Health inspection·December 19, 2022

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, resident interview, staff interview, and review of facility policy, the facility failed to have fall interventions in place. This affected two residents (#7 and #37) of four reviewed for accidents. The census was 50. Findings include: 1. Review of Resident #7's medical record revealed an admission date of 10/25/22. Diagnoses list included metabolic encephalopathy, dysphagia, hypertension, osteoarthritis, atrial fibrillation, and rheumatoid arthritis. Review of a recent minimum data set (MDS) assessment for Resident #7, revealed resident was assessed as being moderately cognitively impaired, required supervision with bed mobility, extensive assistance with transfers, and had falls prior to admission. Review of a care plan initiated on 10/26/22, revealed Resident #7 had potential for and was at risk for injuries/falls. Interventions included monitor safety/preventative devices for applications, instruct on use of adaptive equipment as needed and a perimeter mattress to help define bed boundaries. Review of progress notes dated 11/16/22 at 8:01 P.M., revealed Resident #7 was lying on the floor on her right side near bed and vital signs were taken. Resident #7 complained of right arm pain and had a hematoma to her right forehead. Review of progress notes dated 11/16/22 at 8:20 P.M., revealed Resident #7 was sent to a local emergency room for evaluation. Review of an interdisciplinary team (IDT) notes dated 11/17/22 at 10:18 A.M., revealed Resident #7 fell from her bed on 11/16/22 at 7:45 P.M. Notes indicated Resident #7 was in bed and rolled out. IDT notes indicated a new intervention for a scoop/perimeter mattress was added and the care plan was updated. During an interview on 12/13/22 at 7:31 A.M. with Resident #7 indicated she fell out of bed and busted her face. Observation 12/14/22 at 2:25 P.M. with the Director of Nursing (DON), revealed Resident #7's bed did not have a scoop/perimeter mattress. Interview with DON at the same time indicated Resident #7's Page 1 of 5 365448 365448 12/19/2022 Rest Haven Nursing Home Inc 1096 North Ohio Street Greenville, OH 45331

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few bed should have had a scoop/perimeter mattress in place as a fall intervention and verified Resident #7's bed did not have scoop/perimeter mattress per her care plan. 2. Review of Resident #37's medical record revealed Resident was admitted to the facility on [DATE]. Diagnoses included Coronavirus (COVID-19), Alzheimer's disease, dysphagia, psychosis, anxiety disorder and urinary tract infection. Review of the quarterly MDS assessment for Resident #37, dated 09/06/22, revealed resident had severely impaired cognition. Further review of the MDS assessment revealed Resident # 37 required extensive assistance from staff with bed mobility, transfers, dressing, eating and personal hygiene. Review of the progress note for Resident #37 dated 07/13/22 revealed resident had a fall from the bed, and the facility identified the need for a parameter mattress to define bed boundaries. Progress note dated 09/02/22, revealed Resident #37 was found sitting on the floor on the side of the bed and the facility identified the need to pad Resident #37's bed frame for injury prevention. Progress note dated 10/21/22, revealed Resident #37 was found on the floor in her room next to her bed and the facility identified the need to have a fall mat placed on the right side of her bed as an intervention. Review of physician orders dated 07/14/22 for Resident #37, revealed resident was ordered a perimeter mattress to define bed boundaries for fall preventions. Physician orders dated 09/06/22, revealed resident was ordered a padded lateral bed frame for injury preventions. Physician orders dated 10/28/22, revealed resident was ordered a fall mat to floor on right side of bed every shift for fall interventions for injury prevention. Observation on 12/14/22 at 10:06 A.M. with Occupational Therapist (OT) # 162 revealed Resident #37 was lying in bed with no fall mat on the floor at the bed side as ordered. Interview at same time with OT #162 indicated Resident #37 should have a fall mat on the floor and next to bed when resident was in bed due to fall risk. OT #162 verified no fall mat was in place for Resident #37. Observation on 12/14/22 at 1:23 P.M. with the Director of Nursing (DON) revealed Resident #37 did not have a parameter mattress on her bed and the bed frame did not have padding on it as ordered. Interview with DON at same time, revealed Resident #37 was recently moved from another room and the staff did not mot the correct bed with resident. DON verified resident's bed should have a parameter mattress and a padded bed frame for fall interventions. Review of the facility policy titled, Falls and Fall Risk Managing, undated, Based on previous evaluations and current data, the staff will identify interventions related to the resident's specific risks and causes to try to prevent the resident from falling and to try to minimize complications from falling. 365448 Page 2 of 5 365448 12/19/2022 Rest Haven Nursing Home Inc 1096 North Ohio Street Greenville, OH 45331

F 0880 Provide and implement an infection prevention and control program. 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, staff interview, and review of facility policy, the facility failed to ensure staff followed standard precautions and transmission-based precautions (TBP) when caring for residents. This affected one resident (#1) of the five residents observed in TBP but had the potential to affect all the residents of the facility. The census was 50. Residents Affected - Few Findings include: 1. Review of Resident #1's medical record revealed an admission date of 05/26/21. Diagnoses listed include multiple sclerosis, tracheostomy/ventilator dependent, hypertension, major depressive disorder, and seizures. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #1 was assessed as being cognitively intact. Review of sputum culture results dated 08/21/22 revealed Resident #1 was positive for the drug resistant organism consistent with extended spectrum beta-lactamase (ESBL). Further medical record review revealed an order dated 08/23/22 for Resident #1 to be in contact precautions. Observation on 12/12/22 at 10:45 A.M. revealed state tested nursing assistant (STNA) #234 in Resident #1's room assisting her at bedside. STNA #234 took a book form Resident #1, handed Resident #1 her bed controller, touched, and arranged items on her bedside table. STNA #234 leaned on Resident #1's bedside table and used it to write. STNA #234 was not wearing a gown or gloves. Signs were posted on the entrance to Resident #1's room identifying resident was in contact precautions. A bin containing personal protective equipment, such as gloves and gowns was located at the entrance of Resident's doorway. Observation on 12/12/22 at 10:49 A.M. revealed STNA #234 exited Resident #1's room without washing or sanitizing her hands. Interview with STNA #234 at same time, confirmed Resident #1 was in contact precautions. STNA #234 confirmed she did not wear a gown and gloves while assisting Resident #1. During an interview on 12/12/22 at 11:15 A.M. with Registered Nurse (RN) #206, she confirmed Resident #1 was on extended contact precautions due to being positive for a drug resistant organism. RN #206 confirmed STNA #234 should have been wearing a gown and gloves while caring for Resident #1 and STNA #234 should have completed hand hygiene before exiting Resident #1's room. Review of the facility's undated policy titled Isolation-Categories of Transmission-Based Precautions revealed staff and visitors will wear gloves (clean, non-sterile) when entering the room. Gloves would be removed, and hand hygiene performed before leaving the room. Staff and visitors would wear a disposable gown upon entering the room and remove before leaving the room and avoid touching potentially contaminated surfaces with clothing after gown is removed. Review of the CDC website titled Implementation of Personal Protective Equipment (PPE) Use in Nursing Homes to Prevent Spread of Multidrug-resistant Organisms (MDROs) (https://www.cdc.gov/hai/containment/PPE-Nursing-Homes.html), updated 07/12/22, revealed Added additional rationale for the use of 365448 Page 3 of 5 365448 12/19/2022 Rest Haven Nursing Home Inc 1096 North Ohio Street Greenville, OH 45331

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Enhanced Barrier Precautions (EBP) in nursing homes, including the high prevalence of multidrug-resistant organism (MDRO) colonization among residents in this setting, expanded residents for whom EBP applies to include any resident with an indwelling medical device or wound (regardless of MDRO colonization or infection status), and CDC clarified that, in the majority of situations, EBP are to be continued for the duration of a resident's admission. EBP's are an infection control intervention designed to reduce transmission of resistant organisms that employs targeted gown and glove use during high contact resident care activities. Standard Precautions, which are a group of infection prevention practices, continue to apply to the care of all residents, regardless of suspected or confirmed infection or colonization status. EBP expand the use of PPE and refer to the use of gown and gloves during high-contact resident care activities that provide opportunities for transfer of MDROs to staff hands and clothing. Examples of high-contact resident care activities requiring gown and glove use for Enhanced Barrier Precautions include: dressing, bathing/showering, transferring, providing hygiene, changing linens, changing briefs or assisting with toileting, device care or use (central line, urinary catheter, feeding tube, tracheostomy/ventilator) and wound care 365448 Page 4 of 5 365448 12/19/2022 Rest Haven Nursing Home Inc 1096 North Ohio Street Greenville, OH 45331

F 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review, and staff interview, the facility failed to provide effective pest control to prevent gnats /fruit flies throughout the facility. This affected one resident (#43) out of the 13 residents sampled but had the potential to affect all residents at the facility. The facility census was 50. Residents Affected - Many Findings include: Record review for Resident #43 revealed an admission date of 10/18/22. Her diagnosis included Coronavirus (COVID-19), osteoarthritis, dementia, essential primary hypertension, hypothyroidism, and hyperlipidemia. Review of the admission minimum data set (MDS) assessment revealed resident had impaired cognition. Further review of the MDS assessment, revealed Resident #43 required extensive assistance from staff with dressing, bed mobility, personal hygiene, and transfers. Interview on 12/12/22 at 3:37 P.M. with Resident #43's representative revealed she was sitting in the common dining room with Resident #43 and swatted at gnats/fruit flies. Resident's representative stated she asked the staff several times regarding gnats/fruit flies and why the facility had not treated the issue. Resident's representative stated she was told the gnats/fruit flies were in the building after pumpkins were brought into the facility. Interview on 12/14/22 at 3:54 P.M. with Licensed Practical Nurse (LPN) #140 confirmed the observation of gnats/fruit flies flying around the sink in the residents dining room. Interview on 12/14/22 at 04:19 P.M. with the Maintenance Supervisor (MS) #124 confirmed the facility had an issue with gnats/fruit flies for about a month. MS #124 stated he planned to tell the exterminator when he was at the facility, however, he did not catch him in time to discuss the concerns. MS #124 thought the gnats/fruit flies concern may be an issue with the drains at the facility. Observation on 12/15/22 at 8:55 A.M. during an interview with Social Service Director (SSD) #100 regarding resident accounts revealed she was sitting at her desk swatting her hands in the air at gnats/fruit flies. SSD #100 verified she was trying to get the gnats/fruit flies in the office. Review of the facility policy titled, Pest Control, dated 2001, this facility maintains an on-going pest control program to ensure that the building is kept free of insects and rodents. Review of the Service Agreement with Buckeye Exterminating dated 12/08/22 revealed common exclusions that could be included at an additional cost included, fly& gnat control. 365448 Page 5 of 5