Health 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 Page 1 of 6 365458 365458 11/26/2019 Wood Haven Health Care Senior Living & Rehab 1965 E Gypsy Lane Rd Bowling Green, OH 43402

F 0684 get done. Level of Harm - Minimal harm or potential for actual harm Review of the policy titled Bowel Management Guidelines dated 03/28/17, revealed resident's will be assessed for a bowel movement every three days or resident's identified pattern. If a resident does not have a bowel movement identified per pattern, a bowel protocol will be initiated. Resident's bowel movements are monitored every shift and recorded in Point Click Care. A nurse reviews Resident's for ineffective Bowel Pattern and initiate Bowel Protocol as needed. Residents Affected - Few 365458 Page 2 of 6 365458 11/26/2019 Wood Haven Health Care Senior Living & Rehab 1965 E Gypsy Lane Rd Bowling Green, OH 43402

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and policy review, the failed to ensure restorative range of motion was provided as ordered. This affected one (Resident #49) of two residents reviewed for positioning. The facility identified 24 residents with restorative programs in the last 60 days. The facility census was 73. Findings include: Record review revealed Resident #49 was admitted to the facility on [DATE]. Diagnoses included multiple sclerosis, muscle weakness, lack of coordination, chronic obstructive pulmonary disease, depression, anxiety, heart disease, convulsions, cardiac arrhythmia, neuromuscular dysfunction of bladder, migraine gastro-esophageal reflux disease, overactive bladder, left ankle contracture, osteoporosis, insomnia, cataracts and dysphagia. Review of a physician order dated 03/12/19 revealed the resident could have restorative nursing as indicated. Review of a physical therapy Discharge summary dated [DATE] revealed the resident was being discontinued from therapy with recommendations including a restorative program to maintain the gains made in therapy. Review of a therapy referral dated 05/03/19 revealed Resident #49 was recommended for a retroactive program to include bilateral upper extremity range of motion, 15 repetitions in all planes. Review of the plan of care for Resident #49 dated 05/07/19 revealed Resident #48 had joint contractures. A restorative range of motion program for the upper extremities was to be completed with 15 repetitions, for 15 minutes a day, six to seven days per week. Review of the Minimum Data Set (MDS) assessment, comprehensive significant change dated 10/25/19 revealed Resident #49 had no cognitive deficits. The resident required extensive assistance with bed mobility and eating, was totally dependent for transfers, locomotion, dressing, toileting, hygiene and bathing and her upper and lower extremities had impairments on both sides Interview with Resident #49 on 11/24/19 at 12:27 P.M. revealed she had limitation with her movement. She stated she had therapy at one time but did not receive any follow up and felt she could benefit from exercise or splints. Interview with Registered Nurse #35 on 11/26/19 at 12:45 P.M. verified a restorative program was written by therapy for nursing to follow, but the program was not implemented by nursing. She further stated there had been a restorative staff member at one time, but no longer. Review of the facility policy titled The Restorative Nursing Program, dated May 2009, revealed the program was to provide nursing interventions to promote the resident's ability to adapt to living as independently and safely as possible. The activities were carried out and supervised by nursing staff. Program documentation was to be included on the plan of care and be specific as to what was to be done, measurable goals, approaches being used, frequency and who was to deliver the care. Progress was to be documented. Included programs were ambulation, bed mobility, communication, dressing, 365458 Page 3 of 6 365458 11/26/2019 Wood Haven Health Care Senior Living & Rehab 1965 E Gypsy Lane Rd Bowling Green, OH 43402

F 0688 grooming and bathing, transfers and passive and active range of motion. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 365458 Page 4 of 6 365458 11/26/2019 Wood Haven Health Care Senior Living & Rehab 1965 E Gypsy Lane Rd Bowling Green, OH 43402

F 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and policy review, the facility failed to monitor the dialysis vascular access for function. This affected one (Resident #26) of five residents that receive dialysis. The facility census was 73. Residents Affected - Few Findings include: Review of the medical record for Resident #26 revealed an admission date of 05/04/17. Diagnoses include end stage renal disease. Review of the care plan dated 06/02/17 revealed Resident #26 was at nutritional/hydration risk related to End Stage Renal Disease (ESRD) on hemodialysis, diabetes mellitus type two, hypertension, congestive heart failure, chronic obstructive pulmonary disease, borderline personality disorder, anemia, depression, chronic ischemic heart disease, sleep apnea, anxiety disorder, limited mobility, fluid restriction, difficulty understanding and following therapeutic diet despite multiple educations. Resident #26 had a potential for infection, blood clot, dehydration and electrolyte imbalance related to hemodialysis. Interventions included checking the dialysis vascular access bruit/thrill for function. Review of the quarterly Minimum Data Set (MDS) dated [DATE], revealed Resident #26 was cognitively intact and received dialysis. Review of the treatment administration record for October and November 2019 revealed no documentation of the monitoring of the dialysis vascular access for bruit/thrill. During interview on 11/24/19 at 4:37 P.M., Resident #26 stated the facility does not check her dialysis access for bruit/thrill for function. They used to check her access site when she first had it put in, but they have not checked it for a long time. Interview on 11/25/19 at 3:02 P.M. with Licensed Practical Nurse (LPN) #16 verified the facility has not been checking Resident #26's dialysis vascular access for bruit/thrill. Review of the policy titled Dialysis Policy, revised 04/05/16, revealed all residents that are receiving dialysis will be monitored according to physician orders and residents receiving dialysis require specific interventions as it relates to their care. Staff will follow physician orders as well as the resident's plan of care. 365458 Page 5 of 6 365458 11/26/2019 Wood Haven Health Care Senior Living & Rehab 1965 E Gypsy Lane Rd Bowling Green, OH 43402

F 0732 Post nurse staffing information every day. Level of Harm - Potential for minimal harm Based on observations and staff interview, the facility failed to ensure staffing was accurately posted in a prominent location for residents/visitors to review. This had the potentially to affect all 73 residents residing in the facility at the time of the annual survey. Facility census was 73. Residents Affected - Many Findings include: Observations of the bulletin board near the nursing station on the north west hall on 11/24/19 and 11/26/19 revealed the daily staffing sheet posted was dated 10/17/19. Interview with Licensed Practical Nurse (LPN) #16 on 11/26/19 at 1:57 P.M. confirmed the posted staffing was dated 10/17/19 and was not posted for the current time. 365458 Page 6 of 6