Health inspection·October 4, 2023

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 medical record review, staff and resident interviews, policy review, and review of the Centers for Disease Control (CDC) guidelines, the facility failed to conduct Coronavirus Disease 2019 (COVID-19) testing as per facility policy and CDC guidelines. This affected one (#54) resident out of the five residents reviewed for infection control. The facility census was 78. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #54 revealed an admission date of 08/12/23 with medical diagnoses of Parkinson's disease, hypertensive heart disease, and chronic kidney disease Stage III. Review of the medical record for Resident #54 revealed an admission minimum data set (MDS) assessment, dated 08/19/23, which indicated Resident #54 had moderate cognitive impairment and required extensive staff assistance for bed mobility, transfers, dressing and toileting. Further review of the medical record revealed documentation to support Resident #54 was up to date on COVID-19 vaccinations. Review of the medical record for Resident #54 revealed Resident #54 shared a room with Resident #168, who his/her spouse. The medical record did not contain documentation to support Resident #54 had COVID-19 testing completed since admission to the facility. Interview on 10/04/23 at 11:10 A.M. with Resident #54 confirmed Resident #168 was his/her spouse and the two residents shared a room. Resident #54 confirmed Resident #168 was transferred to the hospital where he/she tested positive for COVID-19. Resident #54 also confirmed he/she had not been tested for COVID-19 since admission to the facility. Resident #54 confirmed he/she had close contact with Resident #168. 2. Review of the medical record for Resident #168 revealed an admission date of 07/28/23 with medical diagnoses of pneumonia, congestive heart failure, hypertensive heart disease, and atrial fibrillation. Further review of the medical record revealed Resident #168 discharged to the hospital on [DATE] and that Resident #168 shared a room with his/her spouse (Resident #54). Review of the medical record for Resident #168 revealed an admission MDS, dated [DATE], which indicated Resident #168 was cognitively intact and required extensive staff assistance with bed mobility, toileting, dressing and was dependent for transfers. Review of the medical record for Resident #168 revealed a nurses note, dated 09/29/23 at 7:09 A.M., which stated resident complained of shortness of breath and oxygen saturation was 68% on high flow Page 1 of 2 365615 365615 10/04/2023 Ayden Healthcare of Belle Springs. 221 North School Street Bellefontaine, OH 43311

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few oxygen. The note stated the physician was notified and Resident #168 was sent to the hospital. Further review revealed a nurse's note, dated 09/29/23 at 10:58 A.M. which stated Resident #168's son came to the facility and informed the nurse Resident #168 was transferred to a different hospital and he/she had tested positive for COVID-19. Interview on 10/04/23 at 2:15 P.M. with Director of Nursing (DON) stated the facility follows CDC guidelines for staff and resident testing for COVID-19. DON confirmed Resident #54 and Resident #168 were in the same room at the time Resident #168 was discharged to the hospital on [DATE]. DON also confirmed Resident #168 tested positive for COVID-19 at the hospital. DON confirmed Resident #54 had not been tested for COVID-19 since admission to the facility. DON confirmed Resident #54 had close contact with Resident #168. Review of facility policy titled COVID-19, revised May 2023, stated staff and resident testing would be conducted following nationally accepted standards, such as CDC guidelines. Review of the CDC website revealed the CDC guidelines stated asymptomatic patients with close contact with someone with SARS-CoV-2 (also known as COVID-19) infection should have a series of three viral tests for COVID infection. Close contact is being within six feet for a cumulative total of 15 minutes or more over a 24-hour period with someone with SARS-CoV-2 infection. The testing is recommended immediately (but no earlier than 24 hours after the exposure) and, if negative, again 48 hours after the first negative test and, if negative, again 48 hours after the second negative test. This would typically be on day one (where day of exposure is zero), day three, and day five. This deficiency represents non-compliance investigated under Complaint Number OH00146953. 365615 Page 2 of 2