Health inspection·January 9, 2020

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, review of facility policy and staff interview, the facility failed to timely develop the resident's care plans. This affected three (Resident #41, #64 and #71) of 24 residents reviewed for care plans. The facility census was 81. Findings include: 1. Medical record review for Resident #41 revealed an admission date of 03/07/18. Diagnoses included obesity, chronic obstructive pulmonary disease (COPD), and chronic pain syndrome. Review of the Minimum Data Set (MDS) assessment, dated 10/30/19, revealed the resident had intact cognition and had obvious broken natural teeth. Review of the MDS care area assessment, dated 10/30/19, revealed triggering conditions related to obvious or broken natural teeth, was a functional impairment that limited the ability of the resident to perform personal hygiene and dry mouth causing buildup of oral bacteria due to medication. The facility documented a dental care would be addressed in the plan of care due to resident was missing teeth and in poor condition. Review of the plan of care for Resident #41, dated 11/30/19, revealed it was silent for a dental plan of care. Interview with Licensed Practical Nurse (LPN) #51 on 01/03/20 at 10:41 A.M. verified the plan of care did not address Resident #41's dental status. The LPN verified the care area assessment stated the resident's dental status would be addressed in the plan of care. 2. Medical record review for Resident #64 revealed an admission date of 01/03/19 with diagnoses including emphysema (abnormal condition of the lungs normal functions), pneumonia (severe inflammation of the lungs) and chronic and acute respiratory failure. Review of the Minimum Data Set (MDS) assessment, dated 11/18/19, revealed the resident had severe cognitive impairment and was receiving oxygen during the assessment period. Review of the physician orders, dated 12/19/19, revealed an order for oxygen administration to Resident #64. Review of the plan of care for Resident #64, dated 12/31/19, revealed it was silent for oxygen Page 1 of 4 365690 365690 01/09/2020 Cedarview Care Center 115 Oregonia Road Lebanon, OH 45036

F 0657 usage or multiple respiratory diagnosis. Level of Harm - Minimal harm or potential for actual harm Interview with Assistant Director of Nursing #65 on 01/04/19 at 10:22 A.M. verified the plan of care did not contain a focus area for respiratory complications related to pneumonia and emphysema. Residents Affected - Few Interview with Licensed Practical Nurse(LPN) #51 on 01/04/20 at 2:09 P.M. verified Resident #64 did not have a respiratory plan of care in place and should have. 3. Review of the medical record for Resident #71 revealed an admission date of 09/28/19. Diagnoses included diffuse traumatic brain injury with loss of consciousness, laceration of scalp, fracture of the occiput, fracture of the occipital floor and major depressive disorder. Review of the comprehensive Minimum Data Set (MDS) dated [DATE] Resident #71 had impaired cognition and needed limited assistance for most activities. Review of the care plan completed on 10/14/19 revealed the comprehensive care plan was not completed. According to the Resident Assessment Instrument (RAI) manual the comprehensive care plan should have been completed on 10/21/19. Interview on 01/04/20 at 12:00 P.M. with Licensed Practical Nurse (LPN) #51 confirmed she had not completed the comprehensive in the seven-day time frame. Review of the facility's undated policy titled Care Plans, Comprehensive Person Centered, revealed a comprehensive, person centered care plan is developed within seven days of the completion of the required comprehensive assessment. 365690 Page 2 of 4 365690 01/09/2020 Cedarview Care Center 115 Oregonia Road Lebanon, OH 45036

F 0849 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, hospice staff interview and review of facility contract for hospice services, the facility failed to designate a staff member to collaborate services. This affected two (Resident #64 and #176) reviewed for hospice services. The facility identified eight residents receiving hospice services. The facility census was 81. Findings include: 1. Medical record review for Resident #64 revealed an admission date of 01/03/19. Diagnoses included dementia, stroke, emphysema, sepsis and pneumonia. Review of the Minimum Data Set (MDS) assessment, dated 11/18/19, revealed the resident had severe cognitive impairment. Review of the physician orders, dated 12/19/19, revealed an order for admission to hospice services. Review of the plan of care, dated 12/31/19, revealed the resident was receiving hospice services. The plan of care was silent for a designated staff member for the coordination of care with hospice. Interview with Hospice Registered Nurse (RN) #55 on 01/03/20 at 12:39 P.M. verified the facility does not have a designated staff member for the collaborates of services. She stated updates the staff nurse of any changes in the resident heath care status and it was not the same staff member each day. Interview with Assistant Director of Nursing #200 on 01/04/20 at 10:57 A.M. verified Resident #64 was currently receiving hospice services and the facility does not have a designated staff member to collaborate care services between the two providers. 2. Medical record review for Resident#174 revealed the resident was admitted to the facility on [DATE]. Diagnoses included metabolic encephalopathy, pneumonia, uterine cancer, and dementia with behavioral disturbances. Review of the MDS assessment, dated 10/29/19, revealed Resident #174 has extensive cognitive impairment. Review of the care plan, dated 11/20/19, revealed the resident was receiving hospice services. The plan of care was silent for a designated staff member for the coordination of care with hospice. Review of the physician orders, dated 12/12/19, revealed to admit to hospice with end stage diagnosis of Alzheimer's dementia with life expectancy of less than six months. Interview with the Social Worker and the Assistant Director of Nursing #200 on 01/03/20 at 10:22 A.M. verified the facility does not have a designated person to coordinate care between hospice and the facility. Review of the nursing facility agreement with hospice program, dated 12/23/15, revealed the facility will designate a member of the facility interdisciplinary team who is responsible to work with hospice personally to coordinate care provided to the hospice patient. 365690 Page 3 of 4 365690 01/09/2020 Cedarview Care Center 115 Oregonia Road Lebanon, OH 45036

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. Based on observation and resident and staff interview, the facility failed to maintain a bed side table locking devices on drawers to prevent loss of theft of personal property and failed to ensure a safe and functional environment for the residents, staff and the public. This affected one (Resident #31) of 24 residents reviewed for physical environment and had the potential to affect all 81 residents residing in the facility. Findings include: 1. Observation and interview with Resident #31 on 01/02/20 at 4:45 P.M. revealed the resident had a bedside table with drawers. The top drawer had a locking mechanism that did not appear to work. The resident stated it did not work. and he does not have a key to this lock. He stated he was unable to securely lock up his valuable items if he would need to. He stated staff told them they were going to put a lock on it but they haven't yet. Observation and interview with Maintenance Director #60 on 01/04/20 at 3:01 P.M. verified Resident #31's bedside table had a locking mechanism and it needed repaired. 2. Observation on 01/02/20 at 9:00 A.M. of the floor in the A and B hall of the facility revealed 42 wooden/laminate flooring planks were broken and peeling. The areas that were missing pieces of the flooring material contained a build up of an unknown dark material. Interview with the Maintenance Director #60 on 01/04/20 at 4:11 P.M. verified the planks needs to be replaced. He stated the facility has inquired about an estimate for replacement. 365690 Page 4 of 4