Health inspection·August 1, 2019

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 review of medical record, review of hospital records, staff interview, and review of facility policy, the facility failed to ensure a resident had a supporting diagnosis for use of an antipsychotic medication. This affected one resident (#102) of five residents reviewed for unnecessary medications. The facility census was 118. Findings include: Review of medical record revealed Resident #102 was admitted to the facility on [DATE]. Diagnoses included anoxic brain damage, other symbolic dysfunctions, type two diabetes with neuropathy, other specified anxiety disorders, major depressive disorder, and vascular dementia with behavioral disturbance. Review of Resident #102's hospital record dated 06/07/19 through 06/14/19 revealed no evidence the resident had a diagnosis of bipolar disorder. Review of comprehensive assessment dated [DATE] revealed the resident was rarely or never understood and the mental status interview was not conducted. The resident did not have indicators of potential psychosis and did not exhibit behavioral symptoms. Review of current physician orders on 07/31/19 revealed Resident #102 had an order for Zyprexa (an antipsychotic medication) 2.5 milligrams (mg) daily for bipolar disorder. There was no evidence the resident had a diagnosis of bipolar disorder. Review of physician progress notes for Resident #102, dated 06/21/19, 06/27/19, 07/08/19, and 07/12/19, revealed no evidence the resident had a diagnosis of bipolar disorder. Interview on 08/01/19 at 9:24 A.M., with the Director of Nursing (DON) verified Resident #102 did not have a diagnosis of bipolar disorders for the use of Zyprexa. Review of facility policy titled Psychotropic Medications, dated 04/09/19 revealed no medications were to be used for off label purposes; they must be used for their intent and purpose. Page 1 of 3 365416 365416 08/01/2019 Ohio Living Westminster-Thurber 717 Neil Avenue Columbus, OH 43215

F 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on observation, staff interview and review of the medication safety alert for insulin pen use, the facility failed to ensure their medication error rate was less than 5%. Two medication errors were noted out of 28 opportunities for a medication error rate of 7.14%. This affected one resident (#64) of three residents observed for medication administration. The facility census was 118. Residents Affected - Few Findings include: Observation of medication administration on 07/31/19 at 8:38 A.M., revealed Licensed Practical Nurse (LPN) #207 prepared medications for Resident #64 which included insulin injections. A Lantus and Novolog Flex pen were prepared by the nurse. The nurse first prepared the Lantus insulin syringe by placing a needle onto the syringe. She dialed one unit and pressed the button on the syringe to prime the needle holding the needle in a horizontal manner. She then dialed 18 units of insulin. She then prepared the Novolog Flex pen in the same manner by priming the needle with 1 unit holding the pen in a horizontal position. She then dialed 8 units on the pen. The nurse confirmed at the time of the injection that she primed the needle with one unit. Review of the literature from the pharmacy provided by the facility revealed step 1, turn the dose selector to 2 units. Step 2 Hold the insulin pen with the needle pointing up and tap the cartridge gently a few times to move the air bubbles to the top. Step 3 Press the push button all the way until the dose selector is back to 0 (zero). A drop of insulin should appear at the tip of the needle. A small air bubble may remain at the needle tip, but it will not be injected. If no drop appears, repeat Steps 1, 2, 3 two to six times, before changing the needle and repeating Steps 1, 2, and 3. 365416 Page 2 of 3 365416 08/01/2019 Ohio Living Westminster-Thurber 717 Neil Avenue Columbus, OH 43215

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, and review of facility policies, the facility failed to ensure infection control practices were followed in the kitchen. This had the potential to affect 116 of 118 residents who receive food from the kitchen. The facility identified two residents (#102 and #104) who received nothing by mouth. The facility census was 118. Findings include: 1. Observation on 07/29/19 at 8:36 A.M., revealed dented cans of prunes, peaches, great northern beans, and jellied cranberry sauce stored on the shelf in the dry storage area. At 8:41 A.M., an observation of the cooler revealed a container of parmesan cheese with a use by date of 07/06/19. Interview with Chef/Production Manager (CPM) # 202 on 07/29/19 at 8:45 A.M., verified the above observations. 2. Observation on 07/29/19 at 12:30 P.M., revealed CPM #202 and [NAME] #206 were in the food preparation area without wearing facial hair protectors. They both at the time of the observation verified they should be wearing a facial hair protector while in the food preparation area but were not. 3. Observation on 07/30/19 at 3:33 P.M., revealed [NAME] #201 was not wearing a facial hair protector while preparing food. Interview with [NAME] #201 at the time of the observation verified he was not wearing a facial hair protector and should have been. 4. Observation of refrigerator by the health care center kitchenette on 07/30/19 at 3:37 P.M. revealed a half gallon carton of skim milk with a best by date of 07/24/19. Interview with Dietary Manager (DM) #207 at the time of the observation verified the skim milk was expired. Review of the undated policy titled Dry Storage Areas, revealed leaking or severely dented cans and spoiled foods should be disposed of promptly to prevent contamination of other foods. Review of the undated policy titled Personal Hygiene Training, revealed staff are to keep beards and mustaches closely cropped and neatly trimmed. When around foods, beards are to be kept restrained. Review of the undated policy titled General Food Preparation and Handling, revealed the kitchen is to be kept neat and orderly. 365416 Page 3 of 3