Health inspection·October 25, 2022

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, staff and resident interview, and policy review, the facility failed to ensure resident rooms remained clean. This affected two residents (#21 and #64) out of 73 residents' rooms observed. The facility census was 73. Findings include: 1. Review of the medical record of Resident #21 revealed an admission date of 11/12/10 and a readmission date of 12/08/20. Diagnoses included aphasia following a cerebral infarction, hemiplegia and hemiparesis following cerebral infarction affecting left non-dominate side, osteoarthritis, benign neoplasm of peripheral nerves and autonomic nervous system, disorders of brain, and cerebrovascular disease. Review of the annual minimum data assessment dated [DATE] revealed Resident #21 was cognitively intact and had 12 to 14 days of feeling down, depressed, or hopeless. She had trouble falling or staying asleep or sleeping too much two to six days, and felt tired or had little energy seven to 11 days. The total score was a six indicating a moderate potential for depression. The assessment indicated she required extensive assistance of two staff for bed mobility, dressing, toilet use and personal hygiene, and was totally dependent on two staff for transfers. The assessment indicated she had not received any therapy for the two week period. Interview on 10/17/22 1:42 P.M., with Resident #21 revealed the housekeepers had not cleaned the room. She said the toilet in the bathroom had been dirty for awhile now and the mirror had toothpaste spray on it for over a week. Observation on 10/17/22 1:58 P.M. of Resident #21's room revealed the floor to the left of the bed had a black, dried substance. The bathroom toilet had dried stool inside the toilet on the riser. The mirror had dried white blotches on the lower section. A pink bedpan was noted on the floor, under the counter, in a clear plastic bag. Observation on 10/18/22 1:21 P.M. of Resident #21's room revealed the dried black substances to the left of the bed remained on the floor, the dried stool remained in the toilet. The white blotches were still on the mirror. A pink bedpan was on the floor, under the counter, in a clear plastic bag and stool was visible on the pan. Interview on 10/18/22 at 1:39 P.M., with the Assistant Director of Nursing (ADON) #276 verified the above condition of Resident #21's room and bathroom. Page 1 of 17 365341 365341 10/25/2022 Briarwood Village 100 Don Desch Drive Coldwater, OH 45828

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the facility policy titled Housekeeping Services, dated 01/20 revealed in resident care areas, cleaning of non-carpeted floors and other horizontal surfaces will be done daily and more frequently if spillage or visible soiling occurs. Horizontal surfaces included toilet seats. 2. Review of medical record for Resident #64 revealed admission date of 08/22/10. Diagnoses included myotonic muscular dystrophy, anemia and muscle weakness. The annual Minimum Data Set (MDS) dated [DATE] revealed Resident #64 had intact cognition. The resident required extensive two person assistance for bed mobility, toilet use, one person assistance for eating and was totally dependent for transfers. Interview and observation on 10/17/22 at 10:35 A.M. with Resident #64 and a visitor revealed a medicine cup had been under the bed for several days. Observation revealed a medicine cup was on the floor about mid mattress and approximately two feet from the end of the bed. Observation on 10/18/22 at 1:41 P.M. revealed a medicine cup remained under the bed. Observation on 10/20/22 at 9:41 A.M. revealed a medicine cup remained under the bed. Interview on 10/20/22 at 9:49 A.M., with the Housekeeping Supervisor #344 revealed rooms were cleaned daily, which included sweeping the floors. The Housekeeping Supervisor #344 verified a medicine cup remained under Resident #64's bed. 365341 Page 2 of 17 365341 10/25/2022 Briarwood Village 100 Don Desch Drive Coldwater, OH 45828

F 0636 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and staff and family interview, the facility failed to ensure a comprehensive skin assessment was completed on residents. This affected one resident (#46) out of 18 residents sampled. The facility census was 73. Findings include: Review of medical record for Resident #46 revealed admission date of 08/19/22. Diagnoses included dementia without behaviors, chronic obstructive pulmonary disease, depression, and congestive heart failure. The admission Minimum Data Set (MDS) dated [DATE] revealed he had intact cognition and required extensive two-person assistance for bed mobility, toilet use, one person for transfers and supervision for eating. No skin alterations documented. Review of the plan of care for potential/actual impairment to skin integrity related to fragile skin was created on 09/21/22. No other skin care plans were in place. Review of a progress note for Resident #46 dated 08/19/22 revealed a large brown protruding mole to the top of the scalp which measured two centimeters by two centimeters. Interview and observation on 10/17/22 at 1:13 P.M. with Resident #46's son revealed he had been a resident in the facility's assisted living area and had known skin cancer area to the top of his head. Resident #46's son believed the staff were putting something on it, and as far as he knew it had not continued since being moved to the skilled side and the son felt the area had doubled in the last four weeks. An area approximately 25 millimeters (mm) in diameter growth was protruding from the top of Resident #46's head. Review of the physician progress note dated 10/12/22 revealed Resident #46 had exophytic (growing outward beyond the surface epithelium from which it originates) mass growing from the top of his head and the side of his face. Interview on 10/20/22 at 11:28 A.M., with the MDS Registered Nurse (RN) #230 revealed the initial skin assessment for Resident #46 provided no documentation on the admission assessment for any skin conditions, therefore it was not added to the care plan. RN #230 confirmed Resident #46 was an established resident of the facility Medical Director and she was unaware why there was no diagnosis addressing the area on the admitting history and physical. The skin area was present on Resident #46 during the initial admission MDS assessment. 365341 Page 3 of 17 365341 10/25/2022 Briarwood Village 100 Don Desch Drive Coldwater, OH 45828

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** 2. Review of the medical record of Resident #38 revealed an admission date of 11/11/15. Diagnoses included other speech disturbances, unspecified hydrocephalus, contusion of left knee sequela, unspecified constipation, other dysphagia, unspecified systolic (congestive) heart failure, paroxysmal atrial fibrillation, non-ST elevation myocardial infarction, and rhabdomyolysis. Review of the PAS (Pre-admission Screen) Review dated 04/11/13 revealed Resident #38 had no indications of serious mental illness nor a developmental disability. Review of the medical record revealed a diagnosis of unspecified psychosis not due to a substance or known physiological condition dated 09/27/17, and a diagnosis of unspecified dementia, unspecified severity with agitation dated 10/03/22. The record had no documentation of any additional PAS Reviews were completed. Interview on 10/20/22 at 1:35 P.M. with RSC #306 verified the lack of a second screening completed for Resident #38. Based on record review and staff interview, the facility failed to ensure an updated assessment was completed when residents had a new diagnosis added. This affected three residents (#47, #38, and #17) out of five residents reviewed for Preadmission Screening and Resident Review. The facility census was 73. Findings include: 1. Review of the record for Resident #47 revealed she was admitted [DATE]. Diagnoses included Parkinson's disease, chronic obstructive pulmonary disease, asthma, depression, hypokalemia, atherosclerotic heart disease, osteoarthritis, neuromuscular dysfunction, abdominal hernia, intervertebral disc degeneration of lumbar region, cerebral ischemia, acute kidney failure, cardiomyopathy, dementia without behavioral disturbance, hypotension, benign paroxysmal vertigo, psychotic disorder with hallucinations, hypothyroidism, anemia and hyperlipidemia. Review of the Minimum Data Set, dated [DATE] revealed Resident #47 had moderate cognitive impairment and required supervision with eating. The resident required extensive assistance with dressing, toilet use, personal hygiene, bed mobility and transfers. Review of the Preadmission Screening and Resident Review (PASRR) for Resident #47 dated 05/10/22 revealed no diagnosis of dementia or of mental illness. Review of the physician's orders revealed Resident #47 had a diagnosis of dementia and a diagnosis of psychotic disorder with hallucinations added on 06/02/22. During an interview with the Resident Services Coordinator (RSC) #306 on 10/20/22 at 10:27 A.M. verified she had not completed an updated assessment for Resident #47 when she received her new diagnoses on 06/02/22. Review of the policy titled Preadmission Screening, revised 03/17/15 revealed its purpose was to 365341 Page 4 of 17 365341 10/25/2022 Briarwood Village 100 Don Desch Drive Coldwater, OH 45828

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few ensure that individuals with mental illness and intellectual disabilities received the care and services they needed in the most appropriate setting. The facility must not admit any residents with mental illness or intellectual disability unless those boards have determined they need the level of services provided by a nursing home and if the resident required any specialized services. 3. Medical record review for Resident # 17 revealed an admission date of 02/02/22. Diagnoses included dementia with behaviors, type two diabetes, anxiety disorder and mood affective disorder. Review of the quarterly Minimum Data Set (MDS) assessment for Resident #17 revealed a severely impaired cognition. Resident #17 required extensive to total assistance for activities of daily living. Resident #17 was coded as having dementia with behaviors, and mood affective disorder. Review of the plan of care for Resident #17 dated 02/11/22 and revised on 7/21/22 revealed the resident had cognitive deficits and confusion. Resident #17 had diagnoses including dementia, anxiety and mood disorders. Interventions included secure care to ankles, offer support and reassurance as needed observe for moods, anxiety and behaviors, and encourage resident to express thoughts and feelings. Review of the Preadmission Screening and Resident Review (PASRR) Identification Screen dated 02/05/22 revealed Resident #17 had a diagnosis of dementia. Section E of the PASRR had no indication of serious mental illness. Interview on 10/20/22 at 2:15 P.M., with the RSC #306 verified the diagnosis of mood disorder for Resident #17 was not on the PASRR as it should have been. 365341 Page 5 of 17 365341 10/25/2022 Briarwood Village 100 Don Desch Drive Coldwater, OH 45828

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to ensure an actual skin concern was developed in the plan of care. This affected one resident (#46) out of 18 residents sampled. The facility census was 73. Findings include: Review of medical record for Resident #46 revealed admission date of 08/19/22. Diagnoses included dementia without behaviors, chronic obstructive pulmonary disease, depression, and congestive heart failure. The admission Minimum Data Set (MDS) dated [DATE] revealed he had intact cognition and required extensive two-person assistance for bed mobility, toilet use, one person for transfers and supervision for eating. No skin alterations documented. Review of the plan of care for potential/actual impairment to skin integrity related to fragile skin was created on 09/21/22. No other skin care plans were in place. Review of a progress note for Resident #46 dated 08/19/22 revealed a large brown protruding mole to the top of the scalp which measured two centimeters by two centimeters. Interview and observation on 10/17/22 at 1:13 P.M. with Resident #46's son revealed he had been a resident in the facility's assisted living area and had known skin cancer area to the top of his head. Resident #46's son believed the staff were putting something on it, and as far as he knew it had not continued since being moved to the skilled side and the son felt the area had doubled in the last four weeks. An area approximately 25 millimeters (mm) in diameter growth was protruding from the top of Resident #46's head. Review of the physician progress note dated 10/12/22 revealed Resident #46 had exophytic (growing outward beyond the surface epithelium from which it originates) mass growing from the top of his head and the side of his face. Interview on 10/20/22 at 11:28 A.M., with the MDS Registered Nurse (RN) #230 revealed the initial skin assessment for Resident #46 provided no documentation on the admission assessment for any skin conditions, therefore it was not added to the care plan. RN #230 confirmed Resident #46 was an established resident of the facility Medical Director and she was unaware why there was no diagnosis addressing the area on the admitting history and physical. The skin area was present on Resident #46 during the initial admission MDS assessment. 365341 Page 6 of 17 365341 10/25/2022 Briarwood Village 100 Don Desch Drive Coldwater, OH 45828

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 medical record review, observation, and resident and staff interviews, the facility failed to ensure dependent residents were repositioned. This affected one resident (#39) out of one resident reviewed for positioning. The facility census was 73. Residents Affected - Few Findings include: Review of the medical record for Resident #39 revealed an admission date of 03/20/18. Diagnoses included unspecified dementia, displaced oblique fracture of shaft of right tibia, subsequent encounter for closed fracture with routine healing (10/06/22), displaced oblique fracture of shaft of right fibula (10/06/22), unspecified disorder of adult personality and behavior, and history of falling. Review of the comprehensive minimum data set (MDS) dated [DATE] revealed Resident #39 had impaired cognition and was totally dependent on two people for bed mobility and transfers. Resident #39 had not rejected care. Review of a physician order dated 11/05/18 revealed Resident #39 needed to be checked every two hours for incontinence. Review of the current care plan for Resident #39 revealed she had a self care deficit related to decreased mobility. Interventions included two people to assist with bed mobility. Observations throughout the day on 10/17/22 and 10/18/22 revealed Resident #39 lying in bed. Interview at the same time with Resident #39 revealed she preferred staying in bed. Observation on 10/19/22 at 7:53 A.M. revealed Resident #39 sleeping on her back. Her shoulders and hips appeared flat on the bed, no bolsters or pillows were observed. Observation on 10/19/22 at 10:22 A.M. revealed Resident #39 sitting up in bed with the head of bed elevated. No bolsters or pillows were observed at that time. Concurrent interview with Resident #39 revealed staff had not repositioned her that day. Observation on 10/19/22 at 11:26 A.M. revealed Resident #39 sleeping. Her position appeared unchanged from the previous observation. Observation on 10/19/22 at 12:05 P.M. revealed Resident #39 was awake, looking at a word search puzzle. Resident #39's position appeared to be unchanged from the previous observation. Concurrent interview with Resident #39 revealed staff had not repositioned her. Interview on 10/19/22 at 1:54 P.M. with State Tested Nurse Aide (STNA) #266 revealed she was assigned to care for Resident #39, and verified she had not repositioned Resident #39 since prior to 10:22 A.M. that morning. Interview on 10/19/22 at 2:07 P.M. with STNA #236 confirmed she had not repositioned or provided care for Resident #39 since first thing this morning. Interview on 10/19/22 at approximately 6:00 P.M. with the Director of Nursing (DON) verified 365341 Page 7 of 17 365341 10/25/2022 Briarwood Village 100 Don Desch Drive Coldwater, OH 45828

F 0684 Resident #39 could not reposition herself in bed. Level of Harm - Minimal harm or potential for actual harm A follow-up interview on 10/20/22 at 9:35 A.M. with the DON revealed Resident #39 had no skin breakdown on her backside. Residents Affected - Few This deficiency shows non-compliance related to allegation in Complaint Number OH00135342. 365341 Page 8 of 17 365341 10/25/2022 Briarwood Village 100 Don Desch Drive Coldwater, OH 45828

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 record review, policy review, and staff interview, the facility failed to ensure pressure ulcers were accurately assessed and documented treatment in place. This affected one resident (#46) out of three residents reviewed for pressure ulcers. The facility census was 73. Residents Affected - Few Findings include: Review of medical record for Resident #46 revealed admission date of 08/19/22. Diagnoses included dementia without behaviors, chronic obstructive pulmonary disease, depression, and congestive heart failure. The admission Minimum Data Set (MDS) dated [DATE] revealed he had intact cognition and required extensive two-person assistance for bed mobility, toilet use, one person for transfers and supervision for eating. No skin alterations documented. Review of the plan of care for potential for pressure ulcer development on 08/20/22 due to decreased mobility. Interventions in place included a pressure relieving mattress and a cushion in the wheelchair. Review of the progress note dated 09/23/22 revealed the hospice aid reported reddened areas to Resident #46's spine. Two areas were documented as measuring one centimeter (cm) by two cm. The areas blanched but were sluggish. The physician and the hospice staff were updated. Review of the hospice notes dated 09/29/22 revealed documentation of a pressure ulcer which measured 0.4 cm by 0.4 cm to the lower spine of Resident #46. Review of the physician orders for Resident #46 revealed an order on 09/24/22 for a foam border dressing to the residents back and change every three days thru 10/8/22. Review of the weekly skin assessments for Resident #46 revealed no new areas was documented on 09/24/22, 10/01/22, 10/08/22, 10/15/22, and on 10/22/22. There was no documented assessment of the current pressure area including measurements and descriptions. Review of the hospice note dated 10/12/22 revealed the documented pressure ulcer for Resident #46 increased in size to 1.2 cm by 1.0 cm with sloughing noted. Interventions were a bordered dressing change every three days with a start effective date of 10/05/22. Review of the physician orders dated from 10/08/22 to 10/19/22 revealed no documentation for the bordered dressing order. Review of the Treatment Administration Record (TAR) dated from 10/08/22 to 10/19/22 revealed no documentation of the bordered dressing. Review of the wound assessment dated [DATE] revealed a stage three pressure ulcer wound which measured 2.5 cm by 2.0 cm continued to Resident #46's mid-spine, the wound was red/pink in color with white/tan slough in center. A second scabbed area to the mid-spine was documented and an Optifoam dressing was applied and encouragement to offload pressure to the area was provided. 365341 Page 9 of 17 365341 10/25/2022 Briarwood Village 100 Don Desch Drive Coldwater, OH 45828

F 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the physician orders revealed an order for the Optifoam dressing to the mid spine every three days, assess wounds, and report any worsening with a start date of 10/19/22. Observation on 10/17/22 at 10:55 A.M., revealed a pressure reducing mattress was in place on Resident #46's bed. On 10/18/22 at 1:15 P.M., Resident #46 asked the surveyor to leave the room and would not allow observation of the residents back. Resident #46 was observed in bed and up in his wheelchair throughout the survey. Interview on 10/20/22 at 2:12 P.M. with the Director of Nursing (DON) revealed skin assessment were done weekly, however Resident #46's documented pressure area was not assessed or measured by the facility until 10/19/22. The DON verified it was the expectation of the facility areas of pressure and documented skin concerns should be assessed, measured, and documented on weekly. A follow-up interview on 10/24/22 at 2:10 P.M. with the DON verified there were no treatment orders in place for Resident #46 from 10/08/22 until 10/19/22. Review of the policy titled Pressure Ulcer Policy last reviewed 04/2016 revealed all residents would be assessed for pressure ulcer risk on admission, monitored weekly and reviewed quarterly and as needed. 365341 Page 10 of 17 365341 10/25/2022 Briarwood Village 100 Don Desch Drive Coldwater, OH 45828

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, staff interview and policy review, the facility failed to ensure as-needed (PRN) psychotropic medications were limited to 14 days, and failed to ensure a physician evaluated the resident before continuing a PRN psychotropic medication. This affected two residents (#48 and #66) out of seven residents reviewed for unnecessary medications. The facility census was 73. Findings include: 1. Review of the medical record for Resident #48 revealed an admission date of 01/16/13 and a readmission date of 02/23/21 with medical diagnoses of Alzheimer's disease, anxiety disorder, dementia with behavioral disturbance, and unspecified abnormalities of gait and mobility. Review of the quarterly minimum data set (MDS) dated [DATE] revealed Resident #48 had impaired cognition and required extensive assistance of two people for bed mobility, transfers, dressing, toileting, extensive assistance of one person for hygiene, and limited assistance of one person for eating. Further review revealed she received an antipsychotic during the previous seven days. Review of the current care plan revealed Resident #48 used daily scheduled psychotropic medications and as-needed (PRN) psychotropic medications. Interventions included monitoring the resident for side effects of medication use, notifying the physician of any adverse side effects, and using non-pharmacological interventions and documenting their effectiveness Review of the physician orders for Resident #48 revealed an order dated 09/30/20 for lorazepam (an anti-anxiety medication) tablet 0.5 milligrams (mg), give one tablet by mouth every eight hours as needed for anxiety/agitation/sleep. The order ended on 08/21/21. Further review of the orders revealed Resident #48's orders for PRN lorazepam continued until 10/14/21. Review of a new PRN order dated 12/08/21 for lorazepam tablet 0.5 mg, give 0.5 mg by mouth every four hours as needed for anxiety/shortness of breath related to anxiety disorder. The order ended on 09/12/22. Interview on 10/19/22 at 5:10 P.M., with the Regional Director of Clinical Services #347 verified the PRN order for lorazepam dated 09/30/20 was the first time PRN lorazepam was ordered for Resident #48, and confirmed the end date for the order was 08/21/21 and exceeded 14 days. Further interview at that time revealed the facility could not provide verification Resident #48 was evaluated by the physician 14 days after the PRN order for lorazepam dated 09/30/20. It was confirmed the order dated 12/08/21 for PRN lorazepam had an end date of 09/12/22 and the facility could provide no verification the physician evaluated Resident #48 after 14 days of receiving a PRN psychotropic medication. 2. Review of the medical record for Resident #66 revealed an admission date of 03/26/21 and medical diagnoses of anxiety disorder, urge incontinence, and chronic obstructive pulmonary disease. Review of the quarterly MDS dated [DATE] revealed Resident #66 had intact cognition and required 365341 Page 11 of 17 365341 10/25/2022 Briarwood Village 100 Don Desch Drive Coldwater, OH 45828

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few extensive assistance of two people for bed mobility, transfers, toileting, and extensive assistance of one person for personal hygiene. Review of the current care plan for Resident #66 revealed she received psychotropic medications for diagnoses of anxiety and depression. Interventions included administering medications as ordered and monitor and document side effects and effectiveness, and monitor/record/report to the physician any PRN side effects and adverse reactions of psychoactive medications. Review of the physician orders for Resident #66 revealed an order dated 03/27/21 for alprazolam (an anti-anxiety medication) tablet 0.5 mg, give one tablet by mouth every six hours as needed for anxiety. The order ended on 09/07/21. Interview on 10/20/22 at 11:58 A.M. with the Regional Director of Clinical Services #347 verified the PRN order for alprazolam began on 03/27/21 and ended on 09/07/21 which exceeded 14 days. Further interview revealed Resident #66 had a PRN order for alprazolam dated 03/26/21 and discontinued on 03/27/21, and the order started 03/27/21 was the first PRN order that extended at least 14 days. The facility could not provide verification Resident #66 was evaluated by the physician 14 days after the PRN order for alprazolam dated 03/27/21. Review of the facility policy titled Psychotropic Drugs, revised March 2017 revealed psychotropic medications used on a PRN basis with a physician's note indicating that the use of the drug, or continued of the drug is clinically appropriate, and the reasons why this use is clinically appropriate. This note must demonstrate that the physician has carefully considered risk/benefit to the resident. 365341 Page 12 of 17 365341 10/25/2022 Briarwood Village 100 Don Desch Drive Coldwater, OH 45828

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. Based on observation, staff interview, and policy review, the facility failed to ensure medications were stored at proper temperatures. This affected 15 residents (#11, #56, #14, #42, #14, #48, #34, #26, #15, #13, #61, #07, #06, #37 and #274) and had the potential to affect all 59 residents on the A, B, C, and D halls. The facility identified three resident medication refrigerators. The facility census was 73. Findings include: 1. Interview and observation on 10/19/22 at 1:20 P.M. with Registered Nurse (RN) #245 of the A, B, C, and D hall refrigerator revealed the third shift charge nurse was responsible to check the refrigerator temperatures and log them daily. The log sheet on the refrigerator had temperatures on 10/03/22, 10/05/22, 10/17/22, 10/18/22, and 10/19/22 and each were documented within the 35 to 46 degree Fahrenheit parameters. The temperature during the observation the temperature during observation was 50 degrees. This was verified at the time of finding. 2. Interview and observation on 10/19/22 at 1:28 P.M. with RN #245 of the refrigerator in the infection preventionist's office revealed the temperature was 44 degrees Fahrenheit. RN #245 verified there was no log for temperature checks and could not provide documentation. Interview on 10/19/22 at 4:38 P.M., with the Director of Nursing revealed individual medications and contingency medications were being disposed of by recommendation of the pharmacy due to the low temperatures in the refrigerators. Review of the policy titled Medication Storage in Facility, revised 02/11/22 revealed medications requiring refrigeration were to be kept in a refrigerator with a thermometer, with temperatures to be recorded daily. 365341 Page 13 of 17 365341 10/25/2022 Briarwood Village 100 Don Desch Drive Coldwater, OH 45828

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, review of the kitchen daily cleaning schedule, and policy review, the facility failed ensure foods were labeled and dated, discard expired foods, and resident meals trays were covered during transport to resident rooms. In addition, the kitchen area and equipment was not maintained in a sanitary manner. This had the potential to affect all residents who resided in the facility and received food from the kitchens. The facility census was 73. Findings include: Observation on 10/17/22 at 9:20 A.M. of the facility kitchen and storage area revealed the following sanitation violations: 1. In the dry food storage one large bag of brown sugar next to a large plastic storage bin with brown sugar both open and undated. The large plastic storage container storing the brown sugar was sitting on a plastic food service tray with brown sugar laying on the surface. In the walk-in refrigerator, the following items were opened, unlabeled and undated, 1. Open package of cheddar cheese. 2. Open package of mozzarella cheese, 3. Open package of shredded lettuce, 4. Opened package of ham base. 5. Opened package of pepperoni. 6. Opened package of smoked ham. In the facility walk in freezer, the following items were opened, unlabeled and undated. Further observation revealed the food was not sealed properly. 1. Opened, undated and unsealed bag of broccoli. 2. Opened, undated and unsealed package of Garden burgers. 3. Opened, undated and unsealed package of cubed potatoes. Interview on 10/17/22 at 10:02 A.M. with Assistant Dietary Manager #246 verified the findings and the foods should have been labeled and dated with an open date. She verified perishable foods should have been discarded on the expiration date or 7 days after opening. 2. Observation on 10/17/22 at 10:22 A.M. of the facility main kitchen revealed six heated food storage carts being utilized for storage of warm food until transportation to individual serveries. All six food storage carts had multiple unidentified spills inside the units, on the doors and side of the carts and the wheel casters had accumulation of unknown brown, black colored substances. 365341 Page 14 of 17 365341 10/25/2022 Briarwood Village 100 Don Desch Drive Coldwater, OH 45828

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Observation on 10/17/22 at 10:25 A.M. of the facility main kitchen revealed a long stainless-steel worktable in the middle of the kitchen. The table had shelves under the top surface area. The shelves had multiple brown/black and yellow colored streaking on the legs, shelves and wheel castors. Observation on 10/17/22 at 10:30 A.M. of the facility main kitchen revealed cook units had unidentified gray/white dry flaky debris on top of the units. Further observation revealed unidentified streaking down the sides of both units and brown, black colored accumulation around inside shelves oven racks. Observation on 10/17/22 at 10:35 A.M. in the facility main kitchen revealed three black serving carts. The serving carts had three shelves. Observation on all three carts revealed multiple streaking of unidentified material on the handles, shelves and wheel castors. Review of the kitchen daily routine cleaning schedule posted for staff to initial revealed the last documentation was dated 03/22. Interview on 10/17/22 at 10:45 A.M. verified the observations regarding the heated food storage units, shelves under stainless steel tables, cook units and serving carts were not kept in a sanitary manner. Further confirmed the daily cleaning schedule was not completed as it should have been. Interview on 10/20/22 at 12:40 P.M. with the Administrator and completed a tour of the dry storage area, and main kitchen cook areas and verified the daily cleaning schedule was not current and the last month the schedule was utilized was March 2022. The Administrator further verified the kitchen areas were not maintained in a sanitary manner regarding the heated storage carts, ovens, and stainless-steel table shelves. Interview on 10/20/22 at 4:10 P.M. with the Director of Nursing (DON) verified the facility had no residents that did not receive food from the dietary department at the time of the survey. 3. Observation on 10/17/22 at 11:34 A.M. of Dietary cook #221 preparing meal tray to be transported from the unit serveries to residents eating in their room. Dietary Staff #270 transported a lunch tray for Resident #36 without appropriate coverings. Observation on 10/17/22 at 11:36 A.M. of Dietary [NAME] #221 prepare a meal tray to be transported form the unit serveries to residents eating in their room. Dietary Staff #270 transported a lunch tray for Resident #16 without appropriate coverings. Observation on 10/17/22 at 11:42 A.M. of Dietary [NAME] #221 prepare a meal tray to be transported form the unit serveries to residents eating in their room. Dietary Staff #270 transported a lunch tray for Resident #86 without appropriate coverings. Interview on 10/17/22 at 11:50 A.M. with Dietary [NAME] #221 stated the meal trays should be covered when they are transported to the resident's room. Dietary [NAME] #221 verified trays were not covered as they should have been. Review of facility policy titled Food Storage, dated 02/07/2018 revealed the facility failed to implement the policy as written. Letter A of the policy states food storage areas will be clean at all times. Letter B of the policy states all packaged food, or food items will be dated, kept clean and dry and dry at all times. 365341 Page 15 of 17 365341 10/25/2022 Briarwood Village 100 Don Desch Drive Coldwater, OH 45828

F 0812 Level of Harm - Minimal harm or potential for actual harm Review of facility policy titled Sanitation, dated 02/17/2016 revealed the facility failed to implement the policy as written. Letter B of the policy states all utensils, counters, shelves and equipment will be kept clean and maintained in good repair. Residents Affected - Many 365341 Page 16 of 17 365341 10/25/2022 Briarwood Village 100 Don Desch Drive Coldwater, OH 45828

F 0947 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention. Based on staff interview and review of personnel files, the facility failed to provide newly hired State Tested Nurse Aides (STNA) with training on caring for residents with a diagnosis of dementia. This had the potential to affect 44 residents (#41, #51, #40, #328, #50, #27, #30, #48, #68, #277, #26, #60, #03, #07, #39, #69, #17, #56, #38, #12, #06, #19, #374, #62, #04, #28, #63, #70, #46, #08, #35, #37, #02, #29, #31, #15, #47, #36, #18, #67, #22, #124, #375, and #13) out of 44 residents diagnosed with dementia. The facility census was 73. Findings include: Review of the personnel file for STNA #231 revealed a hire date of 12/29/21. Further review revealed no documented training for residents with dementia. Review of the personnel file for STNA #236 revealed a hire date of 04/01/22. Further review revealed no documented training for residents with dementia. Interview on 10/20/22 at 1:31 P.M. with the Human Resources Director #248 verified the personnel files for STNA #231 and STNA #236 contained no verification they had received training on caring for residents with dementia. Interview on 10/20/22 at 3:15 P.M. with the Assistant Director of Nursing (ADON) #276 revealed she trained newly hired nurse aides and further revealed the training included no specific training on caring for residents with dementia. 365341 Page 17 of 17