Health inspection·December 4, 2023

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. Based on medical record review and staff interview, the facility failed to ensure resident Pre-admission Screening and Resident Review (PASARR) documents accurately reflected resident current conditions and diagnoses. This affected one (Resident #54) of three residents reviewed for PASARR documents. The census was 93. Findings include: Review of the medical record for Resident #54 revealed an admission date of 10/02/20 with diagnoses including were non-Hodgkin's lymphoma, dysphagia, cognitive social or emotional deficits, dementia, anxiety, depression, hypertension, foot drop, suicidal ideations, noncompliance with medical treatment, traumatic brain injury, unspecified psychosis, and chronic pain syndrome. Review of the Minimum Data Set (MDS) assessment for Resident #54 dated 09/01/23 revealed the resident had severe cognitive impairment. Review of the PASARR document for Resident #54 dated 10/01/20 revealed it did not include any active psychiatric diagnoses. Interview on 11/30/23 at 11:42 A.M. with the Director of Nursing (DON) confirmed Resident #54 had a new diagnosis of unspecified psychosis which was added on 12/27/21. The DON confirmed an updated PASARR was not completed for this resident after the addition of a new mental health diagnosis in 2021. Page 1 of 8 365620 365620 12/04/2023 Riverview Post Acute 7743 County Road 1 South Point, OH 45680

F 0646 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Notify the appropriate authorities when residents with MD or ID services has a significant change in condition. Based on medical record review and staff interview the facility failed to ensure all significant mental health changes were communicated to the state mental health agency. This affected one (Resident #54) of three residents reviewed for Pre-admission Screening and Resident Review (PASARR) documents. The census was 93. Findings Include: Review of the medical record for Resident #54 revealed an admission date of 10/02/20 with diagnoses including were non-Hodgkin's lymphoma, dysphagia, cognitive social or emotional deficits, dementia, anxiety, depression, hypertension, foot drop, suicidal ideations, noncompliance with medical treatment, traumatic brain injury, unspecified psychosis, and chronic pain syndrome. Review of the Minimum Data Set (MDS) assessment for Resident #54 dated 09/01/23 revealed the resident had severe cognitive impairment. Review of the PASARR document for Resident #54 dated 10/01/20 revealed it did not include any active psychiatric diagnoses. Interview on 11/30/23 at 11:42 A.M. with the Director of Nursing (DON) confirmed Resident #54 had a new diagnosis of unspecified psychosis which was added on 12/27/21. The DON confirmed an updated PASARR was not completed for this resident after the addition of a new mental health diagnosis in 2021 and the state mental health agency was not notified of Resident #54's new diagnosis. 365620 Page 2 of 8 365620 12/04/2023 Riverview Post Acute 7743 County Road 1 South Point, OH 45680

F 0661 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview the facility failed to timely complete a discharge summary for residents upon discharge from the facility and failed to provide residents and their representatives with discharge instructions. This affected one (Resident #51) of three residents reviewed for discharge. The facility census was 93. Findings include: Review of the medical record for Resident #51 revealed an admission date of 10/25/23 and diagnoses including displaced intertrochanteric fracture of right femur, atrial fibrillation, atherosclerotic heart disease, heart failure, end stage renal disease, diabetes mellitus, obstructive sleep apnea, major depressive disorder, and a discharge date of 11/22/23. Review of the admission Minimum Data Set (MDS) assessment for Resident #51 dated 11/01/23 revealed the resident was moderately cognitively impaired and used a walker and wheelchair to aid in mobility. Review of the MDS for Resident #51 dated 11/22/23 revealed the resident was discharged from the facility with a return not anticipated. Review of the medical record for Resident #51 on 11/29/23 at 3:57 P.M. revealed it did not include a discharge summary or discharge instructions provided to the resident and/or the resident's representative upon discharge. Interview by phone on 11/30/23 at 2:18 P.M. with Registered Nurse (RN) #167 confirmed Resident #51 was discharged to home on [DATE] and the facility did not provide the resident with discharge instructions prior to him leaving. RN #167 further confirmed Resident #51's family came to the facility on [DATE] to obtain a list of the resident's medications because it had not been provided at discharge. RN #167 confirmed Resident #51's discharge paperwork was not finalized until 11/30/23. 365620 Page 3 of 8 365620 12/04/2023 Riverview Post Acute 7743 County Road 1 South Point, OH 45680

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 Based on medical record review, observations, and staff interview the facility failed to provide timely and appropriate nail care for a resident who was dependent upon staff for assistance with activities of daily living (ADLs). This affected one (Resident #254) of two residents reviewed for ADLs. The facility census was 93. Residents Affected - Few Findings include: Review of the medical record for Resident #254 revealed an admission date of 11/21/23 with diagnoses including Alzheimer's disease, acute cystitis without hematuria, retention of urine, and nondisplaced intertrochanteric fracture of right femur. Review of the care plan for Resident #254 dated 11/22/23, revealed the resident had an ADL self-care, mobility, and functional ability performance deficit. Interventions included staff should provide nail care as needed. Observation on 11/27/23 at 2:30 P.M. revealed Resident #254 was lying in bed and was alert and pleasantly confused. The resident fingernails were observed to be long and jagged and to have a layer of black debris caked underneath them. Observation on 11/28/23 at 10:34 A.M. revealed the fingernails of Resident #254 continued to be long and jagged and to have a layer of black debris caked underneath them. Observation on 11/28/23 at 12:15 P.M. revealed Resident #254 was consuming her lunch meal and used her hands to pick up food items off her tray to place them in her mouth. The resident's fingernails continued to be long and jagged and have a layer of black debris caked underneath them. Observation on 11/29/23 at 9:25 A.M. revealed Resident #254 was lying in bed and appeared to have received recent assistance with bathing and grooming. However, the resident's fingernails remained long and jagged and had a layer of black debris underneath them. Interview on 11/29/23 at 11:15 A.M. with State Tested Nursing Assistant (STNA) #292 confirmed Resident #254's fingernails were long and jagged and had a layer of black debris underneath them and were in need of being trimmed and cleaned. STNA #292 stated she would obtain the needed supplies and trim and clean them immediately. 365620 Page 4 of 8 365620 12/04/2023 Riverview Post Acute 7743 County Road 1 South Point, OH 45680

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm Based on medical record review, observation, staff interview, and review of the facility policy, the facility failed to ensure pressure ulcer prevention interventions were in place per the plan of care. This affected one (Resident #25) of one resident who was reviewed for positioning during the annual survey. The facility identified two residents with pressure ulcers. The facility census was 93. Residents Affected - Few Findings include: Review of the medical record for Resident #25 revealed an admission date of 04/08/20 with diagnoses including dementia, peripheral vascular disease, heart failure, and diabetes mellitus. Review of the quarterly Minimum Data Set (MDS) assessment for Resident #25 dated 09/29/23 revealed the resident had intact cognition evidenced by a Brief Interview for Mental Status (BIMS) assessment score of 15. The resident was assessed to require extensive assistance from staff for bed mobility and toileting and to be dependent upon staff for transfers. Review of the care plan for Resident #25 dated 01/25/22, revealed the resident was at risk for altered skin integrity. Interventions included the staff should apply a Prevalon boot to the left foot while in bed. Observation on 11/27/23 at 11:25 A.M., on 11/29/23 at 10:34 A.M. and on 11/30/23 at 1:08 P.M. revealed Resident #25 was lying in bed with his left leg was placed on a pillow with the heel lying directly on the mattress. There was no Prevalon boot in place to Resident #25's left foot or on the bed. Interview on 11/30/23 at 1:08 P.M. with State Tested Nursing Assistant (STNA) #222 confirmed Resident #25 was lying in bed with his left leg placed on a flattened pillow and the resident's left heel was positioned directly on the mattress with no Prevalon boot in place. STNA #222 stated she did not believe the resident needed to have a Prevalon boot and confirmed there was not a Prevalon boot present in the resident's room. Interview on 11/30/23 at 1:55 P.M. with Registered Nurse (RN) #188 on 11/30/23 at 1:55 P.M. verified Resident #25 did not have a Prevalon boot in place to his left foot per his care plan. Review of the facility policy titled Pressure Ulcer Prevention Protocols/Risk Assessment dated 06/08/22 revealed the facility would identify residents at risk for the development of pressure ulcers and would implement supportive/preventative precautions as appropriate. 365620 Page 5 of 8 365620 12/04/2023 Riverview Post Acute 7743 County Road 1 South Point, OH 45680

F 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm Based on medical record review and staff interview the facility to ensure antibiotic medications were prescribed and administered only when necessary. This affected one (Resident #10) of the three residents reviewed for antibiotic use. The facility census was 93. Residents Affected - Few Findings include: Review of the medical record review for Resident #10 revealed an admission date of 06/07/23 with diagnoses including dementia, chronic kidney disease, diverticulosis of the large intestine, anxiety, and acquired absence of part of the stomach. Review of the quarterly Minimum Data Set (MDS) assessment for Resident #10 dated 09/27/23 revealed the resident had mildly impaired cognition evidenced by a Brief Interview for Mental Status (BIMS) assessment score of 12. The resident was assessed to require extensive assistance for bed mobility, transfers, and toileting. Review of the results of the urinalysis with culture and sensitivity (UA with C&S) for Resident #10 dated 11/22/23 revealed the presence of over 100,000 colony forming units per milliliter (CFU/ml) of mixed pathogens indicating probable contamination of the urine specimen. No further UA C&S testing was completed for Resident #10. Review of the physician's order for Resident #10 dated 11/25/23 revealed an order for 250 milligrams (mg) of vancomycin (an antibiotic medication) to be administered four times a day for five days for possible clostridium difficile (c-diff) infection. Review of the physician's order for Resident #10 dated 11/26/23, revealed an order for one gram of ertapenem Sodium Solution (an antibiotic medication) to be administered intravenously for three days for infection. Review of the results of the stool specimen for Resident #10 dated 11/28/23, revealed the specimen was negative for infection, including c-diff infection. Interview on 11/29/23 at 3:38 P.M with Medical Director (MD) #400 confirmed the antibiotic medication ertapenem was ordered and administered to Resident #10 for a possible urinary tract infection (UTI). MD #400 confirmed the results of the UA with C&S obtained on 11/22/23 revealed probable contamination and did not indicate that Resident #10 had an active UTI. Interview on 11/30/23 at 10:10 A.M. with Registered Nurse (RN) #189 confirmed antibiotic medication vancomycin was ordered and administered to Resident #10 for a possible c-diff infection. RN #189 confirmed results of the stool specimen obtained for Resident #10 on 11/28/23 revealed the resident did not have an infection. 365620 Page 6 of 8 365620 12/04/2023 Riverview Post Acute 7743 County Road 1 South Point, OH 45680

F 0773 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results. Based on medical record review, observation, staff interview, and review of facility policy the facility failed to ensure physician-ordered laboratory tests and specimens were obtained timely and as ordered. This affected two residents (#10 and #84) out of the eight residents reviewed for antibiotic use and unnecessary medications during the annual survey. The facility census was 93. Findings include: 1. Review of the medical record for Resident #10 revealed an admission date of 06/07/22 with diagnoses including dementia, chronic kidney disease, diverticulosis of the large intestine, anxiety, and acquired absence of part of the stomach. Review of the quarterly Minimum Data Set (MDS) assessment for Resident #10 dated 09/27/23 revealed the resident had mildly impaired cognition evidenced by a Brief Interview for Mental Status (BIMS) assessment score of 12. The resident was assessed to require extensive assistance for bed mobility, transfers, and toileting and to be independent for eating. The resident was assessed to have an indwelling foley catheter. Review of the physician's order for Resident #10 dated 11/17/23, revealed an order for a urinalysis with culture and sensitivity (UA with C&S) to be obtained stat (immediately). Review of the UA with C&S result for Resident #10 dated 11/22/23 revealed the specimen showed possible contamination. Review of the physician's order for Resident #10 dated 11/24/23 revealed an order for a stool sample to be obtained to rule out possible clostridium difficile (c-diff) infection and for a UA with C&S to be obtained on 11/27/23. Review of the care plan for Resident #10 dated 11/27/23 revealed the resident had possible clostridium difficile (c-diff) infection. Interventions included the following: follow facility protocols for contact isolation for duration of treatment, give medications per physician order, utilize personal protective equipment (PPE) as appropriate. Observation on 11/27/23 at 11:05 A.M. revealed Resident #10 was in isolation precautions for possible c-Diff infection. The resident was observed to have an indwelling foley catheter in place. Review of the laboratory record for Resident #10 revealed a stool specimen was obtained on 11/28/23, and the results were not yet available. Interview with Medical Director #400 on 11/29/23 at 3:38 P.M. confirmed the UA with C&S ordered for Resident #10 should have been obtained as ordered on 11/17/23 as the resident had an indwelling foley catheter. MD #400 confirmed a stool specimen for possible c-diff infection had been ordered to be obtained on 11/27/23 and he was still awaiting the results to review. Review of the facility policy titled Lab and Diagnostic Tests dated 06/08/22, revealed staff were to check physicians' orders for the test, specimen collection directions, and the date on which the test was due. Staff should mark the word stat on requisitions appropriately to bring the testing time 365620 Page 7 of 8 365620 12/04/2023 Riverview Post Acute 7743 County Road 1 South Point, OH 45680

F 0773 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few frame to the attention of the laboratory. Stat requests would also be called to the laboratory as soon as ordered. 2. Review of the medical record for Resident #84 revealed an admission date of 10/19/23 with diagnoses including neutropenia due to infection, sepsis, myelodysplastic, atrial fibrillation, atherosclerotic heart disease, hyperlipidemia, generalized anxiety disorder, major depressive disorder, dysphagia, hypertension, and cognitive communication deficit. Review of the laboratory test results of the complete blood count (CBC) for Resident #84 dated 10/23/23 revealed the resident's hemoglobin (protein in red blood cells that delivers oxygen to tissues) was low at 8.6 g/dl (grams per deciliter) and the reference range was 14.0 to 18.0. Review of the physician's order for Resident #84 dated 10/24/23 revealed an order to obtain a weekly complete blood count (CBC). Review of the MDS for Resident #84 dated 10/26/23 revealed the resident was cognitively intact and required a walker and wheelchair for mobility. Review of the laboratory results for Resident #84 revealed a CBC was not completed for the resident until11/20/23. Review of the CBC results revealed the resident's hemoglobin level was 8.1 g/dl which was low. Interview with the Director of Nursing (DON) on 11/30/23 at 8:40 A.M. confirmed Resident #84 had an order for a weekly CBC dated 10/24/23, but the CBC was not completed until 11/20/23. Further interview with the DON confirmed the facility did not notify the attending physician of the abnormal lab result (low hemoglobin level) noted on 11/20/23. 365620 Page 8 of 8