Health inspection·September 30, 2024

F 0694 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 2. Review of Resident #2's medical record revealed the resident admitted to the facility on [DATE] with the diagnoses including, chronic respiratory failure, dependence on ventilator, acute respiratory failure with hypoxia, congestive heart failure, tracheostomy, peripheral vascular disease, cerebral infarction, and chronic kidney disease. Review of the most current MDS assessment dated [DATE] assessed Resident #2 with intact cognition and was dependent on staff for the completion of activities of daily living. Resident #2 was incontinent of bowel and bladder, received nutrition via tube feeding, was at risk for pressure ulcer development with no skin breakdown, and received intravenous (IV) medications. Review of Resident #2's medical record revealed on 09/20/24 a physician order was obtain for the placement of a midline catheter to be placed for antibiotic therapy one time only for one day. On 09/21/24, the midline catheter was to be discontinued. Further review revealed no orders related to care or treatment application in the medical record following 09/21/24. Observation on 09/30/24 at 7:40 A.M. noted Resident #2 with a midline catheter inserted into the right arm. The dressing was peeling from the outer edges with a folded gauze dressing placed over the insertion site and a transparent dressing covering the entire site. Interview with Registered Nurse (RN) #300 during the observation revealed the dressing was to be changed every 7 days. On 09/30/24 at 9:08 A.M., observation with RN #300 during Resident #2's midline catheter dressing change noted the transparent dressing peeling off and once removed exposed a gauze dressing covering the insertion site with large amount dried blood tinged drainage. Interview with the ADON on 09/30/24 at 1:05 P.M., during a review of Resident #2's medical record, confirmed the physician ordered indicated Resident #2's midline catheter was to be placed for one day and removed on 09/21/24. The ADON verified there were no current orders in the medical record for the placement of the midline or associated dressing changes or insertion site care. 3. Review of Resident #3's medical record revealed the resident admitted to the facility on [DATE] with the diagnoses including, chronic respiratory failure, dependence on ventilator, tracheostomy, peripheral vascular accident, neuromuscular dysfunction of bladder, anemia, persistent vegetative state, gastrostomy, hypertension, and encephalopathy. Review of the most current MDS assessment dated [DATE] assessed Resident #3 as comatose and dependent on staff for the completion of activities of daily living. Resident #3 utilized an indwelling urinary catheter, was incontinent of bowel, received nutrition via feeding tube, was at risk for pressure ulcer development with no skin breakdown, and had an intravenous (IV) access. Review of the medical record revealed on 06/15/24 a physician order was obtained for Resident #3 to have a central line (a long, thin, flexible tube that's inserted into a large vein near the heart) to the right chest with dressing change every 7 days and as needed. Observation on 09/30/24 at 8:02 A.M. with Licensed Practical Nurse (LPN) #400 noted Resident #3 with a right central line dressing in place and dated 09/22/24. Interview with LPN #400 at the time of the observation verified the dressing was to be changed every 7 days and was not. Review of Resident #3's medical record noted the right central venous catheter dressing was changed on 09/22/24 at 12:04 P.M. and 09/28/24 with no time indicated. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365523 If continuation sheet Page 2 of 3 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365523 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/30/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arbors at Oregon 904 Isaac Streets Drive Oregon, OH 43616 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0694 Level of Harm - Minimal harm or potential for actual harm According to facility Care and Maintenance of Central Venous Catheter policy, reviewed 12/13/23, revealed documentation is to be obtained for the indications of use, insertion date, and type of catheter in the residents medical record. Physician orders are to be obtained for the specific care and maintenance instructions. Staff are to document activities in nurses notes and or medication administration record (MAR). Residents Affected - Few This deficiency represents non-compliance investigated under Master Complaint Number OH00158337. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365523 If continuation sheet Page 3 of 3