Health inspection·February 20, 2020

F 0676 Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview; the facility failed to ensure a resident was provided a restorative nursing program as recommended to maintain current level of mobility. This affected one (#4) of one resident reviewed for activities of daily living (ADL). The facility census was 43. Residents Affected - Few Findings include: Review of the medical record for Resident #4 revealed the resident was admitted to the facility on [DATE]. Diagnoses included hypertension, hemiplegia, hypertension, dizziness, hypothyroidism, major depressive disorder, muscle weakness, overactive bladder, and abnormal posture. Review of the plan of care dated 05/22/19 revealed Resident #4 had a need for restorative intervention due to ADL self-care performance deficits/limited and physical mobility related to stroke as evidenced by assistance required from staff to performs her ADL. The goal was the resident will increase level of mobility walking to and from dining room with assistance of one. Interventions include: 1. Active range of motion: Nu Step (recumbent cross trainer) 10-15 minutes to be completed up to five times a week as tolerated. Give the option of using or not using hands, however encourage using hands as much as possible. 2. Active range of motion: standing marches with two pound weights, 15 repetitions for two sets to be completed up to five times a week as tolerated. Provide 100 percent contact assistance with gait belt, encourage no holding on with hands to improve balance and strength in legs. 3. Active range of motion: balance (seated or standing) as tolerated; ball toss/balloon tapping for core engagement and balance as tolerated to be completed three times a week as tolerated. 4. Active range of motion: upper arm extremities; gentle stretching/active range of motion (AROM) and upper extremity lifting within a pain free range with two pound weight for shoulder, elbow and wrist to be completed three to six times times a week as tolerated. 5. Active range of motion: hand writing exercises to keep up dexterity to be completed three to six times a week as tolerated. 6. Moist heat to low back, left hip, left knee, left thigh area, and bilateral shoulders for 15 to Page 1 of 2 365887 365887 02/20/2020 Serenity Spring Senior Living at Arlington 100 Powell Drive Arlington, OH 45814

F 0676 20 minutes. Level of Harm - Minimal harm or potential for actual harm Review of a physician order dated 05/22/19, revealed restorative therapy was to work with Resident #4 at least five times a week. Residents Affected - Few Review of the annual Minimum Data Set (MDS) assessment dated [DATE], revealed Resident #4 had moderately impaired cognition. The resident required limited assistance of one staff for bed mobility, transfers, and toilet use. The resident required extensive assistance of one for personal hygiene and dressing. Review of restorative therapy documentation from 01/21/20 to 02/19/20 revealed no evidence the facility offered or provided Resident #4 the restorative therapy program for the Nu Step from 01/21/20 to 01/28/20, from 01/30 to 02/13/20, and from 02/15/20 to 02/19/20. Continued review of restorative documentation revealed no evidence the facility offered or provided Resident #4 with the standing marches with two pound weights, balance, upper arm extremity gentle stretching/AROM and lifting and hand writing exercises from 01/21/20 to 02/13/20 and from 02/15/20 to 02/19/20. Further review of the medical record revealed there was no evidence of the facility provided the restorative program for moist heat throughout the reference period except on 01/29/20 and 02/14/20 when refusal was documented. Review of the nurse progress notes dated 01/20 to 02/20, revealed no documentation Resident #4 was provided restorative therapy or of the resident refusing restorative therapy. Interview on 02/19/20 at 1:55 P.M. with State Tested Nurse Aide (STNA) #450 revealed restorative therapy programs are documented in the resident's medical record. The STNA revealed if a resident refused to participate with the restorative therapy, the refusal would be documented in the medical record. STNA #450 revealed Resident #4 was to be provided restorative therapy three to six times a week. The STNA revealed it was sometimes difficult to complete Resident #4's therapy program because the STNA's shift ended at 2:45 P.M. and the family preferred the therapy be completed after the resident's afternoon nap, which was about 2:00 P.M. Interview on 02/19/20 at 2:15 P.M. with the Director of Nursing (DON) verified the medical record for Resident #4 contained no evidence of restorative therapy being provided for Resident #4 as written in the plan of care. The DON further verified the medical record for Resident #4 contained no evidence of the resident refusing to participate with restorative therapy. 365887 Page 2 of 2