms [ROOM NUMBERS] were broken creating jagged, uneven edges. Observation and interview on 12/13/23 at 3:30 P.M. with State Tested Nursing Assistant (STNA) #990 verified the tiles located in the bathroom shared by rooms [ROOM NUMBERS] were broken and had jagged edges which could cause a resident to trip or cut their feet. STNA #990 verified three residents used the restroom with the broken, jagged tiles. Observation and interview with Maintenance Technician #950 on 12/14/23 at 2:00 P.M. verified the three tiles in the bathroom shared by rooms [ROOM NUMBERS] were broken, jagged and needed replaced. Maintenance Technician #950 denied reports from facility staff of the tiles in the bathroom being broken or in of being replaced. 365313 Page 7 of 7