Health inspection·July 28, 2023

F 0602 Protect each resident from the wrongful use of the resident's belongings or money. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interviews and facility policy review, the facility failed to prevent the misappropriation of Resident #16's power wheelchair. This affected one resident (#16) of one resident reviewed for misappropriation. The facility census was 90. Residents Affected - Few Findings Include: Review of the medical record for Resident #16 revealed an initial admission date of 01/16/12 with the latest readmission of 01/22/22 with diagnoses including chronic obstructive pulmonary disease, chronic pain syndrome, dependence on wheelchair, alcoholic cirrhosis, bradycardia, chronic respiratory failure, hypertension, mood disorder, edema, major depressive disorder, carpal tunnel syndrome left upper limb, dysphagia, anxiety disorder, constipation and anemia. Review of the plan of care dated 11/26/14 revealed the resident had impaired physical mobility related to utilize electric wheelchair for mobility related to generalized muscle weakness, impaired vision and use of psychotropic medications. Interventions included ambulation with front wheelchair walker, encourage to turn and reposition with care rounds, encourage to use self-releasing seat belt while utilizing motorized wheelchair, non-skid footwear at all times and trapeze bar to bed. Review of the resident's quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident had no cognitive deficit. The resident required supervision with bed mobility, transfers and locomotion on/off the unit. The assessment indicated the resident utilized both a walker and wheelchair for mobility. Review of the monthly physician orders for July 2023 revealed an order (initiated 01/22/22) to encourage use of self-releasing seat belt while utilizing motorized wheelchair, verify able to self release every shift while using. On 07/28/23 at 8:25 A.M., interview with the Administrator revealed Resident #16 had received a new power chair and the resident's old power chair was being stored on the 300 hallway (for several months). The Administrator revealed a roll off dumpster was brought in to clean out the 300 hallway for re-opening and during the clean out the resident's chair was discarded in the dumpster. On 07/28/23 at 9:00 A.M., interview with Resident #16 revealed permission was not given to the facility to discard the power wheelchair and he was not provided the opportunity to remove the chair from the facility. Review of the facility policy titled, Abuse, Neglect, Exploitation & Misappropriation of Resident Page 1 of 4 365435 365435 07/28/2023 Embassy of Logan 300 Arlington Avenue Logan, OH 43138

F 0602 Level of Harm - Minimal harm or potential for actual harm Property, last revised 10/2020 revealed the facility will not tolerate Abuse, Neglect, Exploitation of its residents or the Misappropriation of Resident property. Misappropriation is defined as the deliberate misplacement, exploitation, or wrongful, temporary, or permanent use of a resident's belongings or money without the resident's consent. Residents Affected - Few This deficiency represents non-compliance investigated under Complaint Number OH00144749. 365435 Page 2 of 4 365435 07/28/2023 Embassy of Logan 300 Arlington Avenue Logan, OH 43138

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, interview and facility policy review, the facility failed to maintain acceptable infection control practices to prevent cross contamination of two Stage IV (full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed) pressure ulcers during an observed dressing change for Resident #44. This affected one resident (#44) of three residents reviewed for pressure ulcers. The facility census was 90. Residents Affected - Few Findings Include: Review of the medical record for Resident #44 revealed an initial admission date of 09/29/20 with the latest readmission of 09/22/21. Diagnoses including schizophrenia, low back pain, Stage IV pressure ulcer to left buttocks, morbid obesity, anxiety disorder, hyperlipidemia, Vitamin D deficiency, hypothyroidism, bipolar disorder, tremor, anemia, major depressive disorder, insomnia, epilepsy, carpal tunnel syndrome, asthma, gastroesophageal reflux disease (GERD), osteoarthritis (OA), lumbar spina bifida, diabetes mellitus, hypertension and left below the knee amputation. Review of the plan of care dated 01/26/23 revealed the resident had an actual area of skin impairment related to Stage IV pressure ulcer to left ischial and right ischial, Interventions included encourage resident to lay down throughout the day to relieve pressure, air mattress as ordered, encourage to relieve pressure to wound areas, evaluate pain and provide pain relieving interventions as ordered, followed by Nurse Practitioner (NP) and wound care consultants, initiate wound treatment, continue wound treatment as ordered, nursing to observe dressing daily to ensure that the dressing remains intact and there are no signs/symptoms of infection or increased drainage, observe for clinical changes, resident prefers to use scooter without ROHO cushion, refer to dietician to determine need/no need for dietary interventions and skin observation and document on bath/shower days. Review of the resident's quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident had no cognitive deficit. The resident required extensive assistance of two for bed mobility and toilet use and dependent on two for transfers. The assessment indicated the resident has an indwelling urinary catheter and was frequently incontinent of bowel. The assessment indicated the resident was at risk for skin breakdown and had one unhealed Stage IV pressure ulcer that was present on admission. Review of the monthly physician orders for July 2023 revealed an order (initiated 03/15/23) to pack wound to left ischium with half strength Dakins soaked Kerlix roll, cover with bordered dressing and change daily and cleanse wound to right ischium with half strength Dakins', pat dry, pack with half strength soaked gauze daily and as needed. Review of a weekly pressure skin grid dated 07/24/23 revealed the resident had a Stage IV pressure ulcer to the right ischium measuring 2.0 centimeters (cm) by 1.0 cm by 3.0 cm. The wound had tunneling at 12 o'clock measuring 2.8 cm. The wound had attached wound edges and macerated peri-wound with a moderate amount of serous drainage. The wound was determined to have been unchanged. Review of the weekly pressure skin grid dated 07/24/23 revealed the resident had a Stage IV pressure ulcer to the left ischium measuring 1 0 cm by 3.0 cm by 4.0 cm with 100% granulation bed, unattached edges, macerated edges and moderate serosanguinous drainage. The wound had tunneling around the clock measuring 4.0 cm. 365435 Page 3 of 4 365435 07/28/2023 Embassy of Logan 300 Arlington Avenue Logan, OH 43138

F 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 07/28/23 at 10:30 A.M., observation of Licensed Practical Nurse (LPN) #110 and #124 provide the physician ordered treatment to Resident #44's Stage IV pressure ulcer to the right and left ischium revealed the LPN's washed their hands and set up the required supplies on a barrier after sanitizing the bedside table. LPN #124 cleansed hands and donned gloves. LPN #124 cleansed the wound to the right ischium with wound cleanser and drain sponge, then dried the wound using a drain sponge. LPN #124 then cleansed the wound with wound cleanser and drain sponge, then dried the wound using a drain sponge. LPN #124 then sanitized her hands and donned gloves. LPN #124 cut two pieces of Kerlix and placed in one half Dakins' solution. LPN #124 then packed the Dakins' soaked packing in the wound to the right ischium using a Q-tip. LPN #124 then obtained another Q-tip and packed the wound to the left ischium with the Dakins' soaked Kerlix. LPN #124 sanitized her hands and donned a pair of gloves. LPN #124 then covered the right ischium wound with a bordered gauze. LPN #124 then covered the wound to the left ischium with a boarded gauze dressing. LPN #124 verified the dressing changes to the two Stage IV pressure ulcers were completed together instead of separate to prevent potential cross contamination. Review of the facility policy titled, Pressure Injury Prevention and Management, dated 08/22/22 revealed the facility was committed to the prevention of avoidable pressure injuries, unless clinically unavoidable and to provide treatment and services to heal the pressure ulcer/injury, prevent infection and the development of additional pressure ulcers/injuries. This deficiency represents non-compliance investigated under Complaint Number OH00144381. 365435 Page 4 of 4