Health inspection·September 5, 2024

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 interview, medical record review, and review of facility policy, the facility failed to ensure bathing was completed for Resident #55 and Resident #87 as scheduled. This affected two residents (Residents #55 and #87) of three residents reviewed for bathing. The facility census was 114. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #55 revealed an admission date of 02/24/24 with diagnoses including primary hypertension, atrial fibrillation, type two diabetes mellitus, dysphagia, osteoarthritis, cerebral infarction affecting the left non-dominant side, and hemiplegia. Review of the care plan dated 02/25/24 revealed Resident #55 required assistance with activities of daily living (ADLs) related to pain, impaired mobility, weakness, and hemiplegia. Interventions included two staff for all shower transfers and one, sometimes two, staff to complete all the effort for bathing. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment completed on 06/07/24 revealed Resident #55 had intact cognition and impaired range of motion of the upper and lower extremities on one side. Further review of the MDS assessment revealed Resident #55 was dependent on others for bathing/showering. Review of the shower documentation revealed Resident #55 was bathed on 08/07/24, 08/14/24, 08/20/24, 08/21/24, and 09/03/24. Interview on 09/04/24 at 5:43 P.M. with State Tested Nurse Aide (STNA) #329 revealed resident baths got missed by the STNAs because the bathing schedule was not always printed at the nurses' station and the information in the electronic record that should populate to the STNAs documentation tab was not always updated properly, so the STNAs never knew if a bath was missed unless the resident complained. Interview on 09/05/24 at 1:20 P.M. with Resident #55 revealed she was supposed to be bathed three times a week. Resident #55 further verbalized the facility did not adhere to the three times a week schedule a few months ago (dates unspecified), and recently Resident #55 went two weeks without any bathing at all. During the interview, Resident #55 said bathing resumed this week, but had not occurred for the two preceding weeks. Interview on 09/05/24 at 2:42 P.M. with STNA #372 revealed if a bath/shower was offered to a resident, it would be documented in the electronic medical record, whether the resident received the bath, refused the bathing task, or was not in the facility at the time the bath was scheduled. Page 1 of 3 365853 365853 09/05/2024 Greenbriar Center 8064 South Avenue Boardman, OH 44512

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interviews conducted on 09/05/24 between 5:40 P.M. and 6:05 P.M. with Nursing Staff Scheduler #395 confirmed Resident #55's shower schedule was every Monday, Wednesday, and Friday and there was no documentation of bathing between 08/21/24 and 09/03/24. Review of the undated policy titled Routine Resident Care revealed routine resident care was necessary to promote quality of life and dignity and included assistance with activities of daily living, such as bathing and dressing. The policy further revealed the facility was to promote resident-centered care and honor resident lifestyle preferences while attending to the total medical, nursing, physical, emotional, mental, social, and spiritual needs of each resident. 2. Review of the medical record for Resident #87 revealed an admission date of 04/1/24 with diagnoses including unspecified fracture of the lumbar vertebrae, low back pain, essential (primary) hypertension, chronic obstructive pulmonary disease (COPD), heart failure, type two diabetes mellitus, liver disease, osteoarthritis, and need for assistance with personal care. Review of the quarterly Minimum Data Set (MDS) assessment completed 07/22/24 revealed Resident #87 had intact cognition and was dependent for bathing. Review of the care plan dated 04/16/24 revealed Resident #87 required assistance with activities of daily living (ADLs) related to functional deficits and pain. Interventions included one helper to perform all the bathing effort for Resident #87. Review of the shower documentation revealed Resident #87 refused a bath or shower on 08/03/24, received a bed bath on 08/14/24, 08/17/24, 08/21/24, 08/28/24, 08/31/24, and documentation the bath or shower was Not Applicable on 09/04/24. There was no documentation a bath or shower was offered between 08/03/24 and 08/14/24 or between 08/21/24 and 08/28/24. Interview on 09/04/24 at 5:35 P.M. with Medication Aide #351 confirmed there is a shower schedule at the nurses' station and Resident #87 gets showered during the afternoon shift (3:00 P.M. to 11:00 P.M.), but the STNAs were preparing to transfer Resident #87 to a different unit during that shift and she was uncertain about his shower schedule for that evening. Interview on 09/04/24 at 5:43 P.M. with State Tested Nurse Aide (STNA) #329 confirmed uncertainty as to whether Resident #87 was scheduled to be bathed on this date, and that if he was, it would not be done on that unit because they were getting ready to move him to another unit. STNA #329 further revealed resident baths get missed by the STNAs because the bathing schedule is not always printed at the nurses' station and the information in the electronic record that should populate to the STNAs documentation tab is not always updated properly, so the STNAs never know if a bath is missed unless the resident complains. Interview on 09/05/24 at 3:00 P.M. with Resident #87 confirmed he had not received a shower on 09/04/24 and he denied refusing a bath or shower on 09/04/24. During the interview, Resident #87 emphatically stated, as he pointed to a box of personal items on his nightstand, that if the facility could not take the time to unpack his personal items (packed in a box from the room change), then how did the surveyor suppose they found time to give him a shower last night. Interview on 09/05/24 at 6:05 P.M. with Nursing Staff Scheduler #395 confirmed Resident #87 was on the shower schedule every Wednesday and Saturday and the available documentation does not reflect Resident #87 received a bath/shower twice a week for the past 30 days, including 08/03/24, 08/10/24, 365853 Page 2 of 3 365853 09/05/2024 Greenbriar Center 8064 South Avenue Boardman, OH 44512

F 0677 08/24/24, and 09/04/24. Level of Harm - Minimal harm or potential for actual harm Review of the undated policy titled Routine Resident Care revealed routine resident care was necessary to promote quality of life and dignity and included assistance with activities of daily living, such as bathing and dressing. The policy further revealed the facility was to promote resident-centered care and honor resident lifestyle preferences while attending to the total medical, nursing, physical, emotional, mental, social, and spiritual needs of each resident. Residents Affected - Few This deficiency represents non-compliance investigated under Complaint Number OH00156864. 365853 Page 3 of 3