Health inspection·January 2, 2024

F 0641 Ensure each resident receives an accurate assessment. 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, staff interview, and review of facility policy for wound care, this facility failed to ensure residents assessments were accurate to refect a pre-existing skin injury during admission assessments. This affected one (Resident #141) of four residents reviewed for skin care and prevention. The facility census was 70. Residents Affected - Few Findings include: Review of the medical record for Resident #141 revealed an initial admission date of 07/23/23, and re-entry date of 11/29/23, and a discharge date of 12/13/23. Diagnoses included acute respiratory failure with hypoxia, altered mental status, and sepsis unspecified organism. Review of the plan of care dated 11/30/23 revealed Resident #141 was at risk for skin breakdown and has skin breakdown. Interventions include to apply triad cream twice a day after incontinence episode as needed, assist with repositioning and or turning at frequent intervals to provide pressure relief, keep skin clean and dry, assist with skin care based on residents limitations, and report changes in skin integrity to the nurse. Review of Resident #141's admission Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of 15 out of 15 indicating the resident had an intact cognition for daily decision making abilities. Resident #141 required supervision assistance for personal hygiene and was dependent on staff for toileting, dressing, and transfers. Resident #141 was noted to be free of any skin injuries or pressure wounds during this assessment review. Review of Resident #141's physician orders for December 2023 revealed the following: -Apply triad cream to buttocks/coccyx area every day and night shift for redness. Start on 11/29/23. -Monitor bruising to left and right forearm every shift for monitoring until healed. Review of weekly skin observations for Resident #141 from 11/29/23 through 12/13/23 revealed the resident was free of any skin injuries or pressure wounds. Interview on 12/27/2023 at 11:38 A.M. with the Assistant Director of Nursing (ADON) #172 revealed Resident #141 was admitted to the facility with a red area to her buttocks and she got a order for cream for redness. She thought she out a progress note in the residents medical record but could not find it anywhere. Normally this would have been documented under weekly skin assessments or pressure Page 1 of 7 365485 365485 01/02/2024 Flint Ridge Nrsg & Rehab Ctr 1450 West Main Street Newark, OH 43055

F 0641 charting. Level of Harm - Minimal harm or potential for actual harm Interview on 12/27/2023 at 11:42 A.M. with the Director of Nursing (DON) confirmed Resident #141's MDS assessment did not note her per-existing skin condition when admitted to the facility as well as there was no documentation in the medical record under weekly skin observations to indicate the resident was admitted with a skin concern. Residents Affected - Few Review of the facility policy titled Wound Care, revised 10/2010, revealed under section titled Documentation The following information should be recorded in the resident's medical record: type of wound care given, all assessment data including wound bed color, size, drainage, and etc. This is an incidental finding identified during investigation for Complaint Number OH00148998. 365485 Page 2 of 7 365485 01/02/2024 Flint Ridge Nrsg & Rehab Ctr 1450 West Main Street Newark, OH 43055

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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, and staff interview, this facility failed to ensure residents receiving antibiotics were monitored for effectiveness including obtaining and monitoring vital signs. This affected one (Resident #141) of the four residents reviewed for antibiotic use. The facility census was 70. Residents Affected - Few Findings include: Review of the medical record for Resident #141 revealed an initial admission date of 07/23/23, and re-entry date of 11/29/23, and a discharge date of 12/13/23. Diagnoses included acute respiratory failure with hypoxia, altered mental status, and sepsis unspecified organism. Review of Resident #141's admission Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of 15 out of 15 indicating the resident had an intact cognition for daily decision making abilities. Resident #141 required supervision assistance for personal hygiene and was dependent on staff for toileting, dressing, and transfers. Resident #141 was noted to be receiving intravenous antibiotic during stay. Review of Resident #141's physician orders for December 2023 revealed the following: -Change peripherally inserted central catheter (picc) line dressing and end cap every week to right upper arm on Monday. -Flush picc before and after antibiotic administration with 10 milliliters (ml) of normal saline to right upper arm day and night -Imipenem-Cilastatin IV (antibiotic to treat bacterial infections) solution reconstituted 500 milligrams (mg), use 500 mg two times a day for sepsis with urinary tract infection (UTI) for 28 administrations. Review of Resident #141's vital sign monitoring revealed no blood pressure, temperature, or pulse was obtained since admission through discharge from the facility. The last documented blood pressure, temperature, or pulse was 03/28/22. Interview on 12/27/23 at 11:42 A.M. with the Director of Nursing (DON) confirmed Resident #141's was receiving intravenous antibiotic due to a recent hospital stay with the diagnosis of Sepsis. The DON also confirmed the residents medical record lacked the evidence of vital signs being obtained and/or monitored during her stay at the facility and while receiving intravenous antibiotic for an infection and should have been. This is an incidental finding identified during investigation for Complaint Number OH00148998. 365485 Page 3 of 7 365485 01/02/2024 Flint Ridge Nrsg & Rehab Ctr 1450 West Main Street Newark, OH 43055

F 0760 Ensure that residents are free from significant medication errors. 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, staff interview, and facility policy for medication administration, this facility failed to ensure residents thyroid medication was administered at the scheduled time. This affected one (Resident #41) of the four residents reviewed for accurate medication administration. The facility census was 70. Residents Affected - Few Findings include: Review of the medical record for Resident #41 revealed an admission date of 04/13/23. Diagnoses included hemiplegia and hemiparesis following an cerebral infarction affecting the right dominant side, diabetes insipidus, anxiety disorder, obesity, and hypothyroidism. Review of Resident #41's quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of 15 out of 15 indicating the resident had an intact cognition for daily decision making abilities. Resident required supervision or set up assistance for eating, oral care, toilet hygiene, dressing, personal hygiene. Noted to have an indwelling catheter and always continent of bowel function. Review of Resident #41's physician orders for November 2023 revealed an order for Levothyroxine sodium 125 milligrams (mg), give one tablet in the morning for hypothyroidism. Continued review revealed this medication was scheduled to be administered at 6:00 A.M. daily. Review of the medication administration record (MAR) for November 2023 revealed the medication Levothyroxine Sodium was documented by the nurse administering this medication as being administered at 6:00 A.M. daily. Review of the progress note dated 11/29/2023 at 11:49 A.M. created by the Director of Nursing (DON) revealed, Resident #41's, son reports resident's Levothyroxine levels were low and endocrinologist was thinking of increasing the Levothyroxine. Son request medication review at this time. Pharmacist in the facility reviews medications and recommend that protonix be given at bedtime to increase absorption of Levothyroxine. Certified Nurse Practitioner (CNP) #30 made aware of the recommendation. Protonix changed to 9:00 P.M. to improve absorption of Levothyroxine. Son, made aware of medication time change. Review of the progress note dated 12/03/2023 at 3:59 P.M. created by Registered Nurse (RN) #150 revealed, This nurse was manager on call. Received call from administrator pertaining to a resident not receiving a 6:00 A.M. medication at the scheduled time, son of patient confirms. Resident states that night shift nurse gives all her medication at 8:00 P.M. the night prior to the 6:00 A.M. medication being due. This nurse went to facility, educated all licensed nursing staff of the 6 rights to medication administration. Nurse named in the incident was disciplined. Physician and pharmacy both notified of same. Review of Resident #41's lab results for Thyroid-stimulating hormone (TSH) dated 12/06/2023 revealed this residents value to be <0.10 and the reference range is 0.40 to 5.40 microunits per milliliter (uIU/mL) Interview on 12/27/2023 at 2:30 P.M. with the DON confirmed Resident #41 was receiving her 6:00 365485 Page 4 of 7 365485 01/02/2024 Flint Ridge Nrsg & Rehab Ctr 1450 West Main Street Newark, OH 43055

F 0760 Level of Harm - Minimal harm or potential for actual harm A.M. scheduled thyroid medication, Levothyroxine during the previous night shift 8:00 P.M This medication is to be administered by its self in the early morning hours. Review of the facility policy titled Administering Medications, dated 04/2019 revealed 4. Medications are administered in accordance with prescriber orders, including any required time frame. Residents Affected - Few This deficiency represents non-compliance investigated under Complaint Number OH00148925. 365485 Page 5 of 7 365485 01/02/2024 Flint Ridge Nrsg & Rehab Ctr 1450 West Main Street Newark, OH 43055

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, and facility policy for charting and documentation, this facility failed to ensure information documented in residents medical records were accurate to reflect care provided. This affected one (Resident #41) of four residents reviewed for accurate medical record documentation. The facility census was 70. Findings include: Review of the medical record for Resident #41 revealed an admission date of 04/13/23. Diagnoses included hemiplegia and hemiparesis following an cerebral infarction affecting the right dominant side, diabetes insipidus, anxiety disorder, obesity, and hypothyroidism. Review of Resident #41's quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of 15 out of 15 indicating the resident had an intact cognition for daily decision making abilities. Resident required supervision or set up assistance for eating, oral care, toilet hygiene, dressing, and personal hygiene. Noted to have an indwelling catheter and always continent of bowel function. Review of Resident #41's physician orders for November 2023 revealed an order for Levothyroxine sodium 125 milligrams (mg), give one tablet in the morning for hypothyroidism. Continued review revealed this medication was scheduled to be administered at 6:00 A.M. daily. Review of the medication administration record (MAR) for November 2023 revealed the medication Levothyroxine Sodium was documented by the nurse administering this medication as being administered at 6:00 A.M. daily. Review of the progress note dated 11/29/2023 at 11:49 A.M. created by the Director of Nursing (DON) revealed, Resident #41's, son reports resident's Levothyroxine levels were low and endocrinologist was thinking of increasing the Levothyroxine. Son request medication review at this time. Pharmacist in the facility reviews medications and recommend that protonix be given at bedtime to increase absorption of Levothyroxine. Certified Nurse Practitioner (CNP) #30 made aware of the recommendation. Protonix changed to 9:00 P.M. to improve absorption of Levothyroxine. Son, made aware of medication time change. Review of the progress note dated 12/03/23 at 3:59 P.M. created by Registered Nurse (RN) #150 revealed, This nurse was manager on call. Received call from administrator pertaining to a resident not receiving a 6:00 A.M. medication at the scheduled time, son of patient confirms. Resident states that night shift nurse gives all her medication at 8:00 P.M. the night prior to the 6:00 A.M. medication being due. This nurse went to facility, educated all licensed nursing staff of the 6 rights to medication administration. Nurse named in the incident was disciplined. Physician and pharmacy both notified of same. Interview on 12/27/23 at 2:30 P.M. with the Director of Nursing (DON) confirmed nurse staff were documenting in Resident #41's MAR that the thyroid medication was being administered at 6:00 A.M. when really it was being given at 8:00 P.M. 365485 Page 6 of 7 365485 01/02/2024 Flint Ridge Nrsg & Rehab Ctr 1450 West Main Street Newark, OH 43055

F 0842 Level of Harm - Minimal harm or potential for actual harm Review of facility policy titled Charting and Documentation, no date noted revealed 3. Documentation in the medical record will be objective (no opinionated or speculative), complete and accurate. This deficiency represents non-compliance investigated under Complaint Number OH00148925. Residents Affected - Few 365485 Page 7 of 7