Health inspection·August 1, 2023

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 record review and interview, the facility did not ensure Resident #40 received a post-surgical follow up visit with her surgeon in a timely manner. This affected one resident (Resident #40) of three residents reviewed for hospitalization. The facility census was 39. Residents Affected - Few Finding include: Record review for Resident #40 revealed she was admitted to the facility on [DATE] for post-surgical aftercare and rehabilitation following spinal surgery on 05/05/23. Her list of diagnoses upon admission included sepsis, type two diabetes mellitus, spinal stenosis, cirrhosis of the liver, chronic kidney disease stage three, history of bacteremia, multidrug resistant organisms, urinary tract infection, splenial megaly, anemia and hypothyroidism. Resident #40 was discharged to the hospital on [DATE] at the request of her family for an evaluation. Review of physician orders from 05/09/23 to 05/26/23 revealed an order for the facility to call Resident #40's surgeon's office on 05/10/23 to set up a follow-up appointment as soon as possible. The order did not specify if the appointment needed to be in-person or via telehealth appointment. There were no other orders to reflect an actual appointment date had been set with the surgeon either via telehealth visit or in-person office visit for Resident #40 through 05/26/23. Review of the facility document provided to the surveyor by Medical Records (MR) #310 revealed MR #310 kept a calendar of medical appointments scheduled for residents at the facility. On this calendar she had written the cost to transport Resident #40 by ambulance would be a rate of $742.00. An appointment was scheduled on 05/18/23 at 9:15 A.M. then was cancelled by the facility. The appointment was moved to 06/08/23 with notes on the calendar reflecting the facility was trying to make a telehealth appointment due to the expense of transportation by ambulance. Review of progress notes dated 05/09/23 to 05/26/23 revealed no evidence the facility had asked Resident #40 or her family if they still wanted to proceed with the ambulance ride to the follow-up appointment on 05/18/23 with the surgeon despite the out-of-pocket cost nor were any alternative options for transportation or a telehealth option documented as discussed with the resident or her family. Review of nurse practitioner visit notes dated 05/11/23 and 05/25/23 and authored by Nurse Practitioner (NP) #329 revealed Resident #40 had a surgical incision on her back with sutures (a row of stitches holding a surgical wound together) and the surgeon would need to give orders regarding the status of the sutures. Page 1 of 2 365580 365580 08/01/2023 Shepherd of the Valley-Boardman 7148 West Blvd Youngstown, OH 44512

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the plan of care meeting notes dated 05/17/23 revealed a plan of care meeting was held with Resident #40 and her family. The note was silent from any discussion regarding when or how Resident #40 would be transported to her follow-up appointment with her surgeon or when a follow-up appointment would take place. Review of the progress note dated 05/26/23 revealed the family insisted Resident #40 be sent to the hospital for an evaluation. The facility had her transferred via ambulance on 05/26/23. Interview was conducted on 07/31/23 at 4:08 P.M. with NP #329 who explained sutures do not get removed until the surgeon gives an order to remove the sutures. NP #329 verified as of 05/25/23 Resident #40 had no orders from the surgeon regarding the sutures. Interview was conducted on 08/01/23 at 9:30 A.M. with MR #310 who verified she was responsible to schedule Resident #40's follow up appointment and there was a physician order to call the surgeon's office on 05/10/23 and have a follow-up appointment scheduled as soon as possible. MR #310 also verified an appointment was successfully scheduled with the surgeon on 05/18/23 but the facility cancelled the appointment due to the cost of ambulance transportation and instead was seeking a telehealth appointment on 06/08/23. Interview was conducted on 08/01/23 at 11:55 A.M. with Licensed Practical Nurse (LPN) #300 who identified herself as the skin nurse at the facility. LPN #300 verified Resident #40 had still not been seen for a post-surgery follow-up visit by the surgeon prior to her discharge to the hospital on [DATE]. Interview was conducted on 08/01/23 at 1:55 P.M. via telephone with Employee #969 from Resident #40's surgeon's office who verified the facility had called their office on 05/11/23 and secured a follow-up appointment for Resident #40 on 05/18/23 then called back to cancel it related to the cost to transport Resident #40 to the appointment. Employee #969 said the surgeon took time off every year around Memorial day so the follow-up appointment was re-scheduled for 06/08/23 via telehealth. This deficiency represents non-compliance as an incidental finding during the investigation of Complaint Number OH00144797. 365580 Page 2 of 2