Health inspection·August 24, 2023

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Based on medical record review, staff interview, and review of the facility policy, the facility failed to notify the physician of a significant weight change for Resident #34. This affected one (Resident #34) of three residents reviewed for notification of change. The facility census was 67. Findings include: Review of Resident #34's medical record revealed an admission date of 07/12/23. The resident was discharged from the facility on 08/22/23. Diagnoses included Alzheimer's disease, hypertension, and chronic kidney disease stage four. Review of the admission Minimum Data Set (MDS) assessment, dated 07/24/23, revealed Resident #34 was cognitively impaired. Review of Resident #34's physician orders, revealed an order for weekly weights, one time per day every four weeks on Wednesday. Review of Resident #34's plan of care dated 07/26/23, revealed the resident had altered cardiovascular status related to arrhythmia, mitral insufficiency, mitral prolapse, aortic valve stenosis, and hypertension, with a goal to remain free from signs/symptoms of complications. Interventions included monitoring/documenting/reporting to physician changes in lung sounds on auscultation, edema and changes in weight. Review of Resident #34's weight record revealed on 07/19/23, the resident weighed 158 pounds (lbs.). On 08/01/23, the resident weighed 171.8 lbs. which was a 8.73 % significant weight gain. Review of Resident #34's medical record, revealed no evidence the physician was notified of Resident #34's significant gain. Interviews on 08/24/23 from 9:07 A.M. to 11:15 A.M. with the Director of Nursing (DON) and the Assistant Director of Nursing (ADON) #500 verified the physician was not notified of Resident #34's weight gain and should have been. Review of the facility policy titled Monitoring of Weights, revised September 2012, revealed if there was an actual five-percent or more weight gain/loss in one month, the resident, family, physician, and Nutrition Services Director were to be notified by the nursing department. The date of such notification was to be documented on the weight sheet in the appropriate column. Review of the facility-provided document titled Federal and Ohio Resident Rights & Facility Responsibilities, revealed a facility must immediately inform the resident, consult with the resident's Page 1 of 3 365681 365681 08/24/2023 Windsor Lane Healthcare Center 355 Windsor Lane Gibsonburg, OH 43431

F 0580 Level of Harm - Minimal harm or potential for actual harm physician, and notify, consistent with his or her authority, the resident representative when there was a significant change in the resident's physical status. This deficiency represents non-compliance investigated under Complaint Number OH00145755. Residents Affected - Few 365681 Page 2 of 3 365681 08/24/2023 Windsor Lane Healthcare Center 355 Windsor Lane Gibsonburg, OH 43431

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm Based on medical record review and staff interview, the facility failed to follow physician orders to obtain weekly weights for Resident #34. This affected one (Resident #34) of three residents reviewed for weights. The facility census was 67. Residents Affected - Few Findings include: Review of Resident #34's medical record revealed an admission date of 07/12/23. The resident was discharged from the facility on 08/22/23. Diagnoses included Alzheimer's disease, dementia, anemia, hypertension, and chronic kidney disease stage four. Review of the admission Minimum Data Set (MDS) assessment, dated 07/24/23, revealed Resident #34 was cognitively impaired and required extensive assistance of one staff for toileting and personal hygiene. Review of Resident #34's physician orders,dated 07/12/23, revealed an order for weekly weights, one time per day every four weeks on Wednesday. Review of Resident #34's plan of care dated 07/26/23, revealed the resident had altered cardiovascular status related to arrhythmia, mitral insufficiency, mitral prolapse, aortic valve stenosis, and hypertension, with a goal to remain free from signs/symptoms of complications. Interventions included monitoring/documenting/reporting to physician changes in lung sounds on auscultation, edema and changes in weight. Review of Resident #34's weight record revealed on 07/12/23, the resident weighed 154.3 pounds. No weight was documented for 07/26/23. The resident weighed 171.8 pounds on 08/01/23. Interviews on 08/24/23 from 9:07 A.M. to 11:15 A.M. with the Director of Nursing (DON) and the Assistant Director of Nursing (ADON) #500, revealed all residents were weighed weekly for at least three weeks upon admission. ADON #500 verified Resident #34's physician order was to weigh weekly and Resident #34 was not weighed weekly. ADON #500 stated the physician order was not put in correctly, resulting in the missed weight. The DON also verified Resident #34's weight was not obtained on 07/26/23 and it should have been. This deficiency represents non-compliance investigated under Complaint Number OH00145755. 365681 Page 3 of 3