Health inspection·October 8, 2024

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, resident and staff interview, medical record review, and review of a facility policy, the facility failed to maintain a clean, sanitary, and homelike environment. This had the potential to affect all 72 residents residing in the facility. The census was 72. Findings Include: 1. Review of the medical record for Resident #64 revealed an admission date of 07/19/24 and diagnoses of malignant neoplasm of lower third of esophagus, hypothyroidism, diabetes mellitus type two, protein-calorie malnutrition, chronic obstructive pulmonary disease, hepatitis C, morbid obesity, bacteremia, and hypertension. Review of the most recent Minimum Data Set (MDS) assessment dated [DATE] for Resident #64 revealed a brief interview for mental status (BIMS) score of 14, indicating Resident #64 was cognitively intact. Interview on 10/07/24 at 8:01 A.M. with Resident #64 revealed the toilet and the toilet riser in his restroom had not been cleaned and were covered with feces. Resident #64 also stated the linens on his bed were soiled and had not been changed. Observation on 10/07/24 at 8:04 A.M. revealed the toiled and toiled riser in his restroom were covered with feces. Observation on 10/07/24 at 8:05 A.M. revealed the linen on Resident #64's bed was soiled with an unknown brown substance. Interview on 10/07/24 at 9:05 A.M. with Housekeeping Assistant #118 verified the toilet and toilet riser in Resident #64's restroom were covered in feces and verified the linen on Resident #64's bed was soiled with an unknown brown substance. 2. Review of the medical record for Resident #59 revealed an admission date of 10/05/22 with diagnoses of injury of unspecified body region, morbid obesity, hypothyroidism, hyperlipidemia, iron deficiency anemia, chronic pulmonary embolism, hypertension, syncope and collapse, and bipolar disorder. Review of the most recent MDS assessment dated [DATE] for Resident #59 revealed a BIMS score of 11, indicating Resident #59 was moderately cognitively intact. Page 1 of 2 365617 365617 10/08/2024 Ayden Healthcare of Waterville 8885 Browning Drive Waterville, OH 43566

F 0921 Observation on 10/07/24 at 9:05 A.M. revealed the floor in Resident #59's room was dirty. Level of Harm - Minimal harm or potential for actual harm Interview on 10/07/25 at 9:05 A.M. with Resident #59 revealed her room was not kept clean. Residents Affected - Many Interview on 10/07/24 at 9:08 A.M. with Licensed Practical Nurse (LPN) #136 verified the dirt on Resident #59's bedroom floor. 3. Observation on 10/07/24 at 9:18 A.M. revealed the carpet in the 300 Hall was stained and dirty with pieces of food ground into it. Interview on 10/07/24 at 9:19 A.M. with State Tested Nurse Aide (STNA) #100 verified the appearance of the 300 Hall carpet and stated that was how the area normally looked and was maintained. Review of the facility policy titled, Quality of Life - Homelike Environment, dated 05/17, revealed residents are provided with a safe, clean, comfortable, and homelike environment. 365617 Page 2 of 2