Health inspection·December 18, 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 record review, staff interview and observation, the facility failed to provide dignity and respect for three residents (#15, #24 and #133). This affected three of 15 residents who ate in the dining room. The facility census was 141. Findings include: 1. Review of Resident #15's medical record revealed he was admitted to the facility on [DATE]. Diagnoses included Alzheimer's disease with late onset, heart disease, anxiety and depression. Review of the Minimum Data Set (MDS) assessment, dated 10/04/19, revealed Resident #15 to have severe cognitive impairment. His functional status was listed as one to two-person limited assistance for activities of daily living. Review of Resident #24's medical record on 12/15/19 revealed she was admitted to the facility on [DATE]. Diagnoses included Alzheimer's disease, chronic obstructive pulmonary disease (COPD), psychosis, depression and inability to relax and leisure. Review of the MDS assessment, dated 10/09/19, revealed Resident #24 had moderate cognitive deficit and her functional status was listed as extensive one to two person assist. Observation of the first dining room on 12/15/19 from 12:25 P.M. until 1:10 P.M. revealed staff were passing lunch trays at 12:25 P.M. It was discovered Resident #15 and Resident #24's lunch tray were not delivered with the other trays. During the passing of the other resident's lunch trays, Resident #15 would leave his table and go up to the tray cart and ask for his lunch. Resident #15 was becoming angry and loudly stating when do I get my lunch. It was discovered at 12:45 P.M. that Resident #15 and Resident #24 did not have lunch trays so the Staff #1 called down to the kitchen to get them a tray. At 12:55 P.M., more trays were sent up from the kitchen and they also did not have Resident #15 or Resident #24's trays on the cart. This further upset Resident #15 and he started to curse. At 1:10 P.M., Resident #15 and Resident #24 received their lunch trays. Interview with Staff #1 on 12/15/19 at 12:30 P.M. revealed 15 residents receive trays in the dining room. Subsequent interview with Staff #1 on 12/15/19 at 12:45 P.M. verified she had called the kitchen and requested the trays be sent up. She also verified the trays were not on the second cart and she called down to the kitchen again for Resident #15 and Resident #24's trays. 2. Review of Resident #133's medical records revealed he was admitted to the facility on [DATE]. Page 1 of 7 365722 365722 12/18/2019 Wood Glen Alzheimer's Community 3800 Summit Glen Drive Dayton, OH 45449

F 0550 Level of Harm - Minimal harm or potential for actual harm Diagnoses included dementia with behavioral disturbances, diabetes mellitus, adult failure to thrive and dysphagia, oral phase. Review of the MDS assessment, dated 12/03/19, revealed Resident #133 had severe cognitive impairment. His functional status was listed as extensive one person assists for eating. Residents Affected - Few Review of the care plan, dated 10/30/19, revealed Resident #133 refuses to eat/resists feedings. Resident #133 does not like food. Observations of the first dining room on 12/15/19 at 12:25 P.M. revealed Staff #46 standing while feeding Resident #133. Interview with the Director of Nursing (DON) on 12/15/19 at 12:27 P.M. confirmed Staff #46 should be sitting while feeding the resident. The DON then went and retrieved a chair and asked Staff #46 to sit while feeding the resident. Resident #133 was the only resident being assisted to eat. 365722 Page 2 of 7 365722 12/18/2019 Wood Glen Alzheimer's Community 3800 Summit Glen Drive Dayton, OH 45449

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. Based on observation, medical record review, and staff interview, the facility failed to ensure a revision was made to the care plan for falls and fluid restriction. This affected two (#2 and #47) of 28 residents reviewed for care plans. The facility census was 141. Findings included: 1. Medical record review for Resident #2 revealed an admission date of 01/31/19. Diagnoses included Alzheimer's Disease. Review of the quarterly Minimum Data Set (MDS) assessment, dated 12/11/19, revealed the resident was cognitively intact. Review of the physician orders, dated 11/29/19, revealed a fluid restriction of 1000 milliliters per day. Subsequently the fluid restriction was discontinued on 12/04/19. Review of the care plan, dated 11/29/19, revealed the resident had potential for fluid deficit related to fluid restriction of 1000 milliliters per day. The care plan was not revised to indicate the fluid restriction was discontinued on 12/04/19. Interview with Registered Dietician (RD) #201 on 12/18/19 at 9:00 A.M. verified the resident was not on a fluid restriction and she should have updated the care plan because she missed it. 2. Medical record review for Resident #47 revealed an admission date of 01/06/18. Diagnoses included Alzheimer's Disease. Review of the quarterly MDS assessment, dated 10/18/19 revealed he was severely cognitively impaired. Review of the care plan, dated 11/04/19, revealed the resident was at risk for falls related to confusion. Interventions included for the resident to wear hard soled shoes while out of bed. Observation of the resident on 12/18/19 at 8:30 A.M. sitting in the dining room revealed he didn't have the hard soled shoes on his feet. Interview with the Director of Nursing (DON) on 12/18/19 at 8:45 A.M. verified the care plan needed revised and stated the intervention should have said as tolerated because at times he shuffles his feet and the shoes were a fall hazard. 365722 Page 3 of 7 365722 12/18/2019 Wood Glen Alzheimer's Community 3800 Summit Glen Drive Dayton, OH 45449

F 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, staff interview and policy review, the facility failed to ensure activities were provided for cognitively impaired residents. This affected four residents (#22, #47, #52 and #127) of six reviewed for activities during the annual survey. The facility census was 141. Residents Affected - Some Findings included: 1. Medical record review for Resident #127 revealed an admission date of 08/23/19. Diagnoses included Alzheimer's disease. Review of the quarterly Minimum Data Set (MDS) assessment, dated 10/14/19, revealed Resident #127 was severely cognitively impaired. Functional status was extensive assistance from staff for bed mobility and transfers and toilet use was total dependence on staff. Review of the care plan, dated 09/10/19, revealed she had adjustment issues to admission and demonstrated little interest in doing things. Interventions were to encourage participation in conversation with staff and other residents daily and introduce to residents with similar background, interests and encourage and facilitate interaction. Review of the resident's activity participation from 11/16/19 through 12/16/19 revealed it was silent for any resident participation. Review of the progress notes during this time frame revealed they were silent for any activities for the resident. Observation of Resident #127 on 12/15/19 at 9:03 A.M., 12:10 P.M. and 4:20 P.M. revealed the resident was lying in bed and there were not any interactions with the resident from activity staff. Further observation on 12/16/19 at 8:10 A.M. revealed the resident was lying in bed. There were not any observations of activities on the unit nor any encouragement of activities on 12/15/19 and the morning of 12/16/19. 2. Medical record review for Resident #47 revealed an admission date of 01/06/18. Diagnoses included Alzheimer's disease. Review of the quarterly MDS assessment, dated 10/18/19, revealed he was severely cognitively impaired. His functional status was extensive assistance for bed mobility, transfers and toilet use. Review of the care plan, dated 04/23/18, revealed Resident #47 was dependent on staff for activities, cognitive stimulation and social interaction related to cognitive deficits. Interventions were to invite the resident to scheduled activities on the unit, special and going outside, and provide resident with assistance/escort to activity functions. Review of the resident's activity participation record, from 12/11/19 through 12/16/19, revealed they were silent for any participation from the resident. Review of progress notes for the same dates revealed they were silent for activities. Observation of the resident on 12/15/19 at 9:02 A.M., 12:08 P.M. and 3:39 P.M. revealed he was in his room either lying in bed or resting on the side of his bed. Further observation on 12/16/19 at 8:00 A.M. revealed he was in bed. There were not any observations of activities on the unit nor any 365722 Page 4 of 7 365722 12/18/2019 Wood Glen Alzheimer's Community 3800 Summit Glen Drive Dayton, OH 45449

F 0679 encouragement of activities on 12/15/19 and the morning of 12/16/19. Level of Harm - Minimal harm or potential for actual harm 3. Medical record review for Resident #52 revealed an admission dated of 05/01/19. Diagnoses included Alzheimer's disease. Residents Affected - Some Review of the quarterly MDS assessment, dated 10/17/19, revealed the resident was moderately cognitively impaired. His functional status was extensive assistance from staff for bed mobility, total dependence on staff for transfer and toilet use. Review of the care plan, dated 05/06/19, revealed he had some activity preferences that continue to offer him some positive feelings of self, identity, purpose and meaning despite assessed cognitive loss due to dementia. Interventions were to create activity setting to recreate pleasurable past experiences, and offer programs in small group settings. Review of the resident's activity participation from 11/16/19 through 12/16/19 revealed it was silent for any resident participation. Review of the progress notes during this time frame revealed they were silent for any activities for the resident. There were not any observations of activities on the unit nor any encouragement of activities on 12/15/19 and the morning of 12/16/19. Observation of Resident #52 on 12/15/19 at 9:20 A.M. revealed he was sitting in the dining room at the table by himself. At 3:51 P.M., he was lying in bed. There were no activities in front of him during these two observations. 4. Medical record review for Resident #22 revealed an admission date of 08/19/16. Diagnoses included Alzheimer's disease. Review of the quarterly MDS assessment, dated 10/11/19, revealed the resident was severely cognitively impaired. Her functional status revealed she was an extensive assistance from staff for bed mobility, transfers and toilet use. Review of the care plan, dated 04/11/18, revealed the resident had limited group activity involvement and needed encouragement to participate in a structured activity. Interventions were to encourage participation by inviting to church and gospel music and one on one visits three times a week and to provide assistance/escort to activity functions as needed. Review of the resident's activity participation from 11/16/19 through 12/16/19 revealed it was silent for any participation. Review of the progress notes during this time frame revealed they were silent for any activities for the resident. There were not any observations of activities on the unit nor any encouragement of activities on 12/15/19 and the morning of 12/16/19. Observation of Resident #22 on 12/15/19 at 9:17 A.M. revealed the resident was sitting in the dining room. At 12:13 P.M. she was in bed in her room, and at 3:52 A.M. she was lying in her bed. On 12/16/19 at 11:32 A.M., she was sitting in the dining room with her hand on her head. Review of the activity calendar for 12/15/19 revealed on [NAME] Bay unit at 8:00 A.M. was music/exercise, daily chronicles, devotions, sensory and monthly gazette. 2:00 P.M. Music and [NAME], 3:00 P.M. hymn singing, 4:30 P.M. lotion massages, and 6:30 P.M. reminiscing. further review of the calendar for 12/16/19 revealed at 8:00 A.M. daily chronicles, scripture of the day, coloring,and hydration and snack cart. 365722 Page 5 of 7 365722 12/18/2019 Wood Glen Alzheimer's Community 3800 Summit Glen Drive Dayton, OH 45449

F 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Interview with the Administrator on 12/16/19 at 4:17 P.M. stated the activities director resigned about three to four weeks ago and do not have an activities director at the time of the interview. He verified there wasn't any activities provided on 12/15/19 and the morning of 12/16/19 for Residents #127, #47, #52 and #22. He stated there had been someone who floated to the [NAME] Bay unit, but it wasn't consistent and there wasn't any charting to prove they were doing it. He stated the Unit Manager for the unit should have been doing some of the activities for the residents. Interview with Unit Manager (UM) #85 on 12/17/19 at 11:13 A.M. revealed she was the UM on the [NAME] Bay unit and said they were providing activities a couple of days a week, but couldn't provide any documentation for the activities. She verified there wasn't any activities on 12/15/19 or the morning of 12/16/19. Review of facility's policy titled Activities Program, dated 05/30/19, revealed it was the policy of the facility to provide resident centered care that meets the psychosocial, physical, and emotional needs and concerns of the residents. The activity program is: a. Designed to encourage restoration to self-care and maintenance of normal activity that is geared to the individual resident's needs. b. Scheduled daily and residents are given an opportunity to contribute planning, preparation, conducting, cleanup and critique of the program. c. Consists of individual and small and large group activities which are designed to meet the needs and interests of each resident. d. Posted on the resident's bulletin boards showing the scheduling. e. Comprised of individual and group activities. f. Reflect the schedules, choices and rights of the resident: are offered at hours convenient to the residents including weekends and holidays; reflect the cultural and religious interests of the residents; and appeal to both men and women as well as all age groups of residents residing in the facility. 365722 Page 6 of 7 365722 12/18/2019 Wood Glen Alzheimer's Community 3800 Summit Glen Drive Dayton, OH 45449

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. Based on medical record review, observation and staff interview, the facility failed to ensure a physician order splint device was in place as ordered. This affected one (Resident #23) of two residents review for positioning /mobility. The facility census was 141. Findings include: Review of medical record for Resident #23 revealed an admission date of 11/29/18. Diagnoses included Alzheimer's disease late onset, muscle weakness, dementia without behavioral disturbances and major depressive disorder. Review of the physician order, dated 07/15/19, documented Resident #23 was to wear a right hand palm protector at all times, except it was to be off for hygiene and range of motion (ROM) during activities of daily living (ADLs). Review of the comprehensive care plan, dated 07/16/19, revealed Resident #23 was to wear the right hand palm protector at all times as tolerated and off for hygiene and ROM during ADLs. It was to be discontinued if there were any signs of redness or irritation. Review of the Treatment Administration Record (TAR) revealed the order for the resident was to wear the right hand palm protector at all times as tolerated and off for hygiene and ROM during ADLS. It was to be discontinued if there were any signs of redness or irritation. Further review from 12/01/19 through 12/16/19, revealed it lacked any documentation to ensure the splint device was in place or refused by Resident #23. Review of the nursing progress notes, from 12/01/19 through 12/16/19, revealed it lacked any documentation of the right hand protector being in place or documentation of the resident refusing to where the splint device as ordered. Observation on 12/15/19 at 10:12 A.M. revealed Resident #23's right hand appeared contracted with no splint devices in place. Subsequent observation on 12/15/19 at 2:02 P.M., Resident #23's right hand appeared contracted with no splint device in place. Interview on 12/16/19 at 11:44 A.M. with Unit Manager #85 verified Resident #23 was to have a right hand palm protector in place due to her contracture. She then verified it was not in place and it should be in place at all times. during the interview. Unit Manager was observed placing the splint device on Resident #23 without any resistance. 365722 Page 7 of 7