Health inspection·April 11, 2022

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** Based on observation, medical record review, and staff interviews, the facility failed to ensure a resident's bruises were monitored. This affected one (#24) of one residents reviewed for skin impairment. The census was 41. Residents Affected - Few Findings include: Review of the medical record for Resident #24 revealed an admission date of 12/23/19, with diagnoses of cerebral infarction, aphasia, hemiplegia affecting the left nondominant side, weakness, encephalopathy, osteoarthritis, atrial fibrillation, and altered mental status. Review of the Medicare 5 Day Minimum Data Set (MDS) assessment dated [DATE], revealed Resident #24 had a Brief Interview of Mental Status (BIMS) of 00, indicating she is rarely or never understood and she required extensive two staff assistance for bed mobility and toilet use, total dependence of two staff for transfers, and extensive assistance of one staff for personal hygiene. It also stated the resident had wounds and was at risk for skin impairment. Review of Resident #24's physician orders revealed orders for Apixaban 2.5 milligrams (mg) in the morning and night for atrial fibrillation and Lispro insulin per sliding scale (unit amount of insulin is based on the blood glucose amount) every six hours. Review of the care plan dated 05/13/20 revealed the resident was at risk for abnormal bleeding and abnormal lab values related to use of anti-coagulant due to a stroke. Interventions included give medications per physician orders, handle the resident carefully when turning,positioning or transferring, and monitor skin for bruising. Review of the care plan dated 02/16/22 revealed the resident as at risk for hypo/hyperglycemic reactions, abnormal lab values and diabetic ulcers related to the use of antidiabetic medications with interventions to obtain accuchecks per physician orders, medications per physician orders, monitor skin weekly and monitor for signs of hypo/hyperglycemia. Review of the skin assessment dated [DATE] revealed the resident had no documented evidence of bruising to her right arm. Review of the skilled notes dated 04/05/22 and 04/07/22 revealed there were no concerns with bruising on her skin. Observation on 04/05/22 at 7:54 A.M., revealed Resident #24 with a quarter sized, dark purple/red bruise noted to her right upper arm. Interview on 04/07/22 at 8:59 A.M., with the Director of Nursing (DON) revealed if a resident is on an anticoagulant, staff are to monitor bruising and document it under skin assessments. She confirmed Resident #24 had a bruise and there was no documented evidence of Resident #24's bruise being Page 1 of 8 365323 365323 04/11/2022 Marion Pointe 409 Bellfontaine Avenue Marion, OH 43302

F 0684 monitored. Level of Harm - Minimal harm or potential for actual harm Interview on 04/07/22 at 1:43 P.M., with the Administrator revealed Resident #24's shower days are on Saturdays per the families request so each Saturday they scan for abnormal bruising. She stated the DON is doing education with staff that anytime they give insulin, to look for bruising and it is expected. She stated staff were thinking that it was not abnormal for her to have the bruising due to her history and her medication use (insulin and anticoagulant). Residents Affected - Few 365323 Page 2 of 8 365323 04/11/2022 Marion Pointe 409 Bellfontaine Avenue Marion, OH 43302

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, and policy review, the facility failed to assess a resident after a fall that resulted in injury. This affected one (#6) of two residents reviewed for falls. The facility census was 41. Findings include Review of the medical record for Resident #6 revealed an admission date of 08/23/21, with diagnoses including: heart failure, weakness, hemiplegia, atrial fibrillation, depression, anxiety, chronic obstructive pulmonary disease, kidney disease stage three, hypertension, and muscle atrophy. Review of the Quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #6 was cognitively intact and required supervision assistance for transfers and mobility. Review of the plan of care dated 01/11/22 revealed Resident #6 revealed resident was at risk for falls with a history of falls with injury. The interventions included having common articles within reach, reinforce to call for assistance, ensure environment is free of clutter, complete a fall risk assessment quarterly and as needed and have therapy screen and treat as needed. Review of the progress notes dated 03/27/22 revealed Resident #6 informed the nurse of a bruise 3 x 3 centimeters (cm) purple in color with a skin tear. Resident #6 informed the nurse he fell when going to the bathroom last night. Resident #6 stated to the nurse, he did not tell any staff about his fall until after it occurred. The nurse informed the family and the physician of the fall. A progress note dated 03/27/22 revealed resident had a second fall when he leaned over to kiss his wife who was also admitted to the facility. Nurse completed fall assessment and found no new injuries and resident denied new pain. Review of the fall risk assessment dated [DATE] revealed Resident #6 scored a 9 and was at low risk for falls. Review of the fall risk assessment dated [DATE] revealed Resident #6 scored a 13 and was at a high risk for falls. The falls assessment dated [DATE] revealed the resident had a fall this date, when he leaned over and kissed his wife. There was no mention about a fall that occurred either 03/26/22 or 03/27/22 which caused injury. Interview on 04/06/22 at 10:17 A.M., with Licensed Practical Nurse (LPN) #152 revealed if a resident reported a fall occurred they should be assessed for possible injuries and emergency contact and physician should be notified. Interview on 04/07/22 at 8:58 A.M. and 10:41 A.M., with the Director of Nursing (DON) revealed she would expect staff to assess residents after each fall for injuries and complete an assessment detailing any injuries found. DON confirmed Resident #6 did not have an assessment after the first fall on 03/27/22. DON revealed staff were informed of the first fall on 03/27/22 at 11:00 A.M. and Resident #6 had another fall about 3 hours later. DON revealed if staff did not have time to assess his injuries and document a separate fall assessment for the first fall, then the first fall should have been mentioned in the later fall assessment. DON confirmed their was no mention of the earlier fall in the fall assessment dated [DATE]. 365323 Page 3 of 8 365323 04/11/2022 Marion Pointe 409 Bellfontaine Avenue Marion, OH 43302

F 0689 Level of Harm - Minimal harm or potential for actual harm Interview on 04/07/22 at 9:55 A.M., with LPN #129 revealed after a resident reports a fall, a fall assessment needs to be completed to check for any pain and injuries. Review of the policy titled Falls and Managing Falls Risk dated 02/2018, revealed facility policy does not include fall assessments, but only addresses fall interventions. Residents Affected - Few 365323 Page 4 of 8 365323 04/11/2022 Marion Pointe 409 Bellfontaine Avenue Marion, OH 43302

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 medical record review and staff interviews, the facility failed to ensure a resident was not started on a anti-psychotic medication (Seroquel) without adequate indications of the need of its use. This affected one (#15) of five residents reviewed for unnecessary medications. The facility census was 41. Findings include: Review of Resident #15's medical records identified admission to the facility occurred on 06/11/21, with medical diagnosis including: dementia, glaucoma, high blood pressure, anxiety and depression. Resident #15 was additionally diagnosed with COVID-19 on 01/20/22. Review of the facility quarterly minimum data set (MDS) assessment dated [DATE] identified Resident #15 as having moderately impaired cognition and required supervision with ambulation. Review of Resident #15's medication regime identified on 01/31/22 the anti-psychotic medication Seroquel 25 mg was started daily. The progress notes identified on 01/20/22, Resident #15 was diagnosed with COVID-19 and was on isolation until 01/30/22. The medical record and progress notes identified no evidence of any concerns that would warrant the use of psychotropic medications. Review of the medical record identified since the start of the Seroquel, Resident #15 has fallen on 02/07/22, 02/10/22, 03/07/22, 03/16/22 and 03/22/22 without major injuries. Review of the undated written plan of care for the use of the psychotropic medications identified it was being used for depression and anxiety. The plan lacks any documented evidence of a reason for the use of a antipsychotic medication. Interview on 04/06/22 at 11:39 A.M., with the Director of Nursing, revealed Resident #15 had no documented evidence of the need for a antipsychotic medication in the record. The interview additionally confirmed Resident #15 has had a increase in falls since the start of the Seroquel. 365323 Page 5 of 8 365323 04/11/2022 Marion Pointe 409 Bellfontaine Avenue Marion, OH 43302

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, staff interviews and policy review, the facility failed to ensure medications were stored appropriately. This had the potential to affect six (#2, #6, #15, #22, #23, and #25) of 41 residents in the facility. The facility census was 41. Findings include: 1. Observation of the 200 hall medication cart on [DATE] at 8:00 A.M., with Licensed Practical Nurse (LPN) #128 revealed three Biscodyl 5 milligram (mg) tablets loose in the top drawer of the cart and one bottle of Aspirin 325 mg that expired in February 2022. Interview on [DATE] at 8:00 A.M., with LPN #128 confirmed the above findings. 2. Observation of the 300 hall medication cart on [DATE] at 8:40 A.M., with LPN #126 revealed a bottle of Preservision tablets that expired in [DATE]. Interview on [DATE] at 8:40 A.M., with LPN #126 confirmed the above findings. 3. Observation of the medication room on [DATE] at 10:00 A.M., with LPN #152 revealed a bottle of Simethicone 80 milligrams (mg) that expired in February 2021 and four containers of Benecal 330 calorie supplement that expired on [DATE]. Interview on [DATE] at 10:00 A.M., with LPN #152 confirmed the above findings. Interview on [DATE] at 2:50 P.M., with the Administrator revealed there were no residents receiving Benecal or Preservision. She provided information stating Resident #15 was the only resident receiving Aspirin 325 mg, two Residents (#2 and #23) were receiving Simethicone, and three Residents (#6, #22, and #25) were receiving Biscodyl 5 mg tablets. Review of the policy titled, Storage of Medications, dated February 2018, revealed the facility shall not use discontinued, outdated, or deteriorated drugs or biological's and such drugs shall be returned to the dispensing pharmacy or destroyed. It further stated that all nursing staff shall be responsible for maintaining medication storage and preparation areas in a clean, safe and sanitary manager. The policy revealed that drugs shall be stored in an orderly manner in cabinets, drawers, carts, or automatic dispensing systems. 365323 Page 6 of 8 365323 04/11/2022 Marion Pointe 409 Bellfontaine Avenue Marion, OH 43302

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, staff interview and policy review, the facility failed to safety store food in dry storage area and in the refrigerator. This affected 40 of 40 residents (except #24) who eats food from the kitchen. The facility census was 41. Findings include: Observation on 04/04/22 at 6:34 P.M., revealed a six pound can of country sausage gravy with a large fist sized dent. A tied bag of Oreo's and a tied bag of coconut were found to be undated. Review of the refrigerator revealed a turkey sandwich wrapped in foil with no date and four cups of apple juice that expired in November 2021. Interview on 04/04/22 at 6:45 P.M., with [NAME] #162 confirmed the can had a large dent and revealed the facility would serve food from a dented can if it could be opened with the can opener. [NAME] #162 confirmed the Oreo's and coconut was not dated. [NAME] #162 confirmed the turkey was not dated and the four apple juice containers were expired. Observation on 04/06/22 at 9:38 A.M., revealed the can of country sausage gravy remained on the shelf but was placed behind a another can without a dent. Two cups of apple juice remained in the refrigerator and had expired November 2021. Interview on 04/06/22 at 9:38 A.M., with Kitchen Manager (KM) #177 revealed any cans found with dents should be marked refused and returned to the supplier. KM #177 confirmed the can of country sausage remained on the shelf and had a large dent. KM #177 confirmed the apple juice in the fridge expired November 2021 and should not be served. Review of the policy titled, Food Receiving and Storage, dated February 2018, revealed when food was delivered it would be inspected for safe transport and quality before being accepted. All food in the refrigerator would be dated with a use by date. The policy did not specify what facility would do with dented cans and open food should be cover/sealed and dated. 365323 Page 7 of 8 365323 04/11/2022 Marion Pointe 409 Bellfontaine Avenue Marion, OH 43302

F 0883 Develop and implement policies and procedures for flu and pneumonia vaccinations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, policy review and staff interview, the facility failed to offer the pneumococcal vaccine to a resident. This affected one (#14) of five residents reviewed for immunizations. The facility census was 41. Residents Affected - Few Findings include: Review of the medical record for Resident #14 revealed an admission date of 07/19/21, with diagnoses including: diabetes type two, encephalopathy, chronic obstructive pulmonary disease, muscle wasting, atrophy, dysphagia, dysfunction of the bladder, dementia with behaviors, heart disease, depression, Alzheimer's and chronic kidney disease. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #14 had moderate cognitive impairment. Review of section O of the MDS revealed Resident was not given the pneumococcal vaccine and it was not offered to the resident. Further review of resident's medical record revealed no evidence resident received or was ever offered the pneumococcal vaccine. Interview on 04/07/22 at 10:41 A.M., with the Director of Nursing (DON) verified Resident #14 did not get the pneumococcal vaccine. DON revealed she contacted the physician and the vaccine was ordered for her to receive 04/07/22. Review of the policy titled Pneumococcal Vaccine, dated February 2018, revealed prior to admission or within five working days, residents would be assessed for eligibility to receive the pneumococcal vaccine. The policy revealed the pneumococcal vaccine will be administered to residents unless medically contraindicated, refused or already given) according to facility protocol. For residents who receive the vaccine the date, lot number, expiration date, person administering the vaccine and the site of the vaccination will be documented in the resident's medical record. 365323 Page 8 of 8