Health inspection·December 20, 2023

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** THE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NON-COMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Based on review of the facility fall log, resident medical record and staff interview, the facility failed to ensure Resident #98's physician and family were timely notified of a change in resident condition including falls and hospital transfer. This affected one resident (#98) of three residents reviewed for falls. The facility census was 98. Findings include: Review of the facility fall and accident log for the last 30 days (11/12/23- 12/12/23) revealed Resident #98 had four falls on 11/29/23. Review of Resident #98's closed medical record revealed an admission date of 02/18/19 with diagnoses that included chronic obstructive pulmonary disease and hypertension. Resident #98 was transferred to the hospital on [DATE] and did not return to the facility. Review of the resident's nursing progress notes revealed the first nursing progress note completed on 11/29/23 was an entry dated 11/29/23 at 9:45 A.M. as a late entry note. The note included the following: This nurse arrived on the unit at nurses request that resident be transferred to a psychiatric hospital for evaluation due to falls. Staff reported two unwitnessed falls this morning. The resident was noted to have purple discoloration to the right fourth knuckle and forearm and light purple scattered petechiae to her face. The note revealed the resident denied pain and had active range of motion/typical strength at that time. The note revealed the Psych 360 Nurse Practitioner would be in the facility tomorrow to evaluate the resident. The note failed to contain any evidence the physician and/or resident's family were notified of these falls. The next nursing progress note, dated 11/29/23 at 3:02 P.M. revealed the resident was found on the floor in her bathroom by an STNA after she had taken in her breakfast tray. When asked what happened the resident stared blankly at staff. Ten minutes later the resident was observed by the STNA attempting to sit on the floor and roll around, back and forth in front of her bed. When asked what happened at that time she was breathing with pursed lips with a moan on exhale and wouldn't answer any of staff's questions. This note indicated the physician was notified but did not return call. The resident was brought to the hallway in a wheelchair to be monitored by floor nursing staff. The resident continued to try to stand up and ambulate without assistance or rollator walker. A short while later, during lunch, staff had found her with her left leg around the wheelchair break handle and she was laying in the seat of the wheelchair holding on to the backrest. Staff assisted the resident to Page 1 of 11 365604 365604 12/20/2023 Green Meadows Skilled Nursing and Rehab 7770 Columbus Road NE Louisville, OH 44641

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few stand and sit in the wheelchair. Resident refused her lunch tray. Just as shift had changed at roughly 2:42 P.M., when on-coming nurse turned onto the hallway, the resident stood without assistance and fell forward onto her face. She hit her face on the floor and had a very large lump with purple bruising. The resident's forehead also had some small red dots that resembled petechiae. The resident's left dorsal hand had a large purple bruise as well as her left forearm showed purple bruising. The physician was called with no response. The afternoon shift nurse assessed the resident. 911 called. Review of the facility fall investigations for Resident #98 revealed four falls on 11/29/23: The first fall occurred at 8:00 A.M. with no evidence physician or family notification was completed. The second fall occurred at 8:30 A.M. with no evidence physician or family notification was completed. The third fall occurred at 8:50 A.M. with no evidence physician or family notification was completed. The resident sustained a fourth fall at 3:00 P.M., there was no evidence the resident's family was notified timely following this fall. After the fourth fall, Resident #98 was sent to the local hospital for evaluation. No evidence of family notification of emergency transfer was found. On 12/12/23 at 11:55 A.M. interview with the Director of Nursing verified on 11/29/23 nursing staff failed to notify and document family and physician notification related to Resident #98's falls and hospital transfer. The deficiency was corrected on 12/01/23 after the facility implemented the following corrective actions: • On 11/29/23 Resident #98 was assessed by nursing staff and sent to the hospital for evaluation. • On 11/29/23 Resident #98's physician was notified of the change in condition and transfer to the hospital. • On 12/06/23 floor nurse Licensed Practical Nurse (LPN) #113 for Resident #98 on 11/29/23 was terminated. Last day working in the facility for LPN #113 was 11/29/23. • On 12/01/23 DON conducted an audit of all resident falls in the past 30 days to ensure the family and physician were notified. Negative findings were corrected immediately. 365604 Page 2 of 11 365604 12/20/2023 Green Meadows Skilled Nursing and Rehab 7770 Columbus Road NE Louisville, OH 44641

F 0580 • Level of Harm - Minimal harm or potential for actual harm On 12/01/23 all licensed nursing staff were educated on notification of physician by the DON. • Residents Affected - Few On 12/01/23 an ad hoc Quality Assessment and Performance Improvement (QAPI) meeting was held to review the facility identified concerns related to notification. • Beginning 12/01/23 weekly for four weeks, the DON or designee would audit four falls to ensure the family and physician were notified. The audits would be submitted weekly to the QAPI committee for tracking, trending and recommendations. • The surveyor review of an additional two resident records with identified falls (between 11/30/23 and 12/20/23) with no additional concerns identified related to physician and family notification . This deficiency represents non-compliance investigated under Complaint Number OH00148864. 365604 Page 3 of 11 365604 12/20/2023 Green Meadows Skilled Nursing and Rehab 7770 Columbus Road NE Louisville, OH 44641

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of resident photographs, facility fall log review, resident medical record review, facility policy review and staff interview, the facility failed to appropriately identify and assess an acute change in Resident #98's condition (including altered mental status/and increased falls) to provide timely medical intervention/treatment for the resident. This affected one resident (#98) of three residents reviewed for falls. The facility census was 98. Residents Affected - Few Actual harm occurred on 11/29/23 when Resident #98, who experienced an acute change in condition including three falls within an hour (between 8:00 A.M. and 9:00 A.M.), was not comprehensively assessed or provided timely medical evaluation/intervention. On 11/29/23 at approximately 2:42 P.M., following a fourth fall on this date, Resident #98 was transferred to the local emergency department for evaluation where she was assessed to have an elevated temperature of 103.1 degrees Fahrenheit (F) and was admitted for treatment of a urinary tract infection. The resident was hospitalized until 12/07/23. Findings include: Review of Resident #98's closed medical record revealed an admission date of 02/18/19 with diagnoses that included chronic obstructive pulmonary disease and hypertension. The resident was transferred to the hospital on [DATE] and did not return to the facility. Review of an Activity of Daily Living (ADL) self care performance deficit care plan dated 09/29/22 revealed the resident transferred with supervision assistance and used a walker for ambulation and transfer. Review of Resident #98's Minimum Data Set (MDS) 3.0 annual assessment with a reference date of 11/04/23 indicated the resident had an independent cognition level, used a walker for ambulation, required independent to limited staff assistance with mobility, was independent for transfers, was at risk for falls and had no falls since the previous assessment. Review of the resident's nursing progress notes revealed the first nursing progress note completed on 11/29/23 was an entry dated 11/29/23 at 9:45 A.M. as a late entry note. The note included the following: This nurse arrived on the unit at nurses request that resident be transferred to a psychiatric hospital for evaluation due to falls. Staff reported two unwitnessed falls this morning. The resident was noted to have purple discoloration to the right fourth knuckle and forearm and light purple scattered petechiae to her face. The note revealed the resident denied pain and had active range of motion/typical strength at that time. The note revealed the Psych 360 Nurse Practitioner would be in the facility tomorrow to evaluate the resident. Review of the facility fall and accident log for the last 30 days (11/12/23-12/12/23) revealed Resident #98 sustained four falls on 11/29/23. The resident, who had been assessed previously to have independent cognition, required limited assistance with transfers and no recent history of falls, sustained three falls within an hour (8:00 A.M., 8:30 A.M. and 8:50 A.M.) with noted increase in confusion during this time period. A fall investigation, completed on 12/01/23 by the Director of Nursing (DON) revealed on 11/29/23 at 8:00 A.M. Resident #98 experienced an unwitnessed fall in her bathroom. Staff indicated the 365604 Page 4 of 11 365604 12/20/2023 Green Meadows Skilled Nursing and Rehab 7770 Columbus Road NE Louisville, OH 44641

F 0684 Level of Harm - Actual harm Residents Affected - Few resident was not using her rollator walker to assist with ambulation. Staff assisted the resident back to her bed with walker and reminded the resident to use the walker for ambulation. State Tested Nurse Aide (STNA) reported bruising noted to resident's right hand knuckles, right arm and right side of face. There was no evidence of any additional comprehensive assessment being completed, including vital signs or changes in the resident medical/mental condition or status following this fall. Neither the physician or resident's family were notified of this fall. A fall investigation, completed on 12/01/23 by the DON revealed on 11/29/23 at 8:30 A.M. Resident #98 experienced an unwitnessed fall in her room near her doorway. Staff members were ambulating through the hallway picking up breakfast trays when the STNA observed the resident laying on her right side on the floor. Resident #98's oxygen concentrator was nearby and unplugged from the wall. [NAME] remained near the bed. STNA reports she notified nurse who assessed the resident. Resident assisted to bed in lowest position and oxygen reapplied. The investigation identified the root cause of fall was weakness, impaired gait, ambulating without assistance with lack of required oxygen therapy as a contributing factor. There was no evidence of any additional comprehensive assessment being completed, including vital signs or changes in the resident medical/mental condition or status following this fall or additional information related to the resident's weakness or impaired gait. Neither the physician or resident's family were notified of this fall. A fall investigation, completed on 12/01/23 by the DON revealed on 11/29/23 at 8:50 A.M. Resident #98 sustained an unwitnessed fall in her room at the bedside. The STNA ambulated past the resident's room and found her on the floor next to bed rolling back and forth. The STNA alerted the resident's nurse. The resident was unable to offer insight in cause of fall. STNA and nurse assisted resident into wheelchair with Dycem seating surface and anti-tippers then positioned resident in hallway next to nurse's station for supervision. The root cause analysis indicated the resident had poor safety awareness with increased confusion noted at this time. There was no evidence of any additional comprehensive assessment being completed, including vital signs or changes in the resident medical/mental condition or status following this fall or additional information related to the resident's increased confusion at that time. Neither the physician or resident's family were notified of this fall. Record review revealed no nursing progress notes were documented between the note on 11/29/23 at 9:45 A.M. and the note on 11/29/23 at 3:02 P.M. The nursing progress note, dated 11/29/23 at 3:02 P.M. revealed the resident was found on the floor in her bathroom by an STNA after she had taken in her breakfast tray. When asked what happened the resident stared blankly at staff. Ten minutes later the resident was observed by the STNA attempting to sit on the floor and roll around, back and forth in front of her bed. When asked what happened at that time she was breathing with pursed lips with a moan on exhale and wouldn't answer any of staff's questions. Physician notified but did not return call. The note revealed the DON was notified and had refused to let this nurse send resident out to emergency room for observation and follow-up, stating there is nothing wrong with the resident that she needs to be sent out for. The resident was brought to the hallway in a wheelchair to be monitored by floor nursing staff. The resident continued to try to stand up and ambulate without assistance or rollator walker. A short while later, during lunch, staff had found her with her left leg around the wheelchair break handle and she was laying in the seat of the wheelchair holding on to the backrest. Staff assisted the resident to stand and sit in the wheelchair. Resident refused her lunch tray. Just as shift had changed at roughly 2:42 P.M., when on-coming nurse turned onto the hallway, the resident stood without assistance and fell forward onto her face. She hit her face on the floor and had a very large lump with purple bruising. The resident's forehead also had some small red dots that resembled petechiae. The resident's left 365604 Page 5 of 11 365604 12/20/2023 Green Meadows Skilled Nursing and Rehab 7770 Columbus Road NE Louisville, OH 44641

F 0684 Level of Harm - Actual harm Residents Affected - Few dorsal hand had a large purple bruise as well as her left forearm showed purple bruising. The physician was called with no response. The afternoon shift nurse assessed the resident. The note revealed DON notified and still refusing to send resident out but with persistence from this nurse DON than said to send her out and that she was done arguing with this nurse. 911 called. The nursing progress note also included the resident had shown some behaviors prior to these events. Regular floor staff noticed behaviors that had seemed to become worse over a short period of time that was observed after a medication dosage was decreased. Floor staff had asked that the resident's medication be reviewed and tailored to address her specific needs due to a decline in mood and behaviors starting. The DON and Assistant Director of Nursing (ADON) didn't think the resident would benefit from a review and nothing else had been said by them about it. The nursing progress note revealed the nurse completing the note asked multiple times this shift for one on one assistance and was denied by DON and ADON. Review of a facility fall investigation revealed Resident #98 sustained a fourth fall on 11/29/23 at 3:00 P.M. The fall investigation, completed by the DON on 12/01/23 revealed Resident #98 experienced a fall in the hallway that resulted in bruising to her face when she rose from her wheelchair to ambulate without assistance and fell forward striking her face on the floor. An STNA reported she heard a noise followed by the nurse calling for help and came out of a resident's room to observe the resident on the floor on her abdomen. The STNA assisted other staff to position the resident back in her wheelchair and immediately noted bruising over the resident's left eye and bleeding from her left wrist. The STNA then observed the nurse notify the DON and call 911 for transfer to the emergency room for evaluation. Root cause of fall was altered cognition related to acute illness and intervention was evaluation in emergency room. The nursing notes revealed no evidence of comprehensive resident assessment including assessment of vital signs, cognition and overall status after each of the the first three falls (11/29/23 at 8:00 A.M., 8:30 A.M., and 8:50 A.M.). After the fourth fall (11/29/23 at 3:00 P.M.), Resident #98 was assessed for injury with blood pressure, heart rate and respiration rate assessed with pulse of 121 beats per minute, respirations of 24 breaths per minute and blood pressure of 129/91 mmHg (millimeters of mercury). There was no evidence the vital sign assessment included obtaining the resident's body temperature. The last temperature recorded for the resident was on 11/26/23 at 9:55 A.M. with temperature of 97.4 F. A nursing note on 11/29/23 at 9:20 P.M. indicated Resident #98 was still at the hospital and had (an elevated) temperature of 103.1 degrees F. An additional nursing note on 11/29/23 at 11:50 P.M., indicated Resident #98 was admitted to the hospital with admission diagnoses that included altered mental status, urinary tract infection and status post fall. Review of photographs, taken of Resident #98 on 11/29/23 at the hospital, provided by the resident's representative revealed numerous bruises to the resident's bilateral eyes, forehead, right elbow, left elbow and forearm and right hand. All bruises were red to purple in color and new in appearance. Review of hospital emergency room evaluation and admission records revealed Resident #98 was admitted to the hospital from [DATE] to 12/07/23 with admission diagnoses that included mechanical falls, urinary tract infection, concussion and extracranial scalp hematoma. Hospital stay was complicated with respiratory failure and urinary retention. admission history and physical identified bruising 365604 Page 6 of 11 365604 12/20/2023 Green Meadows Skilled Nursing and Rehab 7770 Columbus Road NE Louisville, OH 44641

F 0684 Level of Harm - Actual harm Residents Affected - Few and swelling around both eyes. Urinalysis identified a large amount of bacteria growth in the resident's urine. Temperature was assessed as being 103.1 degrees F. The resident did not return to the facility following this hospitalization. On 12/12/23 at 11:55 A.M. interview with the Director of Nursing revealed on 11/29/23 nursing staff failed to completely assess Resident #98 following falls including assessment with vital signs and temperature. The DON further verified Resident #98 was admitted to the hospital with a UTI and altered mental status which was a probable cause of the falls on 11/29/23. The surveyor requested to review the facility's post fall assessment policy. On 12/19/23 at 10:30 A.M. the DON reported no post fall assessment policy was found. Review of the facility undated policy Change in Resident's Condition or Status revealed the nurse would notify the resident's attending physician or physician on call when there has been a(an) accident or incident involving the resident. The nurse would record in the resident's medical record information relative to changes in the resident medical/mental condition or status. This deficiency represents non-compliance investigated under Complaint Number OH00148864. 365604 Page 7 of 11 365604 12/20/2023 Green Meadows Skilled Nursing and Rehab 7770 Columbus Road NE Louisville, OH 44641

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** THE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NON-COMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Based on review of facility fall log, review of resident photographs, medical record review and staff interview, the facility failed to implement comprehensive, individualized and effective interventions to decrease the risk of falls for Resident #98. This affected one resident (#98) of three residents reviewed for falls. The facility census was 98. Findings include: Review of Resident #98's closed medical record revealed an admission date of 02/18/19 with diagnoses that included chronic obstructive pulmonary disease and hypertension. The resident was transferred to the hospital on [DATE] and did not return to the facility. Review of Resident #98's care plan dated 09/29/22 revealed the resident was at risk for falls related to decreased strength and endurance and history falls. Fall prevention interventions included walker within reach, call light within reach, keep bed in lowest position, non-skid footwear, education on calling for assistance before transferring, education on oxygen tubing tripping hazard, education on ambulation and transfer techniques and reinforce need to use call light and walker when getting out of bed and wait for assistance. The resident also had an activity of daily living (ADL) self care performance deficit care plan dated 09/29/22 that indicated the resident transferred with (staff) supervision assistance and used a walker for ambulation and transfer. Review of Resident #89's Minimum Data Set (MDS) 3.0 annual assessment with a reference date of 11/04/23 indicated the resident had an independent cognition level, used a walker for ambulation, required independent to limited staff assistance with mobility, was independent with transfers, was at risk for falls and had no falls since the previous assessment. Review of the resident's nursing progress notes revealed the first nursing progress note completed on 11/29/23 was an entry dated 11/29/23 at 9:45 A.M. as a late entry note. The note included the following: This nurse arrived on the unit at nurses request that resident be transferred to a psychiatric hospital for evaluation due to falls. Staff reported two unwitnessed falls this morning. The resident was noted to have purple discoloration to the right fourth knuckle and forearm and light purple scattered petechiae to her face. The note revealed the resident denied pain and had active range of motion/typical strength at that time. The note revealed the Psych 360 Nurse Practitioner would be in the facility tomorrow to evaluate the resident. Review of the facility fall and accident log for the last 30 days (11/12/23-12/12/23) revealed Resident #98 sustained four falls on 11/29/23. The resident, who had been assessed previously to have independent cognition, required limited assistance with transfers and no recent history of falls, sustained three falls within an hour (8:00 A.M., 8:30 A.M. and 8:50 A.M.) with noted increase in confusion during this time period. Review of the facility fall investigations for Resident #98 revealed four falls on 11/29/23: 365604 Page 8 of 11 365604 12/20/2023 Green Meadows Skilled Nursing and Rehab 7770 Columbus Road NE Louisville, OH 44641

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few The resident sustained the first fall at 8:00 A.M. Review of the fall investigation completed on 12/01/23 by the Director of Nursing (DON) revealed Resident #98 experienced an unwitnessed fall in her bathroom. Staff indicated the resident was not using her rollator walker to assist with ambulation. Staff assisted resident back to her bed with walker and reminded the resident to use walker for ambulation. State Tested Nurse Aide (STNA) reported bruising noted to right hand knuckles, right arm and right side of face. The facility root cause of the fall was determined to be weakness and impaired gait along with ambulating without aid of rollator walker. The investigation revealed a new intervention to encourage resident to use call light for assistance. However, this intervention had already been implemented per the plan of care dated 09/29/22. The resident sustained the second fall at 8:30 A.M. Review of the fall investigation completed on 12/01/23 by the DON revealed Resident #98 experienced an unwitnessed fall in her room near her doorway. Staff members were ambulating through the hallway picking up breakfast trays when the STNA observed the resident laying on her right side on the floor. Resident #98's oxygen concentrator was nearby and unplugged from the wall. The resident's walker remained near the bed. STNA reported she notified nurse who assessed the resident. Resident assisted to bed in lowest position and oxygen reapplied. The investigation revealed an intervention to again remind resident to not get up without staff assistance. The facility root cause of the fall was noted to be resident weakness, impaired gait, ambulating without assistance with lack of required oxygen therapy as a contributing factor. A new intervention of education to the resident to not get up without staff assistance. However, this was not a new intervention and had already been implemented per the plan of care dated 09/29/22. The resident sustained the third fall at 8:50 A.M. Review of the fall investigation completed on 12/01/23 by the DON revealed Resident #98 experienced an unwitnessed fall in her room at the bedside. STNA ambulated past the resident's room and found her on the floor next to bed rolling back and forth. STNA alerted the resident's nurse. Resident was unable to offer insight related to the cause of the fall. STNA and nurse assisted resident into wheelchair with Dycem seating surface and anti-tippers then positioned resident in hallway next to nurse's station for supervision. The facility root cause analysis included the resident had poor safety awareness with increased confusion noted at this time. A new intervention to place a Dycem (non-slip material to seat of wheelchair) and anti-tippers were added. The nursing progress note, dated 11/29/23 at 3:02 P.M. revealed the resident was found on the floor in her bathroom by an STNA after she had taken in her breakfast tray. When asked what happened the resident stared blankly at staff. Ten minutes later the resident was observed by the STNA attempting to sit on the floor and roll around, back and forth in front of her bed. When asked what happened at that time she was breathing with pursed lips with a moan on exhale and wouldn't answer any of staff's questions. Physician notified but did not return call. The note revealed the DON was notified and had refused to let this nurse send resident out to emergency room for observation and follow-up, stating there is nothing wrong with the resident that she needs to be sent out for. The resident was brought to the hallway in a wheelchair to be monitored by floor nursing staff. The resident continued to try to stand up and ambulate without assistance or rollator walker. A short while later, during lunch, staff had found her with her left leg around the wheelchair break handle and she was laying in the seat of the wheelchair holding on to the backrest. Staff assisted the resident to stand and sit in the wheelchair. Resident refused her lunch tray. Just as shift had changed at roughly 2:42 P.M., when on-coming nurse turned onto the hallway, the resident stood without assistance and fell forward onto her face. She hit her face on the floor and had a very large lump with purple bruising. The resident's forehead also had some small red dots that resembled petechiae. The resident's left dorsal hand had a large purple bruise 365604 Page 9 of 11 365604 12/20/2023 Green Meadows Skilled Nursing and Rehab 7770 Columbus Road NE Louisville, OH 44641

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few as well as her left forearm showed purple bruising. The physician was called with no response. The afternoon shift nurse assessed the resident. The note revealed DON notified and still refusing to send resident out but with persistence from this nurse DON than said to send her out and that she was done arguing with this nurse. 911 called. The nursing progress note also included the resident had shown some behaviors prior to these events. Regular floor staff noticed behaviors that had seemed to become worse over a short period of time that was observed after a medication dosage was decreased. Floor staff had asked that the resident's medication be reviewed and tailored to address her specific needs due to a decline in mood and behaviors starting. The DON and Assistant Director of Nursing (ADON) didn't think the resident would benefit from a review and nothing else had been said by them about it. The nursing progress note revealed the nurse completing the note asked multiple times this shift for one on one assistance and was denied by DON and ADON. Review of photographs, taken of Resident #98 on 11/29/23 at the hospital, provided by the resident's representative revealed numerous bruises to the resident's bilateral eyes, forehead, right elbow, left elbow and forearm and right hand. All bruises were red to purple in color and new in appearance. On 12/12/23 at 11:55 A.M. interview with the Director of Nursing (DON) verified on 11/29/23 nursing staff failed to adequately document falls in the resident's nursing notes and failed to complete a comprehensive assessment following the falls beginning on 11/29/23 at 8:00 A.M. to ensure comprehensive, individualized and effective interventions were in place to prevent the additional falls the resident sustained on this date. On 12/19/23 at 12:25 P.M. interview with the DON revealed she assessed Resident #98 on 11/29/23 per the floor nurse's request due to the resident having behaviors following the three falls she had sustained earlier in the day. The DON revealed the resident had bruising to her arms and right hand as a result of the falls but denied knowledge of any other injury. A follow-up interview with the DON on 12/19/23 at 1:25 P.M. revealed she completed the fall investigations two days after the fall. The DON verified the floor nurse did not initiate or begin any type of fall incident. The DON verified the new interventions she documented were interventions put into place at the time of the incident including reminding to use call light ad reminding to ask for assistance, which were already care planned as fall interventions for the resident. The deficiency was corrected on 12/01/23 after the facility implemented the following corrective actions: • On 11/29/23 Resident #98 was assessed by nursing staff and sent to the hospital for evaluation. • On 11/29/23 Resident #98's physician was notified of the change in condition and transfer to the hospital. • On 12/06/23 floor nurse Licensed Practical Nurse (LPN) #113 for Resident #98 on 11/29/23 was 365604 Page 10 of 11 365604 12/20/2023 Green Meadows Skilled Nursing and Rehab 7770 Columbus Road NE Louisville, OH 44641

F 0689 terminated. Last day working in the facility for LPN #113 was 11/29/23. Level of Harm - Minimal harm or potential for actual harm • Residents Affected - Few On 12/01/23 the DON conducted an audit of all resident falls in the past 30 days to ensure that neurochecks were completed for unwitnessed falls or when the resident hit their head, a thorough assessment was performed post fall, an investigation was completed with appropriate interventions applied, and the family and physician were notified. Negative findings were corrected immediately. • On 12/01/23 all licensed nursing staff were educated on Falls Best Practice and notification of physician by the DON. • On 12/01/23 an ad hoc Quality Assessment and Performance Improvement (QAPI) meeting was to review the concerns identified by the facility. • Beginning 12/01/23 weekly for four weeks, the DON or designee would audit four falls to ensure that neurochecks were completed for unwitnessed calls or when the resident hit head, a thoroughly assessment was performed post fall, an investigation was completed with appropriate interventions applied, and the family and physician were notified. The audits would be submitted weekly to the QAPI committee for tracking, trending and recommendations. • The surveyor reviewed an additional two resident records with identified falls that occurred between 11/30/23 and 12/20/23 with no additional concerns. This deficiency represents non-compliance investigated under Complaint Number OH00148864. 365604 Page 11 of 11