Health inspection·May 10, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Medical record review for Resident #59 revealed an admission date of 03/10/23. Medical diagnoses included post traumatic stress disorder (PTSD) and diabetes. Review of the quarterly MDS dated [DATE] revealed Resident #59 was moderately cognitively impaired. His functional status was independent for bed mobility, transfers, toilet use and eating. Observation on 05/07/23 at 12:29 P.M. revealed State Tested Nursing Aide (STNA) #63 revealed she knocked on the resident's door and came into the room without the resident saying she could come into the room. Interview with STNA #63 on 05/07/23 at 12:30 P.M. confirmed she should have waited for the resident to acknowledge and say she could enter the room before entering. Review of the policy titled Guest/resident Dignity and Personal Privacy, dated 05/01/22 revealed the facility would provide care for guests/residents in a manner that respects and enhances each guest's/ resident's dignity, individuality, and right to personal privacy. Each guest's/resident's right to personal privacy includes the confidentiality of his or her personal and clinical affairs. Dignity means that when interacting with guests/residents, staff would carry out activities that assist the guest/resident in maintaining and enhancing his or her self-esteem and self-worth. This deficiency represents non-compliance investigated under Complaint Number OH00140119. Based on observation, interview, medical record review, review of an invoice and policy review, the facility failed to ensure residents were treated with dignity and respect. This affected two residents (#05 and #59) of 24 residents sampled for dignified care. The facility census was 70. Findings Include: 1. Review of the medical record for the Resident #05 revealed an admission date of 08/22/22. Diagnoses included acute osteomyelitis. Review of the most recent Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #05 had intact cognition, had no behaviors, did not reject care, and did not wander. Resident #05 required supervision assistance for activities of daily living (ADL) care. Review of an invoice dated 05/03/23 revealed [NAME] Plumbing and Sewer provided plumbing services Page 1 of 16 365558 365558 05/10/2023 The Laurels of Hamilton 2923 Hamilton Mason Road Hamilton, OH 45011

F 0550 to the facility for concerns with water pressure. Level of Harm - Minimal harm or potential for actual harm During an interview on 05/07/23 at 10:54 A.M., Resident #05 stated last week, unsure of exact date, a plumber walked into her room without her permission to look at something in the bathroom, disregarding her pleas for him not to enter as she was unclothed and in the process of dressing after a shower. Residents Affected - Few During an interview on 05/10/2023 at 9:03 A.M., Maintenance #59 confirmed an outside vendor was in the building last week, unsure of the exact date, working on issues with water pressure in resident rooms on the 500-Hall. Maintenance #59 verified he knocked on Resident #05's door, Resident #05 stated she was not completely dressed, asked staff to wait, and the vendor continued to the walk across the room to the resident's bathroom. Maintenance #59 stated he waited until Resident #05 gave permission to enter the room, went into the bathroom, and educated the plumber, about Residents' rights to dignity and not entering a room without a resident's permission. 365558 Page 2 of 16 365558 05/10/2023 The Laurels of Hamilton 2923 Hamilton Mason Road Hamilton, OH 45011

F 0583 Keep residents' personal and medical records private and confidential. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on staff and resident interview, observation, and record review, the facility failed to ensure resident rooms were equipped to maintain complete privacy. This affected one resident (#05) of 24 residents screened for privacy. The facility census was 70. Residents Affected - Few Findings include: Review of the medical record for the Resident #05 revealed an admission date of 08/22/22. Diagnoses included acute osteomyelitis. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #05 had intact cognition, had no behaviors, did not reject care, and did not wander. Resident #05 required supervision assistance for activities of daily living. During an interview on 05/07/2023 at 10:57 A.M. Resident #05 stated her room di not allow her to maintain privacy because her privacy curtain was broken and did not provide privacy all the way around her living area. During an observation and interview on 05/10/2023 at 9:42 A.M. Housekeeper #85 verified the privacy curtain in Resident #05's room was missing a panel and could not provide complete wall-to-wall privacy. Review of the policy titled Guest/resident Dignity and Personal Privacy, dated 05/01/22 revealed staff pulled the privacy curtain to provide privacy during care. 365558 Page 3 of 16 365558 05/10/2023 The Laurels of Hamilton 2923 Hamilton Mason Road Hamilton, OH 45011

F 0679 Provide activities to meet all resident's needs. 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 and resident interview, observation, review of the activity calender, and policy review, the facility failed to ensure activities of resident interests were provided on the weekends. This affected two residents (#26 and #36) of four residents reviewed for activities. The census was 70. Residents Affected - Few Findings included: 1. Medical record review for Resident #26 revealed an admission date of 05/14/14. Diagnoses included traumatic brain dysfunction, peripheral vascular disease, renal insufficiency, and dementia. Review of the activity evaluation dated 01/04/23 for Resident #26 revealed it was very important to keep up with the news, go outside for fresh air, and have books and magazines. The assessment documented it was somewhat important to listen to music, to do his favorite activities, and do activities with groups of people. Review of the activity progress notes from 02/08/23 to 05/07/23 revealed there wasn't any refusals for activities. Review of activity documentation from 04/08/23 to 05/08/23 revealed there wasn't anything marked for the weekends. Review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #26 was cognitively intact. He was independent for bed mobility, transfers, toilet use and eating. Review of the care plan dated 04/20/23 for Resident #26 revealed he liked to attend daily scheduled activities. Review of the activity calendar dated 05/07/23 revealed daily chronicle, word search, coloring page, bible study on three halls, leisure cart, and left right center game conducted on three halls. Further review revealed on 05/14/23, 05/21/23 and 05/28/23 revealed the same schedule. Interview with Resident #26 on 05/07/23 at 3:37 P.M. revealed there wasn't enough activities on the weekends and sometimes there wasn't any at all. 2. Medical record review for Resident #36 revealed an admission of 06/21/22. Diagnoses included cancer, anxiety and depression. Review of the activity evaluation dated 06/22/22 for Resident #36 revealed it was very important to have books and magazines, listen to music, be with animals, groups of people, and do favorite activities. Review of the activity progress notes from 02/08/23 to 05/07/23 revealed there wasn't any refusals for activities. Review of the quarterly MDS dated [DATE] revealed Resident #36 was cognitively intact. The resident required supervision for bed mobility, transfers and toilet use and could eat independently. 365558 Page 4 of 16 365558 05/10/2023 The Laurels of Hamilton 2923 Hamilton Mason Road Hamilton, OH 45011

F 0679 Level of Harm - Minimal harm or potential for actual harm Review of the documentation from 04/08/23 to 05/08/23 revealed there wasn't anything marked for the weekends. Review of the care plan dated 04/13/23 for Resident #36 revealed she liked to attend daily activities as scheduled, and to invite and encourage her to attend scheduled activities of interest. Residents Affected - Few Observations on 05/07/23 at 10:00 A.M. through 4:00 P.M. at random times revealed there wasn't anyone participating in activities. Interview with Activity Aide (AA) #73 on 05/07/23 at 2:25 P.M. revealed she was the only aide for activities on this day. She stated she passed out chronicles, and had the bible study, but only two people attended bible study. She stated she didn't take the leisure cart around to the residents, because it was games no one wanted to play. She stated she invited resident's to play left right center but only got a couple of people to play. She stated there wasn't much to do on Sunday it was the slowest day of the week for activities. She stated there wasn't enough budget on the weekends to play the games like they did during the week. She further revealed it was the same schedule on Sundays every week. Interview with Resident #36 on 05/07/23 at 3:58 P.M. revealed there wasn't much to do on the weekends regarding activities and it was boring. Review of the policy titled Activity Program, 08/03/21 revealed he facility would provide an ongoing activity/recreation program based on the individual guest/resident comprehensive evaluation, care plan, and stated preferences. The activity/recreation program supports guests/residents in their choice of activities and includes group, individual, and independent activities which empowers, maintains, and supports all guests/residents in the facility. Recreational activities are designed to encourage both independence and interaction in the community. 365558 Page 5 of 16 365558 05/10/2023 The Laurels of Hamilton 2923 Hamilton Mason Road Hamilton, OH 45011

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 observation, medical record review, and resident and staff interview, the facility failed to ensure residents received timely medical treatment. This affected one resident (#15) of two residents reviewed for bowel and bladder. The facility census was 70. Residents Affected - Few Findings included: Medical record review for Resident #15 revealed an admission date of 06/14/22. Diagnoses included coronary artery disease, heart failure, hypertension, diabetes and renal insufficiency. Review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #15 was cognitively intact. She was independent for bed mobility, transfers, eating and toilet use. She was always continent of bowel and bladder. Review of the physician orders dated 02/13//23 revealed to give Imodium two milligram (mg) one tablet every six hours as needed for diarrhea. Review of the Medication Administration Record (MAR) for Imodium, revealed from 05/01/23 through 05/08/23 the resident had not been given Imodium for diarrhea. Interview with Resident #15 on 05/07/23 at 11:46 A.M., revealed she doesn't get any medications for her diarrhea. Interview and observation on 05/09/23 at 8:27 A.M., Resident #36 revealed her roommate, Resident #15 asked for something for diarrhea about an hour ago and had not received anything yet. At the time of the interview Licensed Practical Nurse (LPN) #74 was observed on the opposite hall of the resident passing medications. A follow-up interview with Resident #15 on 05/09/23 at 10:16 A.M., revealed she had diarrhea since early this morning. LPN #74 told her she had no Imodium on her medication cart, but would be back later to give her the medication. Interview with the LPN #74 on 05/09/24 at 10:24 A.M., revealed Resident #15 reported she had diarrhea earlier but had no Imodium on her medication cart and there was none on another cart as well. She stated she would have to go all the way over to another building in the basement to get the Imodium and she had time to do that now. 365558 Page 6 of 16 365558 05/10/2023 The Laurels of Hamilton 2923 Hamilton Mason Road Hamilton, OH 45011

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, and staff interview, the facility failed to ensure residents had clean pressure ulcer reducing devices to promote healing and prevent infection. This affected one resident (#03) of four residents reviewed for pressure ulcers. The facility census was 70. Residents Affected - Few Findings included: Medical record review for Resident #03 revealed an admission date of 03/13/12. Diagnoses included non-traumatic brain dysfunction, dementia, neurogenic bladder, and obstructive uropathy. Review of the care plan dated 02/09/23 for Resident #03 revealed to float heels off the bed as tolerated. Review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #03 had moderately impaired cognition, the resident required extensive assistance for bed mobility, total dependence for bed transfers, eating and toilet use. Observation during a dressing change to the right heel of Resident #03 on 05/08/23 at 1:13 P.M. revealed his heel boots were interchangeable with the right and left foot. When the right boot was removed there was dried drainage inside the boot with an odor. The dressing on the right heel revealed there was not any drainage. When the left boot was removed there was dried drainage in this boot with an odor. Resident #03 had no skin breakdown on the left heel or foot at this time. The wound on the right heel had no signs of infection or an odor at this time. Interview with Licensed Practical Nurse (LPN) #10 on 05/08/23 at 1:20 P.M., verified both boots were dirty and had no idea how long the boots had been this way since there wasn't any drainage on the bandage removed from the right foot. She verified the resident had no drainage from his left foot or heel. 365558 Page 7 of 16 365558 05/10/2023 The Laurels of Hamilton 2923 Hamilton Mason Road Hamilton, OH 45011

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on observation, resident and staff interview, medical record review, and policy review, the facility failed to ensure resident oxygen tubing and nebulizers were labeled and changed timely. This affected one resident (#13) of two residents sampled for respiratory care. The facility census was 70. Residents Affected - Few Findings include: Review of the medical record for the Resident #13 revealed an admission date of 05/24/22. Diagnoses included chronic diastolic heart failure, emphysema, and chronic obstructive pulmonary disease (COPD). Review of the care plan dated 06/07/2022 revealed Resident #13 had a potential for difficulty breathing and risk for respiratory complications related to diagnoses of Emphysema/COPD. Interventions included observe/report symptoms of difficulty breathing or respiratory infection and administer medications/treatments as ordered. Review of the medical record revealed Resident #13 had physician orders for Ipatropium-albuterol 0.5-2.5 mg solution (3 mg/ml) one vial inhaled orally every four hours, oxygen continuous at three liters per minute per nasal cannula to maintain saturation above 90 percent and to obtain breath sounds/heart rate before and after nebulizer treatment. Observation on 05/09/23 at 2:56 P.M. there was no date visible on Resident #13's oxygen tubing and label on the hand held nebulizer was dated 12/05/22. During an interview on 05/09/23 at 8:03 A.M., Resident #13 stated she had been at the facility since around Thanksgiving and her oxygen tubing had never been changed. During an interview on 05/09/23 at 2:56 P.M. the Director of Nursing (DON) verified Resident #13's oxygen tubing was not dated and the label on the nebulizer was dated 12/05/22. The DON stated oxygen tubing and hand held nebulizers were to be changed weekly. Review of policy titled Use of Oxygen, dated 08/01/2010 revealed oxygen tubing should be changed weekly and dated. 365558 Page 8 of 16 365558 05/10/2023 The Laurels of Hamilton 2923 Hamilton Mason Road Hamilton, OH 45011

F 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, observation, record review, and policy review, the facility failed to ensure residents with a dialysis access site were monitored. This affected two residents (#23 and #66) of two residents reviewed for dialysis care. The facility census was 70. Residents Affected - Few Findings include: 1. Review of the medical record for the Resident #23 revealed an admission date of 04/02/22. Diagnoses included type II diabetes, hypertensive heart disease, and stage V chronic kidney disease. Review of the most recent Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #23 was cognitively intact, had no behaviors, did not reject care, and did not wander. Review of the care plan dated 04/03/22 revealed Resident #23 was at risk for complications related to dialysis and end stage renal disease. Interventions included upon return from the dialysis center observe the resident's access site, obtain vital signs, and document findings in the medical record. Report abnormal findings to the physician. 2. Review of the medical record for the Resident #66 revealed an admission date of 12/08/22. Diagnoses included stage IV severe chronic kidney disease, dependence on renal dialysis, and type II diabetes. Review of the most recent MDS assessment dated [DATE] revealed the resident had intact cognition, had no behaviors, had not rejected care, and no wandering. Resident #66 was independent with activities of daily living (ADL). Review of the care plan dated 01/24/23 revealed Resident #66 was at risk for complication related to need for dialysis due to stage IV chronic kidney disease. Interventions included upon return from the dialysis center observe the resident's access site, obtain vital signs, and document findings in the medical record. Report abnormal findings to the physician. Observation made on 05/08/23 from 4:15 P.M. to 5:37 P.M. revealed State Tested Nurse Aide (STNA ) #25 gave Resident #23's dialysis communication binder to Licensed Practical Nurse (LPN) #03. As STNA #25 propelled Resident #23 to her room in her wheelchair, Resident #23 stated her fistula had bled a lot after her dialysis treatment that day. The bottom of the fistula started bleeding at dialysis when they took the clamp off. They re-clamped it to stop the bleeding and covered the site on her left arm with a two by two gauze pads and secured with paper tape. LPN #03 remained seated at the nurse's station until she began passing medications to residents on the 500-Hall from 4:20 P.M. until 5:37 P.M. LPN #03 did not enter Resident #23's room during the observation. During an interview on 05/07/23 at 3:30 P.M., Resident #23 stated they never check her fistula or chest port for bleeding when she returned from her dialysis appointments. During an interview on 05/08/23 at 2:58 P.M., Resident #66 stated they cleaned the needle to his chest port at dialysis and placed a dressing over it. There was no monitoring done at the facility. During an interview on 05/08/23 at 4:44 P.M., LPN #03 stated she was scheduled to work until 7:00 365558 Page 9 of 16 365558 05/10/2023 The Laurels of Hamilton 2923 Hamilton Mason Road Hamilton, OH 45011

F 0698 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few P.M. LPN #03 stated Resident #23 had no more medications scheduled on her shift and the LPN had no reason to go into Resident #23's room unless she activated her call light. During a follow-up interview on 05/08/23 at 5:37 P.M., LPN #03 stated she assessed vitals before Resident #23 went to dialysis and put them in the dialysis communication binder. After she returned, LPN #03 stated she looked in the communication binder to make sure there were vital signs completed after dialysis but had not completed any other type of monitoring. During a third follow-up interview on 05/09/23 1:28 P.M., LPN #03 stated she checked for redness and irritation at the port site before Resident #66 left for dialysis. Upon return, she checked the communication binder to make sure there were vitals recorded after dialysis, gave his scheduled medications, and made sure he felt all right. LPN #03 stated she had not looked at Resident #66's chest port unless he said there was a problem. Review of the policy titled Hemodialysis, dated 10/14/21 revealed the facility monitored the hemodialysis access site daily for bleeding, signs of infection, stenosis, and aneurysms. 365558 Page 10 of 16 365558 05/10/2023 The Laurels of Hamilton 2923 Hamilton Mason Road Hamilton, OH 45011

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, interview, record review, and policy review, the facility failed to ensure medications were administered to residents as ordered. This affected two residents (#35 and #42) of four residents sampled for medication administration. The facility census was 70. Findings include: 1. Review of the medical record for Resident #35 revealed an admission date of 05/27/22. Diagnoses included dementia, schizoaffective disorder bipolar type, and Parkinson's disease. Review of the physician orders revealed Resident #35 for routine medications scheduled for administration at 8:00 A.M. included Ativan (antianxiety medication) 0.5 milligrams (mg) by mouth twice daily, benztropine (anticholinergic medication) one mg by mouth twice daily, divalproex (anticonvulsant medication) sodium 500 mg delayed release by mouth twice daily, haloperidol (antipsychotic medication) five mg by mouth once daily, and hydroxyzine (antihistamine) 50 mg by mouth twice daily. 2. Review of the medical record for Resident #42 revealed an admission date of 09/01/22. Diagnoses included dementia and type II diabetes. Review of the medical record revealed Resident #42 had physician orders for sertraline (antidepressant) 25 mg by mouth once daily at 8:00 A.M. and orders for routine medications at 9:00 A.M. including clopidogrel (blood thinner) 75 mg by mouth once daily, glyburide (antidiabetic medication) 2.5 mg by mouth twice daily, glyburide 5 mg by mouth twice daily, metformin (antidiabetic medication) 500 mg by mouth twice daily, aspirin (blood thinner) 81 mg by mouth once daily, vitamin D 25 micrograms (mcg) two tablets by mouth once daily, and colestipol (a medication to lower cholesterol) one gram mouth twice daily. Observation on 05/10/23 at 11:19 A.M. in the 600-Hall mediation cart revealed there were two paper souffle cups sitting in the top drawer which contained pre-pulled medications. One cup contained 5 pills and had a paper inside labeled with a first name only. One paper soufflé cup contained nine pills and a paper labeled with a first name. LPN #04 looked up the medications on the Medication Administration Record (MAR). The medications belonged to Resident #35 and #42, and had already been documented as administered in the MAR's for Residents #35 and #42. During an interview on 05/10/23 at 11:22 A.M., LPN #04 identified the five medications in the first cup as Resident #35's morning medications including Ativan 0.5 mg, benztropine 1 mg, divalproex 500 mg, haloperidol five mg, and hydroxyzine 50 mg, and identified the nine medications on the second cup as Resident #42's morning medications including sertraline 25 mg, clopidogrel 75 mg, glyburide five mg, glyburide 2.5 mg, metformin 500 mg , aspirin 81 mg, vitamin D 25 mcg (two tablets), and colestipol one gram. LPN #04 verified she had not administered morning medications as ordered to Residents #35 and #42 but had documented in the MAR that the pills had been administered. Review of the policy titled Medication Administration, dated 03/01/13 revealed medications were prepared immediately prior to administration and were administered within 60 minutes of the scheduled time unless otherwise specified by the physician. This deficiency represents non-compliance investigated under Complaint Number OH00140119. 365558 Page 11 of 16 365558 05/10/2023 The Laurels of Hamilton 2923 Hamilton Mason Road Hamilton, OH 45011

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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, interview, record review, and policy review, the facility failed to ensure medications were stored properly. This affected two residents (#35 and #42) of four residents sampled for medication administration. The facility census was 70. Findings include: 1. Review of the medical record for Resident #35 revealed an admission date of 05/27/22. Diagnoses included dementia, schizoaffective disorder bipolar type, and Parkinson's disease. Review of the physician orders revealed Resident #35 for routine medications scheduled for administration at 8:00 A.M. included Ativan (antianxiety medication) 0.5 milligrams (mg) by mouth twice daily, benztropine (anticholinergic medication) one mg by mouth twice daily, divalproex (anticonvulsant medication) sodium 500 mg delayed release by mouth twice daily, haloperidol (antipsychotic medication) five mg by mouth once daily, and hydroxyzine (antihistamine) 50 mg by mouth twice daily. 2. Review of the medical record for Resident #42 revealed an admission date of 09/01/22. Diagnoses included dementia and type II diabetes. Review of the medical record revealed Resident #42 had physician orders for sertraline (antidepressant) 25 mg by mouth once daily at 8:00 A.M. and orders for routine medications at 9:00 A.M. including clopidogrel (blood thinner) 75 mg by mouth once daily, glyburide (antidiabetic medication) 2.5 mg by mouth twice daily, glyburide 5 mg by mouth twice daily, metformin (antidiabetic medication) 500 mg by mouth twice daily, aspirin (blood thinner) 81 mg by mouth once daily, vitamin D 25 micrograms (mcg) two tablets by mouth once daily, and colestipol (a medication to lower cholesterol) one gram mouth twice daily. Observation on 05/10/23 at 11:19 A.M. in the 600-Hall mediation cart revealed there were two paper souffle cups sitting in the top drawer which contained pre-pulled medications. One cup contained 5 pills and had a paper inside labeled with a first name only. One paper soufflé cup contained nine pills and a paper labeled with a first name. LPN #04 looked up the medications on the Medication Administration Record (MAR). The medications belonged to Resident #35 and #42, and had already been documented as administered in the MAR's for Residents #35 and #42. During an interview on 05/10/23 at 11:22 A.M., LPN #04 identified the five medications in the first cup as Resident #35's morning medications including Ativan 0.5 mg, benztropine one mg, divalproex 500 mg, haloperidol five mg, and hydroxyzine 50 mg, and identified the nine medications on the second cup as Resident #42's morning medications including sertraline 25 mg, clopidogrel 75 mg, glyburide five mg, glyburide 2.5 mg, metformin 500 mg , aspirin 81 mg, vitamin D 25 mcg (two tablets), and colestipol one gram. LPN #04 stated she had stored the medication in the cart and was planning to administer them later when Resident #42 returned to the unit and Resident #35 awakened. LPN #4 verified the medications were not to be stored pre-pulled in the medication cart and should have been wasted per the policy and safe practice when they were not administered. Review of the policy titled Medication Administration, dated 03/01/2013 revealed medications were stored according to medication and pharmacy guidelines. Medications were prepared immediately prior 365558 Page 12 of 16 365558 05/10/2023 The Laurels of Hamilton 2923 Hamilton Mason Road Hamilton, OH 45011

F 0761 to administration. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 365558 Page 13 of 16 365558 05/10/2023 The Laurels of Hamilton 2923 Hamilton Mason Road Hamilton, OH 45011

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, staff and resident interview and policy review the facility failed to ensure residents had access to menus and substitutions were available. This affected eight residents (#02, #10, #20, #28, 26, #36, #59 and #69) out of eight residents reviewed for menus and substitutions. The facility also failed to ensure double portions were served for one resident (#59) of one resident reviewed for double portions for meals. The facility census was 70. 1. Medical record review for Resident #26 revealed an admission date of 05/14/14. Medical diagnoses included traumatic brain dysfunction, peripheral vascular disease, renal insufficiency, and dementia. Review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #26 was cognitively intact. He was independent for bed mobility, transfers, toilet use and eating. Interview and observation with Resident #26 on 05/07/23 at 3:39 P.M. revealed he didn't receive a menu and wasn't able to get a substitution if he didn't like his meal. There was not a menu in his room. 2. Medical record review for Resident #36 revealed an admission of 06/21/22. Medical diagnoses included cancer, anxiety and depression. Review of the quarterly MDS dated [DATE] revealed Resident #36 was cognitively intact. The resident required supervision for bed mobility, transfers and toilet use. She was independent for eating. Interview and observation on 05/07/23 at 4:00 P.M. Resident #36 revealed was unable to get a menu and could not receive a substitution either. There was not a menu located in her room. 3. Medical record review for Resident #59 revealed an admission date of 03/10/23. Medical diagnoses included post traumatic stress disorder (PTSD), and diabetes. Review of the quarterly MDS dated [DATE] revealed Resident #59 was moderately cognitively impaired. His functional status was independent for bed mobility, transfers, toilet use and eating. Interview and observation with Resident #59 on 05/08/23 at 7:43 A.M., revealed he said he could not get a menu, he has requested double portions and doesn't receive them, and he wasn't able to choose what he wanted to eat. There was not a menu located in his room. Interview with State Tested Nursing Aide (STNA) #26 on 05/09/23 at 7:47 A.M., verified there was not a menu or substitution menu posted on the unit's for Resident's #26, #36 and #59 and there wasn't any in the resident's rooms either. She stated the staff had been passing out the menus, but she couldn't find any. She stated the staff have to walk to the kitchen to find out what the substitution was to let the resident's know what it would be. Observation of a menu ticket and breakfast tray for Resident #59 on 05/09/23 at 7:58 A.M. revealed he was supposed to receive double portions for his meals. On his breakfast tray he had two waffles, and four slices of bacon like all the other residents' had on their trays. 365558 Page 14 of 16 365558 05/10/2023 The Laurels of Hamilton 2923 Hamilton Mason Road Hamilton, OH 45011

F 0803 Level of Harm - Minimal harm or potential for actual harm Interview with STNA #26 on 05/09/23 at 8:00 A.M., confirmed Resident #59's meal ticket said double portions and he had not received a double portion on his breakfast tray. Interview with STNA #53 on 05/09/23 at 8:28 A.M. revealed the residents' get what they get because the facility often doesn't have substitutions. Residents Affected - Some Interview with the Dietary Aide (DA) #67 on 05/09/23 at 12:00 P.M. revealed the substitutions were not known to the residents until the kitchen can figure out what they had available and the new kitchen manager started yesterday. 4. Observation on 05/07/23 through 05/10/23 revealed no menus were available for residents' use to know what the planned meals for the day or what substitutions were available. Interview on 05/07/23 at 2:44 P.M., Resident #02 said they were not provided menus or substitutions for the meals served. Interview on 05/08/23 at 9:02 A.M., Resident #10 said they were not provided menus or substitutions for the meals served. Interview on 05/09/23 at 8:01 A.M., Resident #20 said they were not provided menus or substitutions for the meals served. Interview on 05/10/23 at 9:50 A.M., Resident #28 said they were not provided menus or substitutions for the meals served. Interview on 05/08/23 at 1:39 P.M., and on 05/09/23 at 11:02 A.M., with dietary staff #39 and #67 stated the menus were not offered to residents and substitutions were not offered unless brought up by the residents' and the substitutions were not always available due to food available at the facility. Review of the policy titled Meal Service, dated 11/19/21 revealed the residents are to be interviewed for preferences upon admission and as needed on what they like to eat, where they like to eat, guest are assisted as needed to the dining room and with meal set up and feeding if needed. Clothing protectors as needed, no mention of menus or food preference in policy. This deficiency represents noncompliance in Complaint Number OH00140119. 365558 Page 15 of 16 365558 05/10/2023 The Laurels of Hamilton 2923 Hamilton Mason Road Hamilton, OH 45011

F 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. Based on observation, staff and resident interview and policy review, the facility failed to ensure substitutions were available for each resident who would like a different choice of foods during meal service. This had the potential to affect all residents who receive meals from the kitchen. The facility census was 70. Findings include: Interview on 05/07/23 at 2:44 P.M., Resident #02 said they were not provided menus or substitutions for the meals served. Interview on 05/08/23 at 9:02 A.M., Resident #10 said they were not provided menus or substitutions for the meals served. Interview on 05/09/23 at 8:01 A.M., Resident #20 said they were not provided menus or substitutions for the meals served. Interview on 05/10/23 at 9:50 A.M., Resident #28 said they were not provided menus or substitutions for the meals served. Interview on 05/08/23 at 1:39 P.M., and on 05/09/23 at 11:02 A.M., with dietary staff #39 and #67 stated the menus were not offered to residents and substitutions were not offered unless brought up by the residents' and the substitutions were not always available due to food available at the facility. Interview on 05/09/23 at 8:28 A.M., State Tested Nursing Assistant (STNA) #53 said the residents' get what they get because they often have no substitutions available. Observation of the facility kitchen on 05/08/23 at 1:39 P.M., and on 05/09/23 at 11:02 A.M., revealed the facility had no substitution options for meals and no substitution logs available to review. This was verified by the Kitchen Manager #55 and the [NAME] #39. Review of a policy titled Meal Service, dated 11/19/21 revealed residents are interviewed for preferences upon admission and as needed on what they like to eat, where they like to eat, guest are assisted as needed to the dining room and with meal set up and feeding if needed. This deficiency represents noncompliance in Complaint Number OH00140119. 365558 Page 16 of 16