Health inspection·July 11, 2019

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, resident interview, staff interview, and family interview, the facility failed to preserve the dignity of one resident by having her use a bedside commode instead of providing her assistance to use the toilet in the bathroom which would provide privacy. This affected one (Resident #7) of one resident reviewed for resident rights. The census was 45. Findings include: Review of the medical record revealed Resident #7 was admitted on [DATE]. Diagnoses included dementia with behavioral disturbances, unspecified lack of coordination, mono-arthritis, left knee, pain in right wrist, muscle weakness and difficulty in walking. Review of the plan of care for Resident #7 revealed the resident was at risk for falling related to a history of falls and decline in her Activity of Daily Living (ADL)'s. Her goal was to remain free from falls with major injury. Her interventions included the resident required two staff assistance with transfers and to encourage the commode during bedtime care. Review of the Individual Plan Report for Resident #7 for ADL's from Matrix Care which was what the aides used to assist residents, revealed she used a walker and required one to two assistance with ADL's. Fall interventions included to use the commode for toileting for safety. Review of progress notes for Resident #7 dated 03/31/18 at 11:52 A.M. which was an interdisciplinary team note revealed the resident tends to show signs of weakness with ambulating to the restroom. When resident was returning to the bed, the resident lost balance and was lowered to the floor. Intervention was to have the resident use the commode due to increased weakness and balance concerns. Interview with spouse of Resident #7 of 07/08/19 at 9:26 A.M., revealed she was not able to use the toilet in her room because there was a male resident in the adjoining room who uses it so she had to use a bed side commode. Observation of toileting on 07/09/19 at 11:59 P.M., with Certified Resident Care Associate (CRCA) (#400, #401) in the room of Resident #7 for toileting before lunch was completed. They used a two-assistance transfer with a gait belt to the commode. Resident #7 was in her wheelchair in her room, the bedside commode was by the curtain which was pulled. Resident pulled up using the walker and moved her feet slightly to aide with the transfer. Interview with CRCA #400 on 07/10/19 at 11:17 A.M. revealed Resident #7 had not walked to the Page 1 of 3 365387 365387 07/11/2019 Briar Hill Health Campus 600 Sterling Dr North Baltimore, OH 45872

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few bathroom for about a year and she was pivoted to the bedside commode unless she was having a shower then they take her to the shower room toilet but never use the toilet in her room. Interview with CRCA# 401 on 07/09/19 at 12:10 P.M., verified they do not take her into the bathroom because they use the commode with her all the time. She stated the resident can't use the regular toilet due to it being used by the male resident in the adjoining room. Observation on 07/09/19 at 1:30 P.M., of Resident #7 in therapy room revealed she was on the bike machine using her arms and legs. Interview with Director of Therapy #500 on 07/09/29 at 1:30 P.M., revealed Resident #7 does work with the therapist and uses the toilet in the therapy room. Interview with Resident #7 on 07/11/19 at 10:30 A.M. revealed she does not like using the bedside commode due to it seems very public and she expressed she was a private person. She would rather go into a toilet with a door for privacy. She likes her room and does not want to move but just wants to use the bathroom for toileting. 365387 Page 2 of 3 365387 07/11/2019 Briar Hill Health Campus 600 Sterling Dr North Baltimore, OH 45872

F 0558 Reasonably accommodate the needs and preferences of each resident. 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, resident interview, and staff interview, the facility failed to provide a resident with a special shoe accommodation. This affected one Resident (#37) of three residents reviewed for accommodations. The facility census was 45. Residents Affected - Few Findings include: Review of Resident #37's medical record revealed an admission date of 05/14/15. Diagnoses included atherosclerotic heart disease, rheumatoid arthritis, hypertension, wedge compression fracture of the first lumbar vertebra, osteoarthritis, muscle weakness, difficulty walking, history of falling, anxiety disorder, and diabetes mellitus. Review of the physician orders revealed an order dated 12/11/18 for Resident #37 to be fitted for diabetic shoes. Review of the progress notes dated 12/12/18 at 11:18 A.M., revealed notification had been made to a shoe company initiating the process of retrieving diabetic specialty shoes for Resident #37. Review of Resident #37's quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident to be dependent on staff for mobility and transfers. Interview and observation on 07/08/19 at 10:08 A.M., with Resident #37 revealed the resident reported she was waiting on specially ordered shoes that were to be of a wider width to accommodate her bunions. The resident stated the shoes were ordered approximately four months ago but had not received the shoes as to date. Observation at this time revealed the resident did not have diabetic specialty shoes in place and was wearing house slippers. Resident #37 did confirm the availability of tennis shoes but stated they were tight fitting across her toes. Interview on 07/09/19 at 10:43 A.M., with Social Services Staff (SSS) #100 confirmed Resident #37 had informed staff that she had been measured for diabetic specialty shoes. SSS #100 revealed the resident had been seen by the podiatrist at the facility but was not aware of any shoes being ordered. Interview on 07/09/19 at 2:40 P.M., with Registered Nurse (RN) #200 confirmed awareness of Resident #37 being fitted for specialty shoes but was unaware of the date in which this occurred. Review of the progress notes dated 07/09/19 at 2:57 P.M., revealed SSS #100 notified the family and resident regarding the cost for private payment of the specialty shoes. Interview on 07/09/19 at 3:15 P.M., with SSS #100 confirmed Resident #37 had been fitted for specialty diabetic shoes in December 2018 and that she had forgotten about it. SSS #100 revealed calling the shoe company on 07/09/19 to inquire about the specialty shoes and was advised Resident #37's insurance required prior authorization and had denied the claim for the shoes. Interview on 07/10/19 at 2:30 P.M. with SSS #100 revealed a fax had been sent to the medical director of the facility at a number that was not the facility's fax number on 12/30/18 regarding the shoe company not being in Resident #37's insurance provider network. 365387 Page 3 of 3