Health inspection·September 15, 2022

F 0645 PASARR screening for Mental disorders or Intellectual Disabilities Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Record Review of Resident #20 revealed this resident was admitted to the facility on [DATE] with the following medical diagnoses: abnormal posture, atherosclerosis, atrial fibrillation, dementia, GERD, mesothelioma, muscle weakness, post-traumatic stress disorder, protein-calorie malnutrition, adult failure to thrive, hypertension, ileus, mood disorder, myocardial infarction, seizures, COVID-19, lack of coordination, and anemia. Residents Affected - Few Review of the Minimum Data Set(MDS) assessment completed on 02/09/22 revealed this resident had severe cognitive impairments. Resident #20 was admitted with an active diagnosis of PTSD and mood disorder on review of admitting diagnoses on 09/28/21. Review of the Preadmission Screening and Resident Review(PASARR) revealed this was completed by sending facility on 09/28/21. On Section E(Indications of Serious Mental Illness) the information provided this resident did not have any of the mental disorders listed. This included Mood Disorder, which was one of the resident's medical diagnoses on admission. On 09/14/22 at 9:33 AM Interview with Social Service Director #265 verified Mood Disorder was an active diagnosis on the medical record and was not accurately captured on the PASARR screening result notice. She also verified this diagnosis should have been indicated on this screen. Based on record review and interview the facility failed to complete the Pre-admission Screening and Resident Review (PASARR) Identification Screen correctly for two residents (Resident #20 and #58) out of six residents reviewed during the annual survey. The facility census was 64. Findings include. 1. Medical record review for Resident #58 revealed an admission date of 08/12/22. Diagnoses included but were not limited to chronic obstructive pulmonary disease, idiopathic aseptic necrosis of right femur, right femur fracture, ventricular tachycardia, major depressive disorder, generalized anxiety disorder, unspecified mood disorder, bipolar disorder, and history of alcohol dependence. Review of Resident #58's physician orders revealed an order for Clonazepam one milligram by mouth twice daily, start date of 08/13/22, Aripiprazole 10 milligrams by mouth once daily for depression, start date of 08/12/22, and Sertraline 50 milligrams by mouth once daily for depression, start date of 08/12/22. Page 1 of 4 365791 365791 09/15/2022 Sanctuary at Ohio Valley 2932 South 5th Street Ironton, OH 45638

F 0645 Level of Harm - Minimal harm or potential for actual harm Review of Resident #58's Clinical admission Paperwork-Long Term Care Referral dated 08/08/22 revealed diagnoses including but not limited to bipolar disorder, major depressive disorder, and generalized anxiety disorder. Current medications included but were not limited to Clonazepam one milligram by mouth twice daily, start date of 07/14/22, Aripiprazole 10 milligrams by mouth once daily for depression, start date of 07/15/22, and Sertraline 50 milligrams by mouth once daily for depression, start date of 07/15/22. Residents Affected - Few Review of Level 1 Pre Admission-Screening and Resident Review (PASARR) Identification Screen completed on 08/12/22 revealed no diagnoses of mental illness were indicated in section E,1. No diagnoses of a substance use related disorder was indicated section E,2 of the PASARR. And no psychotropic medications were indicated in section E,6 of the PASARR. Interview on 09/14/22 at 9:27 A.M. with Social Worker #265 confirmed the PASARR completed on 08/12/22 for Resident # 58 did not indicate any diagnoses of mental illnesses in section E,1., did not indicate any diagnosis of a substance use related disorder was checked in section E,2., and did not indicate any psychotropic medications were checked in section E,6. 365791 Page 2 of 4 365791 09/15/2022 Sanctuary at Ohio Valley 2932 South 5th Street Ironton, OH 45638

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to administer oxygen as ordered by the physician and failed to obtain physician orders for the administration of oxygen. This affected two residents (#36 and #38) of the three residents reviewed for respiratory care. The facility census was 64. Residents Affected - Few Findings include: 1. Record review for Resident #36 revealed this resident was admitted to the facility on [DATE] and had diagnoses including legal blindness, dementia, history of falling, hypertension, and dyspnea. This resident had no known allergies. Review of the annual Minimum Data Set (MDS) assessment, dated 07/14/22, revealed this resident had severely impaired cognition. This resident was assessed to require extensive assistance from one staff member for bed mobility, extensive assistance from two staff members for transfers, extensive assistance from one staff member for toileting, and extensive assistance from one staff member for eating. This resident was assessed to have used oxygen while in the facility. Review of the care plan, revised on 01/21/22, revealed this resident had altered respiratory/pulmonary status/difficulty breathing. Interventions included to change and date nebulizer tubing weekly, change and date oxygen tubing weekly, oxygen saturation levels as ordered, and oxygen settings at two liters per minute via nasal cannula. Review of the active physicians order, dated 04/10/22, revealed this resident was ordered to receive oxygen at two liters per minute continuously by nasal cannula due to a diagnosis of dyspnea. Review of the Medication Administration Record (MAR), dated 09/01/22 through 09/13/22, revealed the resident was documented to be receiving oxygen at two liters per minute by nasal cannula continuously as ordered. Observation on 09/12/22 at 3:00 P.M. revealed Resident #36 was sitting on the back porch of the facility and was not observed to have oxygen being administered. There was not an oxygen concentrator or tank located on the back porch where the resident was sitting. Observation on 09/13/22 at 1:11 P.M. revealed Resident #36 was lying in bed and did not have oxygen being administered. There was not an oxygen concentrator located in the room for the residents use. Observation and interview with Licensed Practical Nurse (LPN) #345 on 09/13/22 at 1:36 P.M. verified Resident #36 did not have oxygen being administered and did not have an oxygen delivery device located in the room. LPN #345 stated Resident #36 had been on oxygen previously but had not had oxygen administered for approximately one week. LPN #345 verified Resident #36 continued to have an active order for the administration of oxygen at two liters per minute continuously which had been inaccurately documented by nursing staff as being administered. 2. Record review for Resident #38 revealed this resident was admitted to the facility on [DATE] and had diagnoses including acute respiratory failure with hypercapnia, muscle weakness, and unspecified psychosis. 365791 Page 3 of 4 365791 09/15/2022 Sanctuary at Ohio Valley 2932 South 5th Street Ironton, OH 45638

F 0695 Level of Harm - Minimal harm or potential for actual harm Review of the admission MDS assessment, dated 07/08/22, revealed this resident had intact cognition evidenced by a Brief Interview for Mental Status (BIMS) assessment score of 15. This resident was assessed to require extensive assistance from two staff members for transfers, bed mobility, and toileting and was assessed to require limited assistance from one staff member for eating. This resident was assessed to use oxygen while a resident of the facility. Residents Affected - Few Review of active physicians orders revealed no order for the administration of oxygen. Observation on 09/12/22 at 10:30 A.M. revealed Resident #38 was observed lying in bed with oxygen being administered at a rate of three liters per minute via nasal cannula. The humidification bottle connected to the oxygen concentrator was almost out of water. Observation on 09/13/22 at 2:15 P.M. revealed Resident #38 was observed to have oxygen being administered at a rate of three liters per minute and the water humidification bottle attached to the concentrator was empty. Observation and interview with LPN #345 on 09/13/22 at 2:30 P.M. verified Resident #38 was being administered oxygen at a rate of three liters per minute via nasal cannula and the water humidification bottle attached to the oxygen concentrator was empty. LPN #345 verified Resident #38 did not have an active physicians order for the administration of oxygen. 365791 Page 4 of 4