Health inspection·September 26, 2019

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, resident interview, staff interview, and review of facility policy, the facility failed to respect the rights of two residents (#47 and #178) of two observed wearing smoking aprons when they were not needed. The facility census was 81. Findings include: 1. Review of Resident #47's medical record revealed an admission date of 7/18/18 with diagnoses including type two diabetes mellitus, congestive heart failure, left above the knee amputation, and major depressive disorder. Review of Resident #47's care plan dated 07/19/19 revealed the resident had a history of smoking and desired to smoke. Interventions included to smoke safely in designated areas, offer smoking cessation options, staff to provide smoking materials and light cigarettes and not to leave resident unattended when smoking. Review of Resident #47's smoking assessment dated [DATE] revealed interventions included allowing the resident to smoke independently in designated areas, and the resident did not require a smoking apron or vest. Review of Resident #47's Minimum Data Set (MDS) dated [DATE] revealed resident was cognitively intact. Observation of residents smoking on 09/23/19 at 10:03 A.M. revealed State Tested Nurse Aide (STNA) #520 placed a smoking apron on Resident #47. Interview with Resident # 47 on 09/24/19 at 8:51 A.M. revealed the facility had never put smoking aprons on the residents in the past and wearing a smoking apron made him feel uncomfortable and embarrassed. 2. Review of Resident #178's medical record revealed an admission date of 09/21/19 with diagnoses including cerebral infarction (stroke) and anxiety disorder. Review of Resident #178's care plan dated 9/22/19 revealed the resident had a history of smoking and desired to smoke with interventions to smoke safely in designated areas, offer smoking cessation options, staff to provide smoking materials, light cigarettes and not to leave resident unattended when smoking. Page 1 of 5 365621 365621 09/26/2019 Hillsboro Post Acute 1141 Northview Drive Hillsboro, OH 45133

F 0550 Level of Harm - Minimal harm or potential for actual harm Review of Resident #178 smoking assessment dated [DATE] revealed revealed interventions included allowing resident to smoke independently in designated areas and the resident was not required to wear a smoking apron or vest. Observation on 09/23/19 at 10:03 A.M. revealed STNA #520 placed a smoking apron on Resident #178. Residents Affected - Few Interview with STNA #520 on 09/23/19 at 3:16 P.M. revealed only one resident was deemed as needing a smoking apron on the smoking assessment, however she just puts them on the residents to be sure. STNA #520 confirmed Resident #47 and Resident #178 had a smoking apron on at the 10:03 A.M. smoke break. Interview with Resident #178 on 09/26/19 at 10:27 A.M. revealed he did not like wearing a smoking apron when he smoked and did not understand why he had to wear one. Review of the facility policy untitled dated 08/11/06 revealed the interdisciplinary team (IDT) will evaluate and make a decision if a resident is independent or an at risk smoker and if a patient is deemed at risk, the resident will be required to wear a smoking vest or apron. 365621 Page 2 of 5 365621 09/26/2019 Hillsboro Post Acute 1141 Northview Drive Hillsboro, OH 45133

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 facilities policy review, the facility failed to ensure two staff members were present with the use of a mechanical lift during transfers for safety. This affected one resident (#8) of six reveiwed for accidents. The facility census was 81 . Findings include: Review of the medical record for Resident #8 revealed an admission date of 03/07/19 with diagnoses including morbid obesity, diabetes mellitus, depression, and peripheral vascular disease. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #8 had no cognitive deficits and required a total assistance of two people for transfers. Review of the care plan revealed Resident #8 required assistance with transferring as evidence by weakness related to spinal stenosis and diabetes mellitus with neuropathy. Intervention included to utilize mechanical lift with large sling for transfers. Observation and interview on 09/24/19 at 10:00 A.M. revealed State Tested Nursing Assistant (STNA) #611 was getting Resident #8 up for the day and she was the only staff member in the room. STNA #611 confirmed she did lift the resident with mechanical lift by herself. She revealed the resident was a a total assist for transfers with mechanical lift and one person could lift him with the lift. Interview on 09/25/19 at 1:36 P.M. with the Director of Nursing (DON) revealed it was her expectation staff always used two staff members when using a mechanical lift for safety. Review of facilities Mechanical Lift Policy dated April 2019 revealed the purpose was to move immobile or obese residents for whom manual transfer poses potential for staff or resident injury. Use of a mechanical lift requires a second caregiver. 365621 Page 3 of 5 365621 09/26/2019 Hillsboro Post Acute 1141 Northview Drive Hillsboro, OH 45133

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to initiate a gradual dose reduction (GDR) attempt on residents taking psychotropic medications and also failed to provide proper diagnoses for residents taking antidepressant medications. This affected three residents (#43, #6 and #63) of five reviewed for unnecessary medications. The facility census was 81. Findings include: 1. Review of Resident #43's medical record revealed an admission date of 02/09/19 with diagnoses including type two diabetes mellitus, anxiety, congestive heart failure (CHF), and depression. Review of Resident #43's quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #43's cognition was intact. Review of Resident #43's current medications revealed Buspirone (anti-depressant) 10 milligrams (mg), one tablet by mouth two times per day related to depression and Duloxetine Capsule 30 mg, take one capsule by mouth one time in the afternoon related to depression, and Trazodone tablet 50 mg take one tablet by mouth at bedtime for insomnia. Review of Resident #43's monthly pharmacy reviews revealed no irregularities were noted from February 2019 through September 2019. There was no evidence an attempts for a GDR was made with any of the resident's psychotropic medications. Interview on 09/26/19 at 2:32 P.M. with the Director of Nursing (DON) verified the facility had not attempted a GDR for Resident #43. 2. Review of Resident #6's medical record revealed the resident was admitted to the facility on [DATE] with the following diagnoses, congestive heart failure, chronic kidney disease, diabetes mellitus type II, depression, and anxiety. Review of the most recent MDS assessment dated [DATE] revealed the resident was cognitively intact. Review of Resident #6's current medications revealed Duloxetine 60 mg, one capsule daily for depression and Aripiprazole 2 mg, one tablet for depression Review of Resident #6's monthly pharmacy review with the last date of 09/18/19 revealed the resident had been taking the Duloxetine and Aripiprazole for a diagnosis of depression since the resident's admission date of August 2018. There was no evidence a GDR had been attempted. On 09/25/19 at 1:51 P.M., interview with the Director of Nursing (DON) verified a GDR had not been recommended by the pharmacy, and none have been attempted. 3. Review of Resident #63's medical record revealed an admission date of 02/29/16 with diagnoses including chronic kidney disease stage three, dementia, unspecified psychosis, and altered mental status. 365621 Page 4 of 5 365621 09/26/2019 Hillsboro Post Acute 1141 Northview Drive Hillsboro, OH 45133

F 0758 Level of Harm - Minimal harm or potential for actual harm Review of Resident #63's physician order dated 03/13/19 revealed an order for Sertraline (anti-depressant) 50 mg for the treatment of dementia with behavior disturbance. Review of Resident #63's Minimum Data Set (MDS) dated [DATE] revealed the resident was cognitively impaired. Residents Affected - Few Interview with the Director of Nursing (DON) and the Social Services Director on 09/26/19 at 11:04 A.M. confirmed Resident #62 was on Sertraline for behavioral disturbances due to dementia. The DON further revealed the resident had not had any behaviors for the last 18 months. 365621 Page 5 of 5