Health inspection·August 27, 2021

F 0569 Notify each resident of certain balances and convey resident funds upon discharge, eviction, or death. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to convey a resident's funds within 30 days of death. This affected one (Resident #403) of one resident reviewed who had expired. This had the potential to affect twenty-four residents with personal funds accounts. The facility census was 54. Residents Affected - Few Findings include: Review of Resident #403's progress notes revealed the resident expired in the facility on [DATE]. Review of the facility's personal funds documentation revealed an undated letter to the Ohio Attorney General advising of the resident's death on [DATE]. The resident had a balance of $3153.00. The check was issued on [DATE], 16 months after the resident died. Interview on [DATE] with Administrator confirmed the facility had not timely refunded Resident #403's personal funds balance to the State Attorney General's office. Page 1 of 2 365538 365538 08/27/2021 Friends Extended Care Center 150 East Herman Street Yellow Springs, OH 45387

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on record review, interview and policy review, the facility failed to test for Legionella in the hot water sources from the facility kitchen, shower room, and shower room for the rehabilitation unit. This had the potential to affect all residents who resided in the facility. The census was 54. Residents Affected - Many Findings include: Review of the Legionnaire's Disease Testing documentation revealed no weekly testing of the hot water system for the kitchen sinks, main shower room, and the rehabilitation shower room. Interview on 08/26/21 at 1:55 P.M. Maintenance Director #85 verified the temperature checks had not been performed weekly. Review of the facility policy titled Monitoring Waterborne Organisms Legionnaires Disease, revised date 01/09/21 revealed water control measures: 1) Legionella testing on the water system will be done on an annual basis, 2) daily temperature check of mix valve for Extended Care Facility (ECF), 3) weekly visual inspection on the 6 inch water main, and 4) weekly temperature check of the hot water system for kitchen sinks, room sinks, shower room, and room shower (Rehabilitation). 365538 Page 2 of 2