Health inspection·September 12, 2023

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Actual harm Based on closed record review, review of facility policy and interview, the facility failed to ensure Resident #70's change of condition was identified and addressed timely. Residents Affected - Few Actual Harm occurred on 02/10/23 when nursing staff failed to timely evaluate and provide intervention for an acute change in Resident #70's condition. On 02/10/23 in the A.M., therapy staff found Resident #70 to be very lethargic, hard to arouse, and profusely sweating. However, the physician and/or nurse practitioner was not notified until 02/10/23 at 8:13 P.M. of the resident's change in condition. On 02/10/23 at 8:13 P.M. Resident #70's blood pressure was 86/54 (hypotensive) and he was transported to the local Emergency Department via EMS (Emergency Medical Services). The resident was admitted to the hospital with diagnoses of sepsis and acute kidney injury. This affected one resident (Resident #70) of three resident's reviewed for change of condition. The facility census was 68. Findings include: Review of Resident #70's medical record revealed an admission date of 02/08/23 and a discharge date of 02/10/23. Resident #70's diagnoses included hemiplegia and hemiparesis following nontraumatic intracerebral hemorrhage affecting the right dominant side, obstructive sleep apnea and type two diabetes mellitus. Review of Resident #70's Gold Form Provider Orders dated 02/08/23 included admitting diagnosis of intracerebral hemorrhage (stroke) and additional diagnoses calf deep venous thrombosis (DVT), gastric bypass status for obesity and presence of inferior vena cava filter. Resident #70 was a full code. Resident #70 spent time in the intensive care unit, and was on a ventilator during the hospitalization. Care recommendation was for inpatient care at a skilled nursing facility and hospital therapy services recommended therapy in a skilled nursing facility to work on rebuilding Resident #70's strength. Resident #70's prognosis was good and rehab potential, function was to improve. Review of Resident #70's admission Assessment with Baseline Care Plan dated 02/08/23 included Resident #70 was admitted from the hospital and had the cognitive ability to be oriented to his room and surroundings. Resident #70 was oriented to the room, call bell, bed controls and side rails. Resident #70 was alert to person and situation and had clear verbal communication. Resident #70 was non ambulatory. Review of Resident #70's care plan dated 02/09/23 included Resident #70 had the potential for complications related to cerebrovascular accident (CVA), as evidenced by cognitive impairment, communication impairment, and decline in activity of daily living (ADL) abilities. Interventions included physical therapy (PT), occupational therapy (OT) and speech therapy (ST) evaluation and treatment per orders; report to physician, nurse practitioner an ADL decline, increased confusion, memory loss, or Page 1 of 9 365354 365354 09/12/2023 Longmeadow Care Center 565 Bryn Mawr Ravenna, OH 44266

F 0684 delirium and increased communication problems. Level of Harm - Actual harm Review of Resident #70's PT Evaluation and Plan of Treatment note dated 02/09/23 included Resident #70 demonstrated excellent rehab potential as evidenced by high prior level of function (PLOF), ability to follow multi-stop directions, strong family support and able to make needs known. Residents Affected - Few Review of Resident #70's nursing progress note on 02/10/23 at 12:23 A.M. included Resident #70 was alert. Review of Resident #70's Blood Pressure Summary on 02/10/23 at 12:24 A.M. revealed Resident #70's blood pressure was 137/76. Another blood pressure was not documented until 02/10/23 at 8:05 P.M. at which time the resident's blood pressure was 86/74 (hypotensive). Review of Resident #70's Speech Therapy Treatment Encounter Note dated 02/10/23 included lemon glycerin swabs were used to stimulate swallow function by placing pressure on the lingual groove with swallow 4/12 swabs. Resident #70 produced weak voicing with decreased volume, was oriented to 0, auditory comprehension was severely reduced and Resident #70 was unable to complete the entire evaluation. The notes were signed on 02/10/23 at 1:35 P.M. Review of Resident #70's Occupational Therapy Treatment Encounter Note dated 02/10/23 included Resident #70 had decreased alertness, needed repeated verbal cues and sternal rubs to try and arouse. Resident #70 was sweating profusely on this date. The note indicated: Nursing aware and blood sugars recorded. Family stated Resident #70 often sweated profusely and blood sugars generally were not low. The OT notes were signed on 02/10/23 at 3:01 P.M. Review of Resident #70's Physical Therapy Treatment Encounter Notes dated 02/10/23 included attempted to stand Resident #70 in the sit to stand lift with 100 percent cues and tactile cues to stand up. Resident #70 was very lethargic and hard to arouse this date. Resident #70 could not stand in the sit to stand lift. Sitting balance at the edge of the bed was poor to fair, balance was noted. Resident #70 required cues to maintain upright position in sitting. The PT note was not signed until 02/11/23 at 7:15 P.M. Review of Resident #70's progress notes written by Nurse Practitioner (NP) #306 dated 02/10/23 at 8:00 A.M. revealed Resident #70 was sitting in a chair in no acute distress, Family Member #308 was visiting and assisted with Resident #70's medical history. Resident #70 was able to talk but currently was tired and only able to answer yes or no to questions. Resident #70 was able to follow simple commands. NP #306 was not in the facility on 02/10/23 at 4:54 P.M. but documented at 4:54 P.M. Resident #70's blood pressure was 137/76, pulse 78, respirations 18, temperature 97.9 Fahrenheit, and oxygen saturation was 97 percent on room air. The vital signs matched the vital signs recorded in Resident #70's medical record on 02/10/23 at 12:24 A.M. The progress notes did not include therapy concerns as documented on 02/10/23 regarding Resident #70 being very lethargic, hard to arouse, and sweating profusely. Review of Resident #70's medical record revealed no additional progress notes form the last nursing progress note on 02/10/23 at 12:23 A.M. to indicate the resident was assessed after the change in condition noted by therapy staff. There was no evidence the physician or NP were notified of the change in resident condition. Review of blood sugars recorded in the medical record on 02/10/23 revealed there were no blood sugars recorded for Resident #70 until 02/10/23 at 8:07 P.M. when Resident #70 was transported via EMS services to the local hospital Emergency Department. 365354 Page 2 of 9 365354 09/12/2023 Longmeadow Care Center 565 Bryn Mawr Ravenna, OH 44266

F 0684 Level of Harm - Actual harm Residents Affected - Few Review of Resident #70's nursing progress notes dated 02/10/23 at 8:13 P.M. documented by Licensed Practical Nurse (LPN) #284 revealed Resident #70's family called him into the room because they were concerned about Resident #70's condition. Resident #70 was diaphoretic and cold to the touch, his blood pressure was 84/68, pulse 64, respirations 16, and temperature was 97.4 Fahrenheit. Nurse Practitioner (NP) #306 was contacted, and the family was adamant about having Resident #70 sent to the hospital Emergency Department for evaluation. NP #306 agreed to have resident #70 sent to the Emergency Department and 911 was called. Review of Resident #70's Prehospital Care Report Summary dated 02/10/23 included a call was received at 8:13 P.M. and Emergency Medical Services (EMS) were on the scene and had patient contact at 8:19 P.M. The dispatch reason was Resident #70 was unconscious, fainting and the chief complaint was a change in mental status, the duration was not documented. The altered mental status was not normal for Resident #70 and he had aphasia (loss of ability to understand or express speech) which was not normal for him. Resident #70's blood pressure was 87/30. Resident #70 was found in bed conscious, but not responding to verbal prompts. Family stated Resident #70 had a cerebral hemorrhage one month ago and was at the facility for rehab. Resident #70 had a deterioration of cerebral function, and suddenly was unable to speak. Resident #70 was very lethargic, and only able to answer yes or no questions with head shakes and nods. Review of Resident #70's Emergency Department and hospital admission notes dated 02/10/23 included Resident #70 was admitted to the Emergency Department with a diagnosis of sepsis and acute kidney injury. The notes further stated due to high probability of imminent or life-threatening deterioration the patient required the highest level of preparedness and emergent intervention. Critical intervention was fluid resuscitation, and IV (intravenous) antibiotics (antibiotics). Resident #70 was hemodynamically unstable. Emergency Department notes stated Resident #70 presented for gradual confusion after recent discharge from the main hospital campus for ICH (intracerebral hemorrhage). Resident #70 appeared clinically dehydrated and was not receiving water via PEG (percutaneous endoscopic gastrostomy tube) which he was getting at the hospital. Resident #70 recently complained of increased thirst. Resident #70 was treated for aspiration pneumonia and urinary tract infection while in the hospital. Work up in the Emergency Department showed leukocytosis with left shift, acute kidney injury (AKI), lactate elevated at 3.2 (used to help diagnose sepsis). Resident #70 was administered antibiotics, but the source of infection was not identified. Resident #70's mental status improved with intravenous fluids (IVF). Resident #70 was temporarily hypotensive, but this responded to IVF and was felt to be secondary to dehydration. Interview on 09/06/23 at 4:54 P.M. of Family Member (FM) #308 revealed Resident #70 passed away on 08/10/23. FM #308 indicated Resident #70 had resided in the facility two and a half days, from 02/08/23 through 02/10/23. FM #308 stated Resident #70 was discharged on 02/10/23 when 911 was called. FM #308 stated the resident was alert and oriented on 02/08/23 when he was admitted to the facility, was learning to speak, and did not have an infection. FM #308 indicated Resident #70 was diagnosed with sepsis and acute kidney failure when he was taken to the Emergency Department on 02/10/23. FM #308 stated the physician at the hospital asked what the facility did to him and stated they had undone everything the hospital did for him before he was transferred to the facility. FM #308 revealed Resident #70 had a stroke about a month ago, was hospitalized and was admitted to the facility afterwards for rehabilitation and strengthening. FM #308 indicated she was at the facility from 6:00 A.M. until 9:00 P.M. on 02/09/23 and on 02/10/23 from 6:00 A.M. until he went to the hospital around 8:30 P.M. FM #308 stated she never left his room, and felt he was not taken care of and was not checked every two hours. FM #308 stated the nurses did not come in Resident #70's room unless she insisted. FM #308 stated on 02/10/23 Resident #70 was not looking well and was sweating. FM #308 365354 Page 3 of 9 365354 09/12/2023 Longmeadow Care Center 565 Bryn Mawr Ravenna, OH 44266

F 0684 Level of Harm - Actual harm Residents Affected - Few indicated on 02/10/23 around 8:00 A.M. Physical Therapist/Therapy Manager (PT/TM) #213 and Occupational Therapist (OT) #309 came in the room and were unable to assist Resident #70 to sit up. FM #308 stated Resident #70 was sweating, not responding to her or her son and PT/TM #213 and OT #309 asked her if he sweated like that all the time. FM #308 stated OT #309 said he did not like the way Resident #70 looked and acted, and wanted to check his blood sugar. Resident #70 was sweating like crazy and a mechanical lift was used to transfer him to the wheelchair and he was taken to the Physical Therapy room. When Resident #70 came back to the room a short time later, FM #308 indicated OT #309 told her Resident #70's blood sugar was checked, it was fine, and he did not know what was wrong. FM #308 stated Speech Therapist (ST) #307 came in the room around 9:45 A.M., asked what was wrong with Resident #70, tried to work with him, was unable to get a response, and stated she could not work with him when he was like this. FM #308 stated by this time Resident #70 was shaking, his eyes were bulging, she tried to get staff to help her, and it took at least four hours for the staff to assist Resident #70 from the wheelchair into his bed. FM #308 stated she kept asking and yelling for staff and they did not come. FM #308 stated she later looked at Resident #70's medical record and the documentation did not reflect the issues Resident #70 was having. FM #308 stated his blood pressure, pulse and oxygen saturation were not checked when he was feeling badly. FM #308 stated she insisted Licensed Practical Nurse (LPN) #284 come in to check Resident #70 on 02/10/23 in the evening and insisted and yelled for him to call 911 to have an ambulance transport Resident #70 to the hospital. FM #308 stated Resident #70 never sweated profusely and she did not tell facility staff Resident #70 often sweated profusely. Interview on 09/07/23 at 10:38 A.M. of Speech Therapist (ST) #307 revealed Resident #70 was only in the facility a couple days, he was friendly and his family was very involved in his care. ST #307 stated on 02/10/23 while she worked with Resident #70 she noticed he was sweating, and she told the nurse he was sweating profusely. ST #307 stated she did not remember which nurse she told or if the nurse went in the room to evaluate Resident #70. ST #307 stated she wrote her notes at the end of the day, and her visit with Resident #70 was probably in the morning. ST #307 stated she could not remember if Resident #70 was hard to arouse, but recalled he was dripping with sweat. ST #307 stated she was sure she told the nurse because she was very concerned about Resident #70's condition. ST #307 stated on 02/09/23 Resident #70 was very interactive, but on 02/10/23 she just remembered him sweating. Interview on 09/07/23 at 12:00 P.M. of Physical Therapist/Therapy Manager (PT/TM) #213 revealed Resident #70 was a complex case, was a stroke victim and could not do much on the right side. PT/TM #213 stated on 02/09/23 Resident #70 was alert and a mechanical lift was used to transfer Resident #70 to a wheelchair. PT/TM #213 stated on 02/10/23 an unsuccessful attempt was tried to have Resident #70 stand. PT/TM #213 stated Resident #70 was very lethargic and hard to arouse, and unable to stand. PT/TM #213 stated the time of the therapy session was not documented but stated she probably saw him late morning or early afternoon. PT/TM #213 stated if a resident was not feeling well during therapy it was reported to nursing. PT/TM #213 indicated she did not remember if she talked to a nurse on 02/10/23. Interview on 09/07/23 at 6:19 P.M. of Licensed Practical Nurse (LPN) #284 revealed he worked night shift and took care of Resident #70 on 02/09/23 and 02/10/23. LPN #284 stated on 02/09/23 Resident #70 was more talkative. LPN #284 stated on 02/10/23 Resident #70's wife yelled at him, told him to come in the room to see Resident #70 and insisted an ambulance was called. LPN #284 stated Resident #70 did not look good, his blood pressure was low, he called NP #306 and Resident #70 was sent via a 911 call and EMS services to the Emergency Department. 365354 Page 4 of 9 365354 09/12/2023 Longmeadow Care Center 565 Bryn Mawr Ravenna, OH 44266

F 0684 Level of Harm - Actual harm Residents Affected - Few Interview on 09/11/23 at 8:17 A.M. of Nurse Practitioner (NP) #306 revealed Resident #70 was only in the facility a couple days and she did not remember many details about his stay. NP #306 stated she received a call late in the day around 8:00 P.M. on 02/10/23 when Resident #70 had altered mental status, low blood pressure and his family wanted him sent to the hospital. NP #306 stated the only time she was called by the facility nurses' was right before Resident #70 was transported via Emergency Medical Services (EMS) to the hospital. NP #306 stated she saw residents in the facility in the morning and was gone from the facility around 12:00 P.M. Interview on 09/11/23 at 10:23 A.M. of the Director of Nursing (DON) and Assistant Director of Nursing (ADON) #219 revealed if a nurse checked a blood sugar it should be documented under weights and vital signs in the resident's electronic medical record. The DON and ADON #219 confirmed on 02/10/23 Resident #70 did not have a blood sugar documented in the morning and no blood sugars were documented until 8:07 P.M. Review of the facility policy titled Notification of Changes revised 04/15/21 included the purpose of the policy was to ensure the facility promptly informed the resident, consulted the resident's physician, and notified consistent with his or her authority the resident's representative when there was a change requiring notification. Circumstances requiring notification included a significant change in the resident's physical, mental or psychosocial condition such as deterioration in health, mental or psychosocial status. This might include life-threatening conditions or clinical complications. This deficiency represents non-compliance investigated under Complaint Number OH00145033. 365354 Page 5 of 9 365354 09/12/2023 Longmeadow Care Center 565 Bryn Mawr Ravenna, OH 44266

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on interview, record review and review of facility policy the facility failed to ensure Resident #70 had physician's orders and parameters for continuous oxygen administration via nasal cannula. This affected one resident (Resident #70) out of three residents reviewed for oxygen administration. The facility census was 68. Residents Affected - Few Findings include: Review of Resident #70's medical record revealed an admission date of 02/08/23 and a discharge date of 02/10/23. Resident #70's diagnoses included hemiplegia and hemiparesis following nontraumatic intracerebral hemorrhage affecting the right dominant side, obstructive sleep apnea and type two diabetes mellitus. Review of Resident #70's admission Assessment with Baseline Care Plan dated 02/08/23 included Resident #70 was admitted from the hospital, had the cognitive ability to be oriented to his room, surroundings and was oriented to room, call bell, bed controls and side rails. Resident #70 was alert to person and situation and had clear verbal communication. Resident #70 was non ambulatory. Review of Resident #70's physician orders dated 02/08/23 at 3:44 PM. revealed CPAP (continuous positive airway pressure) with one to three liters bleed in to maintain SpO2 (percentage of blood saturated with oxygen) greater that 92 percent at bedtime. Further review of Resident #70's physician orders did not reveal orders for continuous oxygen at three liters per minute via nasal cannula. Review of Resident #70's care plan dated 02/09/23 revealed it did not include a care plan for oxygen administration. Review of Resident #70's respiratory progress notes dated 02/09/23 at 5:30 A.M. and under the category of oxygen mask or nasal cannula, if ordered and on revealed Resident #70 was placed on three liters oxygen per minute via nasal cannula due to SpO2 was 88 percent on room air and order for CPAP was to keep SpO2 greater than 92 percent. Resident #70 was placed on CPAP three liters for bedtime at midnight. Review of Resident #70's oxygen saturation level dated 02/09/24 at 5:24 A.M. revealed 98 percent on room air. Resident #70's oxygen saturation level dated 02/10/23 at 12:24 A.M. revealed 97 percent on room air. Review of Resident #70's respiratory progress notes dated 02/10/23 at 4:46 A.M. and under the category of oxygen mask or nasal cannula, if ordered and on revealed Resident #70 was on oxygen three liters per minute via nasal cannula to keep SpO2 above 92 percent. SpO2 is 97 percent. Resident #70 was placed on CPAP at 11:00 P.M. Interview on 09/07/23 at 12:34 P.M. of Respiratory Therapist (RT) #251 revealed she did not remember Resident #70 but she probably put Resident #70 on oxygen at three liters per minute via nasal cannula because she was trying to keep his oxygen saturation above 92 percent as ordered for Resident #70's CPAP. RT #251 stated if he needed it at night generally it was needed during the day as well, and Resident #70 was probably using oxygen all day and night. Interview on 09/07/23 at 2:30 P.M. of Family Member (FM) #308 revealed Resident #70 was using 365354 Page 6 of 9 365354 09/12/2023 Longmeadow Care Center 565 Bryn Mawr Ravenna, OH 44266

F 0695 oxygen via nasal cannula during the day on 02/09/23 and 02/10/23. Level of Harm - Minimal harm or potential for actual harm Interview on 09/11/23 at 10:23 A.M. of the DON confirmed Resident #70 did not have an order for continuous oxygen via nasal cannula. The DON stated if Resident #70 needed oxygen per nasal cannula in addition to the CPAP then the nurses should have obtained an order from the physician or nurse practitioner for continuous oxygen. The DON confirmed Resident #70's oxygen saturation levels on 02/09/23 and 02/10/23 were documented at room air and should have been documented using oxygen via nasal cannula or CPAP depending on the time. Residents Affected - Few Review of the facility policy titled Oxygen Administration undated included oxygen was administered under orders of a physician, except in the case of an emergency. In such case, oxygen was administered and orders for oxygen were obtained as soon as practicable when the situation was under control. Staff should document the initial and ongoing assessment of the resident's condition warranting oxygen and the response to oxygen therapy. The resident's care plan should identify the interventions for oxygen therapy, based upon the resident's assessment and orders, such as, but not limited to the type of oxygen delivery system, when to administer, such as continuous or intermittent and, or when to discontinue, equipment setting for the prescribed flow rates, monitoring of SpO2 (oxygen saturation) levels and or vital signs as ordered, monitoring for complications associated with the use of oxygen. 365354 Page 7 of 9 365354 09/12/2023 Longmeadow Care Center 565 Bryn Mawr Ravenna, OH 44266

F 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm Based on interview, record review and review of the facility policy ,the facility failed to ensure Resident #70 was free from significant medication errors. This affected one resident (Resident #70) out of three residents reviewed for medication administration. The facility census was 68. Residents Affected - Few Findings include: Review of Resident #70's medical record revealed an admission date of 02/08/23 and a discharge date of 02/10/23. Resident #70's diagnoses included hemiplegia and hemiparesis following nontraumatic intracerebral hemorrhage affecting the right dominant side, obstructive sleep apnea and type two diabetes mellitus. Review of Resident #70's Gold Form Provider Orders dated 02/08/23 included an admitting diagnosis of intracerebral hemorrhage (stroke) and additional diagnoses included calf DVT (deep venous thrombosis), and presence of inferior vena cava filter. Review of Resident #70's hospital information Patient Care Summary for Transfer dated 02/08/23 at 10:51 A.M. included Heparin Sodium 5000 units subcutaneous every 8 hours was given at on 02/08/23 at 6:17 A.M. and the next dose was due on 02/08/23 at 2:00 P.M. Review of Resident #70's admission Assessment with Baseline Care Plan dated 02/08/23 included Resident #70 was admitted from the hospital, had the cognitive ability to be oriented to his room, surroundings and was oriented to room, call bell, bed controls and side rails. Resident #70 was alert to person and situation and had clear verbal communication. Resident #70 was non ambulatory. Review of Resident #70's physician orders dated 02/08/23 at 2:45 P.M. revealed orders for Heparin Sodium (porcine) injection solution 5000 units per milliliter, inject 5000 units subcutaneously every 8 hours for anticoagulant. Review of Resident #70's Medication Administration Record (MAR) revealed on 02/08/23 Heparin Sodium (porcine) injection solution 5000 units per milliliter (ml) was scheduled to be administered at 10:00 P.M. and there was no documentation the medication was administered. On 02/09/23 Heparin Sodium 5000 units per ml was scheduled to be administered at 6:00 A.M. and there was no documentation the medication was administered. Review of Resident #70's Medication Administration Audit Report revealed Heparin Sodium injection solution 5000 units per ml was scheduled to be administered on 02/09/23 at 2:00 P.M. and was not administered until 4:23 P.M. Review of the Medication Administration Audit Report did not reveal Heparin Sodium injection solution 5000 units per ml was administered on 02/08/23 at 2:00 P.M. and 10:00 P.M. or on 02/09/23 at 6:00 A.M. as ordered. Resident #70 did not have Heparin Sodium injection solution 5000 units per ml administered from 02/08/23 at 6:00 A.M. through 02/09/23 at 4:23 P.M., for a total of 34 hours between injections. Review of Resident #70's care plan dated 02/10/23 included Resident #70 had the potential for bleeding or hemorrhage related to the use of anticoagulant medication. Resident #70 would be free from abnormal reactions to anticoagulant use. Interventions included to give medication as prescribed. Review of the facility Swing Kit Contents revealed Heparin Sodium Injection 5000 units per ml was 365354 Page 8 of 9 365354 09/12/2023 Longmeadow Care Center 565 Bryn Mawr Ravenna, OH 44266

F 0760 included in the stock medications available at the facility. Level of Harm - Minimal harm or potential for actual harm Interview on 09/07/23 at 9:09 A.M. with Nurse Practitioner (NP) #306 revealed if a resident was not getting their anticoagulant as ordered, and were non-ambulatory it could cause a DVT (deep vein thrombosis) or a PE (pulmonary embolus). NP #306 stated if a resident had a DVT and was not getting their anticoagulant as ordered it could cause a PE and could potentially be fatal. NP #306 stated she was not aware Resident #70 did not receive his scheduled Heparin Sodium 5000 units from 02/08/23 at 6:00 A.M. through 02/09/23 at 4:23 P.M. for a total of 34 hours. NP #306 stated she did not know why the Heparin was not given, and they did not hold the Heparin. Residents Affected - Few Interview on 09/11/23 at 10:23 A.M. of the Director of Nursing (DON) and Assistant Director of Nursing (ADON) #219 confirmed Resident #70's Heparin Sodium 5000 units was not documented it was given on 02/08/23 at 10:00 P.M. and on 02/09/23 at 6:00 A.M. The DON confirmed Heparin 5000 units subcutaneously should also have been administered on 02/08/23 at 2:00 P.M. The DON and ADON #219 confirmed Heparin Sodium Injection 5000 units per ml was available in the stock medications and they did not know why it was not given. Review of the facility policy titled Medication Administration revised 08/22/22 included medications were administered by licensed nurses, or other staff who were legally authorized to do so in this state, as ordered by the physician and in accordance with professional standards of practice, in a manner to prevent contamination or infection. This deficiency represents non-compliance investigated under Complaint Number OH00145033. 365354 Page 9 of 9