Inspection·November 26, 2019

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 Based on record review, staff interview, resident interview and review of the facility bowel protocol, the facility failed to monitor for bowel movements and failed to administered as needed laxatives as ordered. This affected one (Resident #26) of five residents reviewed for unnecessary medications. The facility census was 73. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #26 revealed an admission date of 05/04/17. Review of the care plan dated 06/02/17, revealed Resident #26 had a potential for constipation related to increased weakness, decreased mobility, and use of narcotics. Interventions included following bowel management guidelines, monitor abdomen for distention, monitor bowel sounds, provide high fiber foods as needed and record bowel movement size and consistency and report any abnormalities to supervisor. Review of the quarterly Minimum Data Set (MDS) assessment, dated 09/27/19, revealed Resident #26 was cognitively intact, occasionally incontinent of bladder and always continent of bowel. Review of the current physician orders for Resident #26 revealed an order dated 01/22/19, to initiate bowel protocol. The resident had an ordered dated 03/21/19 for Senna, a laxative, 8.6 mg, two tablets by mouth every six hours as needed for constipation; on 05/20/19, an order for Miralax powder 17 gram (gm) daily as needed for constipation; on 06/11/19 an order for Lactulose, 15 ml every 12 hours as needed for constipation. On 11/19/19, the Senna was changed from as needed to twice daily. Review of the medication administration record (MAR) revealed no as needed Lactulose or Miralax was administered for November 2019. Review of the task documentation for the State Tested Nursing Assistants (STNA) revealed no documentation Resident #26 had a bowel movement from 11/04/19-11/10/19, 11/12/19-11/17/19, and 11/21/19-11/25/19. Interview on 11/25/19 at 9:31 A.M. with Resident #26 revealed her last bowel movement was on Friday 11/20/19 and they have not given her anything to help her bowels move. Resident #26 stated she didn't know if she had anything ordered to help her bowels move. Interview on 11/25/19 at 3:02 P.M. with LPN #16 verified Resident #26 did not have a bowel movement from 11/04/19- 11/10/19, 11/12/19-11/17/19 and 11/21/19-11/25/19 and no interventions were done. LPN #16 verified the nurses are to print a bowel movement report each day, but that does not always (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 6 Event ID: 365458 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365458 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/26/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wood Haven Health Care Senior Living & Rehab 1965 E Gypsy Lane Rd Bowling Green, OH 43402 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)