Health inspection·December 5, 2019

F 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview and review of facility policy the facility failed to ensure residents and responsible parties were provided with a written notice of transfer upon transfer/discharge from the facility. This affected one (Resident #38) of one resident reviewed for hospitalizations. The facility identified four residents transferred to the hospital in the last 60 days. The facility census was 57. Findings include: Review of the medical record for Resident #38 revealed the resident was admitted to the facility on [DATE] and was re-admitted on [DATE]. Diagnoses include schizoaffective disorder, bipolar type, moderate intellectual disabilities, convulsions, vitamin D deficiency, bacteriuria, chronic respiratory failure, heart failure, hypertension, hyperlipidemia, vitamin B deficiency, osteoarthritis, legally blind, depression, insomnia, restless and agitation, auditory hallucinations, paranoid personality disorder, post-traumatic stress disorder, anxiety and conversion disorder with seizures or convulsions. Review of a comprehensive significant change Minimum Data Set 3.0 assessment dated [DATE] revealed the resident had severe cognitive deficits , delusions and fluctuating periods of inattention and disorganized thinking. Review of physician orders dated 09/03/19 and 10/24/19 revealed the resident was sent to the hospital on two separate occasions. Further review of the medical record revealed no documentation was present to indicate the resident and/or responsible party were provided with a written notice of transfer for either transfer. Review of a Transfer Notice dated 09/03/19 revealed the resident was sent to the hospital. There was no documentation of who the form was provided to. Review of a Transfer Notice dated 10/25/19 revealed the resident was sent to the hospital. There was no documentation of who the form was provided to. Interview with Business Office Manager #300 on 12/03/19 at 10:20 A.M. verified the facility did not provide residents and families with a written notice of transfer when the residents were transferred to the hospital. Review of facility policy Skilled Nursing Facility Transfer and discharge Required Notices Policy Page 1 of 4 365570 365570 12/05/2019 Park View Care Center 328 West Vine Street Edgerton, OH 43517

F 0623 Level of Harm - Minimal harm or potential for actual harm dated 02/2018 revealed the facility was to provide a transfer notice that provided appeal right to the resident and representative at the time of transfer or as soon as practicable, if the resident was transferred to the hospital for an inpatient stay. Residents Affected - Few 365570 Page 2 of 4 365570 12/05/2019 Park View Care Center 328 West Vine Street Edgerton, OH 43517

F 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Review of the medical record for Resident #41 revealed the resident was admitted to the facility on [DATE]. Diagnoses included dementia, cognitive communication deficit, chronic obstructive pulmonary disease, muscle wasting, major depression, hypercholesterolemia, hypertension, anxiety, folate deficiency, vitamin D deficiency, difficulty walking, paranoid schizophrenia, bipolar disorder, gastro-esophageal reflux disease, diabetes mellitus type II ad chronic kidney disease. Review of a quarterly MDS 3.0 assessment dated [DATE] revealed the resident had no cognitive deficits or abnormal behaviors. Extensive assistance was required for bed mobility, transfers, dressing, toileting and hygiene, with supervision required for walking, locomotion and eating. The resident was incontinent of bowel and bladder and had no pain. The resident had one fall but no injuries. The assessment further revealed the resident received antipsychotics on a routine basis only as well as insulin and antidepressants Review of physician orders for 12/2018 revealed the resident received Prozac (anti-depressant medication) 20 mg by mouth twice daily as well as Chlorpromazine (anti-psychotic medication) 100 mg by mouth twice daily. Review of a Physician Recommendation form dated 02/26/19 revealed the pharmacist had informed the physician it was time for a GDR for the continued use of Chlorpromazine. The form was signed by Certified Nurse Practitioner (CNP) #400 on 06/20/19 with a disagreement of the recommendation. Review of an additional Physician Recommendation form dated 02/26/19 revealed the pharmacist had informed the physician it was time for a semi annual review for Prozac. The form was signed by CNP #400 on 06/20/19 with a disagreement of the recommendation. Review of a Physician Recommendation form dated 03/25/19 revealed the pharmacist had informed the physician it was time for a semi annual review for the continued use of Topiramate. The form was signed by CNP #400 on 06/20/19 with a disagreement of the recommendation. Interview with Regional Nurse #500 on 12/03/19 at 9:45 A.M. verified the Physician Recommendation forms had been missed and were not signed by the physician or delegate in a timely manner as required. Review of an undated facility policy Medication Regimen Review revealed the consultant pharmacist was to perform a monthly medication regimen review for each resident to determine if irregularities existed. A report was to be provided to the DON of all irregularities and the attending physician was to act upon those recommendations as required by Federal and State guidelines. Based on medical record review, staff interview, and review of a facility policy, the facility failed to ensure pharmacy recommendations were responded to in a timely manner. This affected two (Resident's #36 and #41) of five residents reviewed for unnecessary medications. he facility census was 57. Findings include: 365570 Page 3 of 4 365570 12/05/2019 Park View Care Center 328 West Vine Street Edgerton, OH 43517

F 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 1. Review of Resident #36's medical record revealed an admission date of 08/01/18. Diagnoses included dementia with behavioral disturbance, anxiety disorder, hypertension, major depressive disorder, and neuropathy. Review of Resident #36's Minimum Data Set (MDS) dated [DATE] revealed the resident was moderately cognitively impaired. Resident #36 required supervision for bed mobility, transfer, walking, locomotion, dressing, toilet use, and personal hygiene. Resident #36 had delusions during the review period and Resident #36 had mood concerns of being fidgety or restless two to six days during the review period. Review of Resident #36's care plan revised 10/28/19 revealed supports and interventions for potential for alterations in skin integrity, nutritional and dehydration risk, antidepressant medication use with risk for adverse reaction, fluctuating cognitive state, potential for difficulty for expressing thoughts, potential for verbal aggression, risk for falls, pain, risk for side effect or adverse effects related to antianxiety medications, risk for decline in mobility, risk for elopement, psychosocial wellbeing problem, risk for changes in mood, and self-care deficit. Review of Resident #36's Gradual Dose Reduction (GDR) recommendations from the pharmacist revealed a recommendation dated 06/25/19 where the pharmacist recommended the physician review Resident #36's use of hydroxyzine for the treatment of insomnia and anxiety. The pharmacist indicated a review was recommended due to this medication noted to not be utilized for insomnia and anxiety in geriatric patients due to its strong anticholinergic properties leading to falls, urinary retention and confusion. The pharmacist requested the physician to please consider switching to a low-dose zolpidem 5 milligrams (mg) or trazodone 12.5 to 25 mg as an alternative. No physician response was found. An unsigned note on the bottom of the recommendation form indicated on 09/12/19 Resident #36's hydroxyzine was discontinued. On 10/22/19 the pharmacist recommended the physician consider GDR discontinuing or changing Resident #36's tramodol to another pain medication due to Resident #36 taking Duloxetine 30 mg with Tramadol 50 mg. It was noted the co-administration of the medications could potentiate the risk of serotonin syndrome and increase the risk of seizures. The physician responded on 12/03/19 and agreed with the recommendation. The physician discontinued Resident #36's Tramadol on 12/03/19. The physician review came 42 days following the 10/22/19 recommendation from the pharmacist. Interview on 12/03/19 at 2:58 P.M. with the Administrator and Director of Nursing (DON) verified the pharmacy recommendations made on 06/25/19 and 10/22/19 were not followed up with by the physician in a timely manner. 365570 Page 4 of 4