Health inspection·April 19, 2021

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on medical record review, observation, and staff interview, the facility failed to ensure residents nonverbal communication of hunger was responded to. This affected one (#53) of four residents observed on the secured unit who received meals in their rooms. The facility census was 65. Findings include: Review of Resident #53's medical record revealed an admission date of 12/18/19. Diagnoses included vascular dementia with behavioral disturbance, major depressive disorder, and anxiety disorder. Review of Resident #53's care plan, revised 03/30/21, revealed an intervention for a communication problem which included supports to anticipate and meet Resident #53's needs. An additional intervention was found for increased nutritional risk. Supports included saving Resident #53's meals for later consumption if Resident #53 did not eat. Observation on 04/13/21 at 12:25 P.M. found Resident #53 pacing in his room. Resident #53 was observed sitting on the bed, getting up and walking to the door, looking at the meal tray cart, going back in his room, sitting on the bed and positioning the gray side table in front of him. Resident #53 was observed repeating this process four times in three minutes. Observation on 04/13/21 at 12:28 P.M. of the meal trays on the hall cart found Resident #53's lunch tray was on the cart. The lunch tray was covered and appeared untouched. Interview on 04/13/21 at 12:29 P.M. with State Tested Nursing Assistant (STNA) #157 verified the untouched lunch tray on the meal cart was Resident #53's. STNA #157 reported Resident #53 placed the lunch tray in the hallway after it was initially delivered. STNA #157 verified she picked up the untouched tray and put it back on the cart. STNA #157 stated Resident #53 must have not wanted it. Coinciding observation of Resident #53 found him sitting on his bed with his side table in front of him, looking at the meal cart and his tray as it went by. STNA #157 did not stop and ask Resident #53 if he was hungry or if he wanted his meal. STNA #157 was observed pushing the meal cart down the hallway and adding other resident's used lunch trays to the cart to be taken back to the kitchen. Observation on 04/15/21 at 8:05 A.M. of Resident #53 found Resident #53 seated on his bed with his breakfast meal on the gray side table positioned in front of him. Resident #53 was observed eating and drinking independently. Interview on 04/15/21 at 8:07 A.M. with STNA #165 revealed Resident #53 was not able to verbally communicate if he was hungry. STNA #165 reported they knew he was hungry by his nonverbal Page 1 of 3 365337 365337 04/19/2021 The Manor at Greendale 2101 Greendale Boulevard Findlay, OH 45840

F 0550 Level of Harm - Minimal harm or potential for actual harm communication. STNA #165 explained Resident #53 took his meals in his room and he would get fidgety when he was hungry. STNA #165 stated Resident #53 would pace and move his gray table around when he was hungry and wanted to eat. STNA #165 reported if Resident #53 refused his food they were to make additional attempts to offer his meal to him and/or offer an alternate. Residents Affected - Few 365337 Page 2 of 3 365337 04/19/2021 The Manor at Greendale 2101 Greendale Boulevard Findlay, OH 45840

F 0569 Notify each resident of certain balances and convey resident funds upon discharge, eviction, or death. Level of Harm - Minimal harm or potential for actual harm Based on review of resident funds records, staff interview, and review of facility policy, the facility failed to return resident funds to the resident's responsible party within 30 days of the resident's death. This affected one resident (#165) of one resident reviewed for discharge funds. The facility census was 65. Residents Affected - Few Findings include: Review of Resident #165's medical record revealed an admission date of 05/21/20 and a discharge date of 11/23/20. Diagnoses included osteoarthritis, emphysema, chronic kidney disease, and neoplasm of kidney Further review of medical record revealed the resident was private pay. Review of copy of check dated 02/04/21 addressed to the estate of Resident #165's revealed the amount of $1,417.48. Interview on 04/19/21 at 11:27 A.M. with Business Office Manager #177 verified Resident #165's funds were not returned within 30 days of the resident's death. Review of facility policy titled Resident Personal Funds dated November 2016, revealed within 30 days of a resident's death, the Manor will transfer funds in their personal account to their estate. 365337 Page 3 of 3