Health inspection·November 21, 2019

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, staff interview, and resident interview the facility failed to ensure residents were provided with dignity during dining. This affected six (#7, #57, #92, #113, #129 and #358) of 30 residents reviewed for dining. The facility census was 152. Findings include: 1. Record review revealed Resident #92 was admitted to the facility on [DATE]. Diagnoses included dementia, paranoid schizophrenia, anxiety and chronic kidney disease. Review of the quarterly assessment dated [DATE] revealed the resident had impaired cognition, and required supervision to eat. Review of the nurse notes dated from 08/01/19 to 11/20/19 had no documentation to support staff were being rude or disrespectful, however notes throughout documented the resident was frequently upset with staff for not being able to hear what she was saying. Observation on 11/20/19 at 7:49 A.M., Resident #92 was sitting at the table in the dining area, and State Tested Nursing Assistant (STNA) #326 had just set down a bowl of cold cereal, a glass of juice and a glass of milk. STNA #326 then sat at the table next to Resident #92 and began looking over dining tickets. Resident #92 stated she had told STNA #326 she did not want any milk and the STNA needed to come and take it away. STNA #326 responded to the resident with a direct stern tone that she would take the milk away in a minute and that the resident could hold on. STNA #326 made eye contact with the surveyor the her tone immediately changed. STNA #326 continued to tell the resident she had not put the milk in her cereal and knew the resident wanted to eat it dry. Resident #92 was eating dry cereal and the milk was not poured in the bowl. Interview on 11/20/19 at 7:50 A.M., STNA #326 apologized for sounding stern, and said she should not have done that. She also stated she had not poured the milk in the cereal and was going to take away the milk when she was finished with the dietary tickets for other residents. Interview on 11/20/19 at 8:05 A.M., the Administrator and Director of Nursing (DON) were made aware of the interaction between STNA #326 and Resident #92. They both stated they have zero tolerance for rudeness or disrespect and they were going to begin to investigate and provided education immediately. Interview on 11/20/19 at 2:40 P.M., Resident #92 stated STNA #326 did not like it when she told her Page 1 of 5 365346 365346 11/21/2019 Otterbein Lebanon Retirement Community 585 North State Route 741 Lebanon, OH 45036

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some she did not want milk with her cereal. She said it bothered her but she would not let it upset her. She said she did not think it was respectful. She said the STNA always sounded like that, but the resident denied reported it to management before. 2. Record review revealed Resident #358 was admitted to the facility on [DATE]. Diagnoses included fracture of the right pubis, protein calorie malnutrition, dysphasia, dementia, major depression, and malignant neoplasm. Review of the admission assessment dated [DATE] revealed he had impaired cognition, he required extensive assistance of one staff for eating and had loss of food from his mouth. Review of the plan of care (POC) dated 11/12/19 revealed he was at risk for nutritional decline due to diagnoses and his interventions included to encourage him to eat, drink and may need assistance due to his dementia he may not even be interested in food. Observation on 11/19/19 at 10:00 A.M., Resident #358 was sitting in the dining room attempting to eat scrambled eggs, a banana, a biscuit, and a two handled lidded sipper cup. He was sitting with Speech Therapy (ST) #300 at this time. Observation on 11/19/19 at 11:40 A.M., Resident #358 was sitting in the dining room in front of his breakfast meal of scrambled eggs, a biscuit and banana. He was not eating at this time, but would pick up the fork and attempt to fork something in the bowl and then just put his fork down. At 11:42 A.M., Culinary Aide #226 and #293 arrived to the area to begin the lunch meal. At 11:49 A.M., Resident #358 attempted multiple times to get his fork from his bowl then just stopped. He began to chatter and then picked up the fork out of the bowl and kept trying to fork the biscuit but could not get any and then he put the fork down. At 12:09 P.M., Unit Secretary #136 came into the dining room and asked Resident #358 if he was going to eat any more of his breakfast as it was almost lunch time and then she removed the breakfast plate. On 11/20/19 at 9:01 A.M., Unit Secretary #136 was observed feeding the resident his breakfast and he was eating some of the food. Interview on 11/20/19 at 9:43 A.M., Unit Secretary #136 stated she saw the resident the day before sitting there with his breakfast and lunch was about to be served so she removed his plate. She was unsure why he still had his breakfast plate sitting in front of him. Interview on 11/20/19 at 10:20 A.M., ST #300 stated the day before she had been completed a swallowing treatment with the resident and he had not been interested in eating, she gave him a banana and he slammed it on the table. She said he was able to pick up the fork and take a few bites of egg. She left the plate in front of him because he would often pick up bits and pieces of foods especially finger foods to try and eat since he was in the dining area. She thought STNA's #4 and #48, working on the hall would have taken away the plate. 3. Review of the medical record for Resident #57 revealed the resident was admitted to the facility on [DATE] with a diagnoses of dementia, intellectual disabilities, schizophreniform disorder, and type II diabetes. Review of the Minimum Data Set (MDS) dated [DATE] revealed Resident #57 had severe cognitive impairment. Her functional status was listed as extensive one-person physical assist for eating. 365346 Page 2 of 5 365346 11/21/2019 Otterbein Lebanon Retirement Community 585 North State Route 741 Lebanon, OH 45036

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of the nutrition screen dated 09/30/19 revealed Resident #57 was a set-up to supervision to dependent depending on her cognition. Did well with finger type foods per staff. 4. Review of the medical record for Resident #129 revealed the resident was admitted to the facility on [DATE] with a diagnoses of legal blindness, unspecified mental disorder due to known psychological condition. Review of the MDS dated [DATE] revealed Resident #129 had severe cognitive impairment. His functional status was listed as extensive one-person physical assist for eating. Observation of the lunch time dining on 11/18/19 at 12:00 P.M. until 1:00 P.M. revealed four facility staff passing trays in the dining room and down the A hall. At 12:00 P.M., Resident #57 and Resident #129 were in the dining room, with their clothing protectors in place and waiting to eat. Further observation revealed five Residents (#7, #52, #57, #113, and #129) who needed to be fed their lunch. Staff were observed passing trays to the residents in the dining room and also to the residents who were still in their rooms. Interview with STNA #180 on 11/18/19 at 12:30 P.M. revealed the resident who needed fed would had to wait until all the trays were passed in the dining room and halls. She revealed then staff would have time to feed them. At approximately 12:40 P.M. staff began to fed three of the residents (#7, #52, and #113). At 12:55 P.M. a staff member began feeding Resident #129 and at 12:58 P.M. a staff member began feeding Resident #57. Observation of the breakfast dining on 11/20/19 at 8:00 A.M. revealed staff brought Residents (#7, #57, #113 and #129) to the dining room and placed clothing protectors on them. At 8:30 A.M. two facility staff were observed passing trays to residents who could feed themselves in the dining room and also in the halls. At 9:10 A.M. two more facility staff arrived and started feeding the residents who needed assistance. 365346 Page 3 of 5 365346 11/21/2019 Otterbein Lebanon Retirement Community 585 North State Route 741 Lebanon, OH 45036

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on observation and staff interview, the facility failed to ensure a receptacle plug was safely covered in the secured dementia unit. This had the potential to affect nine Residents (#6, #19, # 26, #27, #32, #33, #51 #55 and #67) whom the facility identified as being cognitively impaired and independently mobile. Facility census was 152. Findings include: Observation of the day room in the Magnolia unit on 11/19/19 at 4:00 P.M. revealed a broken receptacle cover that had exposed wires on the electrical terminals. Interview with Registered Nurse (RN) # 49 on 11/19/19 at 6:10 P.M. verified the receptacle cover was broken with the electrical terminals being exposed. RN #349 noted there had been no residents with injuries consistent with an electrical shock. The facility identified nine Residents (#6, #19, # 26, #27, #32, #33, #51 #55 and #67) as being cognitively impaired and independently mobile. 365346 Page 4 of 5 365346 11/21/2019 Otterbein Lebanon Retirement Community 585 North State Route 741 Lebanon, OH 45036

F 0732 Post nurse staffing information every day. Level of Harm - Potential for minimal harm Based on observation, staff interview and review of a staffing tool, the facility failed to ensure the daily staffing posting was complete and accurate. This had the potential to affect all residents that resided in the facility. Facility census was 152. Residents Affected - Many Findings include: Observation of the posted daily staffing sheet on 11/21/19 at 7:30 A.M. revealed the facility had a total census of 201 residents and the posting included staff and residents from the Assisted Living (AL) unit. Interview with the Director of Nursing (DON) on 11/21/19 at 8:00 A.M. verified the posted daily staffing sheets were inaccurate by containing staff and residents from the AL unit. Review of the staffing tool for 11/12/19 through 11/18/19 also revealed the facility included staff and residents from the AL on their posted daily staffing sheets. 365346 Page 5 of 5