Health inspection·January 4, 2020

F 0625 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Review of Resident #11's medical record revealed an admission date to the facility occurred on 04/18/18. Diagnoses which included dementia with psychosis and stroke. The record identified Resident #11 payer source was Medicaid. The record identified Resident #11 required hospitalization on 08/02/19 for a total of 12 days. The record lacked any evidence of bed hold notification at that time. Additionally, Resident #11 required hospitalization on 12/27/19. The record identified Resident #11's family was provided the bed hold notification, however the notification did not include the number of her remaining bed hold days for the year. Interview with Business Office Manager (BOM) #550 on 01/03/20 at 12:26 P.M. confirmed the bed hold notification dated 12/27/19 was not completed accurately and did not identify the number of remaining bed hold days and was not completed on 08/02/19. Review of the facility's policy titled Bed Hold Policy, last revised on 11/18/16, revealed the campus would properly inform the residents in advance of their option to make a bed-hold payment and the amount of the facilities bed hold charge. The policy further revealed the purpose of the policy was to follow all state and federal guidelines related to therapeutic bed hold. Based on record review, review of facility policy and staff interview, the facility failed to notify the resident's and/or resident representatives of the facilities bed hold policy when the resident discharged to the hospital. This affected two (#11 and #24) of two residents reviewed for hospitalization. The facility census was 58. Findings include: 1. Review of Resident #24's medical record revealed the resident was admitted to the facility on [DATE]. Diagnoses included chorionic atrial fibrillation, heart failure and unspecified dementia. Review of the Minimum Data Set (MDS) 3.0 assessment, dated 08/01/19 revealed the resident had impaired cognition. The resident was noted to discharge to the hospital on [DATE] and returned from the hospital on [DATE]. There was no evidence in the resident's medical record the resident and/or resident's representative was provided the facility's bed hold policy at the time her discharge to the hospital on [DATE]. Page 1 of 3 365841 365841 01/04/2020 Valley View Health Campus 1247 North River Rd Fremont, OH 43420

F 0625 Level of Harm - Minimal harm or potential for actual harm Interview on 01/03/20 at 12:27 P.M. with the Business Office Manager (BOM) #550 revealed the bed hold policy was not given to the Resident #24 or the resident's representative when she discharged to the hospital on [DATE]. Residents Affected - Few 365841 Page 2 of 3 365841 01/04/2020 Valley View Health Campus 1247 North River Rd Fremont, OH 43420

F 0881 Implement a program that monitors antibiotic use. Level of Harm - Minimal harm or potential for actual harm Based on medical record review, laboratory testing results and staff interview, the facility failed to ensure antibiotics were not being utilized for a resident with a negative test result. This affected one (#23) of five residents reviewed for antibiotics. The facility census was 58. Residents Affected - Few Findings include: Review of Resident #23's medical record revealed an admission to the facility occurred on 10/19/19. Diagnoses included fractured femur, chronic kidney disease and chronic pain. The record identified on 12/26/19 a urine specimen was submitted to the laboratory for testing to determine if an infection was present. The record identified an antibiotic (Cipro 250 milligrams) was ordered at that time for five days. Review of the completed laboratory culture results, dated 12/29/19, identified Resident #23 was negative for an infection. The record lacked any evidence the physician was notified of the negative testing results and subsequently Resident #23 continued on the unnecessary Cipro. Interview with the facility's Infection Control Registered Nurse (RN) #500 on 01/03/19 at 1:00 P.M. confirmed there was no evidence Resident #23's physician was notified of the negative urine culture results on 12/29/19. The interview confirmed Resident #23 remained on an unnecessary antibiotic treatment. 365841 Page 3 of 3