Health inspection·November 7, 2019

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Record review of Resident #76 revealed an admission date of 09/28/19 and a discharge home on [DATE] with pertinent diagnoses of: cellulitis of left lower limb, cognitive communication deficit, hypertension, psoriasis, and type two diabetes mellitus. Residents Affected - Few Review of the Discharge Return Not Anticipated Minimum Data Set (MDS) assessment dated [DATE] revealed Section A recorded Resident #76 discharged to the hospital on [DATE]. Review of Progress Notes dated 10/05/19 at 12:15 P.M. revealed Resident #76 discharged home at this time. Discharge instructions provided with no questions or concerns at this time. Resident ambulates out of facility via walker with brother with no distress noted at this time. Staff interview on 11/06/19 at 3:57 P.M. with Registered Nurse (RN) #99 verified Resident #76 was discharged home and the MDS was coded incorrectly. 3. Record Review of Resident #2 revealed this resident was admitted to the facility on [DATE] with the following medical diagnoses: dementia, dysphagia, abnormal posture, chronic foot ulcer, peripheral vascular disease, anxiety, falls, muscle weakness, acute kidney failure, depression, asthma, hypoxia, and oxygen dependence. This resident is alert and oriented to person, place, and time with a current BIMS score of 9 on the most recent MDS assessment completed on 10/22/19, indicating minimal/moderate cognitive impairments. This resident has no known drug allergies. Review of Physician orders, progress notes, and nursing notes, revealed Resident #2 has received Plavix 75mg by mouth daily, and does not have an order for hospice services. On 11/07/19 at 1:43 P.M. Registered Nurse #99 verified that she was informed by corporate that they should code Plavix as an anticoagulant as it needs monitored for bleeding on a daily basis. Also verified that Resident #2 was coded as receiving hospice services for medications only, but not for room and board. She verified that Resident #2 was coded incorrectly for anticoagulants, and Resident #2 was coded incorrectly for hospice care. 4. Record review of Resident #50 revealed that this resident was admitted to the facility on [DATE] with the following medical diagnoses: anemia, low back pain, hypertension, renal dialysis, arteriovenous fistula, chronic kidney disease stage 4, cerebral infarction, spondylosis, chronic obstructive pulmonary disease, atherosclerotic heart disease, congestive heart failure, hyperlipidemia, shortness of breath, and diabetes mellitus type II. Page 1 of 15 365398 365398 11/07/2019 Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694

F 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few This resident is alert and oriented to person, place, and time with a current BIMS score of 15 on the most recent MDS assessment completed on 09/30/19, indicating no cognitive impairments. This resident has no known drug allergies. Review of Physician orders, progress notes, and nursing notes, revealed Resident #50 is receiving Plavix 75mg by mouth daily for peripheral vascular disease. On 11/07/19 at 1:43 P.M. Registered Nurse #99 verified that she was informed by corporate that they should code Plavix as an anticoagulant as it needs monitored for bleeding on a daily basis. Also verified that Resident #50 was coded incorrectly for anticoagulants. Based on observation, medical record review, and interview the facility failed to accurately code residents Minimum Data Set Assessment (MDS) assessments when dialysis was not coded for Resident #13, discharge status was inaccurate for Resident #76, anticoagulant use was miscoded for Resident #2 and Resident #50, and hospice was miscoded for Resident #2. This affected four residents (Resident #13, #76, #2, and #50) out of 22 residents assessed for MDS accuracy. The facility census was 86. Findings include: 1. Review of the medical record for Resident #13 revealed an admission date of 12/13/16 with diagnoses including but not limited to cognitive communication deficit, dependence of renal dialysis, end stage renal disease, and Alzheimer's. Review of physician orders dated November, 2019 revealed Resident #13 received dialysis three times a week on Tuesday, Thursday, and Saturday. Review of nursing note dated 06/29/19 revealed Resident #13 goes to dialysis three times a week. Review of nursing note dated 08/20/19 revealed care plan meeting was held and discussed medication and dialysis treatment. Review of nutritional assessment dated [DATE] revealed Resident #13 continued to receive dialysis. Review of Resident #13's quarterly MDS dated [DATE] revealed dialysis was coded no that she did not receive dialysis treatment. Review of Resident #13's care plan revealed she received dialysis related to renal failure. Interview was conducted on 11/07/19 at 11:12 A.M. with Registered Nurse (RN) #81 and she verified the quarterly MDS for Resident #13 was coded wrong and should have been coded yes as receiving dialysis treatment. 365398 Page 2 of 15 365398 11/07/2019 Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694

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. Based on record review and staff interview the facility failed to refer a resident with a new diagnosis of schizophrenia for a pre-admission screening and resident review (PASARR). This affected one (Resident #35) of one resident reviewed for PASARR. The facility census was 86. Findings include: Record review of Resident #35 revealed an admission date of 10/11/17 with pertinent diagnoses of: malignant neoplasm of rectum, anus, and anal canal, lymphedema, schizophrenia, bipolar disorder, major depressive disorder, anxiety disorder, and viral hepatitis B. Review of the 09/18/19 quarterly Minimum Data Set (MDS) revealed the resident was cognitively intact and required limited assistance for transfer, walk in room, dressing, toilet use and personal hygiene. The resident was always continent of bowel and bladder and used a walker to aid in mobility. Review of the medical record on 11/05/19 revealed a new diagnosis of schizophrenia on 06/26/19. The medical record did not have a PASARR for her new serious mental disorder completed. Interview with the Director of Nursing (DON) on 11/07/19 at 9:41 A.M. verified the most recent PASARR was done on 11/06/17. The DON verified a new schizophrenia diagnosis was given on 06/26/19 and that a new PASARR was not completed after the diagnosis. 365398 Page 3 of 15 365398 11/07/2019 Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694

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 observation, resident and staff interview, and record review the facility failed to develop comprehensive care plans for Resident #32 for anti-anxiety medication use, Resident #2 for oxygen use, and Resident #41 for dental. This affected three (Resident #2, #32 and #41) of 22 residents reviewed for care plans. The facility census was 86. Findings include: 1. Record review of Resident #32 revealed an admission date of 12/04/18 with pertinent diagnoses of: venous insufficiency, heart failure, atherosclerotic heart disease of native coronary artery, atrial fibrillation, hyperlipidemia, , hypothyroidism, and major depressive disorder. Review of the the 09/15/19 quarterly Minimum Data Set (MDS) assessment revealed the resident was cognitively intact and used an anti-anxiety medication seven times during the seven day look back period of the MDS. Review of a Physician Order dated 07/12/19 revealed an order for buspirone (an anti-anxiety medication) give 25 milligrams (mgs) by mouth two times a day for anxiety. Review of the medical record on 11/05/19 revealed no care plan for anxiety, or a diagnosis of anxiety on the diagnosis sheet. Interview with Registered Nurse #99 on 11/06/19 at 4:00 P.M. verified that Resident #32 was on buspirone and she did not have a care plan for anxiety or an anti-anxiety medication care plan. 3. Record review of Resident #2 revealed this resident was admitted to the facility on [DATE] with the following medical diagnoses: dementia, dysphagia, abnormal posture, chronic foot ulcer, peripheral vascular disease, anxiety, falls, muscle weakness, acute kidney failure, depression, asthma, hypoxia, and oxygen dependence. This resident is alert and oriented to person, place, and time with a current BIMS score of 9 on the most recent MDS assessment completed on 10/22/19, indicating minimal/moderate cognitive impairments. This resident has no known drug allergies. Review of physician orders revealed this resident has an order for continuous oxygen per nasal cannula at 2 liters per minute due to hypoxia, effective on 08/26/19. Resident #2 was not care planned for the use of oxygen therapy. On 11/07/19 at 9:37 A.M., Interview with the Director Of Nursing verified that Resident #2 did not have a written care plan for the use of supplemental, continuous oxygen at 2 liters per minute. 2. Review of the medical record for Resident #41 revealed an admission date of 03/23/19 with diagnoses including but not limited to heart failure, diabetes mellitus, obesity, chronic kidney disease, and hypertension. 365398 Page 4 of 15 365398 11/07/2019 Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694

F 0656 Review of physician orders dated November 2019 Resident #41 was on a mechanical soft textured diet. Level of Harm - Minimal harm or potential for actual harm Review of the admission minimum data set (MDS) assessment dated [DATE] revealed Resident #41 had no cognitive deficits and had obvious or likely cavity. Review of the dental care area assessment revealed Resident #41 had no upper teeth, did have dentures but does not wear, had missing, broken, and obvious cavities to lower teeth, no oral pain reported, and received a soft dental diet. It was coded yes to proceed to care plan. Residents Affected - Few Review of nursing note dated 05/28/19 revealed Resident #41 went to dentist appointment and returned with an appointment scheduled for 06/25/19 for a tooth extraction. Review of nursing note dated 06/25/19 revealed Resident #41 had all her teeth extracted due to caries. Review of nurses note dated 07/12/19 revealed dental services was in facility and she was not seen due to she was out of the facility. Review of dietary note dated 11/04/19 revealed Resident #41 had a history of teeth extraction and on mechanical soft diet to aide with chewing and swallowing. Review of Resident #41's care plan revealed there was no dental care plan in place. Observation and interview was conducted on 11/04/19 at 1:53 P.M. with Resident #41 and she was up in her chair in her room. She stated she recently had teeth pulled and her gums were not healed up yet. She stated she has top dentures, however, they were very old. She stated she had all her bottom teeth pulled which was eight teeth. She stated she was not sure what the plan was, however, was hoping to get new dentures for top and get dentures for bottom. Interview was conducted on 11/06/19 at 9:41 A.M. with Social Service Director #6 and she stated the dentist was to be in today and Resident #41 was on the list to be seen. Interview was conducted on 11/06/19 at 3:24 P.M. with Registered Nurse (RN) #81 and she verified Resident #41 did not have a dental care plan in place and should have one. 365398 Page 5 of 15 365398 11/07/2019 Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, and interview the facility failed to update and revise residents care plans. This affected one resident ( Resident #13) out of 22 residents assessed for careplan accuracy when Resident #13's care plan did not reflect she had glasses and her loop recorder was not careplanned. The facility census was 86. Findings include: 1. Review of the medical record for Resident #13 revealed an admission date of 12/13/16 with diagnoses including but not limited to cognitive communication deficit, hypertension, depression, anxiety, dependence of renal dialysis, end stage renal disease, and Alzheimer's. Review of Resident #13's annual minimum data set (MDS) assessment dated [DATE] revealed she had impaired vision and no glasses. Review of quarterly MDS dated [DATE] revealed she had adequate vision. Review of care conference note dated 02/28/19 revealed Resident #13's daughter reported that Resident #13 would be receiving new eye glasses from eye doctor. Review of nurses notes dated 03/01/19 revealed nurse sent loop recorder reading to physician office. Review of nurses notes dated 03/11/19 revealed Resident #13 was to see facility eye doctor and needed to be evaluated for new glasses after cataract surgery. Review of nurses notes dated 03/27/19 revealed eye doctor was in and Resident #13 was ordered new glasses. Review of eye doctor notes dated 03/27/19 revealed Resident #13 was post cataract surgery and glasses order will be processed as requested by the resident. New distance glasses were ordered. Review of nurses notes dated 04/01/19 revealed loop recorder reading sent by manual loop recorder reading. The loop recorder was next to bed and not reading properly and company was made aware. Review of nurses notes dated 04/10/19 revealed Resident #13 received new eye glasses through the mail today and glasses were placed in a case on residents bedside table. Review of eye doctor note dated 05/09/19 revealed Resident #13 was to be seen for glasses adjustment. She was seen on 03/27/19 and new glasses was ordered. There were no glasses seen in her room and staff reported she never wears glasses and had never seen them. It is unclear if she ever received new glasses although note stated they were shipped. Review of Resident #13's care plan revealed she had impaired vision related to diabetes. There was no mention of Resident #13 having eye glasses and no interventions in place for staff to assist with eye glasses. There was no care plan in place for use and care of Resident #13's loop recorder. Interview was conducted on 11/05/19 at 8:51 A.M. with Resident #13's daughter and she stated she thought Resident #13's eye glasses were missing and voiced concern over proper care with her loop recorder. 365398 Page 6 of 15 365398 11/07/2019 Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694

F 0657 Level of Harm - Minimal harm or potential for actual harm Multiple observations was made of Resident #13 from 11/04/19 through 11/06/19 revealed no eye glasses seen and loop recorder was in room next to bed. Interview was conducted on 11/07/19 at 11:18 A.M. with Licensed Practical Nurse (LPN) #21 and she stated Resident #13 did not have eye glasses and even if she did she probably would not wear them. Residents Affected - Few Interview was conducted on 11/07/19 at 2:07 P.M. with Social Service Director #6 and she stated they went back to Resident #13's room and they found her eye glasses in her bottom drawer. Interview was conducted on 11/07/19 at 3:00 P.M. with Director of Nursing and she verified there was no care plan in place for Resident #13's loop recorder and that she had eyeglasses. 365398 Page 7 of 15 365398 11/07/2019 Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694

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** 2. Record review of Resident #35 revealed an admission date of 10/11/17 with pertinent diagnoses of: malignant neoplasm of rectum, anus, and anal canal, lymphedema, schizophrenia, hyperlipidemia, bipolar disorder, major depressive disorder, anxiety disorder, and viral hepatitis B. Residents Affected - Few Review of the 09/18/19 quarterly Minimum Data Set (MDS) revealed the resident was cognitively intact and required limited assistance to transfer, walk in room, dressing, toilet use and personal hygiene. The resident was always continent of bowel and bladder and used a walker to aid in mobility. Review of a Physician Order dated 09/05/19 revealed apply ace wraps to bilateral lower extremities from toes to below the knee due to lymphedema every morning before 6:00 A.M. as tolerated. Observation on 11/04/19 at 1:21 P.M. revealed Resident #35 was in her room sitting in her chair. The resident had swollen feet and no ace wraps were in place per the physician order. Observation on 11/06/19 at 12:52 P.M. revealed Resident #35 was in her room eating lunch, no ace wraps were on her legs. The resident stated she does not refuse the ace wraps to her legs they don't put them on her very often. Interview on 11/06/19 at 2:14 P.M. with the Director of Nursing (DON) verified the resident did not have on her physician ordered ace wraps. Based on observation, medical record review, and interview the facility failed to adequately and accurately assess diabetic foot ulcers and provide geri sleeves per plan of care for Resident #13 and failed to provide ordered ACE bandages in place for Resident #35. This affected two residents (Resident #13 and Resident #35) out of five residents reviewed for care and treatment of skin areas. The facility census was 86. Findings include: 1. Review of the medical record for Resident #13 revealed an admission date of 12/13/16 with diagnoses including but not limited to cognitive communication deficit, hypertension, depression, anxiety, foot drop to left and right foot, dependence of renal dialysis, end stage renal disease, and Alzheimer's. Review of Resident #13's annual minimum data set (MDS) assessment dated [DATE] and the quarterly MDS dated [DATE] revealed she had moderate cognitive deficits and no skin issues. Review of nurses notes dated 09/06/19 revealed Resident #13's daughter came in the facility and requested triple antibiotic ointment and kerlix be wrapped around bilateral feet for diabetic ulcers that are scabbed. The physician was made aware and order to start treatment order daily. Review of physician order dated 09/06/19 revealed to cleanse bilateral feet with soap and water, pat dry, apply triple antibiotic ointment to diabetic ulcers and wrap with kerlix until healed. Review of weekly wound evaluation assessments revealed areas to left foot only and wound initiation was 09/07/19 and described as other wound and not pressure. There was no mention of right foot 365398 Page 8 of 15 365398 11/07/2019 Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694

F 0684 having diabetic ulcers. Level of Harm - Minimal harm or potential for actual harm Review of nurses notes dated 10/02/19 revealed new orders were obtained to discontinue treatment orders to toes and start new order to paint toes with betadine twice daily, use prevalon boots bilaterally to protect heels, and use wool or cotton between toes. Residents Affected - Few Review of nurses notes dated 10/17/19 revealed Resident #13's daughter brought foot sores up to physician and new orders received to paint ulcers on toes with betadine daily, cover toes with clinda gel as prescribed and wrap with kerlix. Review of nurses notes dated 10/20/19 revealed Resident #13 had ulcers present on right toes and was treated once daily. Review of nurses notes dated 11/05/19 revealed physician office was called regarding Resident #13 to clarify orders for treatments to right and left toes and new orders were received. Resident #13's wound evaluations since 09/07/19 have had an error in anatomy stating residents wounds were all on the left toes when Resident #13 has wounds on right and left toes. Review of physician orders dated 11/05/19 revealed to paint ulcers to toes with betadine daily cover with clinda gel as prescribed. Review of November, 2019 treatment administration record revealed order was in place to paint toes with betadine daily, cover with clinda gel and wrap with kerlix. This order was discontinued on 11/05/19 and new order to paint areas to left and right toes with betadine, cover with clinda gel as prescribed until healed. Review of Resident #13's care plan revealed she has the potential for skin impairment related to decreased mobility, weakness, hemiparesis, declined cognition, poor safety awareness, incontinence, diabetes, and history of compromised skin and included intervention of geri sleeves to bilateral upper extremities to be worn during the day and removed at bed time. Resident has diabetic ulcers to left first toe, right first, fourth, and fifth toe related to diabetes and included interventions to observe and document wound size on ongoing basis. Interview was conducted on 11/05/19 at 8:55 A.M. with Resident #13's daughter who stated Resident #13's feet were not dressed and treated daily as it was supposed to be done. Observation of Resident #13 was conducted on 11/05/19 at 10:00 A.M. and at 1:45 P.M. and she was resting in bed. Resident #13 had her right foot wrapped in kerlix and left foot was open to air with a small brown scabbed area noted to left second toe. Prevalon boots were in place and she was not wearing any geri sleeves. Interview was conducted on 11/05/19 at 1:54 P.M. with the Director of Nursing (DON) and she verified only Resident #13's right foot was wrapped in kerlix, left foot was open to air. The DON verified nursing was only documenting and assessing the left foot areas only in the medical record and verified nothing was documented on the right foot. The DON verified nurses skin assessment dated [DATE] only revealed area to left foot and nothing to right foot. Interview was conducted on 11/05/19 at 2:40 P.M. with the DON and she stated Resident #13 has one area to left foot, three areas to right toes. The DON revealed and the nurses were monitoring the 365398 Page 9 of 15 365398 11/07/2019 Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few left foot as three areas. The DON verified Resident #13 had diabetic ulcers to both feet and the nurse should have been monitoring both the left and the right foot. Observation was conducted on 11/06/19 at 8:54 A.M. with Registered Nurse (RN) #25 perform treatments to Resident #13's bilateral toes. There was no kerlix wrapped on either foot prior to treatment. The left foot had a small brown scab area to the left second toe, the right foot had small black scabs to right second toe, right fourth toe, and the right fifth toe. RN #25 painted areas with betadine swabs and applied clinda gel and then reapplied prevalon boots. Interview was conducted on 11/06/19 at 8:54 A.M. with RN #25 and she stated she did not have an order anymore to wrap feet with kerlix. Interview was conducted on 11/07/19 at 11:18 A.M. with Licensed Practical Nurse (LPN) #21 and she verified Resident #13 had not had geri sleeves on and stated she would not wear them even if she had them. She verified Resident #13's care plan interventions stated for geri sleeved to be worn to upper extremities during the day and removed at bedtime. 365398 Page 10 of 15 365398 11/07/2019 Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694

F 0685 Assist a resident in gaining access to vision and hearing services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, and interview the facility failed to provide Resident #13 with ordered assistive devices (glasses) daily. This affected one resident ( Resident #13) out of three residents reviewed for ancillaries. The facility census was 86. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #13 revealed an admission date of 12/13/16 with diagnoses including but not limited to cognitive communication deficit, hypertension, depression, anxiety, dependence of renal dialysis, end stage renal disease, and Alzheimer's. Review of Resident #13's annual minimum data set (MDS) assessment dated [DATE] revealed she had impaired vision and no glasses. Review of quarterly MDS dated [DATE] revealed she had adequate vision. Review of care conference note dated 02/28/19 revealed Resident #13's daughter reported that Resident #13 would be receiving new eye glasses from eye doctor. Review of nurses notes dated 03/11/19 revealed Resident #13 was to see facility eye doctor and needed to be re-evaluated for new glasses after cataract surgery. Review of nurses notes dated 03/27/19 revealed eye doctor was in and Resident #13 was ordered new glasses. Review of eye doctor notes dated 03/27/19 revealed Resident #13 was post cataract surgery and glasses order will be processed as requested by the resident. New distance glasses were ordered. Review of nurses notes dated 04/10/19 revealed Resident #13 received new eye glasses through the mail today and glasses were placed in a case on residents bedside table. Review of eye doctor note dated 05/09/19 revealed Resident #13 was to be seen for glasses adjustment. She was seen on 03/27/19 and new glasses was ordered. There were no glasses seen in her room and staff reported she never wears glasses and had never seen them. It is unclear if she ever received new glasses although note stated they were shipped. Review of Resident #13's care plan revealed she had impaired vision related to diabetes. There was no mention of Resident #13 having eye glasses and no interventions in place for staff to assist with eye glasses. Interview was conducted on 11/05/19 at 8:51 A.M. with Resident #13's daughter and she stated she thought Resident #13's eye glasses were missing. Multiple observations was made of Resident #13 from 11/04/19 through 11/06/19 revealed no eye glasses seen. Interview was conducted on 11/07/19 at 11:18 A.M. with Licensed Practical Nurse (LPN) #21 and she stated Resident #13 did not have eye glasses and even if she did she probably would not wear them. Interview was conducted on 11/07/19 at 2:07 P.M. with Social Service Director #6 and she stated they went back to Resident #13's room and they found her eye glasses in her bottom drawer. She verified 365398 Page 11 of 15 365398 11/07/2019 Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694

F 0685 Resident #13 had not been wearing them. Level of Harm - Minimal harm or potential for actual harm Interview was conducted on 11/07/19 at 3:00 P.M. with the Director of Nursing and she verified there was no careplan for staff to follow that Resident #13 had eye glasses. Residents Affected - Few 365398 Page 12 of 15 365398 11/07/2019 Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation and interviews the facility failed to appropriately date and label oxygen tubing for a resident on continuous oxygen. This affected one resident (Resident #5) of two residents reviewed for respiratory care. Residents Affected - Few Findings include: Record review of Resident #5 revealed that this resident was admitted to the facility on [DATE] with the following medical diagnoses: right below the knee amputation, heart failure, dysphagia, abnormal posture, tibial fracture, chest pain, ischemic heart disease, pressure ulcers, depression, peripheral vascular disease, cognitive communication deficit, muscle weakness, vascular dementia, hypertension, chronic obstructive pulmonary disease, liver disease, osteoarthritis, falls, left femur fracture, and diabetes mellitus type II. This resident is alert to name only with a current BIMS score of 5 on the most recent MDS assessment completed on 10/29/19, indicating severe cognitive impairments. This resident has a verified Full Code order, and has drug allergies to Sulfa. Review of Physician orders revealed this resident is receiving continuous oxygen at 2 liters per nasal cannula to maintain saturations above 92%, and is to be checked twice daily on day and evening shift for a diagnosis of COPD. Care plan in place since 02/25/19 for the use of oxygen therapy. On 11/04/19 at 1:19 P.M., observation of the oxygen mask for Resident #5 was found to be unlabeled and not securely placed on the resident's face. On 11/05/19 at 11:08 A.M., observation of Resident #5 revealed the oxygen tubing and humidifier was not labeled or dated. Flow at correct amount. On 11/06/19 at 9:09 A.M., observation of Resident #5 revealed the oxygen tubing and humidifier was not labeled or dated. Flow at correct amount. 11/07/19 10:06 AM observation of Resident #5 and interview with Licensed Practical Nurse (LPN) #3 verified the oxygen delivery in place at 2 liters per minute, and the tubing remained unlabeled. This was verified by LPN #3, with the nurse also verifying that tubing should be labeled at all times. LPN 33 also verified the oxygen humidifier was unlabeled or dated. 365398 Page 13 of 15 365398 11/07/2019 Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694

F 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm Based on observation , resident interview, record review, and staff interview the facility failed to ensure pain management was provided to residents consistent with professional standards of practice when they failed to monitor and record pain levels for a resident who was coded for pain on the Minimum Data Set assessment and who had a decrease in her pain medication. This affected one (Resident #72) of one resident reviewed for pain. The facility census was 86. Residents Affected - Few Findings include: Record review of Resident #72 revealed an admission date of 04/19/19 with most recent admission of 10/15/19 with pertinent diagnoses of: low back pain, sciatica right side, type 2 diabetes mellitus with diabetic neuropathy, long term use of insulin, gastro-esophageal reflux disease, major depressive disorder, convulsions, hyperlipidemia, heart failure, hypertension, muscle weakness, unspecified abnormalities of gait and mobility, presence of right artificial knee joint, cognitive communication deficit, and morbid obesity due to excess calories. Review of the 10/22/19 admission Minimum Data Set (MDS) assessment revealed the resident was cognitively intact and was on a scheduled pain medication regimen. The resident was coded as having frequent pain of a nine out of ten that made it hard to sleep at night and affected her day to day activities. Review of the progress notes dated 10/18/19 revealed gabapentin 800 milligrams (mgs) was discontinued and patient states she did not have medicine at home. Patient stated that daughter would not pick up her medication. The Physician was notified and new orders received to start gabapentin 100 mg tablet by mouth three times a day. Resident interview on 11/05/19 at 9:23 A.M. revealed she has pain daily and they cut off her pain medications. The resident stated she can't sleep because of pain, they give her a sleeping pill but it does not help much, stated she used to take 800 mg of gabapentin and now only on 100 mgs. The resident did not appear to be in pain. Review of the medical record on 11/06/19 revealed the pain scale was only documented on 10/15/19, 10/20/19, and 11/03/19. The resident was documented as having no pain on those dates. Resident interview on 11/07/19 at 8:26 AM revealed the facility is not taking care of her pain. She stated she has severe pain of a nine (1-10 scale) in her back and had four knee replacements in her right knee. The Resident did not appear to be in severe pain. Review of a care plan dated 10/16/19 revealed the resident has a history of pain related to right sided sciatica, diabetic neuropathy, muscle spasms. Interventions include: Anticipate the resident's need for pain relief and respond immediately to any complaint of pain. Observe/record pain characteristics and PRN: Quality (e.g. sharp, burning); Severity (1 to 10 scale); Anatomical location; Onset; Duration (e.g., continuous,intermittent); Aggravating factors; Relieving factors. Review of a facility Pain Management policy dated 04/01/17 revealed ongoing pain monitoring and effectiveness of intervention is noted in the electronic medical record through the eMAR and progress notes. 365398 Page 14 of 15 365398 11/07/2019 Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694

F 0697 Interview with the Director of Nursing (DON) on 11/07/19 at 10:05 A.M. revealed they do not monitor Level of Harm - Minimal harm or potential for actual harm pain for residents daily including Resident #72. Residents Affected - Few 365398 Page 15 of 15