Health inspection·December 5, 2019

F 0558 Reasonably accommodate the needs and preferences of each resident. 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, and resident and staff interview, the facility failed to accommodate the known preferences for a resident. This affected one individual (#13) of 15 residents interviewed during the survey regarding accommodation of needs. The facility census was 44. Residents Affected - Few Findings include: Resident #13 was admitted to the facility on [DATE] with diagnoses including bilateral above the knee amputations, non pressure ulcer of the above the knee stumps, muscle weakness, anxiety, and depression. Review of the minimum data set (MDS) assessment revealed the resident scored a 15 on the Brief Interview for Mental Status (BIMS) indicating he has no cognitive deficits . He exhibited no behaviors. He requires extensive assistance with bed mobility and transfers. He requires physical help of one person in part of the bathing activity. He propels a manual wheelchair on his own on and off the unit . Review of the plan for care, dated 10/15/19 revealed the resident has an activity of daily living (ADL) self care deficit related to recent hospital stay for sepsis, bilateral above knee amputations, decreased self mobility, generalized muscle weakness, mood/behavior concerns, age, medications taken, non-compliance with prescribed care regimen, verbally aggressive at times. The goal indicated the resident will be clean, dressed and well groomed daily to promote dignity and psychosocial well-being. The interventions included the resident will receive assistance necessary to meet ADL needs, staff will assist to bathe/shower the resident as needed, therapy is to evaluate and treat the resident per physician orders. On 12/02/19 at 9:30 A.M. Resident #13 stated the shower/tub transfer bench in therapy is broken and has been broken for several weeks. He stated he can't practice his shower transfers without a tub/shower bench. He stated he wants to use the transfer bench in the shower room and take a shower like a regular person. He stated he does not want to use the shower chair with a hole in it. On 12/02/19 at 10:00 A.M. observation of the tub /shower bench in the therapy room revealed an area on the seat where a screw with breaking though causing a raised rough surface. Interview with Occupational Therapy Assistant (OTA) #400 on 12/02/19 at 10:00 A.M. verified the tub/shower bench had a rough surface and was not able to be used. She stated she had told the Administrator last week and the Administrator told her she was ordering a new shower bench for therapy. She Page 1 of 14 365600 365600 12/05/2019 Lost Creek Rehabilitation and Nursing Center 804 South Mumaugh Road Lima, OH 45804

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few stated Resident #13 did not currently have a place to live so they were not worried about his ability to use a transfer bench. When asked if the resident could have a transfer bench to take a shower in the shower room of the facility she responded by stating there are shower chairs that he could use because he does not slide transfer and is capable to transfer into a shower chair. She verified that the facility and therapy staff were aware of Resident #13 preference to use a shower bench due to his age and bilateral above the knee amputations but did not fell it was necessary for the resident's care at this time. Interview with Resident #13 on 12/03/19 at 3:00 P.M. he stated on the transitional care unit where he is currently residing there is a refrigerator freezer used for the storage of the resident's food they bring into the facility. He stated he had went to Walmart with activities and bought frozen burritos to have as a snack for when his friend came to visit. The facility placed them in the refrigerator/freezer used for the resident's food. The refrigerator and freezer has a pad lock on the doors. He stated the resident have to have staff unlock the the refrigerator and freezer when he wanted his food. He stated he is capable of getting his food independently but due to the locks he has to ask staff to unlock the refrigerator/freezer and assist him. Interview with the Administrator on 12/03/19 at 3:30 P.M. she verified the refrigerator/freezer located on the transitional care unit was for the residents to store their personal food in that was brought into the facility. She stated one of the former resident's were eating other peoples food so they locked the refrigerator and freezer to prevent that from happening. Interview with OTA #400 on 12/05/19 at 12:00 P.M. she verified the refrigerator and freezer located in the kitchenette on the transitional care unit was used to store the food that resident's brought into the facility. She stated initially the refrigerator was not locked until one of the former resident's got into the refrigerator and ate other resident's food. She verified the former resident was expired/no longer resides in the facility. Interview with State Tested Nursing Assistant (STNA) #210 on 12/05/19 at 12:20 P.M. verified the refrigerator and freezer located in the kitchenette on the transitional care unit was used to store the food that resident's brought into the facility. She stated initially the refrigerator was not locked until one of the former resident's got into the refrigerator and ate other resident's food. She verified the former resident was expired/no longer resides in the facility. She stated there was usually one STNA on the transitional care hallway and if the resident's requested any food from the refrigerated they may have to wait until the STNA was available to unlock the refrigerator. 365600 Page 2 of 14 365600 12/05/2019 Lost Creek Rehabilitation and Nursing Center 804 South Mumaugh Road Lima, OH 45804

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and resident and staff interview, the facility failed to ensure the environment was free from pervasive odors. This affected three (#188, #30, and #13) out of seven residents reviewed. This had the potential to affect 18 (#29, #26, #12, #193, #36, #31, #9, #20, #188, #25, #24, #7, #18, #8, #4, #37, #23 and #32) residents who reside on the 400 hall unit. The current census is 44. Findings include: Observation on 12/02/19 at 8:00 A.M. revealed a strong pervasive odor was noted beginning at the front entrance of the hall to the middle of the hall. The pervasive odor persisted throughout the survey to the exit dated of 12/05/19. Interview on 12/02/19 at 3:10 P.M. with Resident #188 revealed the resident was uncomfortable with the pervasive odor in the resident's hall. Per the resident the smell is constant with no relief. Resident #188 stated the pervasive odor has been in the facility for an extended time and the resident has complained to nurses, housekeepers, and the Administrator with no relief from the odor. Observation of the 400 hallway on 12/02/19 at 9:00 A.M. revealed a very strong pervasive odor near the soiled utility room extending back just beyond room [ROOM NUMBER]. Interview on 12/02/19 at 10:00 A.M. with Resident #13 he stated he has made a couple of friends who lives on the 400 hallway. He stated the 400 hallway smells of a strong urine odor. He stated he has been in the facility for two months and it has always smelled of strong urine. Observation on 12/02/19 at 11:30 A.M. revealed the pervasive odor was present on the 400 hallway. Interview on 12/02/19 at 4:30 P.M. with the Administrator and the Director of Nursing (DON) verified the facility staff are aware of the pervasive odor at the start of the 400 hall. Per the Administrator the pervasive odor is emanating from the soiled linen storage room located in between the beauty shop and the resident's rooms on the 400 hall. On 12/03/19 at 8:15 A.M. the pervasive odor remained in the 400 hallway. On 12/04/19 at 8:30 A.M. the pervasive odor remained in the 400 hallway. Interview on 12/03/19 at 9:19 AM with Resident #30 stated the entrance to the 400 hallway has a bad smell to it. Interview on 12/04/19 at 4:00 P.M. interview with the Maintenance Director #420 stated there has bee a pervasive odor coming from Resident #12 and #18's room for weeks. Observation of Resident #12 and #18's room revealed the floor covering was very worn. The smell did become stronger when approaching the resident in the second bed. The resident was sitting in a fabric chair. The facility confirmed this had the potential to affect 18 (#29, #26, #12, #193, #36, #31, #9, #20, #188, #25, #24, #7, #18, #8, #4, #37, #23 and #32) residents who reside on the 400 hall unit. 365600 Page 3 of 14 365600 12/05/2019 Lost Creek Rehabilitation and Nursing Center 804 South Mumaugh Road Lima, OH 45804

F 0602 Protect each resident from the wrongful use of the resident's belongings or money. 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, review of facility self-reported incidents (SRI's), review of personal files, staff interview, and policy review, the facility failed to ensure residents were free from misappropriation of medications. This affected seven residents, (#25, #29, #37, #189, #190, #191, #192), out of 13 residents reviewed for medications. The current census is 44. Residents Affected - Some Findings include: 1. Review of Resident #25's medical record revealed the resident was admitted to the facility on [DATE]. Diagnoses for Resident #25 include cerebral palsy, osteoarthritis, polyarthritis, and weakness. Review of Resident #25's comprehensive minimum data set, (MDS) dated [DATE] revealed the resident has intact cognition. Review of a facility SRI dated 11/19/19 revealed on 11/18/19 a nurse reported to the Administrator the departing nurse from the previous shift had reported Resident #25 had received an as needed pain medication in the morning. Per the report Resident #25 denied receiving the pain medication when the reporting nurse asked the resident about pain. Per the SRI report, Resident #25 consented to a drug test which was negative for the prescribed pain medication or any other controlled substance. Per the SRI the facility's investigation of the allegation was unsubstantiated as the evidence was inconclusive. Further review of the medications for Resident #25 revealed on 10/15/19 the resident was prescribed to receive Hydrocodone 5/325 milligrams, (mg), every four hours as needed for pain. According to Resident #25's controlled drug record revealed Registered Nurse, (RN) #300 signed out one Hydrocodone tablet on 11/18/19 at 5:15 A.M. Review of Resident #25's Medication Administration Record, (MAR), dated 11/18/19 revealed the resident was administered a Hydrocodone tablet by RN #300. Review of Resident #25's laboratory results revealed on 11/19/19 the resident's drug test results was negative for Hydrocodone. Interview on 12/02/19 at 9:00 A.M. with Resident #25 revealed the resident recalled being interviewed about missing medications but stated she did not have any pain and did not receive any as needed pain medications recently. Interview on 12/04/19 at 2:00 P.M. with the Director of Nursing (DON) revealed all medications for Resident #25 were reviewed after the allegation of misappropriation was reported on 11/18/19. The DON verified when she interviewed Resident #25 the resident claimed she had not taken any of her pain medications. The DON verified the resident agreed to a drug test and the results of the test for the pain medication were negative. Interview on 12/05/19 at 11:20 A.M. with the Administrator and the DON revealed on 11/18/19 after Licensed Practical Nurse, (LPN) #500 reported to the DON the allegation of misappropriation of 365600 Page 4 of 14 365600 12/05/2019 Lost Creek Rehabilitation and Nursing Center 804 South Mumaugh Road Lima, OH 45804

F 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some medications for Resident #25 the DON and Administrator conducted an investigation into the allegation. Per the Administrator the investigation did show missing medications for Resident #25 and other residents. The Administrator stated another SRI dated 11/22/19 was initiated and further medications were discovered to be missing. Per the Administrator all missing medications were signed out by RN #300. Review of the SRI dated 11/22/19 revealed missing narcotic count sheets and medications were discovered by the Administrator and DON during the investigation. Per the SRI, RN #300 was identified as the staff responsible for the missing medications. 2. Review of Resident #29's medical record revealed the resident was admitted to the facility on diagnoses for Resident #29 include obesity, retention of urine, chronic kidney disease, and epilepsy. Review of Resident #29's prescribed medications revealed on 10/04/19 the resident was prescribed to receive Hydrocodone 5/325 mg one tablet every four hours as needed for pain. Review of Resident #29's narcotic count sheets revealed on 11/13/19 RN #300 signed for a new narcotic card for Hydrocodone 5/325 mg. Review of the facility's SRI investigation revealed on 11/13/19 Resident #29 had three Hydrocodone tablets not accounted for on the MAR compared to the narcotic count sheet and card dated 10/28/19. 3. Review of Resident #37's medical record revealed the resident was admitted to the facility on [DATE]. Diagnoses for Resident #37 include heart disease, chronic obstructive pulmonary disease, pneumonia, and arthritis. Review of Resident #37's prescribed medications revealed on 09/03/19 the resident was prescribed to receive Hydrocodone 5/325 mg one tablet every four hours as needed for pain. Review of the facility's SRI investigation revealed from 09/27/19 to 10/10/19 there were 13 Hydrocodone tablets missing from the MAR dated 10/2019 compared to the narcotic count sheets for Resident #37. 4. Review of Resident #189's medical record revealed the resident was admitted to the facility on [DATE] and discharged on 11/15/19. Diagnoses for Resident #189 include heart disease, pain in knees, hypertension, anemia, and diabetes. Review of Resident #189's prescribed medications revealed on 11/01/19 the resident was prescribed to receive Oxycodone 5/325 mg one tablet every four hours as needed for pain. Review of the facility's SRI investigation revealed the from 10/22/19 to 11/03/19 there were three missing Oxycodone tablets missing from the MARs dated 10/2019 to 11/2019 compared to the narcotic count sheets for Resident #189. 5. Review of Resident #190's medical record revealed the resident was admitted to the facility on [DATE] and discharged on 11/15/19. Diagnoses for Resident #190 include heart disease, diabetes, hypertension, and seizures. Review of Resident #190's prescribed medications revealed on 10/07/19 the resident was prescribed 365600 Page 5 of 14 365600 12/05/2019 Lost Creek Rehabilitation and Nursing Center 804 South Mumaugh Road Lima, OH 45804

F 0602 to receive Oxycodone 5/325 mg one tablet four times a day for pain. Level of Harm - Minimal harm or potential for actual harm Review of the facility's SRI investigation revealed RN #300 signed out another narcotic card with documenting the card was emptied. Per the resident's MAR the narcotic count did not match the amount of Oxycodone administered to Resident #190. Residents Affected - Some 6. Record review of Resident #191 revealed the resident was admitted to the facility on [DATE] and discharged on 10/22/19. Diagnoses for Resident #191 include malignant neoplasm of colon and liver, dysphagia, pain, and weakness. Review of Resident #191's physician orders revealed on 07/27/19 the resident was ordered to receive Oxycodone 5/325 mg every four hours as needed for pain. Review of the facility's investigation into Resident #191's medical record revealed the resident's narcotic control record and narcotic pill card did not match. Per the investigation, 13 Oxycodone tablets were missing. 7. Record review for Resident #192 revealed the resident was admitted to the facility on [DATE] and discharged on 09/13/19. Diagnoses for Resident #192 include surgical care of digestive system, dysphagia, seizures, and falls. Review of Resident #192's physician orders revealed on 08/27/19 the resident was ordered to receive Oxycodone-Acetaminophen 5/325 mg every four hours as needed for pain. Review of the facility's investigation into Resident #192's record revealed there was one Oxycodone tablet missing from the resident's narcotic control record and narcotic pill card. Review of RN #300's employee file revealed the nurse was hired at the facility on 02/09/19. The nurse signed the abuse policy on 02/09/19. Review of the disciplinary document in the employee's file revealed the nurse was discharged from employment on 11/19/19. Interview on 12/05/19 at 11:20 A.M. with the Administrator and the DON revealed on 11/22/19 the Administrator initiated another SRI and investigation into all the resident's narcotic count sheet and MARs dated from 09/2019. Per the Administrator the investigation was continuing due to RN #300's employment started on 02/09/19. The Administrator verified there was a total of 43 missing medications from seven (#25, #29, #27, #189, #190, #191 and #192) residents discovered during the facility's investigation. The DON and Administrator verified RN #300 was the nurse responsible for all the missing medications. The Administrator verified RN #300 was hired in 02/2019 and the DON and Administrator started to investigate the missing medications from 09/2019 to 11/2019. The Administrator stated due to time constraints the full/thorough investigation had not been completed at the time of the survey. Review of the undated facility policy titled, 'Abuse', revealed the resident's have the right to be free from misappropriation. Per the policy the facility will prevent all misappropriation of resident's property. 365600 Page 6 of 14 365600 12/05/2019 Lost Creek Rehabilitation and Nursing Center 804 South Mumaugh Road Lima, OH 45804

F 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. 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, review of facility self-reported incidents (SRI's), review of personal files, staff interview, and policy review, the facility failed to implement their abuse policy to ensure residents were free from misappropriation of medications and to ensure misappropriation of medications was thoroughly investigated. This affected seven residents, (#25, #29, #37, #189, #190, #191, #192), out of 13 residents reviewed for medications. The current census is 44. Residents Affected - Some Findings include: 1. Review of Resident #25's medical record revealed the resident was admitted to the facility on [DATE]. Diagnoses for Resident #25 include cerebral palsy, osteoarthritis, polyarthritis, and weakness. Review of Resident #25's comprehensive minimum data set, (MDS) dated [DATE] revealed the resident has intact cognition. Review of a facility SRI dated 11/19/19 revealed on 11/18/19 a nurse reported to the Administrator the departing nurse from the previous shift had reported Resident #25 had received an as needed pain medication in the morning. Per the report Resident #25 denied receiving the pain medication when the reporting nurse asked the resident about pain. Per the SRI report, Resident #25 consented to a drug test which was negative for the prescribed pain medication or any other controlled substance. Per the SRI the facility's investigation of the allegation was unsubstantiated as the evidence was inconclusive. Further review of the medications for Resident #25 revealed on 10/15/19 the resident was prescribed to receive Hydrocodone 5/325 milligrams, (mg), every four hours as needed for pain. According to Resident #25's controlled drug record revealed Registered Nurse, (RN) #300 signed out one Hydrocodone tablet on 11/18/19 at 5:15 A.M. Review of Resident #25's Medication Administration Record, (MAR), dated 11/18/19 revealed the resident was administered a Hydrocodone tablet by RN #300. Review of Resident #25's laboratory results revealed on 11/19/19 the resident's drug test results was negative for Hydrocodone. Interview on 12/02/19 at 9:00 A.M. with Resident #25 revealed the resident recalled being interviewed about missing medications but stated she did not have any pain and did not receive any as needed pain medications recently. Interview on 12/04/19 at 2:00 P.M. with the Director of Nursing (DON) revealed all medications for Resident #25 were reviewed after the allegation of misappropriation was reported on 11/18/19. The DON verified when she interviewed Resident #25 the resident claimed she had not taken any of her pain medications. The DON verified the resident agreed to a drug test and the results of the test for the pain medication were negative. Interview on 12/05/19 at 11:20 A.M. with the Administrator and the DON revealed on 11/18/19 after 365600 Page 7 of 14 365600 12/05/2019 Lost Creek Rehabilitation and Nursing Center 804 South Mumaugh Road Lima, OH 45804

F 0607 Level of Harm - Minimal harm or potential for actual harm Licensed Practical Nurse, (LPN) #500 reported to the DON the allegation of misappropriation of medications for Resident #25 the DON and Administrator conducted an investigation into the allegation. Per the Administrator the investigation did show missing medications for Resident #25 and other residents. The Administrator stated another SRI dated 11/22/19 was initiated and further medications were discovered to be missing. Per the Administrator all missing medications were signed out by RN #300. Residents Affected - Some Review of the SRI dated 11/22/19 revealed missing narcotic count sheets and medications were discovered by the Administrator and DON during the investigation. Per the SRI, RN #300 was identified as the staff responsible for the missing medications. 2. Review of Resident #29's medical record revealed the resident was admitted to the facility on diagnoses for Resident #29 include obesity, retention of urine, chronic kidney disease, and epilepsy. Review of Resident #29's prescribed medications revealed on 10/04/19 the resident was prescribed to receive Hydrocodone 5/325 mg one tablet every four hours as needed for pain. Review of Resident #29's narcotic count sheets revealed on 11/13/19 RN #300 signed for a new narcotic card for Hydrocodone 5/325 mg. Review of the facility's SRI investigation revealed on 11/13/19 Resident #29 had three Hydrocodone tablets not accounted for on the MAR compared to the narcotic count sheet and card dated 10/28/19. 3. Review of Resident #37's medical record revealed the resident was admitted to the facility on [DATE]. Diagnoses for Resident #37 include heart disease, chronic obstructive pulmonary disease, pneumonia, and arthritis. Review of Resident #37's prescribed medications revealed on 09/03/19 the resident was prescribed to receive Hydrocodone 5/325 mg one tablet every four hours as needed for pain. Review of the facility's SRI investigation revealed from 09/27/19 to 10/10/19 there were 13 Hydrocodone tablets missing from the MAR dated 10/2019 compared to the narcotic count sheets for Resident #37. 4. Review of Resident #189's medical record revealed the resident was admitted to the facility on [DATE] and discharged on 11/15/19. Diagnoses for Resident #189 include heart disease, pain in knees, hypertension, anemia, and diabetes. Review of Resident #189's prescribed medications revealed on 11/01/19 the resident was prescribed to receive Oxycodone 5/325 mg one tablet every four hours as needed for pain. Review of the facility's SRI investigation revealed the from 10/22/19 to 11/03/19 there were three missing Oxycodone tablets missing from the MARs dated 10/2019 to 11/2019 compared to the narcotic count sheets for Resident #189. 5. Review of Resident #190's medical record revealed the resident was admitted to the facility on [DATE] and discharged on 11/15/19. Diagnoses for Resident #190 include heart disease, diabetes, hypertension, and seizures. 365600 Page 8 of 14 365600 12/05/2019 Lost Creek Rehabilitation and Nursing Center 804 South Mumaugh Road Lima, OH 45804

F 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of Resident #190's prescribed medications revealed on 10/07/19 the resident was prescribed to receive Oxycodone 5/325 mg one tablet four times a day for pain. Review of the facility's SRI investigation revealed RN #300 signed out another narcotic card with documenting the card was emptied. Per the resident's MAR the narcotic count did not match the amount of Oxycodone administered to Resident #190. 6. Record review of Resident #191 revealed the resident was admitted to the facility on [DATE] and discharged on 10/22/19. Diagnoses for Resident #191 include malignant neoplasm of colon and liver, dysphagia, pain, and weakness. Review of Resident #191's physician orders revealed on 07/27/19 the resident was ordered to receive Oxycodone 5/325 mg every four hours as needed for pain. Review of the facility's investigation into Resident #191's medical record revealed the resident's narcotic control record and narcotic pill card did not match. Per the investigation, 13 Oxycodone tablets were missing. 7. Record review for Resident #192 revealed the resident was admitted to the facility on [DATE] and discharged on 09/13/19. Diagnoses for Resident #192 include surgical care of digestive system, dysphagia, seizures, and falls. Review of Resident #192's physician orders revealed on 08/27/19 the resident was ordered to receive Oxycodone-Acetaminophen 5/325 mg every four hours as needed for pain. Review of the facility's investigation into Resident #192's record revealed there was one Oxycodone tablet missing from the resident's narcotic control record and narcotic pill card. Review of RN #300's employee file revealed the nurse was hired at the facility on 02/09/19. The nurse signed the abuse policy on 02/09/19. Review of the disciplinary document in the employee's file revealed the nurse was discharged from employment on 11/19/19. Interview on 12/05/19 at 11:20 A.M. with the Administrator and the DON revealed on 11/22/19 the Administrator initiated another SRI and investigation into all the resident's narcotic count sheet and MARs dated from 09/2019. Per the Administrator the investigation was continuing due to RN #300's employment started on 02/09/19. The Administrator verified there was a total of 43 missing medications from seven (#25, #29, #27, #189, #190, #191 and #192) residents discovered during the facility's investigation. The DON and Administrator verified RN #300 was the nurse responsible for all the missing medications. The Administrator verified RN #300 was hired in 02/2019 and the DON and Administrator started to investigate the missing medications from 09/2019 to 11/2019. The Administrator stated due to time constraints the full/thorough investigation had not been completed at the time of the survey. Review of the undated facility policy titled, 'Abuse', revealed the resident's have the right to be free from misappropriation. Per the policy the facility will prevent all misappropriation of resident's property. Per the policy the facility Administrator will conduct a full investigation into allegations of abuse. 365600 Page 9 of 14 365600 12/05/2019 Lost Creek Rehabilitation and Nursing Center 804 South Mumaugh Road Lima, OH 45804

F 0610 Respond appropriately to all alleged violations. 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, review of facility self-reported incidents (SRI's), review of personal files, staff interview, and policy review, the facility failed to ensure misappropriation of medications was thoroughly investigated. This affected seven residents, (#25, #29, #37, #189, #190, #191, #192), out of 13 residents reviewed for medications. The current census is 44. Residents Affected - Some Findings include: 1. Review of Resident #25's medical record revealed the resident was admitted to the facility on [DATE]. Diagnoses for Resident #25 include cerebral palsy, osteoarthritis, polyarthritis, and weakness. Review of Resident #25's comprehensive minimum data set, (MDS) dated [DATE] revealed the resident has intact cognition. Review of a facility SRI dated 11/19/19 revealed on 11/18/19 a nurse reported to the Administrator the departing nurse from the previous shift had reported Resident #25 had received an as needed pain medication in the morning. Per the report Resident #25 denied receiving the pain medication when the reporting nurse asked the resident about pain. Per the SRI report, Resident #25 consented to a drug test which was negative for the prescribed pain medication or any other controlled substance. Per the SRI the facility's investigation of the allegation was unsubstantiated as the evidence was inconclusive. Further review of the medications for Resident #25 revealed on 10/15/19 the resident was prescribed to receive Hydrocodone 5/325 milligrams, (mg), every four hours as needed for pain. According to Resident #25's controlled drug record revealed Registered Nurse, (RN) #300 signed out one Hydrocodone tablet on 11/18/19 at 5:15 A.M. Review of Resident #25's Medication Administration Record, (MAR), dated 11/18/19 revealed the resident was administered a Hydrocodone tablet by RN #300. Review of Resident #25's laboratory results revealed on 11/19/19 the resident's drug test results was negative for Hydrocodone. Interview on 12/02/19 at 9:00 A.M. with Resident #25 revealed the resident recalled being interviewed about missing medications but stated she did not have any pain and did not receive any as needed pain medications recently. Interview on 12/04/19 at 2:00 P.M. with the Director of Nursing (DON) revealed all medications for Resident #25 were reviewed after the allegation of misappropriation was reported on 11/18/19. The DON verified when she interviewed Resident #25 the resident claimed she had not taken any of her pain medications. The DON verified the resident agreed to a drug test and the results of the test for the pain medication were negative. Interview on 12/05/19 at 11:20 A.M. with the Administrator and the DON revealed on 11/18/19 after Licensed Practical Nurse, (LPN) #500 reported to the DON the allegation of misappropriation of 365600 Page 10 of 14 365600 12/05/2019 Lost Creek Rehabilitation and Nursing Center 804 South Mumaugh Road Lima, OH 45804

F 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some medications for Resident #25 the DON and Administrator conducted an investigation into the allegation. Per the Administrator the investigation did show missing medications for Resident #25 and other residents. The Administrator stated another SRI dated 11/22/19 was initiated and further medications were discovered to be missing. Per the Administrator all missing medications were signed out by RN #300. Review of the SRI dated 11/22/19 revealed missing narcotic count sheets and medications were discovered by the Administrator and DON during the investigation. Per the SRI, RN #300 was identified as the staff responsible for the missing medications. 2. Review of Resident #29's medical record revealed the resident was admitted to the facility on diagnoses for Resident #29 include obesity, retention of urine, chronic kidney disease, and epilepsy. Review of Resident #29's prescribed medications revealed on 10/04/19 the resident was prescribed to receive Hydrocodone 5/325 mg one tablet every four hours as needed for pain. Review of Resident #29's narcotic count sheets revealed on 11/13/19 RN #300 signed for a new narcotic card for Hydrocodone 5/325 mg. Review of the facility's SRI investigation revealed on 11/13/19 Resident #29 had three Hydrocodone tablets not accounted for on the MAR compared to the narcotic count sheet and card dated 10/28/19. 3. Review of Resident #37's medical record revealed the resident was admitted to the facility on [DATE]. Diagnoses for Resident #37 include heart disease, chronic obstructive pulmonary disease, pneumonia, and arthritis. Review of Resident #37's prescribed medications revealed on 09/03/19 the resident was prescribed to receive Hydrocodone 5/325 mg one tablet every four hours as needed for pain. Review of the facility's SRI investigation revealed from 09/27/19 to 10/10/19 there were 13 Hydrocodone tablets missing from the MAR dated 10/2019 compared to the narcotic count sheets for Resident #37. 4. Review of Resident #189's medical record revealed the resident was admitted to the facility on [DATE] and discharged on 11/15/19. Diagnoses for Resident #189 include heart disease, pain in knees, hypertension, anemia, and diabetes. Review of Resident #189's prescribed medications revealed on 11/01/19 the resident was prescribed to receive Oxycodone 5/325 mg one tablet every four hours as needed for pain. Review of the facility's SRI investigation revealed the from 10/22/19 to 11/03/19 there were three missing Oxycodone tablets missing from the MARs dated 10/2019 to 11/2019 compared to the narcotic count sheets for Resident #189. 5. Review of Resident #190's medical record revealed the resident was admitted to the facility on [DATE] and discharged on 11/15/19. Diagnoses for Resident #190 include heart disease, diabetes, hypertension, and seizures. Review of Resident #190's prescribed medications revealed on 10/07/19 the resident was prescribed 365600 Page 11 of 14 365600 12/05/2019 Lost Creek Rehabilitation and Nursing Center 804 South Mumaugh Road Lima, OH 45804

F 0610 to receive Oxycodone 5/325 mg one tablet four times a day for pain. Level of Harm - Minimal harm or potential for actual harm Review of the facility's SRI investigation revealed RN #300 signed out another narcotic card with documenting the card was emptied. Per the resident's MAR the narcotic count did not match the amount of Oxycodone administered to Resident #190. Residents Affected - Some 6. Record review of Resident #191 revealed the resident was admitted to the facility on [DATE] and discharged on 10/22/19. Diagnoses for Resident #191 include malignant neoplasm of colon and liver, dysphagia, pain, and weakness. Review of Resident #191's physician orders revealed on 07/27/19 the resident was ordered to receive Oxycodone 5/325 mg every four hours as needed for pain. Review of the facility's investigation into Resident #191's medical record revealed the resident's narcotic control record and narcotic pill card did not match. Per the investigation, 13 Oxycodone tablets were missing. 7. Record review for Resident #192 revealed the resident was admitted to the facility on [DATE] and discharged on 09/13/19. Diagnoses for Resident #192 include surgical care of digestive system, dysphagia, seizures, and falls. Review of Resident #192's physician orders revealed on 08/27/19 the resident was ordered to receive Oxycodone-Acetaminophen 5/325 mg every four hours as needed for pain. Review of the facility's investigation into Resident #192's record revealed there was one Oxycodone tablet missing from the resident's narcotic control record and narcotic pill card. Review of RN #300's employee file revealed the nurse was hired at the facility on 02/09/19. The nurse signed the abuse policy on 02/09/19. Review of the disciplinary document in the employee's file revealed the nurse was discharged from employment on 11/19/19. Interview on 12/05/19 at 11:20 A.M. with the Administrator and the DON revealed on 11/22/19 the Administrator initiated another SRI and investigation into all the resident's narcotic count sheet and MARs dated from 09/2019. Per the Administrator the investigation was continuing due to RN #300's employment started on 02/09/19. The Administrator verified there was a total of 43 missing medications from seven (#25, #29, #27, #189, #190, #191 and #192) residents discovered during the facility's investigation. The DON and Administrator verified RN #300 was the nurse responsible for all the missing medications. The Administrator verified RN #300 was hired in 02/2019 and the DON and Administrator started to investigate the missing medications from 09/2019 to 11/2019. The Administrator stated due to time constraints the full/thorough investigation had not been completed at the time of the survey. Review of the undated facility policy titled, 'Abuse', revealed the resident's have the right to be free from misappropriation. Per the policy the facility will prevent all misappropriation of resident's property. Per the policy the facility Administrator will conduct a full investigation into allegations of abuse. 365600 Page 12 of 14 365600 12/05/2019 Lost Creek Rehabilitation and Nursing Center 804 South Mumaugh Road Lima, OH 45804

F 0685 Assist a resident in gaining access to vision and hearing 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 and family and and staff interview the facility failed to ensure residents had there assistive devices, glasses, to maintain their highest abilities at all times. This affected one (#7) out of three residents reviewed for assistive devices. The current census is 44. Residents Affected - Few Findings include: Review of Resident #7's medical record revealed the resident was admitted to the facility on [DATE]. Diagnoses for Resident #7 include heart disease, dementia, overactive bladder, and altered mental status. Review of the minimum data set (MDS) comprehensive assessment dated [DATE] revealed the resident has impaired cognition and does have corrective lens for vision. Review of the electronic medical record for Resident #7 included a picture of the resident, in the picture the resident was wearing glasses. Review of Resident #7's care plans dated 10/05/16 revealed a focus for impaired vision. Per the care the resident received a new pair of glasses on 10/06/16. Interventions for the focus include the resident is to wear her glasses at all times. Interview on 12/03/19 at 10:00 A.M. with Resident #7's family representative revealed the family have reported to the facility Resident #7 has lost her glasses at the facility awhile ago, unable to recall exact date but stated felt like two to three months. Per the representative there has been no response from the facility to the family to notify them if the glasses have been searched for or found. Per the family representative, Resident #7 was admitted with glasses and needs the glasses to read the newspaper which is the resident's preferred activity. Observation on 12/05/19 at 8:02 A.M. of Resident #7 revealed the resident was sitting in her wheelchair in the main lounge of the facility. Resident #7 was observed with no glasses on. Resident #7 was observed calm with a newspaper located on the table within reach. It did not appear Resident #7 was reading the newspaper during the observation. Interview on 12/05/19 at 12:03 P.M. with the Business Office Manager, (BOM), revealed the BOM had no knowledge if Resident #7 wore glasses. Per the BOM she has never observed the resident with glasses. The BOM verified Resident #7 was not wearing glasses during the observation on 12/05/19. Interview on 12/05/19 at 1:10 P.M. with MDS Nurse #100 revealed after searching for Resident #7's glasses in the resident room and around the facility the resident's glasses were located in the social services office in the desk. Per MDS Nurse #100 there was no knowledge of how long the glasses were in the social service office or when the glasses were reported missing. Per MDS Nurse #100 the social worker was unable to be interviewed due to illness. 365600 Page 13 of 14 365600 12/05/2019 Lost Creek Rehabilitation and Nursing Center 804 South Mumaugh Road Lima, OH 45804

F 0807 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides drinks consistent with resident needs and preferences and sufficient to maintain resident hydration. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation and staff and resident interview, the facility failed to provide ice water to a resident per request. This affected one (#188) out of seven residents reviewed for choices. The current census is 44. Findings include: Record review of Resident #188 revealed the resident was admitted to the facility on [DATE]. Diagnoses for Resident #188 include fusion of spine, disorder of the muscles, convulsions, seizures, depression, anxiety, asthma, hypertension, and syncope and collapse. Review of the Minimum Data Set, (MDS), comprehensive assessment dated [DATE] revealed Resident #188 had intact cognition. Interview on 12/02/19 at 3:10 P.M. with Resident #188 revealed due to the broken ice machine in the dining room the second shift staff are not able to provide resident's fresh ice water during the dinner meal preparation. Resident #188 stated the aides are not allowed to enter the kitchen and get ice out of the only machine that is working. Resident #188 stated the ice machine in the dining room has been broken for weeks and stated the residents have complained to the Administrator about the broken machine. Observation on 12/02/19 at 6:00 P.M. of Resident #188's water pitcher in the resident's room revealed there was no ice in the water pitcher. Interview on 12/0219 at 11:01 A.M. with Maintenance Manager #420 revealed the ice machine in the main dining room is accessible to the resident's but has been broken for three months. Interview on 12/03/19 at 5:10 P.M. with State Tested Nurse Aide, (STNA) #411, revealed there was an issue obtaining ice during the dinner service. Per the STNA the only working ice machine is located in the kitchen and during meal preparation the aides are not able to get ice for resident's water. Per the aide the resident's are served ice water once per shift and upon request. 365600 Page 14 of 14