Health inspection·October 1, 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, and review of the facility policy, the facility failed to notify the resident representative of changes of condition requiring as needed intramuscular injection for behavior. This affected one resident (#100) of one resident reviewed for notifications. The facility census was 82. Findings include: Review of the medical record for Resident #100 revealed he was admitted on [DATE] and discharged on 08/07/24. Resident #100 was admitted with diagnoses of Alzheimer's, dementia with behavioral disturbance, delirium, restlessness, and agitation. Review of the physician orders for 07/24 for Resident #100 revealed he was ordered geodon (used for agitation) 10 milligram (mg) intramuscular (IM) as needed (PRN), and Zyprexa (used for agitation) 10 mg IM PRN. Review of the Medication Administration Record (MAR) for 07/24 for Resident #100 revealed he was administered Zyprexa 10 mg IM on 07/04/24 at 5:35 P.M. for agitation and Geodon 10 mg IM on 07/22/24 at 8:59 P.M. and on 07/27/24 at 9:03 P.M. for agitation. Review of the nursing progress notes for Resident #100 revealed there was no documentation of notification to the resident's representative regarding PRN antipsychotic medication administration. Interview on 10/01/24 at 10:43 A.M. with the Director of Nursing (DON) verified the nursing progress notes for Resident #100 did not document notification that a PRN antipsychotic medication was ordered for administration. Further interview with the DON revealed it was the expectation for staff to contact family and notify of change in behavior and need for PRN medication. Interview on 10/01/24 at 12:09 P.M. with Licensed Practical Nurse (LPN) #372 stated the expectation of the nursing staff would be to contact family or guardian and notify them of the behaviors and the need for PRN antipsychotic medication. Interview on 10/01/24 at 1:30 P.M. with Clinical Nurse Practitioner (CNP) #371 stated the expectation would be to notify family of the need for PRN medication and change in behavior. CNP #371 further stated sometimes family is able to help redirect a resident. Review of the undated facility policy titled, Change in Resident's Condition or Status, revealed Page 1 of 2 365745 365745 10/01/2024 Swanton Valley Rehabilitation and Healthcare Cente 401 W Airport Hwy Swanton, OH 43558

F 0580 Level of Harm - Minimal harm or potential for actual harm the facility will notify the resident, his or her attending physician, and the resident representative of changes in the resident's medical/mental condition and/or status. This deficiency represents non-compliance investigated under Complaint Number OH00157829. Residents Affected - Few 365745 Page 2 of 2