Health inspection·January 2, 2024

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 observation, resident and staff interview, and facility policy the facility failed to ensure clean and sufficient laundry was available to residents. This affected three (Residents #60, #64, and #68) of three residents reviewed. The facility census was 74. Findings include: Observation on 12/26/23 and 12/28/23 revealed a common area inaccessible to residents with an abundant of both hung, folded, and unfolded clothing and blankets. Interview on 12/26/23 at 10:56 A.M. with State Tested Nursing Assistant (STNA) #202 revealed the only concern they have at the facility is supplies, specifically towels and resident laundry. STNA #202 reported they always needed to hunt down resident laundry so the resident has something to wear. Interview on 12/26/23 at 11:28 A.M. with Laundry and Housekeeping Supervisor #203 verified the common area inaccessible to residents was used as a folding area. Laundry and Housekeeping Supervisor #203 verified other than what aides were able to do in their spare time laundry had not been folded since last Saturday (3 days). Laundry and Housekeeping Supervisor #203 verified residents have run out of clothing and needed to wear gowns or aides have had to hunt through stacks of clothing. Interview on 12/26/23 at 12:44 P.M. with Resident #64 verified she had allowed another resident to wear her pair of pants because the resident did not have any pants to wear and wanted to get out of bed. Interview on 12/26/23 at 10:05 A.M. with Resident #60 revealed she had be admitted with ten pairs of pants but had no clean pants to wear today so Resident #64 allowed her to wear hers. Interview on 12/28/23 at 4:45 P.M. with Resident #68 verified she had no clean clothing that fit her and had to wear the same clothing as the day prior. Review of the Resident Rights policy, dated December 2016, verified residents have the right to a dignified existence. This deficiency represents non-compliance investigated under Complaint Number OH00148660. Page 1 of 4 365617 365617 01/02/2024 Ayden Healthcare of Waterville 8885 Browning Drive Waterville, OH 43566

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. 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, staff interview and facility policy, the facility failed to ensure resident's received timely assistance with eating. This affected one (Resident #59) of three residents reviewed for assistance with Activities of Daily Living (ADLs). The facility census was 74. Residents Affected - Few Findings include: Review of the medical record revealed Resident #59 was admitted on [DATE]. Diagnoses included arthropathic psoriasis, bulimia nervosa, bipolar disorder, suicidal ideations, post traumatic stress disorder, major depressive disorder, hypothyroidism, essential (primary) hypertension. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed the residents cognition was not assessed. Resident #59 required supervision or touching experience for eating. Observation on 12/26/23 at 1:00 P.M. revealed Resident #59 laying in bed with his eyes closed. The lunch meal tray was sitting on the bedside table with a plate cover over the food and the tray appeared untouched. Further observation revealed State Tested Nursing Assistant (STNA) #204 was picking up lunch meal trays in other resident rooms in the hall. Interview on 12/26/23 at 1:05 P.M. with Licensed Practical Nurse (LPN) #205 verified Resident #59 required assistance with eating as of recent. LPN #205 verified Resident #59 had not been assisted with eating lunch and did not know when the lunch meal was served but verified other residents in the hall had already eaten and their discarded lunch meal trays were being collected. Review of policy Supporting ADL's, dated March 2018, verified residents who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming and personal and oral hygiene. This deficiency represents non-compliance investigated under Complaint Number OH00149305 and Complaint Number OH00149319. 365617 Page 2 of 4 365617 01/02/2024 Ayden Healthcare of Waterville 8885 Browning Drive Waterville, OH 43566

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** Based on medical record review, observation, resident interview, staff interview, and facility policy the facility failed to ensure fall interventions were in place. This affected one (Resident #57) of three residents reviewed for falls. The facility census was 74. Findings include: Review of the medical record revealed Resident #57 was initially admitted on [DATE]. Diagnoses included paranoid schizophrenia, muscle weakness, parkinsonism, auditory hallucinations, anxiety disorder, unspecified lack of coordination, hypothyroidism, and major depressive disorder recurrent severe with psychotic symptoms. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed the resident was rarely understood. Review of the most recent care plan revealed Resident #57 was care planned for falls due to impaired balance/poor coordination, use of psychotropic medications, impaired decision making and unsteady balance. Interventions included having a perimeter mattress. Observation on 12/26/23 at 1:06 P.M. revealed Resident #57 leaning heavily on her top left side on the left side of the bed and appeared to be nearly falling off the bed. Resident #74 was noted to not to have a perimeter mattress. Interview on 12/26/23 at 1:06 P.M. with Resident #57 verified she was unable to reposition herself and stated she was holding on for dear life. Interview on 12/26/23 at 1:08 P.M. with State Tested Nursing Assistant (STNA) #204 verified Resident #57 was unable to reposition herself. STNA #204 stated she had been in the resident's room just a few minutes prior and had not noted how close she was to the edge. Interview on 12/26/23 at approximately 3:00 P.M. with STNA #204 verified Resident #57 did not have a perimeter mattress. Review of the Managing Fall and Fall Risk policy, dated March 2018, verified the staff, with input from the attending physician will implement a resident-centered fall prevention plan to reduce the specific risk factor(s) of falls for each resident at risk or with a history of falls. This deficiency represents non-compliance investigated under Complaint Number OH00149305 and Complaint Number OH00149319. 365617 Page 3 of 4 365617 01/02/2024 Ayden Healthcare of Waterville 8885 Browning Drive Waterville, OH 43566

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on observation, resident and staff interviews, and facility policy, the facility failed to ensure a clean and sanitary environment. This affected six (Residents #53, #74, #78, #79, #81, and #82) of six residents reviewed for environment. The facility census was 74. Findings include: Observation on 12/28/23 at 12:25 P.M. revealed light red colored sponge like spots covering all walkable areas of Resident #57's floor. Subsequent interview with Resident #57 revealed the spots were blood from when her foot wound bled through the dressing yesterday. Resident #57 verified the dressing was changed but the blood was not cleaned. Observation on 12/28/23 at 4:45 P.M. revealed the identified blood spots throughout Resident #57's floor had not been cleaned and remained visible. Interview on 12/28/23 at 4:37 P.M. with Laundry and Housekeeping Supervisor #203 verified housekeeping had not cleaned Resident #57's hall due to leaving early. Housekeeping and Laundry Supervisor #203 verified the blood spots throughout the floor. Subsequent interview with the unknown aide working the hall verified she had been in and out of Resident #57's room throughout the day and had not noticed the blood on the floor. Observation on 01/02/24 at 10:20 A.M. revealed Resident #74, #78, 79, #81, and #82 resident room's heat/air unit filters all had a thick layer of dust. Residents #79 and #82's heat/air units appeared to have construction like debris on and in the unit. Interview on 01/02/24 at 10:29 A.M. with Housekeeping #220 revealed housekeeping would clean the top of the heat/air unit but not inside including the filters. Interview on 01/02/24 at 10:35 A.M. with Maintenance #219 verified Resident #74, #78, 79, #81, and #82's heat/air units had a heavy build up of dust. Maintenance #219 stated it was housekeeping's responsibility to clean the units but maintenance regularly maintains the unit but did not know the regular schedule. Review of the Cleaning and Disinfection of Environmental Surfaces, dated August 2019, verified housekeeping surfaces (floors, tabletops) will be cleaned on a regular basis, when spills occur, and when these surfaces are visibly soiled. Environmental surfaces will be disinfected (or cleaned) on a regular basis and when surfaces are visibly soiled. This deficiency represents non-compliance investigated under Complaint Number OH00149554. 365617 Page 4 of 4