Health inspection·December 18, 2019

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on medical record review, observation, and interview, the facility failed to ensure a resident's urinal was emptied on a regular basis which resulted in urine saturated clothing. This affected one (Resident #76) of one resident reviewed for dignity. Findings include: Review of Resident #76's medical record revealed an admission date of 11/23/19 with the diagnoses of chronic atrial fibrillation, muscle weakness, difficult walking and chronic pain. Review of Resident #76's annual Minimum Data Set (MDS) 3.0 dated for 11/18/19 revealed resident with intact cognition, adequate hearing and vision and able to make self understood and able to understand others. Resident #76 required extensive assistance from two staff members for bed mobility, transfers, and toilet use and dressing. Resident #76 was frequently incontinent of urine. Review of physician orders for Resident #76 revealed an order dated for 06/11/19 for Furosemide (a diuretic to help treat urine retention) 40 milligrams (mg) tablet, by mouth twice a day for congestive heart failure. Interview on 12/18/19 at 10:50 A.M. with Resident #76 revealed his concern that staff were not emptying his urinal after he uses it to urinate in. Resident #76 revealed he is currently taking Furosemide 40 mg twice a day and this makes him have to urinate frequently and not able to wait long periods of time. Resident #76 revealed the staff knows he has to urinate frequently and when he request for them to ensure his urinal is empty so he can use it, they do not do this. Resident #76 claimed he would empty the urinal himself but he is not able to walk into the bathroom and his hand was weak and he had dropped the urinal in the past. Observation on 12/18/19 at 11:40 A.M. revealed Resident #76 sitting in his wheelchair in his room with his call light on. Resident #76's urinal was placed on the side of his trash can, filled to the top with urine. Licensed Practical Nurse (LPN) #256 was observed applying gloves and entering Resident #76's room when the resident pulled on the top of his sweat pants to reveal a large wet area. Resident #76 informed LPN #256 that he has asked many times for his urinal to be emptied because when he has to use the bathroom he has to go and he ends up spilling it all over his pants and this happens all the time. Interview on 12/18/19 at 11:45 A.M. with LPN #256 confirmed Resident #76's urinal was filled to the top of the urinal and resulted in resident trying to use the urinal and spilling it on himself. LPN #256 also confirmed Resident #76 is not able to empty the urinal himself nor is he able to change Page 1 of 10 365585 365585 12/18/2019 Edgewood Manor of Lucasville I 10098 Big Bear Creek Rd Lucasville, OH 45648

F 0550 his urine saturated clothing without assistance. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 365585 Page 2 of 10 365585 12/18/2019 Edgewood Manor of Lucasville I 10098 Big Bear Creek Rd Lucasville, OH 45648

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview and facility policy and procedure review, the facility failed to notify one resident's (Resident #132) primary care physician and family of bruising of an unknown origin. This affected one of 20 sampled residents. Findings Include: Review of Resident #132's medical record revealed an original admission date of 01/29/18 with the latest readmission of 03/05/19. The resident was discharged to an acute care hospital on [DATE]. Diagnoses included, dementia with behavioral disturbances, major depressive disorder with psychotic features, anxiety disorder and aphasia. Review of the resident's quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident had unclear speech, rarely/never understood others, rarely/never made herself understood and had a severe cognitive deficit. Review of the mood and behavior revealed displayed indicators of depression, hallucinations, behaviors not directed towards others and rejected care. The resident was dependent on staff for all activities of daily living. The MDS indicated the resident had no skin issues. Review of the resident's weekly skin integrity review dated 11/28/19 revealed the resident was found to have edema to her left inner thigh with a fluid filled area. The resident was also found to have edema with slight discoloration (bruising) to the resident's left perineal area. Review of the resident's Treatment Administration Record (TAR) for November 2019 revealed an order to monitor the discoloration and edema to the resident's left inner thigh and left perineum. Review of the resident's medical record revealed no documented evidence the resident's primary care physician or the family were notified of the extensive bruising to the resident's left inner thigh or the left perineum. Interview on 12/18/19 at 4:05 P.M. interview with the Director of Nursing (DON) verified the resident's primary care physician and family were not notified of the bruising or edema to her left inner thigh and left perineum. Review of the facility's policy titled, Change in a Resident's Condition or Status, dated 2001 revealed the facility shall promptly notify the resident, his/her attending physician and representative of changes in the resident's medical/mental condition and/or status. 365585 Page 3 of 10 365585 12/18/2019 Edgewood Manor of Lucasville I 10098 Big Bear Creek Rd Lucasville, OH 45648

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 medical record review, observation, interview, and facility policy review the facility failed to monitor weekly blood pressure as ordered and failed to change administration times of medication as recommended by the pharmacist. This affected one resident (Resident #76) out of five residents assessed for unnecessary medications. The facility census was 84. Residents Affected - Few Findings include: Review of the medical record for Resident #76 revealed an admission date of 11/23/18 with diagnoses including but not limited to diabetes mellitus, chronic pain, peripheral vascular disease, orthostatic hypotension, congested heart failure, hypertension, coronary artery disease, and depression. Review of the annual minimum data set assessment dated [DATE] revealed Resident #76 had no cognitive deficits. Review of physician orders dated December 2019 revealed an order to check blood pressure every week on Sunday, and order for Midodrine ( medication used for orthostatic hypotension) three times a day at 9:00 A.M., 1:00 P.M., and at 9:00 P.M. Review of pharmacy recommendation dated 05/22/19 revealed Resident #76 takes Midodrine for treatment of orthostatic hypotension and it is recommended not to give after 6:00 P.M. due to a warning regarding supine hypertension. Recommendation was approved and night time administration of medication was to be changed from 9:00 P.M. to 6:00 P.M. on 06/04/19. Review of medication administration records dated June, July, August, September, October, November, and December 2019 revealed Midodrine was administered at 9:00 P.M. and not 6:00 P.M. Review of June 2019 MAR revealed blood pressure was taken on 06/02/19 and none for 06/09/19, 06/16/19, 06/23/19 and on 06/30/19. There was no other documentation of blood pressures being recorded in medical record for these dates. Review of November 2019 MAR revealed blood pressure was taken on 11/03/19 and none for 11/10/19, 11/17/19 and for 11/24/19. There was no other documentation of blood pressures being recorded in medical record for these dates. Review of December 2019 MAR revealed no weekly blood pressure taken yet. Review of care plan revealed Resident #76 has potential for alteration in perfusion related to congested heart failure, hypertension, and arrthymias and included interventions to obtain vital signs as ordered, medication as ordered, and monitor for signs and symptoms of hypo and hypertension. Interview was conducted on 12/17/19 at 5:24 P.M. with Licensed Practical Nurse #900 and she stated blood pressures are to be documented in the MAR's and if not there they will be documented in the nurses notes. Observation and interview was conducted on 12/18/19 at 10:54 A.M. with Resident #76 and he stated they do not take his blood pressure weekly. 365585 Page 4 of 10 365585 12/18/2019 Edgewood Manor of Lucasville I 10098 Big Bear Creek Rd Lucasville, OH 45648

F 0684 Level of Harm - Minimal harm or potential for actual harm Interview was conducted on 12/18/19 at 11:31 A.M. with the Director of Nursing and she verified the missing weekly blood pressures as ordered and that the medication Midodrine was not changed from 9:00 P.M. to 6:00 P.M. as recommended by the pharmacist. Residents Affected - Few 365585 Page 5 of 10 365585 12/18/2019 Edgewood Manor of Lucasville I 10098 Big Bear Creek Rd Lucasville, OH 45648

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, interview, and facility policy review the facility failed to keep resident's catheters in proper position below the level of the bladder. This affected one resident (Resident #41) out of two residents reviewed with catheters. The facility census was 84. Findings include: Review of the medical record for Resident #41 revealed an admission date of 08/31/10 with diagnoses including but not limited to urinary retention, neurogenic bladder, depression, dementia, and spastic hemiplegia. Review of the annual Minimum Data Set (MDS) assessment dated [DATE] and the quarterly MDS dated [DATE] revealed Resident #41 had a urinary catheter. Review of physician orders dated December 2019 revealed Foley/urinary catheter to a closed drainage system for neurogenic bladder. Review of history and physical dated 02/10/19 revealed Resident #41 was being treated for a urinary tract infection and has an indwelling Foley catheter. Review of physician progress note dated 09/18/19 revealed Resident #41 has chronic urinary tract infections. Review of care plan revealed Resident #41 had altered bladder elimination related to neurogenic bladder with goals to not develop urinary tract infection and not experience any complications related to catheter. Observation was conducted on 12/15/19 at 11:15 A.M. and observed Resident #41 resting in a low bed with catheter bag resting on the floor above resident's waist, there was no dignity bag, no barrier in place , and drainage bag was resting flat on the floor and was above the level of the bladder. Interview was conducted on 12/15/19 at 11:15 A.M. with State Tested Nursing Assistant (STNA) #599 and she verified Resident #41's catheter bag was resting on floor and not in proper position. She stated usually it is secured to bed frame towards bottom of the bed. Interview was conducted on 12/15/19 at 11:23 A.M. with Licensed Practical Nurse (LPN) #966 and she verified Resident #41's catheter bag was resting on floor and was above the level of Resident #41's bladder. Review of facility's Emptying a Urinary Drainage Bag Policy dated October 2010 revealed to always attach the catheter drainage bag to bed frame, keep the drainage bag below the level of the bladder, and keep the drainage bag and tubing off the floor at all times. 365585 Page 6 of 10 365585 12/18/2019 Edgewood Manor of Lucasville I 10098 Big Bear Creek Rd Lucasville, OH 45648

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, and interview the facility failed to provide ordered abdominal binder to possibly prevent complications from resident pulling out feeding tube. This affected one resident (Resident #74) out of one resident reviewed for tube feeding. The facility census was 84. Findings include: Review of the medical record for Resident #74 revealed an admission date of 04/02/19 with diagnoses including but not limited to traumatic brain injury, dysphagia, disruptive mood disorder, psychosis, and gastrostomy status. Review of admission minimum data set (MDS) assessment dated [DATE] and quarterly MDS dated [DATE] revealed cognitive deficits. Review of physician orders dated December 2019 revealed to wear abdominal binder at all times. Review of hospital Discharge summary dated [DATE] revealed Resident #74 had dysphagia and percutaneous endoscopic gastromy tube (Gtube) and underwent procedure on 09/26/19. It was recommended to keep an abdominal binder on at all times to ensure Gtube does not get pulled out. Review of facility's restraint evaluation dated 09/27/19 revealed Resident #74 uses an abdominal binder to maintain use of Gtube due to history of pulling it out and he is to have nothing by mouth and requires Gtube for all nutritional intake. He has agitation , is restless, and resists care. Observations was conducted on 12/16/19 at 9:16 A.M. and at 1:25 P.M. of Resident #74 resting in bed with tube feeding running as ordered and no abdominal binder on. Observation was conducted on 12/16/19 at 2:11 P.M. and at 4:33 P.M. of Resident #74 up in wheel chair and no abdominal binder in place. Observation was conducted on 12/17/19 at 9:39 A.M. and at 11:30 A.M. of Resident #74 and no abdominal binder in place. Interview was conducted on 12/17/19 at 11:34 A.M. with the Director of Nursing and she verified Resident #74 was not wearing his abdominal binder as ordered. She stated Resident #74 does not pull at his Gtube anymore and the binder was used to keep him from pulling it out. 365585 Page 7 of 10 365585 12/18/2019 Edgewood Manor of Lucasville I 10098 Big Bear Creek Rd Lucasville, OH 45648

F 0697 Provide safe, appropriate pain management for a resident who requires such services. 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, interview, and facility policy review the facility failed to monitor and assess for resident's pain. This affected one resident (Resident #76) out of five residents assessed for pain and unnecessary medications. The facility census was 84. Residents Affected - Few Findings include: Review of the medical record for Resident #76 revealed an admission date of 11/23/18 with diagnoses including but not limited to diabetes mellitus, chronic pain, peripheral vascular disease, orthostatic hypotension, congested heart failure, hypertension, coronary artery disease, and depression. Review of annual minimum data set assessment dated [DATE] revealed Resident #76 had no cognitive deficits, received scheduled and as needed pain medications and stated no pain during assessment. Review of physician orders dated December 2019 revealed an order for neurontin three times a day for neuropathy, tramadol four times a day for pain, and has an order for Tylenol every four hours as needed for pain. Review of June 2019 medication administration record (MAR) revealed Resident #76 had Tylenol four times on 06/13/19, 06/15/19, 06/16/19, and 06/19/19. There was no pain flow record and no documentation of any pain characteristics such as level and anatomical location of pain. Review of MAR dated October, November, and December 2019 revealed Resident #76 received no Tylenol. Review of shower sheet dated 12/17/19 revealed Resident #76 refused a shower due to his feet hurt too bad. Review of nurses notes and MAR revealed no interventions were given for Resident #76's pain on 12/17/19. Review of care plan revealed Resident #76 has alteration in pain and comfort related to neuropathy, peripheral vascular disease, and bilateral lower extremity edema, and complaints of pain with interventions including monitor and report to nurse any complaints of pain, monitor pain characteristics such as frequency, quality anatomical location, aggravating and alleviating factors, Observation and interview was conducted on 12/15/19 at 10:54 A.M. with Resident #76 he was sitting up in wheel chair and had edema to both lower extremities. He stated he hurts so bad at night to his legs that he cries and stated he has Tylenol but it does not work. Observation and interview was conducted on 12/18/19 at 10:42 A.M. with Resident #76 he was sitting up in wheel chair participating in activities and did not show any signs of pain. He stated that his legs cause him pain and the nurses are too busy to give him anything so he does not ask them. He stated he did not want to bother the nurses and denied that the nurses ask him if he is in any pain. He stated he sometimes sleeps in his chair because his pain is bad in his legs. Interview was conducted on 12/18/19 at 11:31 A.M. with the Director of Nursing and she stated they 365585 Page 8 of 10 365585 12/18/2019 Edgewood Manor of Lucasville I 10098 Big Bear Creek Rd Lucasville, OH 45648

F 0697 Level of Harm - Minimal harm or potential for actual harm do pain assessments quarterly and he is up daily and does not show any signs of pain and that he was alert enough to say if he was in pain and he never has that she knew of. She stated they only fill out pain flow records and do pain assessment if a resident takes an as needed pain medication and not daily or every shift. She verified there was no pain flow record for June 2019 or any documentation of pain characteristics when he received four doses of Tylenol. Residents Affected - Few Interview was conducted on 12/18/19 at 11:35 A.M. with LPN #256 and she stated Resident #76 has never asked her for anything for pain. Review of facility's Pain Policy dated June 2013 revealed the physician and staff will identify residents who have pain or who have risk for having pain. The nursing staff will assess each residents pain upon admission, at quarterly review, and whenever there is a significant change in condition. The staff will reassess the residents pain and related consequences at regular intervals; at least each shift for acute pain and at least weekly in stable chronic pain. 365585 Page 9 of 10 365585 12/18/2019 Edgewood Manor of Lucasville I 10098 Big Bear Creek Rd Lucasville, OH 45648

F 0880 Provide and implement an infection prevention and control program. 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, interview, and facility policy review the facility failed to maintain infection control practices with residents having urinary catheters when a catheter bag was observed laying on the floor with no barrier. This affected one resident (Resident #41) out of two residents reviewed with catheters. The facility census was 84. Residents Affected - Few Findings include: Review of the medical record for Resident #41 revealed an admission date of 08/31/10 with diagnoses including but not limited to urinary retention, neurogenic bladder, depression, dementia, and spastic hemiplegia. Review of the annual Minimum Data Set (MDS) assessment dated [DATE] and the quarterly MDS dated [DATE] revealed Resident #41 had a urinary catheter. Review of physician orders dated December 2019 revealed Foley/urinary catheter to a closed drainage system for neurogenic bladder. Review of history and physical dated 02/10/19 revealed Resident #41 was being treated for a urinary tract infection and has an indwelling Foley catheter. Review of physician progress note dated 09/18/19 revealed Resident #41 has chronic urinary tract infections. Review of care plan revealed Resident #41 had altered bladder elimination related to neurogenic bladder with goals to not develop urinary tract infection and not experience any complications related to catheter. Observation was conducted on 12/15/19 at 11:15 A.M. and observed Resident #41 resting in a low bed with catheter bag resting on the floor, there was no dignity bag, no barrier in place , and drainage bag was resting flat on the floor. Interview was conducted on 12/15/19 at 11:15 A.M. with State Tested Nursing Assistant (STNA) #599 and she verified Resident #41's catheter bag was resting on floor and stated his dignity bag was still on his chair. Interview was conducted on 12/15/19 at 11:23 A.M. with Licensed Practical Nurse (LPN) #966 and she verified Resident #41's catheter bag was resting on floor with no barrier in place. Review of facility's Emptying a Urinary Drainage Bag Policy dated October 2010 revealed to always attach the catheter drainage bag to bed frame, keep the drainage bag below the level of the bladder, and keep the drainage bag and tubing off the floor at all times. 365585 Page 10 of 10