Health inspection·October 31, 2022

F 0688 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. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review and staff interviews, the facility failed to ensure recommendations for passive range of motion were implemented upon discharge from Occupational Therapy services to maintain range of motion. Actual harm occurred when Resident #7 did not receive passive range of motion exercises as recommended and subsequently developed contractures of both upper extremities. This affected one (#7) of one residents reviewed for range of motion. The facility identified 25 residents with contractures. The facility identified 30 residents who were on the restorative nursing program. The facility census was 101. Findings include: Review of Resident #7's medical record revealed an admission date of 05/20/22, with diagnoses including: anoxic brain damage, acute and chronic respiratory failure, mild protein calorie malnutrition, epilepsy, and need for assistance with personal care. Review of the facility Rehab Communication Form, dated 05/20/22, revealed passive range of motion to bilateral upper extremities in all functional planes involving shoulders, elbows, wrists, and digits to be performed three times a week. Review of the Occupational Therapy (OT) Evaluation and Plan of Treatment, dated 05/23/22, revealed range of motion to Resident #7's left and right upper extremities was assessed to be within functional limits with no contractures present. Review of the OT Discharge summary, dated [DATE], revealed discharge recommendations to include Restorative Nursing Program (RNP) for passive range of motion exercises to bilateral upper extremities. Prognosis to maintain current level of function was documented to be good with consistent staff follow through. Review of the significant change Minimum Data Set (MDS) assessment, dated 07/21/22, revealed the resident was rarely/never understood. Resident #7 was assessed to be dependent upon two staff members for bed mobility and toileting. Resident #7 was assessed to have limited range of motion to bilateral upper and lower extremities. Review of the active care plans for this resident revealed there was not a plan of care or interventions in place addressing limitation in range of motion or contractures. Further review of the medical record revealed no documentation of passive range of motion exercises Page 1 of 7 365469 365469 10/31/2022 Batavia Nursing Care Center 4000 Golden Age Drive Batavia, OH 45103

F 0688 being completed for Resident #7. Level of Harm - Actual harm Observation on 10/25/22 at 10:26 A.M., revealed Resident #7 was lying in bed with no splints or other preventive devices in place to bilateral upper extremities. The resident's fingers, wrists, and elbows were observed to contracted. Residents Affected - Few Interview on 10/27/22 at 9:40 A.M., with Occupational Therapist #170 revealed the employee had assessed and treated Resident #7 in May of 2022. Occupational Therapist #170 verified the resident did not have contractures present at the time of discharge from OT services and recommendations had been made for RNP, which was to include passive range of motion exercises to be completed to the resident's bilateral upper extremities to prevent contractures. Occupational Therapist #170 verified the resident's functional range of motion to bilateral upper extremities were documented to be within functional limits at the time of discharge from OT services. Observation on 10/27/22 at 10:00 A.M., revealed Occupational Therapist #170 entered the room of Resident #7 and assessed the resident's left and right upper extremities for the presence of contractures. Interview with Occupational Therapist #170 at the time of the observation verified the fingers, wrists, and elbows of Resident #7 were currently contracted and passive range of motion exercises being completed may have prevented the development of the contractures. Interview on 10/27/22 at 10:25 A.M., with the Director of Nursing (DON), verified the recommendations for passive range of motion exercises for Resident #7 had not been implemented. 365469 Page 2 of 7 365469 10/31/2022 Batavia Nursing Care Center 4000 Golden Age Drive Batavia, OH 45103

F 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview and policy review, the facility failed to respond timely to pharmacy recommendations after being acknowledge by the physician. This affected one (#96) of five residents reviewed for pharmacy recommendations. The total facility census was 101. Findings include: Review of Resident #96's medical record revealed an admission date of 11/15/19, with diagnoses including: diabetes, quadriplegia, chronic ulcer in foot, pressure hypertension, open wound, colostomy, suprapubic catheter, oxygen via nasal cannula and anxiety. Review of the Minimum Data Set (MDS) comprehensive assessment dated [DATE] revealed the resident had intact cognition and was receiving the medication, Midodrine HCL tablet 10 milligrams every eight hours for hypotension. Review of the pharmacy recommendation dated 03/15/22, revealed the pharmacist recommended the Midodrine order should include parameters to ensure it is only given when clinically appropriate. The physician signed the pharmacy recommendation on 03/23/22, with revised clarification to hold Midodrine with systolic blood pressure greater than 110. Review of physician orders of October 2022 revealed the Midodrine clarification was ordered on 10/26/22 to give 2 tablets by mouth every 8 hours as needed for hypotension and hold Midodrine with systolic blood pressure greater than 110. Interview on 10/27/22 at 11:03 A.M., with the Director of Nursing, (DON) verified the midodrine pharmacy recommendation order was not ordered as a clarification by the physician until 10/26/22 after the surveyor had requested the pharmacist medication recommendations. The DON verified the new clarification should have been ordered when the physician approved the clarification. Review of the policy titled Medication Monitoring, dated 06/21/17 revealed the facility must act on the reports in a manner that meets the needs of the residents. 365469 Page 3 of 7 365469 10/31/2022 Batavia Nursing Care Center 4000 Golden Age Drive Batavia, OH 45103

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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 policy review, the facility failed to ensure food storage was maintained in a clean manner to prevent potential food contamination or food borne illness. This had the potential to affect 50 of 50 resident who reside on the affected units. The facility census was 101. Findings include: Observation on 10/26/22 from 9:50 A.M. through 10:15 A.M., revealed the in the E/F Unit resident refrigerator: the outside of the freezer casket pull away from the top side and corner edge of the door exposing debris; inside the freezer, there was a built up of ice where the door closed, preventing the door from completely shutting and making a complete seal; there was and outside handle missing from the refrigerator door exposing two holes in the door; two large, insulated lunch containers with no name or date; two open containers of fluids with no open date and opened and partially served ice cream cake in freezer with no open date. In the J/K Unit resident refrigerator an opened and partially served resident identified gallon of milk with expiration date 10/19/22; an opened and partially used liter of pop with no open date; an outside refrigerator handle lose in the middle, taped with heavy taping material and soiled with debris and two open containers of fluids with no open date. Interview on 10/26/22 from 9:50 A.M. through 10:15 A.M., with Dietary Manager (DM) #90 verified the refrigerators on the units were for resident food storage only. She verified the open containers of fluids, pop and ice cream cake should have been dated with an open date. She verified the expired food should have been discarded within seven days of opening. She stated the insulated bags should have been labeled and dated or stored elsewhere if the bags contained employees' meals. DM #90 verified E/F refrigerator gasket was in disrepair and did not make contact with the freezer surface to prevent ice build up and the door handle tape and holes were not cleanable surfaces. Review of the policy titled, Food Storage-labeling and Dating dated July 2018, revealed items must be dated after opening with an open date. All foods should be discarded prior to or on day seven. 365469 Page 4 of 7 365469 10/31/2022 Batavia Nursing Care Center 4000 Golden Age Drive Batavia, OH 45103

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm 3. Review of Residnet #89's medcial record revealed an admission date of 02/13/19, with diagnoses including: malignant neoplasm of colon, chronic kidney disease, extended spectrum beta lactamase, obstructive and reflux uropathy, retention of urine, obesity, patients non compliance with other treatment medical treatment and regimen, long term use of insulin, anxiety disorder, secondary malignant neoplasm of lung, osteomyelitis, and type two diabetes mellitus with other diabetic neurological complication. Residents Affected - Many Observation on 10/27/22 at 10:56 A.M., revealed State Tested Nurse Aide (STNA) #100 completing incontinence care and urinary catheter care for Resident #89. STNA #100 gathered her supplies and put on her gloves. STNA #100 filled a basin with water and then removed her gloves and put on clean gloves. She did not wash her hands after removing her soiled gloves. STNA #100 got disposable wipes and a new adult incontinence brief. Resident #89 had a bowel movement in her adult incontinence brief. STNA #100 cleaned the resident's vaginal area of feces and STNA #100 then used a disposal wipe to clean off her gloves and moved the catheter bag to the other side of the bed and turned Resident #89 over. STNA #100 then cleaned the resident's buttocks of feces with wipes. STNA #100 then removed her soiled gloves put on new gloves and she did not wash her hands between changing gloves. STNA #100 completed Resident #89 care including catheter care then dumped water in the toilet took off her gloves cleaned out basin with water and towel. STNA #100 turned on the water, lathered her hands, washed hands used left forearm to turn on water and rinsed right hand, then used washed right hand to hold button to turn on water and rinsed left hand. Interview on 10/27/22 at 11:10 A.M., with STNA #100 verified she did not wash her hands after removing her gloves multiple times. STNA #100 verified that she wiped off her dirty glove with a disposable wipe and then grabbed the residents catheter bag and turned her over and continued doing care. She also verified that she touched the knob of the sink with her right clean hand and did not rewash her right hand when she had finished all care. Review of the policy titled, Infection Control Policy/Procedure Manual dated 11/28/17, revealed all staff should perform hand hygiene, when coming on duty, after handling contaminated objects, and after personal protective equipment removal. Gloves are worn if potential contact with blood or body fluid, and gloves are removed after contact with blood or body fluids. Based on observations, staff interviews, medical record reviews, review of facility policies, and review of the Centers for Disease Control (CDC) prevention online guidance, the facility failed to ensure appropriate isolation precautions and use of Personal Protective Equipment (PPE) were implemented and failed to ensure staff performed adequate hand hygiene when completing care hygienic care. This affected three (#7, #42 and #89) of three residents reviewed for infection control and the potential to affect all residents in the facility. The facility census was 101. Findings include: 1. Review of Resident #7's medical record review revealed an admission date of 05/20/22, with diagnoses including anoxic brain damage, acute and chronic respiratory failure, mild protein calorie malnutrition, epilepsy, tracheotomy status, and need for assistance with personal care. Review of the significant change Minimum Data Set (MDS) assessment, dated 07/21/22, revealed this 365469 Page 5 of 7 365469 10/31/2022 Batavia Nursing Care Center 4000 Golden Age Drive Batavia, OH 45103

F 0880 Level of Harm - Minimal harm or potential for actual harm resident was rarely/never understood. This resident was assessed to be dependent upon two staff members for bed mobility and toileting. Review of the physician's order, dated 07/28/22 and discontinued on 10/25/22, revealed an order for droplet precautions due to Methicillin Resistant Staphylococcus Aureus (MRSA) in sputum. Residents Affected - Many Review of the active physician's order, dated 10/25/22, revealed an order for droplet and contact precautions due to MRSA in sputum. Observation on 10/24/22 at 10:20 A.M., revealed there were isolation signs reading Droplet Precautions present on the room door of Resident #7. Resident #7 was observed to have tracheostomy appliances in place. Observation on 10/25/22 at 10:53 A.M., revealed Respiratory Therapist (RT) #145 was providing care to Resident #7 inside the resident's room only wearing an N-95 mask and gloves. 2. Review of Resident #42's medical record revealed an admission date of 06/12/22 and had diagnoses including acute and chronic respiratory failure, tracheostomy status, and dependent on ventilator. Review of the quarterly MDS assessment, dated 09/20/22, revealed this resident had mildly impaired cognition and was assessed to be dependent upon two staff members for bed mobility and toileting. Review of the physician's order, dated 10/10/22 and discontinued on 10/25/22, revealed an order for droplet precautions due to Extended Spectrum Beta Lactamase (ESBL) in sputum. Review of the physician's order, dated 10/25/22 and discontinued on 10/26/22, revealed an order for droplet and contact precautions due to ESBL in sputum. Observation on 10/24/22 at 10:20 A.M., revealed there were isolation signs reading Droplet Precautions present on the room door of Resident #42. Resident #42 was observed to have a tracheostomy appliances in place. Observation on 10/25/22 at 9:20 A.M., revealed Licensed Practical Nurse (LPN) #21 was observed to be in the room of Resident #42 providing personal care to the resident while wearing an N-95 respirator mask and gloves with no gown. Interview on 10/25/22 at 9:20 A.M., with LPN #21 verified the employee had not worn a gown while providing personal care to Resident #42. LPN #21 stated staff only had to wear an N-95 and gloves in the room while providing care as the resident was only on droplet precautions. Interview on 10/25/22 at 10:53 A.M., with the Director of Nursing (DON) verified RT #145 was not wearing a gown while in the room of Resident #7. The DON stated Resident #7 and Resident #42 should also be on contact precautions due to their infections and appropriate signage was being added. Review of the policy titled Foundations Health Solutions Infection Control Policy/Procedure Manual, revised 11/28/17, revealed a resident with an infection or communicable disease should be placed on Transmission-based precautions as recommended by current CDC Guidelines for Isolation Precautions. Review of the online CDC guidance titled Implementation of Personal Protective Equipment (PPE) Use 365469 Page 6 of 7 365469 10/31/2022 Batavia Nursing Care Center 4000 Golden Age Drive Batavia, OH 45103

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many in Nursing Homes to Prevent Spread of Multidrug-resistant Organisms (MDROs) (https://www.cdc.gov/hai/containment/PPE-Nursing-Homes.html), last reviewed 07/12/2022, revealed the document was intended to provide guidance for the use of PPE and room restriction in nursing homes to prevent the spread of MDROs to include Methicillin Resistant Staphylococcus Aureus (MRSA) and ESBL producing Enterobacterales. Contact Precautions, to include use of gown and gloves, were recommended during any room entry where there was presence of acute diarrhea, draining wounds or other sites of secretions or excretions that are unable to be covered or contained. Face protection may also be needed if performing activity with risk of splash or spray. 365469 Page 7 of 7