Inspection·October 17, 2024

F 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. Based on record review, policy review, review of a respiratory care journal, personnel file review and interview, the facility failed to ensure only competent staff provided tracheostomy care/insertion to residents. This affected one (Resident #58) of two residents reviewed for tracheostomy care. Findings include: Review of Resident #58's closed medical record revealed diagnoses including anxiety disorder, history of malignant neoplasm of the larynx (voice box), acquired absence of the larynx, and tracheostomy ( a surgical procedure that creates an opening in the windpipe (trachea) through the front of the neck. A tube is then inserted through the opening to allow air to bypass the nose and mouth and go directly into the lungs) status. A nursing note dated 04/12/24 at 6:00 P.M. indicated upon Resident #58's arrival his son demonstrated how to put the tracheostomy tube in, get Resident #58 to cough, use of the ventilator over the tracheostomy, and how to clean the tracheostomy tube using water and peroxide. Review of the admission physician orders revealed to suction the resident using a #14 french kit as needed to clear secretions or choking, may use normal saline to help suction as needed and change trach ties daily and as needed. Review of the treatment administration record (TAR) for 04/16/24 and 04/17/24 revealed licensed nurses documented the physician ordered care was provided. During an interview on 10/16/24 at 4:08 P.M., State Tested Nursing Assistant (STNA) #75 stated Resident #58 used to take his tracheostomy tube out. STNA #75 was unable to recall an exact date but stated Resident #58's tracheostomy tube was found on the floor. The tube was dirty and gunky. STNA #75 stated Resident #58's son had shown staff how to change the tracheostomy tube at one time. When a nurse had not responded to the concern regarding Resident #58's tube being removed after approximately an hour she (STNA #75) used a solution Resident #58 had in the bathroom for his tracheostomy care and a scrubber to clean the trach, ran it under water, and let it dry. After it had a chance to dry, she had Resident #58 cough while she inserted the tube back into Resident #58's neck. STNA #75 stated Resident #58 had no extra tracheostomy tubes at bedside. STNA #75 stated she was unaware STNAs could not provide tracheostomy care. STNA #75 indicated she was educated around 05/01/24 that she was unable to do tracheostomy care. On 10/17/24 at 8:05 A.M., STNA #75 stated when she did the tracheostomy care she used clean gloves but not sterile procedure. There was no inner cannula. (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 365559 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 365559 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rolling Hills Rehab and Care Ctr 68222 Commercial Drive Bridgeport, OH 43912 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)