Health inspection·February 9, 2023

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Review of the medical record for Resident #1 revealed an admission date of 06/08/22 with diagnoses including dementia, anxiety, neoplasm of the brain (cancer), and seizures. Review of the quarterly MDS 3.0 assessment dated [DATE] revealed Resident #1 had cognitive impairment and required extensive assist for bed mobility and transfers and was totally dependent on staff for toileting. Review of the physician orders for January 2023 revealed an order for Depakote (anticonvulsant) 125 milligram (mg) used for seizures. Review of the allergy tab revealed no allergy to Depakote. Review of the pharmacy recommendation dated 11/20/23 revealed to remove allergy to Depakote if the resident can tolerate the medication. There was a written note to remove allergy with a check mark. Review of the plan of care dated 01/23/23 revealed Resident #1 was allergic to Valproic Acid a generic for Depakote. Intervention included to check all orders against the allergy list. Interview on 02/09/23 at 2:15 P.M. with the DON stated she changed the allergy tab and did not change revise the care plan. Review of the policy titled Comprehensive Care Plans, dated 08/22/22, revealed it is the policy of this facility to develop and implement a comprehensive person-center care plan for each resident, consistent with the resident rights that includes measurable objectives and timeframes to meet a resident's medical, nursing, and metal and psychosocial needs that are identified in the resident's comprehensive assessment. Based on record review, interview, and facility policy review the facility failed to ensure the care plans for Resident #1 and Resident #9 were updated. This affected two residents (#1 and #9) of 17 resident care plans reviewed. The facility census was 56. Findings include: 1. Resident #9 was admitted to the facility on [DATE] with diagnosis including bipolar disorder, muscle wasting and atrophy, difficulty in walking, fracture of left femur, and personal history of traumatic brain injury. Page 1 of 3 365563 365563 02/09/2023 Autumnwood Nursing & Rehab Center 275 East Sunset Drive Rittman, OH 44270

F 0657 Level of Harm - Minimal harm or potential for actual harm Review of the quarterly Minimum Data Set 3.0 (MDS) assessment dated [DATE] revealed Resident #9 was cognitively intact and required limited assistance for bed mobility, transfers, dressing, toilet use, and personal hygiene. The resident received antipsychotic and opioid medication. Review of the physician's orders for February 2023 revealed no anticoagulants were currently ordered. Residents Affected - Few Review of the care plan dated 05/09/19 revealed Resident #9 had the potential for bleeding or hemorrhage related to the use of anticoagulant medication, or the use of medications that had blood-thinning effects. He was receiving Lovenox, an anticoagulant, injections due to a left hip fracture. Interventions included: alert staff outside facility of anticoagulant therapy should resident require medical or dental procedures, observe for signs of bleeding, black tarry stools, bruising, hematuria, headaches, nosebleeds, and report, protect from falls/injury as much as possible, review labs and report abnormal values immediately, give medication as prescribed, and identify conditions or medications that could inhibit or enhance anticoagulant. Interview with the Director of Nursing (DON) on 02/09/23 01:41 P.M. verified Resident #9's care plan was not updated to reflect the resident no longer received anticoagulants. Review of the Comprehensive Care plans policy, dated 02/22/22, revealed the comprehensive care plan will be reviewed and revised by the interdisciplinary team after each comprehensive and quarterly MDS assessment. 365563 Page 2 of 3 365563 02/09/2023 Autumnwood Nursing & Rehab Center 275 East Sunset Drive Rittman, OH 44270

F 0727 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. Based on record review and staff interview, the facility failed to ensure there was a registered nurse (RN) on duty for at least eight consecutive hours a day, seven days a week as required. This had the potential to affect all 56 residents currently residing in the facility. Findings include: Review of the nursing staff information and staff schedule for 01/14/23, 01/15/23, 01/22/23, 01/28/23, and 01/29/23 revealed no RNs were present working in the facility on those dates. Interview on 02/08/23 at 4:14 P.M. with the Administrator verified the facility did not have an RN on duty in the facility on 01/14/23, 01/15/23, 01/22/23, 01/28/23, and 01/29/23. 365563 Page 3 of 3