Health inspection·October 9, 2024

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 record review, review of facility policy, and staff interview, the facility failed to notify Resident #21's family of a resident's fall in a timely manner. This affected one (Resident #21) of three residents reviewed for family notification. The facility census was 83. Findings include: Review of the medical record for Resident #21 revealed an admission date of 08/15/23 with diagnoses of Parkinson's disease without dyskinesia, muscle weakness, and vascular dementia. Review of the Minimum Data Set (MDS) 3.0 assessment completed 09/26/24 revealed Resident #21 was cognitively intact. Review of Resident #21's General Durable Power of Attorney (POA) form dated 04/20/23 revealed the resident's wife was the POA for healthcare and listed in the medical record as emergency contact number one. Review of the Resident Preferences Evaluation dated 08/26/24 revealed It is very important for the resident to have their family or a close friend involved in discussions about their care. Review of the incident report dated 09/28/24 revealed Resident #21 was exiting the restroom when he slid down to the floor, landing on his bottom. An assessment completed post-fall revealed he was alert and oriented to person, with no injuries found. The report revealed the physician was notified on 09/28/24 at 1:57 A.M., and the spouse was notified on 09/28/24 at 4:36 P.M. Review of the progress notes dated 09/28/24 revealed Resident #21 slid down to the floor while in the restroom with no injury. The medical record did not have evidence that the POA/family were notified of the fall. The progress note dated 09/28/24 at 5:15 P.M. revealed Resident #2's POA was contacted regarding the resident's fall, which occurred approximately 15 hours after the incident. Interview on 10/09/24 at 11:30 A.M. with Registered Nurse (RN) #900 confirmed Resident #21's family/POA was not notified timely after the fall. RN #900 confirmed this nurse observed the fall however did not notify the family immediately after stabilizing the resident and informing the doctor. Interview on 10/09/24 at 1:32 P.M. with RN #999 confirmed family members should be notified as soon as practicable of a resident's fall. Interview on 10/09/24 at 1:58 P.M. with the Administrator, Director of Nursing, and Regional Director of Clinical Operations #1 confirmed family members should be notified immediately after a resident's fall. Page 1 of 2 365717 365717 10/09/2024 The Convalarium of Dublin 6430 Post Rd Dublin, OH 43016

F 0580 Level of Harm - Minimal harm or potential for actual harm Review of the facility's undated policy titled Notification of Change revealed the facility is required to inform the resident's legal representative or an interested family member when there is an accident involving the resident that results in injury and has the potential for requiring physician intervention. It is noted that all family notifications need to be placed in the medical record. Residents Affected - Few This deficiency represents non-compliance investigated under Complaint Number OH00158617. 365717 Page 2 of 2