Health inspection·September 30, 2022

F 0569 Notify each resident of certain balances and convey resident funds upon discharge, eviction, or death. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to ensure residents who were within $200.00 of the Social Security Income (SSI) resource limit of $2,000.00 were appropriately assisted in spending down the money so the resident did not lose their Medicaid eligibility. This affected one resident (#23) of two residents reviewed for personal fund account spend down. Residents Affected - Few Findings include: Review of Resident #23's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses including respiratory diseases, hypertension, depression and dementia. Record review revealed the resident did not have a financial power of attorney or legal guardian. Review of Resident #23's quarterly Minimum Data Set (MDS) 3.0 assessment, dated 07/14/22 revealed the resident was moderately cognitively impaired. Review of Resident #23's personal funds account revealed on 09/29/22 the resident had a balance of $2,364.38 in her personal funds account. As of 11/03/21 Resident #23's account had exceeded the $2,000.00 Social Security Income (SSI) resource limit. A stimulus check, issued 04/07/21 for 1400.00 was included in the amount not spent down within a year (by 04/07/22) and the excess was not sent back to the State. On 09/29/22 at 6:32 P.M. interview with Business Office Manager (BOM) #150 confirmed Resident #23 exceeded the $2,000.00 SSI resource limit. BOM #150 indicated she had noted on Resident #23's quarterly statements her personal funds account exceeded the SSI resource limit and sent letters to the resident's her niece who was in jail. BOM #150 revealed with COVID and the stoppage of outings it had been harder to spend money. BOM #150 indicated she contacted a funeral home in an effort to spend down the money and provided a letter and contract dated 09/23/22 for burial at a funeral home. The BOM revealed she would be sending a check for 2000.00 to the funeral home on friday 09/30/22. However, review of the resident's quarterly statements revealed on 02/25/21 a check for $2,000.00 was deducted from the resident's account for funeral expenses. The resident's file contained a funeral contract for the resident with a receipt from the funeral home dated 03/01/21 confirming receipt (check #5934) for $2000.00 dollars. Review revealed when the facility contacted the funeral home to provide a burial contract (in 09/2022), the funeral home opened a second burial contract for Resident #23. Page 1 of 15 365766 365766 09/30/2022 Parkside Health Care Center 930 East Park Avenue Columbiana, OH 44408

F 0569 Level of Harm - Minimal harm or potential for actual harm On 09/29/22 at 6:48 P.M. a follow up interview with BOM #150 revealed she forgot the resident already had a burial account and that she had sent $2000.00 in 2021 for burial expenses. The BOM verified the facility initiated a second burial contract at the same funeral home and the resident would have paid for burial twice. Residents Affected - Few 365766 Page 2 of 15 365766 09/30/2022 Parkside Health Care Center 930 East Park Avenue Columbiana, OH 44408

F 0602 Protect each resident from the wrongful use of the resident's belongings or money. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to ensure Resident #17 was free from financial exploitation by Former Dietary Aide (DA) #155. This affected one resident (#17) of one resident reviewed for misappropriation/exploitation. Residents Affected - Few Findings include: Review of the medical record for Resident #17 revealed the resident was admitted on [DATE] with diagnoses including encounter for orthopedic aftercare following surgical amputation of left great toe, history of a stroke, type II diabetes and peripheral vascular disease. Review of a facility Self-Reported Incident (SRI), tracking number 218531 initiated 03/02/22 revealed DA #155 asked to borrow $200.00 from Resident #17. The DA reported this to Former Business Office Manager (BOM) #150 on 02/18/22. She was told by the BOM that she should not have done that and needed to give the money back. The DA claimed to have returned the money on 02/19/22 when she placed an envelope with $200.00 in the resident's top drawer. However, no money was found in Resident #17's drawer. The Administrator was informed of the incident on 02/25/22, suspended the DA and began an investigation. As a result of the incident, Resident #17 received his money back from the DA and the DA was terminated. Review of the annual Minimum Data (MDS) 3.0 assessment, dated 07/02/22 revealed the resident was cognitively intact and independent with set up assistance from staff for most activities of daily Living (ADL). On 09/27/22 at 9:45 A.M. interview with Resident #17 verified the DA asked the resident for money since she had been sick and off from work. He also verified he received his money back and there were no further concerns related to the incident. On 09/29/22 at 2:12 P.M. interview with the Administrator verified DA #155 exploited Resident #17 when she asked him for money and then lied about putting the money in the resident's room to repay him. The money was subsequently paid and the DA was terminated. Review of the personnel file for DA #155 revealed she was hired on 08/25/21 and signed the February 2015 Employee Code of Conduct on that date which included prohibition of soliciting residents for monetary or material gain. 365766 Page 3 of 15 365766 09/30/2022 Parkside Health Care Center 930 East Park Avenue Columbiana, OH 44408

F 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to ensure an allegation of financial exploitation involving Resident #17 by former Dietary Aide (DA) #155 was reported to the Administrator timely and failed to ensure the incident was reported to the State agency timely and as required. This affected one resident (#17) of one resident reviewed for misappropriation/exploitation. Residents Affected - Few Findings include: Review of the medical record for Resident #17 revealed the resident was admitted on [DATE] with diagnoses including encounter for orthopedic aftercare following surgical amputation of left great toe, history of a stroke, type II diabetes and peripheral vascular disease. Review of a facility Self-Reported Incident (SRI), tracking number 218531 initiated 03/02/22 revealed DA #155 asked to borrow $200.00 from Resident #17. The DA reported this to Former Business Office Manager (BOM) #150 on 02/18/22. She was told by the BOM that she should not have done that and needed to give the money back. The DA claimed to have returned the money on 02/19/22 when she placed an envelope with $200.00 in the resident's top drawer. However, no money was found in Resident #17's drawer. The Administrator was informed of the incident on 02/25/22, suspended the DA and began an investigation. As a result of the incident, Resident #17 received his money back from the DA and the DA was terminated. Review of the SRI revealed a date of discovery on 02/25/22. The SRI was not created by the facility until 03/02/22 and was completed on 03/08/22. Review of the annual Minimum Data (MDS) 3.0 assessment, dated 07/02/22 revealed the resident was cognitively intact and independent with set up assistance from staff for most activities of daily Living (ADL). Review of personnel file for DA #155 revealed the dietary aide was hired by the facility on 08/25/21. On 09/27/22 at 9:45 A.M. interview with Resident #17 verified the DA asked the resident for money since she had been sick and off from work. He also verified he received his money back and there were no further concerns related to the incident. On 09/29/22 at 2:12 P.M. interview with the Administrator verified DA #155 exploited Resident #17 when she asked him for money and then lied about putting the money in the resident's room to repay him. The money was subsequently paid and the DA was terminated. On 09/29/22 at 4:10 P.M. interview with Former Business Office Manager (BOM) #150 revealed DA #155 told her about borrowing money from Resident #17 as the BOM was walking out of the building on 02/18/22. Since it was a Friday, the BOM informed the DA's supervisor, Dietary Manager (DM) #130, of the incident on Monday morning, 02/21/22 and expected the DM would report it to the Administrator. On 09/29/22 at 4:38 P.M. interview with DM #130 verified BOM #150 told him on 02/21/22 about DA #155 asking Resident #17 for money and stating she was going to pay it back. The DM reported he did not report the incident to the Administrator because he stated he was told the BOM said she would 365766 Page 4 of 15 365766 09/30/2022 Parkside Health Care Center 930 East Park Avenue Columbiana, OH 44408

F 0610 handle it. Level of Harm - Minimal harm or potential for actual harm On 09/29/22 at 4:50 P.M. interview with the Administrator revealed he was informed of DA #155 asking for money from Resident #17 on 02/25/22. The Administrator verified Self-Reported Incident (SRI), tracking number 218531 was filed late. The administrator revealed as a result of the incident he did interview an unknown number of other residents, with no concerns related to financial exploitation by staff, but stated he did not document the interviews and could not identify which residents were interviewed to ensure a thorough investigation had been completed with no other residents experiencing similar concerns. Residents Affected - Few 365766 Page 5 of 15 365766 09/30/2022 Parkside Health Care Center 930 East Park Avenue Columbiana, OH 44408

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review, facility policy and procedure review and interview the facility failed to ensure Resident #3, Resident #5, Resident #9 and Resident #27, who required staff assistance with activities of daily living (ADL) care received timely and adequate nail care to maintain proper hygiene. This affected four residents (#3, #5, #9 and #27) of five residents reviewed for activities of daily living. Residents Affected - Some Findings include: 1. Review of Resident #3's medical record revealed a 02/28/17 admission date with diagnoses including hypokalemia, major depressive disorder, osteoarthritis, hypothyroidism, Alzheimer disease, dementia, chronic kidney disease, need for assist with personal care and anxiety. A plan of care, dated 03/20/19 revealed resident care would be provided according to the plan. An intervention revised 07/13/21 included grooming and hygiene would be provided with assist of one (staff). Review of the 07/02/22 annual Minimum Data Set (MDS) 3.0 assessment revealed the resident was moderately impaired for daily decision making, totally dependent on two staff for bed mobility and transfers and required extensive assistance from one staff for personal hygiene. The assessment revealed the resident had no behaviors. On 09/27/22 at 10:53 A.M. observation revealed all 10 of Resident #3's fingernails were dirty and long. The resident's fingernails were over a quarter inch long with nail polish was coming off. During the observation, the resident stated she had tried to get her nails cut and indicated she had her own polish. On 09/28/22 at 11:24 A.M. observation with Licensed Practical Nurse (LPN) #81 verified all 10 of the resident's fingernails were long and dirty with the middle fingernail of her right hand having the nail partially broken and hanging. Review of the facility Nails, Care of Fingernails policy, dated 11/2021 revealed fingernail care would be done for non diabetic residents by the State Tested Nursing Assistant (STNA) during or after the resident shower/bath and as needed. The STNA would examine the nails of the diabetic resident during their shower and inform the nurse of any issues with the residents fingernails. Fingernail care may also be done by STNA during an activity that involved grooming such as spa day, manicure day. 2. Review of Resident #5's medical record revealed an 08/26/16 admission date with diagnoses including heart failure, hypertension, iron deficiency anemia, and cerebral infarction. Review of the plan of care revealed a plan, dated 03/27/19 indicating resident care would be provided according to the plan. An intervention revised 04/27/21 included grooming and hygiene would be provided with assist of one (staff). Review of the 06/28/22 annual MDS 3.0 assessment revealed the resident was independent for daily decision making, required extensive assistance from two staff for bed mobility and transfers and was totally dependent on one staff for personal hygiene. 365766 Page 6 of 15 365766 09/30/2022 Parkside Health Care Center 930 East Park Avenue Columbiana, OH 44408

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 09/27/22 at 10:53 A.M. observation of Resident #5's left hand thumb and index finger nails revealed they were dirty with dark debris under her nail beds. The resident's right thumb nail had dark debris under the nail beds. On 09/28/22 at 11:21 A.M. observation with LPN #81 verified the resident's left hand thumb and index finger nail beds were dark with debris as well as her right thumb. Review of the facility Nails, Care of Fingernails policy, dated 11/2021 revealed fingernail care would be done for non diabetic residents by the State Tested Nursing Assistant (STNA) during or after the resident shower/bath and as needed. The STNA would examine the nails of the diabetic resident during their shower and inform the nurse of any issues with the residents fingernails. Fingernail care may also be done by STNA during an activity that involved grooming such as spa day, manicure day. 3. Review of Resident #9's medical record revealed a 05/26/21 admission date with diagnoses including hemiplegia, parkinson's disease, need for assistance with personal care and cerebral infarction. A plan of care, (revised 08/21/21) revealed care would be provided according to the plan. An intervention, dated 05/17/21 revealed grooming and hygiene would be provided with assist of one (staff). Review of the 07/07/22 quarterly MDS 3.0 assessment revealed the resident was moderately impaired for daily decision making, had no behaviors and was totally dependent on one staff for personal hygiene. Review of the State Tested Nurse Aide TASK documentation revealed on 09/20/22 the resident had a shower and on 09/27/22 the resident had a bed bath. On 09/27/22 at 9:12 A.M. observation revealed Resident #9 had a brace to her left hand. The resident's fingers were curled onto her palm. The resident's finger nails were over a quarter inch long with brown debris in the nail beds the length of some of the nails. At the time of the observation, Resident #9 indicated her fingernails needed cut. The resident also was noted to have white polish coming off. On 09/28/22 at 10:58 A.M. interview with LPN #81 verified all of the resident's fingernails were long and soiled. The LPN indicated it looked like the nails needed to be soaked. On 09/28/22 at 12:37 P.M. interview with State Tested Nurse Aide (STNA) #96 verified residents were to have nail care when showers were completed. Review of the facility Nails, Care of Fingernails policy, dated 11/2021 revealed fingernail care would be done for non diabetic residents by the State Tested Nursing Assistant (STNA) during or after the resident shower/bath and as needed. The STNA would examine the nails of the diabetic resident during their shower and inform the nurse of any issues with the residents fingernails. Fingernail care may also be done by STNA during an activity that involved grooming such as spa day, manicure day. 4. Review of Resident #27's medical record revealed a 01/16/20 admission dated with diagnoses including hypothyroidism, Parkinson's disease, neurocognitive disorder with Lewy bodies, need for assistance with personal care and contracture. A plan of care, dated 01/29/20 revealed the resident had a self care deficit as evidenced by 365766 Page 7 of 15 365766 09/30/2022 Parkside Health Care Center 930 East Park Avenue Columbiana, OH 44408

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some requiring assistance with activities of daily living due to weakness related to Parkinson's Disease and dementia with Lewy Bodies. Review of the 07/21/22 quarterly MDS 3.0 assessment revealed the resident was moderately impaired for daily decision making and totally dependent on two staff for bed mobility, transfers, locomotion and dressing. The assessment revealed the resident required limited assistance from one staff for eating and was totally dependent on one staff for personal hygiene. Record review revealed the person centered plan of care was revised 08/28/22 and included care would be provided according to the plan. An intervention (dated 05/17/21) revealed grooming and hygiene would be provided with assist of one (staff). On 09/27/22 at 10:29 A.M. observation revealed the resident had long finger nails on both hands measuring over a quarter inch long. The nails were discolored with debris in the nail beds. On 09/28/22 at 02:47 P.M. interview with Registered Nurse (RN) #76 verified the resident;s fingernails were long and dirty. Review of the facility Nails, Care of Fingernails policy, dated 11/2021 revealed fingernail care would be done for non diabetic residents by the State Tested Nursing Assistant (STNA) during or after the resident shower/bath and as needed. The STNA would examine the nails of the diabetic resident during their shower and inform the nurse of any issues with the residents fingernails. Fingernail care may also be done by STNA during an activity that involved grooming such as spa day, manicure day. 365766 Page 8 of 15 365766 09/30/2022 Parkside Health Care Center 930 East Park Avenue Columbiana, OH 44408

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, facility policy and procedure review and interview the facility failed to ensure Resident #29 was provided timely nutritional intervention following a significant weight loss. This affected one resident (#29) of one resident reviewed for weight loss. The facility identified 11 residents with unplanned weight loss or gain. Residents Affected - Few Findings include: Review of Resident #29's medical record revealed a 12/18/03 admission dated with diagnoses including cerebral palsy, Alzheimer's disease, moderate intellectual disabilities, Stage III (full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon, or muscle are not exposed) pressure ulcer to right buttock, peripheral vascular disease, anemia, Vitamin D deficiency, gastroesophageal reflux disease and dysphagia. Review of the physician's orders revealed a diet order, dated 03/21/19 for no concentrated sweets diet, pureed texture, regular/thin consistency liquids related to dysphagia oropharyngeal phase. An order, dated 05/13/19 for Arginaid (supplement) two times a day. An order, dated 11/16/20 for built up curved spoon at all meals and an order dated, 03/22/21 for [NAME] cups with meals. The resident had a plan of care, dated 10/08/21 for a nutritional problem or potential nutritional problem related to nutrition, hydration and skin/skin concerns, gradual weight loss, multiple diagnoses and multiple medication use. The resident had a therapeutic and mechanically altered diet. Interventions included the resident would have no significant weight change. Additional physician orders revealed orders, dated 10/14/21 for a 2.0 calorie supplement three times a day, an order dated, 11/17/21 indicating when the resident was in bed for meals, a towel roll to left side of neck to increase cervical positioning and an order dated, 12/23/21 to be out of bed for breakfast and dinner to motorized power wheelchair to increase safety of swallow. Review of the 07/26/22 quarterly Minimum Data Set (MDS) 3.0 assessment revealed the resident was severely impaired for daily decision making, totally dependent from staff for bed mobility and transfers and did not walk. The assessment revealed the resident was independent for locomotion on the unit with an electric wheelchair, required extensive assistance from one for eating, had no weight loss or gain and had a Stage III pressure ulcer. The assessment also noted the resident had pressure reducing devices for bed and chair and nutrition or hydration interventions. Review of weight record revealed the resident's weight was stable until 09/02/22 when she had a seven pound weight loss. On 08/08/22 the resident weighed 109 pounds. On 09/02/22 her weight was 102 pounds for a 6.4 percent significant weight loss in less than a month. There was no evidence of a re-weight until 09/12/22 when the resident weighed 103.4 pounds, reflecting a 5.14 significant weight loss in a month. There was no evidence of a dietician evaluation until 9/23/22 when a Weight Variance Note included the 9/12/2022 103.4 pound, 5.1% decrease in one month. The residents ideal body Weight (IBW): median was 85 pounds with a 77-94 pound range. The note indicated the resident's no concentrated sweets, pureed diet intake was variable. Supplements included Arginaid one pack two times a day and 2.0 calorie med pass three times a day with a variable supplement intake. The resident had a right buttock 365766 Page 9 of 15 365766 09/30/2022 Parkside Health Care Center 930 East Park Avenue Columbiana, OH 44408

F 0692 Level of Harm - Minimal harm or potential for actual harm pressure ulcer. The resident continued on multivitamin and Arginaid to aid in healing. Secondary to weight decrease the recommendation was made to add six ounces of house supplement to breakfast and dinner. Monitor and make recommendations as needed. On 09/26/22 a physician's order was noted for six ounces of supplement with breakfast and dinner. Residents Affected - Few On 09/27/22 at 10:03 A.M. Resident #29 was observed in bed on her left side with her feet elevated on pillow. The resident was observed to be edentulous. On 09/28/22 at 12:33 P.M. the resident was observed in bed with the head of bed elevated 90 degrees. The resident was being fed by State Tested Nursing Assistant (STNA) #96 pureed tomato soup, grilled cheese, peach crisp and ice cream. The resident's milk was in a lidded Kennedy cup with a straw. The STNA indicated the resident would usually eat everything and when she ate in the dining room she feeds herself. The STNA revealed sometimes the resident would not drink all her drinks. On 09/29/22 at 01:07 P.M. interview with Registered Dietician (RD) #153 revealed she identified weight loss for residents by going into the computer and going into reports to see variances. The dietician revealed she covered 16 facilities and there was not a certain time frame in which she goes in and checks each facility. She stated when she goes into the weights, she prints them out and checks them against the last weight. If there was a five pound weight difference or more she would circle them, and notify the Director of Nursing, Dietary Manager or the unit manager LPN #71 and ask for a re-weight for the resident. The dietician revealed she would check back to the weight variance sheets to see if the resident had been reweighed. Dietician #153 indicated the re-weight should be done right away when the facility identifies a five pound or more weight difference and was unsure why a facility wouldn't know of a five pound or more weight change. She indicated she was not emailed or notified when a re-weight confirmed a five pound or greater weight gain ot loss. To get the results she periodically checks to see if reweighs had been entered. RD #153 verified there was not a weight variance evaluation for Resident #29 until 21 days after the resident initially was assessed to have a significant weight loss. RD #153 verified additional nutritional interventions (the addition of a supplement) was not started for 24 days. The RD acknowledged there was not an order for weekly weights to keep a closer watch for additional weight loss or success of interventions for the resident. Review of the facility Height/Weight policy, revised 11/2019 revealed anytime there was a weight difference of plus or minus five pounds from the previous weight, a re-weight must be done. Reweighs would be completed as soon as possible, preferably within 24-72 hours. A weight variance committee shall meet monthly and as needed to address problems related to the weight status of the residents and to plan approaches for the individualized care. On 09/29/22 at 2:09 P.M. interview with Registered Nurse (RN) #148 and RD #153 verified there was a delay of 10 days in getting the resident reweighed. There was a delay of 11 days after the re-weight for the dietician weight variance evaluation. Once the dietician wrote a recommendation there was an additional three day delay in getting physician approval and starting an additional supplement. RN #148 and RD #153 verified the systemic process of the dietician periodically checking weights and notifying the facility when a re-weight was to be completed was not efficient and timely. The facility should compare the previous weight with the new weight and enter a re-weight per the company policy without being directed by the dietician. The process of the dietician needing to periodically check weights to learn if there was a significant weight loss or gain had also proven to delay intervention. RN #148 and RD #153 verified the resident did not begin to receive a supplement/intervention until 24 days after the significant weight loss weight was initially noted. The RN and RD verified 365766 Page 10 of 15 365766 09/30/2022 Parkside Health Care Center 930 East Park Avenue Columbiana, OH 44408

F 0692 the current process did not result in timely interventions for weight loss. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 365766 Page 11 of 15 365766 09/30/2022 Parkside Health Care Center 930 East Park Avenue Columbiana, OH 44408

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review, policy and interview and interview the facility failed to ensure care plans were developed for oxygen use and failed to ensure oxygen tubing was properly dated and/or changed to maintain proper infection control practices. This affected two resident (#3 and #5) of two residents reviewed for respiratory care. The facility identified four residents with respiratory treatments. Residents Affected - Few Findings include: 1. Review of Resident #3's medical record revealed a 02/28/17 admission date with diagnoses including hypokalemia, major depressive disorder, osteoarthritis, hypothyroidism, Alzheimer's disease, dementia, chronic kidney disease and need for assist with personal care and anxiety. Review of the 07/02/22 annual Minimum Data Set (MDS) 3.0 assessment revealed the resident was moderately impaired for daily decision making, totally dependent on two staff for bed mobility and transfers and required extensive assistance from one staff for personal hygiene. The assessment revealed the resident had no behaviors. The resident was on anti-psychotic medication, anti-anxiety medication, anti-depressant medication, anti-coagulant medication and opioid medication. In addition, the assessment revealed the resident received oxygen. On 09/27/22 at 10:53 A.M. Resident #3 was observed with oxygen on per nasal cannula at two liters per minute. The tubing was dated 09/11/22. Review of the physician's orders revealed an order for oxygen at one to four for oxygen saturation less than 90 percent as needed. There were no physician orders for the changing of oxygen equipment. Review of the plan of care revealed there was no plan of care for the use of oxygen. Review of the facility Oxygen Mask, Nasal Cannula, and Trachea Mask policy, dated 06/2022 revealed residents who utilized the oxygen apparatus on an as needed basis, the cannula or mask must be kept in a plastic bag, dated when used and changed weekly. Review of the facility Aerosol Therapy policy, dated 06/2022 revealed to change equipment once a week. On 09/28/22 at 11:24 A.M. interview with Licensed Practical Nurse (LPN) #81 verified the resident's oxygen tubing was in use and was dated 09/11/22. LPN #81 indicated oxygen tubing was to be changed weekly on Sundays. LPN #81 verified the tubing had not been changed for 17 days. On 09/30/22 at 3:39 P.M. interview with Registered Nurse #148 verified the resident did not have a plan of care in place related to oxygen use. 2. Review of Resident #5's medical record revealed an 08/26/16 admission date with diagnoses including heart failure, hypertension, iron deficiency anemia, and cerebral infarction. Review of the 06/28/22 annual MDS 3.0 assessment revealed the resident was independent for daily decision making, required extensive assistance from two staff for bed mobility and transfers and was totally dependent on one staff for personal hygiene. The assessment revealed the resident did not receive oxygen. 365766 Page 12 of 15 365766 09/30/2022 Parkside Health Care Center 930 East Park Avenue Columbiana, OH 44408

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of a physician's orders revealed an order, dated 06/01/22 for oxygen per nasal cannula at one to four liters per minute (LPM) for a oxygen saturation less than 90 percent. There were no orders to change the oxygen tubing. Review of the resident's plan of care revealed there was no comprehensive plan of care related to the use of oxygen. There was a 06/19/22 heart failure plan of care with an intervention to administer oxygen as ordered. On 09/27/22 at 10:53 A.M. Resident #5 was observed with oxygen on per nasal cannula at three LPM. The tubing was dated 09/11/22. Interview with the resident at the time of the observation revealed staff do not change her oxygen tubing every week. On 09/28/22 at 11:21 A.M. interview with LPN #81 verified the resident's oxygen tubing was in use and was dated 09/11/22. LPN #81 indicated oxygen tubing was to be changed weekly on Sundays. LPN #81 verified the tubing had not been changed for 17 days. On 09/30/22 at 4:04 P.M. interview with Registered Nurse (RN) #61 verified the resident did not have a specific plan of care related to oxygen use. The RN revealed it fell through the cracks. 365766 Page 13 of 15 365766 09/30/2022 Parkside Health Care Center 930 East Park Avenue Columbiana, OH 44408

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, manufacturer guidelines review, facility policy and procedure review and interview the facility failed vials of Tuberculin were dated when opened. This affected six residents (#25, #54, #109, #110, #111 and #208) of 58 residents residing in the facility. Findings include: On 09/28/22 at 10:00 A.M. observation of the East medication room refrigerator revealed an opened multi use vial of Tuberculin (purified protein derivative (PPD)) solution, used to detect tuberculosis disease. The bottle did not contain a date when it had been opened. The label indicated the vial was dispensed from the pharmacy on 04/28/22. Directions on the label included discard after 30 days once opened. On 09/28/22 at 10:16 A.M. interview with Licensed Practical Nurse (LPN) #81 confirmed the Tuberculin vial was open and was not dated as to when it had been opened. On 09/28/22 at 10:22 A.M. observation of the North medication room revealed an opened multi use vial of Tuberculin (purified protein derivative (PPD)) solution. The bottle did not contain a date when it had been opened. The label indicated the vial was dispensed from the pharmacy on 09/16/22. The vial had been dispensed and potentially in use longer than 30 days at the time of the observation. On 09/28/22 at 10:32 A.M. interview with LPN #71 verified the medication refrigerator contained an opened undated vial of Tuberculin purified protein derivative (PPD) solution. LPN #71 verified the vial was to be dated when opened. The facility identified Resident #25, #54, #109, #110, #111 and #208 received Tuberculin testing using the above vials between 06/24/22 and 08/31/22. Review of the Par Pharmaceutical manufacturer guidelines, dated 03/2016 revealed manufacturer's instructions for Tuberculin (PPD) solution revealed the vial should be refrigerated and protected from light. Aplisol vials should be inspected visually for both particulate matter and discoloration prior to administration and discard if either was seen. Vials in use more than 30 days should be discarded due to possible oxidation and degradation which may affect potency. Review of the facility undated Medi-RX Expirations policy revealed Tuberculin PPD should be stored in the refrigerator and was only stable for 30 days after opening. 365766 Page 14 of 15 365766 09/30/2022 Parkside Health Care Center 930 East Park Avenue Columbiana, OH 44408

F 0868 Have the Quality Assessment and Assurance group have the required members and meet at least quarterly Level of Harm - Minimal harm or potential for actual harm Based on review of Quality Assessment and Assurance (QAA) sign-in sheets, record review, facility policy and procedure review and interview the facility failed to ensure quarterly QAA meetings were conducted and failed to ensure all required members, including the Medical Director (MD) participated/attended the meetings as required. This had the potential to affect all 58 residents residing in the facility. Residents Affected - Many Findings include: Review of an undated facility Quality Assessment Performance Improvement (QAPI) member list revealed the MD was listed as a member of the facility QAPI committee. The QAPI list revealed the following facility staff/positions were part of the QAPI committee: The Administrator, Director of Nursing, Medical Director (MD), Clinical Director, Nurse Aide Supervisor, QA Coordinator, Nutrition Services Director, Restorative Supervisor, Wound Nurse, Social Services, Pharmacy and Laboratory. The Activity Director, Maintenance Director, MDS, Admissions Director, Housekeeping/Laundry Supervisor, and Rehabilitation Director were included on the facility monthly meeting list. Review of the QAA sign-in sheets from the meetings conducted from 09/2021 to 08/25/2022 revealed there were no sign in sheets available for review for any meetings in September, October, November or December of 2021 to ensure a meeting was held with all required members during this time period. Review of the first quarter (January to March) of 2022 revealed meetings were held on 01/27/22, 02/24/22 and 03/24/22. However, there was no evidence the Medical Director (MD) was in attendance. On 09/30/22 at 9:58 A.M. interview with the DON verified there was no evidence the Medical Director attended a QAPI meeting during the first quarter of 2022. In addition, the DON revealed QAPI meeting had not been held in 2021 as required. On 09/30/22 at 2:50 P.M. interview with the Administrator revealed the previous DON left in August 2021. Registered Nurse (RN) #62 was the acting DON until the current DON started the end of October 2021. The Administrator revealed he did not recall having any QAPI meetings after the DON left in August 2021. Review of the facility Leadership and Communication policy, revised 08/2018 revealed the the team would meet monthly. Per regulation, the facility must have an ongoing QAA committee that included designated key staff members that met at least quarterly. The committee members must consist of the facility Administrator, DON, Medical Director and at least three other staff members. 365766 Page 15 of 15