Health inspection·January 23, 2025

F 0551 Give the resident's representative the ability to exercise the resident's rights. 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, staff interview and review of the facility resident rights document, the facility failed to ensure requests made by a resident's guardian were adequately addressed. This affected one (#36) of one resident reviewed for requests made by a guardian. The facility census was 46. Residents Affected - Few Findings include: Review of the medical record revealed Resident #36 admitted to the facility on [DATE]. Diagnoses included dementia, severe protein-calorie malnutrition, adult failure to thrive, and muscle weakness. Further review revealed Resident #36's daughter was appointed legal guardian on 12/04/24. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #36 was cognitively impaired. The resident required supervision or touching assistance for chair/bed-to-chair transfers. Review of the plan of care dated 09/06/23, and revised 01/21/25, revealed Resident #36 had an activities of daily living (ADLs) self-care and/or physical mobility performance deficit related to impaired mobility. Interventions included multiple assistive signs hung in room per family request. Further review revealed no evidence of what specific care or needs were identified on the signs hung in Resident #36's room or what requests the facility implemented. Observation on 01/21/25 at 11:40 A.M. revealed Resident #36 was in bed in his room. Further observation revealed numerous signs were posted throughout the resident's room. A sign posted on the wall to the side of the resident's bed stated, Leave wheelchair next to bed as he will get out of bed when he realizes he has to go to the bathroom, not always so please check on him often. The sign also stated to contact the resident's guardian with any questions or concerns and provided a contact phone number. Resident #36's wheelchair was in the bathroom and not next to the resident's bed. Continued observations on 01/21/25 from 11:40 A.M. through 12:47 P.M. revealed Resident #36 remained in bed, with his wheelchair located in the bathroom. Interview on 01/21/25 at 12:47 P.M. with Unit Manager (UM) #386 verified Resident #36 was in bed, while his wheelchair was located in the bathroom. UM #386 confirmed the wheelchair was supposed to be next to Resident #36's bed when he was in it per his guardian's request. Interview on 01/21/25 with Resident #36's legal guardian confirmed she requested the resident's wheelchair be left next to the bed when he was in it and left a sign next to the bed as a reminder to staff. The resident's guardian stated Resident #36 would sometimes attempt to get up independently to Page 1 of 2 365571 365571 01/23/2025 Otterbein Portage Valley 20311 Pemberville Rd Pemberville, OH 43450

F 0551 go to the bathroom and she was concerned he would fall if the wheelchair was not accessible to him. Level of Harm - Minimal harm or potential for actual harm Interview on 01/22/25 at 3:58 P.M. with the Director of Nursing (DON) confirmed Resident #36 sometimes attempted to get out of bed on his own, without staff assistance. Residents Affected - Few Interview on 01/23/25 at approximately 1:00 P.M. with the Administrator confirmed Resident #36's guardian requested the resident's wheelchair be next to the bed but stated she was uncertain why the request was made. The Administrator indicated Resident #36 had no fall history that she was aware of or safety risks associated with the wheelchair being placed next to the resident's bed. The Administrator did not know if Resident #36 attempted to get out of bed on his own and she was uncertain who assessed the resident's mobility/transfer needs, adding he transferred to their facility from another facility. The Administrator reported the wheelchair next to Resident #36's bed was a guardian request, but not necessarily something the facility implemented. The Administrator confirmed there had been no further discussion with the resident's guardian related to the request. Further review of the medical record revealed no evidence the facility reviewed the guardian's request, completed any assessments related to the requests, or implemented any of the specific interventions identified on the signs hanging in Resident #36's room, including the wheelchair left at bedside. Review of the facility document titled Ohio Resident Rights & Facility Responsibilities, revised 01/22/20, revealed residents had the right to participate in decisions that affected their life, including the right to communicate with the physician and employees of the home in planning the resident's treatment or care. The document further stated a sponsor may act on a resident's behalf to assure the home did not deny the resident's rights. This deficiency represents non-compliance investigated under Master Complaint Number OH00161384. 365571 Page 2 of 2