Health inspection·June 20, 2019

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observation, staff interview record review and policy review, the facility failed to administer medication per standard to one Resident. This affected one (#23) out of seven residents reviewed during medication administration. The facility census was 107. Findings include: Observation of Licensed Practical Nurse (LPN) #400 in the [NAME] hallway on 06/18/19 at 5:39 P.M., revealed nurse propelling medication cart to nurses' station. Surveyor requested to observe a medication pass with LPN #400. LPN #400 picked up a medication cup containing oral medication from top of medication cart and asked LPN #453 to watch medication already prepared for another resident but unavailable for administration at that time. LPN #400 proceeded to prepare medication for Resident #23. LPN #400 prepared two oral medications and handed them to LPN #453, surveyor then asked to observe administration, both LPN #400 and LPN #453 then walked with surveyor to the Buckeye dining room and LPN #453 administered the medication to Resident #23. Further review of Resident #23 medication administration record revealed oral medications were signed off by LPN #400 on 06/18/19 (time of signature not available) included Vitamin B 12 500 micrograms (MCG) one tablet and glucosamine and chondroitin 500 milligrams (mg)-400 mg one tablet. An interview with LPN #400 immediately following the observation verified that LPN #453 administered medication. Review of Medication Administration Policy dated 08/16 is silent to the facility allowing one nurse prepare medication and another nurse administer the medication. Page 1 of 5 365506 365506 06/20/2019 Ohio Living Dorothy Love 3003 West Cisco Road Sidney, OH 45365

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, staff interview and policy review, the facility failed to ensure expired medications and supplies were discarded appropriately. This had the potential to affect all 107 residents in the facility. Additionally, the facility failed to properly secure medications. This had the potential to affect four independently mobile and confused residents (#101, #23, #91, #57) identified by the facility. The facility census was 107. Findings include: 1. Observation of the medication room on the Westhall medication storage room on 06/19/19 at 9:05 A.M. revealed Brovana inhalation solution 15 microgram (mcg)/2 millimeter (ml) with an expiration date of 02/19. Interview with Unit Manager #266 on 06/19/19 at 9:25 A.M. verified that the above items were expired and being stored in the medication room during the survey. 2. Observation of the medication room located in the East Hall on 06/19/19 at 9:45 A.M. revealed one idosorb 40 gram (g) tube of ointment with an expiration date of 05/2018, and Citracal gummies calcium supplement with an expiration date of 04/19. 3. Observation of the East Hall medication cart on 06/19/19 at 10:00 A.M., revealed one multiple dose bottle of aspirin 325 milligram(mg) with an expiration date of 05/2019. Interview with Unit Manager #241 on 06/19/19 at 10:05 A.M., verified the above items located in the medication storage room and the medication cart were expired and being stored during the survey. 4. Observation of the Rehabilitation Unit Medication room on 06/19/19 at 10:20 A.M., revealed seven Nicotine Transdermal system patches with an expiration date of 12/18 were being stored during the survey. 5. Observation of the Rehabilitation Unit medication cart on 06/19/19 at 10:35 P.M., revealed three opsite flexigrid dressing with an expiration date of 11/2018, one bottle of Systane 10 ml lubricant eye drops with an expiration date of 04/19 and one package of triple antibiotic ointment with an expiration of 04/19 were being stored in the care during the survey. Interview with the Unit Manager #389 immediately following observation verified the above expired items being stored in the medication room and the medication cart should have been removed and were not. The facility confirmed the expired medications at the potential to affect all 107 residents residing in the facility. Review of the policy titled Medication Storage dated 08/16, was silent regarding expired medication. 6. Observation of medication administration on 06/18/19 at 5:45 P.M. revealed a multiple dose bottle of vitamin B 500 micrograms (MCG) and multiple dose bottle of glucosamine/chondroitin 500 milligram (mg)/400 mg was left on top of the medication cart in the [NAME] hall unsecured and unsupervised 365506 Page 2 of 5 365506 06/20/2019 Ohio Living Dorothy Love 3003 West Cisco Road Sidney, OH 45365

F 0761 while the nurse administered medication in the Buckeye dining room. Level of Harm - Minimal harm or potential for actual harm Interview on 06/18/19 at 5:52 P.M. with LPN #400 verified that she left the medication unlocked on top of the medication cart. The facility confirmed the unsecured medications had the potential to affect four independently mobile and confused residents (#101, #23, #91, #57) who could potentially access the medications. Residents Affected - Many Review of Policy for Medication Storage dated 08/16 revealed all prescription medications must be stored under proper temperature and secured against unauthorized access. 365506 Page 3 of 5 365506 06/20/2019 Ohio Living Dorothy Love 3003 West Cisco Road Sidney, OH 45365

F 0868 Have the Quality Assessment and Assurance group have the required members and meet at least quarterly Level of Harm - Potential for minimal harm Based on review of quality assessment and assurance (QA&A) sign in sheets, staff interview and policy review, the facility failed to ensure the medical director attended all QA&A meetings. This had the potential to affect all 107 residents residing in the facility. The facility census was 107. Residents Affected - Many Findings include: Review of the sign-in documentation for the Quality Assurance and Performance Improvement meetings dated 07/17/18 revealed the physician signature was absent. Review of the sign-in sheet for the meeting date 10/16/18 revealed the physician signature was absent. Interview on 06/19/19 at 1:21 P.M. with the Director of Nursing provided verification the Medical Director did not participate in the required quarterly meetings. Review of the facility policy titled Quality Assurance and Performance Improvement (QAPI) Policy dated 11/19 revealed he medical director or designee will attend the quarterly QA&A meetings. 365506 Page 4 of 5 365506 06/20/2019 Ohio Living Dorothy Love 3003 West Cisco Road Sidney, OH 45365

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, staff interview and policy review, the facility failed to ensure a nurse appropriately cleansed her hands prior to preparing and handling medications. This affected one (#62) out of seven residents reviewed during medication administration. The facility census was 107. Residents Affected - Few Findings include: Observation of Licensed Practical Nurse (LPN) #400 at 5:25 P.M. on 06/18/19, revealed nurse pushed cart up hallway to area beside nurses' station. LPN #400 did not wash her hands or use hand sanitation prior to popping out medication Propranolol 40 milligram (mg) tablet from bubble pack into her hand then dropping the tablet into a plastic medication cup. LPN #400 was then observed opening a multiple dose Vitality vitamin bottle and multiple dose eye vitamin bottle and pouring the pills into her hand then placing them into the plastic container. LPN #400 then administered the medication to Resident #62. Interview with LPN #400 immediately following the observation verified that she touched Resident #62's medications with her hands. Review of facility policy titled General Dose Preparation and Medication Administration, dated 12/01/07, revealed prior to preparing to administering medication, authorized and competent facility staff should follow facility's infection control policy (e.g. handwashing). According to the policy facility staff should not touch the medication when opening a bottle or unit dose package. 365506 Page 5 of 5