Health inspection·February 22, 2024

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, review of facility self-reported incident (SRI) including investigation, observations, staff and resident interviews and review of facility Abuse, Neglect, and Misappropriation policy, the facility failed to ensure residents was free from physical and sexual abuse. This affected two residents (#57, #61) of four residents reviewed for abuse. The facility in-house census was 110. Findings included: 1. Medical record review revealed Resident #61 was admitted to the facility on [DATE] with diagnoses including chronic obstructive pulmonary disease, atrial fibrillation, heart failure peripheral vascular disease, anemia, and mental disorder. Review of Resident #61's quarterly Minimum Data Set (MDS) dated [DATE] revealed the resident's cognition was intact and he had one to three days of other behavioral symptoms not directed towards others. Review of Resident #61's orders and medication administration records dated 02/2024 revealed on 02/08/24 new orders were added to have two staff with care at all times, monitor bruising to right hand first and second digit until resolved and a revised order to monitor target behaviors of refusal of care, refuses to turn and reposition, false accusations with staff, sexually inappropriate, yelling at staff, and inappropriate finger gestures. Resident #61's medications that were due at 6:00 A.M. included Atorvastatin 40 milligrams (mg) once a day for hyperlipidemia, Lasix 20 mg daily for heart failure, Lisinopril 2.5 mg daily for elevated blood pressure, Metoprolol Extended Release (not recommended to crush) 40 mg daily for high blood pressure, Cholecalciferol 1000 units twice daily for supplement, and Eliquis 5 mg twice daily for atrial fibrillation. Further review revealed the resident had six behaviors of refusal to turn and reposition. There was no documented evidence the resident had any other targeted behaviors. Review of Resident #61's behavior plan of care dated 10/15/23 revealed to attempt to redirect when exhibiting behaviors; re-approach when resident had deescalated; communicate care; educate resident on need/benefit of care and risk of refusal, keep resident safe during episodes of behaviors; attempt to redirect, and offer distraction and re-approach later. Review of the facility SRI #243943 including investigation for physical abuse dated 02/08/24 Page 1 of 9 365687 365687 02/22/2024 Arbors at Marietta 400 Seventh Street Marietta, OH 45750

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few revealed Resident #61 alleged he was provided his morning medication crushed and in pudding by Medication Technician (MT) #119. He stated to MT #119 he no longer received his medication crushed and declined to take the medication in that form. MT #119 left the room with the crushed medication and returned with four pills in a medication cup. Resident #61 stated all his medication was not in the cup and declined to take it until he received all medications that were due. MT #119 stated those were the medications ordered. The resident refused to return the four pills in the medication cup or take the pills until someone addressed his issues. Licensed Practical Nurse (LPN) #233 entered the room to speak to Resident #61 and again he stated he would not take the medications until he was provided all the pills that were due and refused to return the medication cup. Resident #61 stated LPN #233 grabbed his hand to retrieve the cup and caused bruising in the process. Review of LPN #233's statement revealed Resident #61 had refused to take the medication stating not all his medications were there and he would not give the medication back to MT #119. He said he was keeping them to show the dayshift nurse he was missing medications. LPN #233 went in and reviewed all medications with him reassuring him that all the medication ordered for that morning was there. He again refused. LPN #233 told him if he wasn't taking the medication, she would need them back because she was not allowed to leave them in the room. The LPN went to grab the cup and Resident #61 grabbed her right wrist and started twisting and wouldn't let go. MT #119 told the resident to let go. LPN #233 reported she did not touch the resident in any way that would potentially cause harm because he had a hold of her right arm, and she had another resident's medication in her left hand. Review of MT #119's statement was consistent with LPN #233's statement. MT #119 reported LPN #233 had grabbed the medications and the Resident (#61) grabbed her by the right wrist and started twisting her arm and would not let go. MT #119 further stated she had to tell the resident he couldn't do that before he finally let go of LPN #233. Review of a skin and pain assessment conducted on Resident #61 revealed a bruise noted on his 1st and 2nd digit on the right hand. It was important to note Resident #61 was on blood thinners causing him to easily bruise. A whole house staff education on abuse was conducted as well as one on one with LPN #233. The resident was able to provide meaningful information when interviewed and the resident (#61) had no effect noticed as a result of the incident. There were two witnesses identified (Stated Tested Nurse's Aide (STNA) #137 and MT #119). The SRI was unsubstantiated as there was no evidence that indicated abuse had occurred. Further review of the investigation revealed no evidence of written statements from LPN #233 and MT #119. Review of STNA #137's statement dated 02/08/24 at 8:05 A.M., revealed Resident #61 informed me about what happened last night when I went to change him this morning. LPN #233 said he took his pills crushed and not whole, but he had been taking them whole for a long time and when she went back there were only four or five pills and he takes about seven. LPN #233 told him if you aren't going to take them, you're not getting any at all. She went to put his pills in his hand and grabbed his right index finger and that's when he grabbed her wrist and told her to get out of here. So, STNA #137 looked at this right index finger and it was red and bruised. STNA #137 informed her nurse and unit manager when he told her, and the nurse went to look at it and talk to the resident. 365687 Page 2 of 9 365687 02/22/2024 Arbors at Marietta 400 Seventh Street Marietta, OH 45750

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of STNA #146's statement dated 02/08/24 revealed when she first arrived at work, she overheard LPN #233 talking about an altercation with a resident to MT #119. LPN #233 told her she went to take Resident #61's pills and had crushed them, but he was upset about it, so she got him new that were whole. LPN #233 stated that he told her they still were not correct and wanted to keep hold of them anyway and she wouldn't let him. She then said she went to grab the pill to take them to be discarded and said the resident grabbed her arm and started to twist it. MT #119 then said he only let go of LPN #223 because MT #119 told him to. Further review of the staff questionnaires revealed the staff interview questions asked if they were aware of any incidents that happened with Resident #61, when were you notified of the incident and by whom, and if notified by the Resident, what did he say. The statement was answered yes or no for the first question, date and time and name for the second question and if there was a statement if the resident said anything. Review of the staff questionnaires revealed the surveyor could not determine the last name on the questionnaire dated 02/08/24 that revealed Resident #61 reported LPN #233 had brought his pills in crushed and he takes them whole. He gets about seven pills, and she only gave him four pills. The LPN told him to take it or leave it. He had the pill cup in his hand and wanted to show someone it wasn't his complete morning meds and LPN #233 had grabbed it out of his hands. Review of the facility investigation revealed interviewable residents were asked if they experienced abuse, and if so explain, and if they felt safe in the facility. There was no evidence skin assessments were completed on not interviewable residents. Review of LPN #186's questionnaire revealed the resident reported his medications were crushed and the medication tech had brought in the cup of medications. He held the cup of medication to ask LPN #233 which pills were missing. He said she stated take it or not. Then she took the pill cup from him. He stated she bruised his fingers. The unit manager was notified. Review of the incident report completed by the Director of Nursing (DON) on 02/08/24 revealed an STNA reported that a resident (#61) stated the nurse on the previous shift grabbed his hand trying to take the cup of pills away. Resident stated that the med tech brought in his morning medications, and they were crushed in pudding. He told the med tech he doesn't take them crushed. States the med tech asked if he was refusing. He replied, no I just don't take them crushed. The med tech left the room and returned with his meds whole in a cup. Resident stated there were only four pills in the up and told the med tech that wasn't all his medications. Med tech stated that was what was ordered. Resident says he told her he was not taking them and was waiting to show someone that his wasn't medication wasn't correct. Med tech told the resident she cannot leave unless you return the meds or take them. The resident refused and the Med tech left. LPN #233 came in and moved the resident's tray table and attempted to take the cup of pills from the resident's hand. The resident turned away and she grabbed my hand. The resident had bruises on the 1st and 2nd digits on the right hand. Pain medication offered but declined. Per the incident report, LPN #233 reported to the DON the resident's medications had always been crushed in pudding. So, she got his meds and crushed them in pudding. MT #119 went to give him his medication and he refused them stating he takes them whole. LPN #233 went in and spoke with him and said you've always taken your pills this way. He replied, I have never taken my pills crushed in pudding. LPN #233 left the room and MT #119 returned with his meds whole in a cup. She told me he refused 365687 Page 3 of 9 365687 02/22/2024 Arbors at Marietta 400 Seventh Street Marietta, OH 45750

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few to take the medications stating not all his meds were there. He wouldn't give the meds back to MT #119. He said he was keeping them to show the dayshift nurse he was missing meds. LPN #233 went in and reviewed all medications with him reassuring him that all the meds ordered for this morning were there. He again refused. LPN #233 told him if he wasn't taking the meds, she needed them back because she is not allowed to leave the meds in the room. LPN #233 went to grab the cup and the resident grabbed her by her right wrist and started twisting her wrist. He wouldn't let go. MT #119 had come in and told him to let go of my arm. The LPN #233 reported she did not touch him in any way to cause harm because he had her right arm, and she had other residents' medications in her left hand. She did not notice any bruising to the resident. Per the incident report, MT #119 reported to the DON she went to give Resident #61 his medications crushed in pudding. The resident stated he doesn't take the crushed in pudding. She went out and told LPN #233. MT brought back the resident meds whole in a cup. The resident still refused to take them stating there were meds missing. MT #119 tried to explain that they were all there and he declined. MT #119 told him if he wasn't going to take them, she needed them back because she is not allowed to leave medication in a room. He refused. MT #119 went and told LPN #233. She came in to tell the resident the same thing. She went to grab the medication and he grabbed her by the right wrist and started twisting her arm. He wouldn't let go. MT #119 had to tell him he couldn't do that before he finally let go. Review of Resident #61's pertinent charting note-behavior and nursing progress note dated 02/08/24 at 6:26 A.M. revealed when administering morning medications, this nurse crushed resident's meds as have done any other time this nurse has given meds to this resident. Resident refused to take the medication. This nurse then gave the resident whole pills and resident refused to take them stating they were not all there. This nurse explained they were all there and went through every medication he was to have, and the resident began yelling at this nurse and refused to take them again. When this nurse went to take cup of meds back due to refusal, resident grabbed this nurse's right arm squeezing and twisting. Review of Resident #61's pertinent charting for change of condition dated 02/08/24 revealed the resident had maroon colored bruising to the right-hand 1st and 2nd digit. The reported nurse grabbed right hand to try and take the cup of pills from him. Investigation initiated, nurse suspended, and pain and skin assessment completed. Review of Resident #61's psychosocial note dated 02/12/24 revealed the resident stated that he wasn't having difficulty sleeping but doesn't think about the incident often. The resident would be observed for seven days per the abuse policy related to psychosocial. Review of Resident #61 charting dated 12/01/23 to 02/20/24 revealed only two behaviors noted. One on 12/04/23 for refusing to have barrier between skin and the bed and the incident on 02/08/24 with LPN #233. Interview on 02/20/24 at 9:54 A.M., with Resident #61 revealed the resident resided next to the window. When the surveyor asked the resident if he had ever been abused, the resident reported yes. The surveyor asked the resident to explain the abuse. The resident reported on February 8th, 2024, the unit manager Licensed Practical Nurse (LPN) #233 was preparing the medications and having Medication Technician (MT) #119 administering the medication to the residents. MT #119 entered his room and placed a medication cup on his bedside table. The medications were crushed in pudding. The MT #119 reported LPN #233 had prepared his medication and she was supposed to bring it to him. The resident 365687 Page 4 of 9 365687 02/22/2024 Arbors at Marietta 400 Seventh Street Marietta, OH 45750

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few responded, I don't take my medication that way, I take them whole. The resident explained to the surveyor that one of the medications was extended release and he was told it could not be crushed. The MT replied, Are you refusing to take them?. The resident replied No, I just need them the way I'm supposed to take them. The MT took the medication cup and left the room. She then returned with the medication cup with the crushed medication and said, You need to take them, or we will chart you refused them. The resident requested that the MT provide him with her name, however he reported she refused to provide it and stated, I don't have to give you my name. He asked her again for her name and she responded Puddin Tane and then she said LPN #233 first name. The MT took the medication cup with the crushed medication and left the room again. MT #119 returned to his room with a medication cup with four whole pills in the cup. The resident told the MT he was supposed to have six pills. The MT reported she would ask the nurse and she came back in and said, This is what the nurse said you are going to get. The resident reported he had the medication cup in his right hand when the MT asked for them back if he wasn't going to take them. The resident reported he was going to keep them until he could show the nurse. At that time LPN #233 stormed in and pushed his bedside tray out of the way and attempted to grab the medication cup out of his hand. The resident reported he moved his right arm over his abdomen towards the window to prevent the nurse from grabbing the medication cup from his hand. The LPN held his arm and leaned over him attempting to get the medication cup out of his hand. The resident reported the LPN was squeezing his hand so hard the cup was pressing into his hand and causing pain. He used his other hand (left hand) to grab her arm and was told to let go so he did, and the LPN took the medication cup and left the room. The resident reported the LPN had squeezed his hand so hard it left bruises on two of his fingers where he was holding the medication cups. The resident showed the surveyor there was still a red mark on this thumb and the pointer finger bruise had resolved. The resident reported one of pills that was missing was red/orange in color, but he did not know the name of the medication. At 11:00 A.M. he finally got all his medications. He has spoken to Social Service and the Administrator; however, he feels the Administrator should be protecting the residents and not the staff. He had recently found out from other staff and residents that LPN #233 had been rude to other people. He was considering filing charges against the nurse and was still very upset about the situation and was concerned about other residents residing in the facility due to LPN #233 had physically abused him. He has requested that LPN #233 not provide care to him and was told she was suspended but she was back to work already. Review of Quality Assurance Form completed on 02/16/24 (completed because of an abuse allegation that occurred on 02/14/24 between resident to resident) revealed Resident #61 told admission Staff #194 he did not feel safe due to issues with a staff member a couple days ago LPN #233. Interview on 02/20/24 at 10:28 A.M., with the Administrator and DON revealed LPN #233 was suspended after the allegation was reported until the following Monday. The resident did not have an order to crush his medication and the LPN should have administered his medication whole and since she had prepared the medication, she should not have had the MT administer the medications she prepared. The LPN had one on one education on abuse and medication administration. The Administrator and DON reported they unsubstantiated the abuse allegation based off staff statements were consistent. The DON reported she determined the bruises were a result of the resident twisting the staff's arm and, on a blood, thinner, not caused by the resident holding the pill cup in his hand. Interview on 02/20/24 at 11:11 A.M., with LPN #233 and DON revealed she was working midnights on the third floor due to there was a call off, but usually works day shift as a unit manager on the first floor. The LPN reported she was administering morning medication and had provided care to Resident #61 a year ago when she worked the 3rd floor and he had 365687 Page 5 of 9 365687 02/22/2024 Arbors at Marietta 400 Seventh Street Marietta, OH 45750

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few received his medication crushed at that time, so she thought he was still a crushed med. The LPN confirmed the resident did not have an order to crush meds. She could not recall which meds he was on but remembers crushing five or six meds. The LPN confirmed she had prepared the meds but handed them to the med tech to administer. LPN #233 reported she was standing outside the door preparing the next resident's medications and the med tech came back out of the room and reported the resident didn't take his medication crushed. She went into the room and the resident told her that he took them whole now. She went back out to get all the new meds and gave them to the med tech to administer. She heard the resident say they were not all there, so she wrote all his meds down and went back into the room and read off the medication he was to receive. Resident #61 kept saying they were not the right medication and she reassured him they were correct. He refused to take them until the nurse came in. She explained she had to stay with him until he took them. He placed the cup on the bed beside his leg by his knees. She reached across his knees to get the med cup and he grabbed her right arm and hand and started to twist it. She had a pill cup and glucometer in her other hand so there was no way she could have touched him. She grabbed the pills with her right hand. The LPN denied squeezing the resident's hand. The LPN reported she was provided education on abuse and med administration. She was suspended on the 8th and was off the weekend anyway and returned on Monday. She was aware the resident requested that she not provide him service/care in the future. Interview on 02/21/24 at 8:46 A.M., with the DON revealed she did not have any written statements from LPN #233 or MT #119 regarding the incident with Resident #61. The DON confirmed she had received verbal statements and typed the statements on the incident report. She was not aware until yesterday the resident and staff had reported to Resident #61 that LPN #233 had been mean to others. Interview on 02/21/24 at 10:35 A.M. with STNA #117 and Registered Nurse (RN) #197 revealed they were unaware of Resident #61 making false accusations against staff. RN #197 and STNA #117 reported the resident is particular about his care. Usually if he refuses care, if you re-approach him, he was usually pretty complaint. He has never been combative with care. Interview on 02/21/24 at 11:42 A.M., with Resident #61 and the Administrator revealed the resident denied that the LPN #233 reviewed his medication with him on February 8th (2024) when he had voiced concern that he did not receive all his morning medication per LPN #233 interview. The resident voiced concerns to the Administrator that he felt the Administrator was more concerned about the food menu the day they spoke instead of the assault. The Administrator confirmed she had spoken to him regarding the alterative menu. The resident reviewed the resident statement that was taken on 02/20/24 at 9:45 A.M. by the surveyor for accuracy. The resident confirmed with the Administrator and surveyor that the statement taken by the surveyor on 02/20/24 at 9:45 A.M. was an accurate timeline of events that occurred on February 8th with LPN #233 and MT #119. Interview via phone on 02/21/24 at 3:12 P.M., with MT #119 revealed she was working the midnight shift and had finished administering her medication and was helping LPN #233 administer medication on her unit. LPN #233 had prepared Resident #61's medications and she took the medication into the resident's room to administering them. She thought his pills looked funny because she had never crushed his pills before when she had administered his medication, but she took them into the resident anyway. The resident reported to her he doesn't take his medication crushed. The MT reported she took the medications back out to LPN #233 and LPN #233 told her to tell the resident that that's all he had. MT reported she took the crushed medication cup back into the resident's room and told him the nurse said that's all he had, and he refused to take them, so she took them back out to LPN #233. LPN #233 then popped out 3-4 pills into a medication cup and gave them to her to administer to the resident. The MT reported Resident #61 usually takes 5-6 meds in the morning, however LPN #233 only 365687 Page 6 of 9 365687 02/22/2024 Arbors at Marietta 400 Seventh Street Marietta, OH 45750

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few gave her 3-4 (pills) to give him. The resident refused to take them again because there were some medications missing. LPN #233 came into the resident's room and leaned over the resident and took the medication out of the resident's right hand. When the surveyor asked MT #119 if this was abuse, MT #119 confirmed LPN #233 was aggressive with the resident and she would have never done that. MT #119 reported she doesn't recall LPN #233 having anything else in her left hand when asked and the resident had the medication cup in his right hand not on the bed when LPN #233 removed them when asked for clarification by the surveyor. The resident grabbed the LPN's arm when she was leaning over him trying to get the medication cup, however he released his hand when asked to let go. MT #119 confirmed she did not provide a written statement and the Director of Nursing (DON) called her about the incident after she had left the facility when her shift ended. Reviewed interview for accuracy and MT #119 confirmed interview statement was accurate. 2 Record review revealed Resident #57 was admitted to the facility on [DATE] with diagnoses including dementia, unspecified severity, with agitation, concussion with loss of consciousness, history of traumatic brain injury, insomnia, anxiety, depression, cognitive deficit, and amnesia. Review of quarterly minimum data set (MDS) assessment dated [DATE] revealed moderately impaired cognitive skills for daily decision making. The resident was noted to have one to three days of other behavioral symptoms not directed toward others (physical symptoms such as hitting or scratching self, pacing, rummaging, public sexual acts, disrobing in public, throwing, or smearing food or bodily wastes, or verbal/vocal symptoms like screaming or disruptive sounds). The resident did not reject care or had wandering. The resident had no impairment in upper or lower extremity and used a wheelchair for mobility. Review of Resident #57's treatment administration record (TAR) dated 02/2024 revealed to monitor target behaviors of sexual inappropriateness, restless, refusal of meds/showers, tearful, and sleepless. The non-pharmacological interventions included food/fluids and distraction. The resident had no sexual inappropriateness behaviors documented in February 2024. Review of care plan dated 10/02/23 revealed Resident #57 was a two person assist with bed mobility and one person assist with dressing, hygiene, toileting, and transfers. Review of behavior plan of care dated 10/02/23 and revised on 02/19/24 revealed the resident has behavior(s) related to dementia and traumatic brain injury as evidenced by refuses medications, refuses showers, sexually inappropriate toward other residents (flashes others), refuses to let staff cut fingernails, refuses to be weighed at times, refuses to let staff take vital signs at times. On 02/19/24 strips off clothes was added. Interventions included to administer medication as ordered, approach resident in a calm manner to avoid frustration and behavior escalation, keep resident safe during episode of behavior, observe, and document inappropriate behaviors and notify physician when behaviors persist or won't de-escalate, distract with food/fluids, and refer to psychologist/psychiatrist services as needed. On 02/15/24 15-minute checks for 72 hours was added and on 02/17/24 the intervention was revised to discontinue the abdominal binder over breast and added to ensure the resident had appropriate size garments on upper body to prevent from sliding up. Review of Resident #57's pertinent charting dated 01/12/24 revealed resident roaming up and down halls stops at male rooms and rooms that people have snacks in. Male resident reported she tries to show him her chest but had a white under shirt on. Review of Resident #57 pertinent charting dated 01/13/24 revealed staff reports resident sitting in 365687 Page 7 of 9 365687 02/22/2024 Arbors at Marietta 400 Seventh Street Marietta, OH 45750

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few front of male resident's door with shirt up, fondling her breast making moaning and groaning sounds. The resident was removed from the male resident's doorway and taken to her room. This is an ongoing issue with resident with male residents. Resident takes binder off after staff places it on her. Review of Resident #57's physician note dated 01/15/24 revealed the [AGE] year-old female with a history of anoxic brain injury with dementia and behaviors, being seen today due to continuously pulling up her shirt. She does have hypersexual behaviors at times and that has increased. She does wear an abdominal binder to help prevent her from pulling up her shift, and easily flashing people, but she had started to do it more again. Review of Resident #57's psych note dated 01/17/24 (signed on 02/21/24) and not in the resident medical record revealed the resident continues to make very sexualized advances and exhibits very sexualized behaviors towards others. The patient was observed to be raising her shirt towards other people, male or female, staff, and residents. The resident very sexualized in her verbalization. The patient appeared to be unaware of the impact she was having on those around her and voiced no concerns for her current behavior. Plan to increase her Effexor to 75 milligrams daily to see if that helps. Continue the Tagamet that she is already on and the Ativan. Review of progress note dated 02/14/24 revealed RN #234 was walking down the hall when she observed Resident #57 and a male resident sitting in the hallway, both in their wheelchair. RN #234 noted that Resident #57's brief was unfastened, and male resident (#113)'s hand was noted to be flat palmed inside the brief up to the 1st set of knuckles. RN #234 immediately intervened and separated the residents. The power of attorney was notified and declined to have the resident be sent out for evaluation. Further review of Resident #57's medical record after the incident on 02/14/24 revealed: On 02/15/24 the resident refused a bath. On 02/17/24 the resident was removed from male resident rooms twice today; has a history of inappropriate sexual behaviors. On 02/17/24 abdominal binder intervention removed today due to resident persistently removing it. On 02/18/24 the resident was noted wheeling self-down hallway completely naked. 02/18/24 the resident had noted increased anxiety and was yelling out to men. Place on 15-minute checks for 72 hours. Record review revealed Resident #113 was admitted [DATE] with diagnosis including mild cognitive impairment, sexual dysfunction not due to a substance of known psychological condition, depression, vascular dementia, mood disorder, history of traumatic brain injury, and diabetes. Review of Resident #113 room census revealed he was admitted to the 3rd floor in a semiprivate room on 01/31/24. He was moved on 02/05/24 to a room on the first floor. On 02/06/24 he was moved back to the third floor and on 02/15/24 until 02/16/24 (discharged ) he remained in that room. Review of Resident #113's social service progress note dated 02/01/24 revealed the resident entered the facility from another skilled nursing facility on 01/31/24. BIMS was assessed at a five showing 365687 Page 8 of 9 365687 02/22/2024 Arbors at Marietta 400 Seventh Street Marietta, OH 45750

F 0600 a severe cognitive impairment. The resident was very concerned that people don't think of him as crazy. Level of Harm - Minimal harm or potential for actual harm Review of the admission MDS dated [DATE] revealed his BIMS was 12 (cognition intact), the resident did not have any behaviors or moods, psychosis present. He had verbal symptoms directed towards other and not directed towards others 1 to 3 days no rejection of care. He had been wandering for one to three days. He had no functional limitation in range of motion and used a walker and wheelchair mobility devices. He was independent with eating, dependent with shower, toileting, and required substantial/maximal assistance with dressing upper and lower body. He had diagnoses of persistent mood disorder and other sexual dysfunction not due to a sub or known physiological condition. Residents Affected - Few Review of Resident #113's admission orders revealed Estradiol 1 milligram (mg) daily for hypersexuality and have psych see resident regarding dementia and sexual behaviors. Review of Resident #113's behavior plan of care dated 02/05/24 revealed the resident was sexually inappropriate towards staff. Interventions included communicating care to residents before starting task, keeping resident safe during episodes of behavior and attempt to redirect. Observe and document episodes of inappropriate behaviors; notify physician when behaviors persist or won't de-escalate; redirect, reposition, one on one, food/fluids. Review of Resident #113's psych note dated 02/09/24 (signed 02/21/24) revealed nursing staff reported increased hypersexual like behaviors and patient did not deny these but attempted to minimize the severity of which it was described. Patient openly acknowledged his willingness to be more mindful in his interactions with others. Review of Resident #113's TAR dated 02/01/24 to 02/16/24 (discharge date ) revealed on 02/05/24 the resident targeted behaviors were sexually inappropriate and verbally aggressive with staff, wandering, agitation, refuses care, restless, and sleepless. The non-pharmacological intervention included reposition, redirection, and offer food and fluids. The resident had behaviors of agitation and wandering, however no evidence he was sexually inappropriate. Review of Resident #113's task for the last 30 days revealed on 02/13/24 the facility started monitoring target behavior of agitation, sexually inappropriate with staff. Review of Resident #113's medical record revealed no evidence the reside[TRUNCATED] 365687 Page 9 of 9