Health inspection·June 14, 2023

F 0552 Ensure that residents are fully informed and understand their health status, care and treatments. 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, observation, and resident and staff interviews, the facility failed to allow a resident to make an informed medical decision regarding his diet. This affected one (Resident #35) of three residents reviewed for resident rights. The facility census was 70. Residents Affected - Few Findings include: Review of Resident #35's medical record revealed an admission to the facility occurred on 03/20/19. with medical Diagnoses included dysphagia (trouble swallowing), morbid obesity, Diabetes, chronic respiratory failure and anxiety. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #35 was cognitively intact and able to make all his needs known. Resident #35 used to have a tube feeding for all his nutritional needs and took nothing by mouth. Review of the Choice Not to Receive Nursing/Medical Services, Care, and or Treatment form dated 01/31/23 revealed Resident #35 was choosing not to consume thickened liquids or pureed foods. The top section of the form identified staff have identified the risks and possible consequences of choosing to not receive the medical treatment initialed below. The form identified having been given all the possible negative outcomes of the choice to not receive the treatment. The resident initialed and signed the form dated 01/31/23. Review of the physician order dated 02/15/23 revealed Resident #35 was ordered a pureed diet with nectar thickened liquids. Review of Resident #35's progress notes dated 06/03/23 at 1:45 P.M. revealed a nurse was called into the room and Resident #35 asked for ice. The nurse told Resident #35 he could not have ice due to safety concerns and his physician order for thickened liquids. Resident #35 became very upset and yelled at the nurse and stated This is expletive. I signed a paper. Resident #35's sister then called the facility asking why Resident #35 cannot have ice. The nurse noted educating the sister on the concerns for aspiration. The nurse said she will give him a can of pop as requested but will not open it for him. The nurse documented when entering the room, the resident stated yelling, you are taking my rights away. Observations and interview with Resident #35 occurred on 11:49 A.M. and 2:45 P.M. Resident #35 confirmed the facility provided him with the risk of consuming regular foods and liquids, however he can make the informed decision himself. Resident #35 confirmed he understands the risks of potential aspiration and still wants the regular food and liquids. Resident #35 was observed drinking a can of Page 1 of 2 365517 365517 06/14/2023 Twilight Gardens Nursing and Rehabilitation 196 W Main St Norwalk, OH 44857

F 0552 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few soda and eating pizza. Resident #35 confirmed he has been ordering regular food outside the facility that was delivered because the facility will not give it to him. Resident #35 stated he was not getting ice and thin liquids (water) when asking was ridiculous, and the staff wonder why I get upset. Interview with Dietary Manager #40 on 06/14/23 at 12:07 P.M. confirmed the kitchen staff follow the physician orders for Resident #35 and send him a pureed diet with thickened liquids. Dietary Manager #40 stated Resident #35 refuses to eat the purred food. Dietary Manger #40 confirmed she was not permitted to send him a regular diet with regular liquids. Interview with the Director of Nursing (DON), Administrator and Regional Nurse #50 on 06/14/23 at 12:18 P.M. confirmed the facility was not allowing Resident #35 to have a regular diet provided by the facility. The facility was following the physician diet order of pureed food with thick liquids), instead of Resident #35's informed decision to have regular food and liquids. They have instructed their staff that Resident #35 was only to have pureed and thickened liquids and were not assisting him to get ice, thin liquids like water, regular food as he wishes. The facility was following the guidance that was provided from their corporation as they were concerned with getting sued if something happened to Resident #35. This deficiency represents non-compliance investigated under Complaint Number OH00143219. 365517 Page 2 of 2