Health inspection·April 22, 2021

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. Based on record review and staff interview the facility failed to ensure resident's medical record accurately reflected the resident's advanced directive for a selected code status. This affected one (#8) of one residents reviewed for advanced directives. The census was 86. Findings include: Review of the medical record for Resident #8 revealed an admission date of 06/05/18 with a diagnosis of multiple sclerosis. Review of the April 2021 physician orders for Resident #8 revealed resident's code status was listed as Do Not Resuscitate Comfort Care (DNRCC)-Arrest. Review of the online dashboard in the electronic medical record for Resident #8 revealed resident's code status was listed as DNRCC-Arrest Review of the care plan for Resident #8 dated 06/07/18 revealed resident's advanced directive was for her code status to be DNRCC-Arrest. Interventions included: advanced directives should be kept on the resident's chart and updated quarterly and as needed. Review of the state of Ohio DNR form dated 06/06/18 for Resident #8 under the advanced directive tab on the resident's chart signed by the physician and resident's representative revealed resident was to be a DNRCC. The box on the form for DNRCC-Arrest was not checked. Interview on 04/20/21 at 3:59 P.M. with Social Worker (SW) #19 confirmed Resident #8's orders, care plan, and electronic record list her code status as DNRCC-Arrest and advanced directive form in the chart signed by the physician indicated the resident was to be a DNRCC. SW #19 confirmed the DNRCC-Arrest box on the form in the resident's chart was not checked and there were no other advanced directive forms on the resident's chart. Page 1 of 23 365889 365889 04/22/2021 Lodge Nursing & Rehab Center 9370 Union Cemetery Road Loveland, OH 45140

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, and review of the facility policy, the facility failed to notify resident physician of elevated resident blood sugar. This affected one (#3) of seven residents reviewed for unnecessary medications. Additionally, the facility failed failed to ensure the facility physician or advanced provider was notified when a resident had a weight gain of five pounds. This affected one (#241) of three residents reviewed. Facility census was 86. Findings include: 1. Review of the medical record for Resident #3 revealed an admission date of 11/16/18 with a diagnosis of diabetes mellitus. Review of the Minimum Data Set (MDS) assessment for Resident #3 dated 04/02/21 revealed resident was cognitively impaired and required extensive assistance of two staff with activities of daily living (ADL's). Review of the care plan for Resident #3 dated 11/16/18 revealed the resident had diabetes mellitus and received insulin and was at risk for hyper/hypoglycemic episodes and secondary complications related to the disease process or potential for adverse effects related to medication usage. Interventions included the following: diabetes medication as ordered by doctor, monitor/document for side effects and effectiveness, fasting serum blood sugar as ordered by the doctor. Review of the March 2021 monthly physician orders for Resident #3 revealed an order for routine Novolog insulin four units to be given subcutaneously at 12:30 P.M., routine Levemir insulin to be given at 9:00 P.M. and to check the residents blood sugar (BS) at 6:00 A.M. and 9:00 P.M. daily and call physician if blood sugar is less than 60 or greater than 350. Review of the March 2021 Medication Administration Record (MAR) for Resident #3 revealed the following the resident's blood sugar exceeded 350 on the following dates and times: 03/03/21 at 9:00 P.M. -BS of 364; 03/05/21 at 9:00 P.M. -BS of 368; 03/15/21 at 9:00 P.M. -BS of 369; and 03/18/21 at 9:00 P.M.-BS of 387. Review of the March 2021 MAR for Resident #3 revealed no blood sugar was recorded on 03/12/21 at 6:00 A.M. on 03/18/21 at 6:00 A.M. Review of the nurse progress notes for Resident #3 dated 03/03/21 through 03/18/21 revealed the notes contained no documentation regarding a call to the physician regarding blood sugars over 350 for Resident #3. The notes contained no documentation regarding a rationale for no blood sugar recorded for 03/12/21 and 03/18/21 at 6:00 A.M. Interview on 04/22/21 at 2:30 P.M. with the Director of Nursing (DON) confirmed Resident #3's record did not reflect physician notification of blood sugars over 350 nor did they reflect an explanation for no blood sugar obtained on 03/12/21 and 03/18/21. Review of the facility policy titled Change of Resident Condition dated 01/2021 revealed the facility staff would notify the resident's attending physician of a change in condition and the nurse 365889 Page 2 of 23 365889 04/22/2021 Lodge Nursing & Rehab Center 9370 Union Cemetery Road Loveland, OH 45140

F 0580 would document notification of changes in the medical record. Level of Harm - Minimal harm or potential for actual harm 2. Review of the medical record for Resident #241 revealed an admission date of 04/09/21. Diagnoses included, but not limited to, congested heart failure (CHF), hypertension (HTN), Alzheimer's disease, dementia, acute kidney failure, nutritional deficiency, and diabetes mellitus. Residents Affected - Few Review of the most recently completed MDS assessment dated [DATE] revealed Resident #241 was cognitively intact, had no behaviors, did not reject care, did not wander, was one person assist and required extensive and limited ADL's. Review of baseline plan of care for Resident #241 dated 04/09/21 revealed resident had CHF and was to be weighed as ordered. Review of physician orders for Resident #241 dated 04/09/21 revealed the resident was ordered to be weighed daily in morning before breakfast and physician was to be notified for weight gain greater than three pounds in 24 hours or five pounds in one week related to CHF. Physician orders also revealed no documented orders or new interventions for five-pound weight gain from 04/10/21 through 04/12/21. Review of weights reveled resident weighed 97 pounds on admission on [DATE] and 102 pounds at the next recorded weight on 04/12/21. Nurses notes also revealed no documented evidence the physician or advanced provider was notified when resident had a five-pound weight gain from 04/10/21 to 04/12/21. Interview with Director of Nursing (DON) on 04/22/21 at 2:50 P.M. verified there was no documented evidence Residents #241's physician was not notified of a weight gain of five pounds from 04/10/21 to 04/12/21. Review of a facility policy titled Weight Changes dated 01/25/21 revealed changes in weight will be monitored, addressed and communicated to the physician without detriment to the resident. The policy indicated when weight changes were indicated, physician was to be notified. 365889 Page 3 of 23 365889 04/22/2021 Lodge Nursing & Rehab Center 9370 Union Cemetery Road Loveland, OH 45140

F 0583 Keep residents' personal and medical records private and confidential. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 4. Review of the medical record for Resident #3 revealed an admission date of 11/16/18 with a diagnosis of diabetes mellitus. Residents Affected - Some Review of the MDS assessment for Resident #3 dated 04/02/21 revealed resident was cognitively impaired and required extensive assistance of two staff with activities of daily living (ADL's). Observation on 04/21/21 at 1:59 P.M. revealed the electronic medical record (EMR) for Resident #3 was left open on top the the 200 hall medication cart with private health information visible. Interview on 04/21/21 at 2:04 P.M. with Licensed Practical Nurse (LPN) #94 confirmed she had left Resident #3's EMR open on top of the 200 hall medication cart with private health information visible. Review of a facility policy titled Confidentiality dated 02/28/20 revealed the facility honored the resident's rights to secure and confidential personal and medical records. Based on medical record review, observations, staff interview and policy review, the facility failed to provide privacy to residents while in their rooms regarding the use of a video monitoring device and the facility failed to ensure private medical information was secured and kept confidential. This affected four (#3, #72, #74 and #233) out of four residents reviewed for privacy. The facility census was 86. Findings include: 1. Record review of Resident #72's chart revealed resident was admitted to the facility on [DATE] with the following diagnoses; major depressive disorder, respiratory disorders in diseases classified elsewhere, chronic respiratory failure with hypoxia, hypertension, unspecified dementia without behavioral disturbance, gastro esophageal reflux disease without esophagitis, overactive bladder, heart failure, other chronic pain and hypertensive retinopathy. Review of Resident #72's quarterly Minimum Data Sets (MDS) assessment dated [DATE] revealed resident to be cognitively intact and required extensive assistance with bed mobility, transfers, dressing, toileting, personal hygiene and eating. Review of Resident #72's fall care plan dated 12/16/20 revealed resident would have video monitoring in his room. Review of Resident #72's chart revealed no written consents for continuous video monitoring in his chart. Review of Resident #72's progress note dated 04/06/21 revealed resident was found sitting on the floor mat with his back against his bed in his room. The resident continues to be monitored with a camera was the intervention for his fall. Resident #72's resident representative was notified. Review of Resident #72's physician orders revealed there to be no order for video monitoring. Observation of Resident #72's room on 04/21/21 at 2:06 P.M. revealed Resident #72 had a camera 365889 Page 4 of 23 365889 04/22/2021 Lodge Nursing & Rehab Center 9370 Union Cemetery Road Loveland, OH 45140

F 0583 monitor in his room that provided continuous video footage to a monitor at the nurses station. Level of Harm - Minimal harm or potential for actual harm Interview with the Director of Nursing (DON) on 04/21/21 at 2:06 P.M. verified Resident #72 had a camera monitor in his room that provided continuous video footage to a monitor at the nurses station. Residents Affected - Some Interview with the Administrator on 04/21/21 at 3:11 P.M. verified the facility did not have a policy on using continuous video in resident rooms. The Administrator also verified Resident #72 and Resident #72's representative did not sign consents for there to be continuous video in his rooms. The Administrator stated Resident #72's representative was notified of continuous video being used as a fall intervention on 04/06/20. 2. Record review of Resident #74's chart revealed resident was admitted to the facility on [DATE] with the following diagnoses; Alzheimer's disease, dementia in other diseases classified elsewhere with behavioral disturbance, type two diabetes mellitus without complications, anxiety disorder, major depressive disorder, hypertension and glaucoma. Review of Resident #74's quarterly MDS assessment dated [DATE] revealed resident to be severely cognitively impaired and required extensive assistance with bed mobility, transfers, dressing, toileting, and personal hygiene. Resident also required limited assistance with eating. Review of Resident #74's fall care plan dated 02/09/21 revealed resident would have video monitoring in her room. Review of Resident #74's chart revealed no written consents for continuous video monitoring in his chart. Review of Resident #74's progress note dated 02/09/21 revealed Resident #74 was found lying on the right side of the floor in her room. The intervention for the fall was to have a video monitor in Resident #74's room at all times. Resident #74's representative was notified. Review of Resident #74's physician orders revealed Resident #74 was to have video monitoring at all times in her room on 02/10/21. Observation of Resident #74's room on 04/21/21 at 2:06 P.M. revealed Resident #74 had a camera monitor in her room that provided continuous video footage to a monitor at the nurses station. Interview with the DON on 04/21/21 at 2:06 P.M. verified Resident #74 had a camera monitor in her room that provided continuous video footage to a monitor at the nurses station. Interview with the Administrator on 04/21/21 at 3:11 P.M. verified the facility did not have a policy on using continuous video in resident rooms. The Administrator also verified Resident #74 and Resident #74's representative did not sign consents for there to be continuous video in her room. The Administrator stated Resident #74's representative was notified of continuous video being used as a fall intervention on 02/09/21. 3. During observation of 300 hall on 04/20/21 at 12:10 P.M. revealed a computer affixed to the 300 Hall medication cart which displayed an active medications list for Resident #233 and no staff members present in the area. Further observation at 12:13 P.M. revealed a visitor for Resident #240 365889 Page 5 of 23 365889 04/22/2021 Lodge Nursing & Rehab Center 9370 Union Cemetery Road Loveland, OH 45140

F 0583 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some walked in the immediate area where Resident #233's private health information was being displayed on the computer. Interview with Licensed Practical Nurse (LPN) #88 on 04/20/21 at 12:21 P.M. verified she left the medication list displayed for Resident #233 unsecured on the computer and verified a visitor walked by her computer where private health information was displayed. LPN #88 stated she forgot to close the screen when she administered medications. 365889 Page 6 of 23 365889 04/22/2021 Lodge Nursing & Rehab Center 9370 Union Cemetery Road Loveland, OH 45140

F 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to send a copy of the transfer or discharge notice to the Ombudsman for a resident that discharged to the hospital. This affected one (#73) out of three residents reviewed for hospitalizations. The facility census was 86. Findings include: Record review of Resident #73's chart revealed resident was admitted to the facility on [DATE] with the following diagnoses; encephalopathy, unspecified fracture of lower end of left radius initial encounter for closed fracture, Alzheimer's disease, unspecified dementia with behavioral disturbance, essential hypertension, generalized anxiety disorder, irritable bowel syndrome without diarrhea, and nutritional deficiency. Review of Resident #73's quarterly Minimum Data Sets (MDS) assessment dated [DATE] revealed resident to be severely cognitively impaired and required limited assistance with bed mobility, dressing, toileting, and personal hygiene. Resident #73 also required supervision with transfers and eating. Review of Resident #73's progress note dated 03/30/21 revealed Resident #73 was discharged to the hospital on [DATE] after having a fall with wrist pain. Further review of Resident's progress note dated 03/30/21 revealed Resident #73 readmitted to the facility on from the hospital on this date. Review of Resident #73's notice of transfer or discharge date d 03/30/21 revealed Resident #73's resident representative was notified of Resident #73's discharge from the facility on 03/30/21. There was no documentation that the Ombudsman was notified or was sent a copy of Resident #73's transfer or discharge notice for his 03/30/21 hospitalization. Review of Resident #73's progress note dated 04/07/21 revealed Resident was transferred to the hospital on [DATE]. Further review of Resident #73's progress note dated 04/09/21 revealed Resident #73 returned to the facility from the hospital on [DATE]. Review of Resident #73's notice of transfer or discharge date d 04/07/21 revealed Resident #73's resident representative was notified of Resident #73's discharge from the facility on 04/07/21. There was no documentation that the Ombudsman was notified or was sent a copy of Resident #73's transfer or discharge notice for his 04/07/21 hospitalization. Interview with the Administrator on 04/21/21 at 12:57 P.M. revealed the Administrator last notified the Ombudsman of transfers and discharges from the facility on 02/16/21. The Administrator confirmed the Ombudsman was not notified of Resident #73's discharge/transfer to the hospital on [DATE] and 04/07/21. 365889 Page 7 of 23 365889 04/22/2021 Lodge Nursing & Rehab Center 9370 Union Cemetery Road Loveland, OH 45140

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview and review of facility policy, the facility failed to ensure residents were weighed according to physician orders. This affected two (#1 and #241) of the three residents reviewed. Facility census was 86. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #1 revealed an admission date of 03/30/21. Diagnoses included, but not limited to, congestive heart failure (CHF), hypertension (HTN), Atrial fibrillation, osteoarthritis, aortic stenosis, and spondylosis. Review of the most recently completed Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #1 was cognitively intact, had no behaviors, did not reject care, did not wander, was one person assist and required extensive and limited assistance with activities of daily livings (ADL's). Review of physician orders for Resident #1 dated 03/30/21 revealed resident was ordered to be weighed daily in morning before breakfast and physician was to be notified for weight gain greater than three pounds in 24 hours or five pounds in one week. Review of nurse's progress notes for Resident #1 from 03/30/21 through 04/20/21 revealed no documented evidence resident refused to be weighed or other documented reasons why resident was not weighed as ordered. Review of the plan of care for Resident #1 dated 03/31/21 revealed resident had potential for nutritional problem related to CHF and medications (Lasix) may cause weight fluctuations. Interventions included weigh resident as ordered. Review of weights for Resident #1 revealed no documented evidence resident was weighed on 04/05/21, 04/10/12, 04/11/21, 04/15/21, and 04/17/21. Review of weights from 03/21/21 through 04/19/21 revealed resident weighed 110 pounds on admission, and 106 pounds on 04/19/21. Review of April 2021 medication administration record (MAR) for Resident #1, revealed no documented evidence resident was weighed on 04/05/21, 04/10/12, 04/11/21, 04/15/21, and 04/17/21. Review of Registered Dietician (RD) notes for Resident #1 dated 04/07/21 revealed resident was on regular diet, underweight, and had weight fluctuations due to CHF and diuretics. Notes indicated the RD's plan included resident to be weighed as ordered. 2. Review of the medical record for Resident #241 revealed an admission date of 04/09/21. Diagnoses included, but not limited to, CHF, HTN, Alzheimer's disease, dementia, acute kidney failure, nutritional deficiency, and diabetes mellitus. Review of the most recently completed MDS assessment dated [DATE] revealed Resident #241 was cognitively intact, had no behaviors, did not reject care, did not wander, was one person assist and required extensive and limited ADL's. Review of baseline plan of care for Resident #241 dated 04/09/21 revealed resident had CHF and was 365889 Page 8 of 23 365889 04/22/2021 Lodge Nursing & Rehab Center 9370 Union Cemetery Road Loveland, OH 45140

F 0684 to be weighed as ordered. Level of Harm - Minimal harm or potential for actual harm Review of physician orders for Resident #241 dated 04/09/21 revealed the resident was ordered to be weighed daily in morning before breakfast and physician was to be notified for weight gain greater than three pounds in 24 hours or five pounds in one week related to CHF. Residents Affected - Few Review of nurse's progress notes for Resident #241 from 04/09/21 through 04/22/21 revealed no documented evidence resident refused to be weighed or other indications why resident was not weighed as ordered. Review of weights for Resident #241 revealed no documented evidence resident was weighed on 04/10/21, 04/11/21, 04/14/21, 04/15/21, 04/17/21, 04/18/21, 04/19/21, and 04/20/21. Review of April 2021 MAR for Resident #241 revealed no documented evidence resident was weighed on 04/10/21, 04/11/21, 04/14/21, 04/15/21, 04/17/21, 04/18/21, 04/19/21, and 04/20/21. Review of RD notes for Resident #241 dated 04/12/21 revealed resident was on regular diet, underweight and had daily weights due to CHF. RD notes indicated resident would be weighed daily as ordered. Interview with Director of Nursing (DON) on 04/22/21 at 2:50 P.M. verified there was no documented evidence Residents #1 and #241 were weighed in accordance with the physician orders on the dates noted. Review of a facility policy titled Weight Changes dated 01/25/21 revealed changes in weight will be monitored, addressed and communicated to the physician without detriment to the resident. 365889 Page 9 of 23 365889 04/22/2021 Lodge Nursing & Rehab Center 9370 Union Cemetery Road Loveland, OH 45140

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. Based on medical record review, observation and resident and staff interview the facility failed to ensure residents wore splints as ordered by the physician to treat contractures. This affected one (#25) of three residents reviewed for limited range of motion. The census was 86. Findings include: Review of the medical record for Resident #25 revealed an admission date of 08/25/19 with diagnoses including cerebral infarction and hemiplegia. Review of the Minimum Data Set (MDS) assessment for Resident #25 dated 02/03/21 revealed resident was cognitively intact, required extensive assistance of two staff with activities of daily living (ADL's) and had contractures to her upper extremities. Review of the care plan for Resident #25 dated 02/09/21 revealed resident had an ADL self-care performance deficit due to cerebrovascular accident (CVA) with left hemiparesis, limited ROM, muscle weakness, and left hand contracture. Interventions included resident was to wear a palmar grip splint in left hand at all times except for hygiene and bathing. Review of the care plan for Resident #25 dated 02/05/21 revealed resident had a behavior problem and behaviors included refusal to wear left hand splint at times. Interventions included the following: explain all procedures before starting and allow the resident an appropriate amount of time to adjust to changes and upon resistance to care reapproach after appropriate amount of time. Review of the occupational therapy (OT) note for Resident #25 dated 02/01/21 revealed resident tolerated wearing of left hand splint Review of the occupational therapy (OT) note for Resident #25 dated 02/02/21 revealed resident was compliant in wearing splint to her left hand Review of the occupational therapy (OT) note for Resident #25 dated 02/03/21 revealed resident told therapist she planned to wear her left hand splint for 24 hours every day to prevent further contracture to her hand, but therapist recommended resident remove splint for hygiene and bathing and resident agreed. Review of the occupational therapy note for Resident #25 dated 02/17/21 revealed therapist donned resident's left hand splint and educated resident to ask for staff assistance with donning splint if they did not offer to don splint. Review of the occupational therapy (OT) discharge summary for Resident #25 dated 02/19/21 revealed Resident #25 was wearing her left hand splint consistently and the therapy discharge recommendations were always for resident to wear the left hand splint except for hygiene and bathing. Review of the April 2021 physician's orders for Resident #25 always revealed an order dated 12/18/20 for resident to wear a palmar grip splint to the left hand except for hygiene and bathing. Review of the April 2021 Treatment Administration Record (TAR) for Resident #25 revealed it 365889 Page 10 of 23 365889 04/22/2021 Lodge Nursing & Rehab Center 9370 Union Cemetery Road Loveland, OH 45140

F 0688 contained no documentation regarding splint to resident's left hand. Level of Harm - Minimal harm or potential for actual harm Observation on 04/19/21 at 8:47 A.M. of Resident #25 revealed resident's left hand was contracted and there was no splint or device in place. Resident was feeding herself breakfast with her right hand. Residents Affected - Few Interview on 04/19/21 at 8:48 A.M. with Resident #25 confirmed her left hand was contracted related to a prior stroke. Resident #25 further confirmed she was supposed to wear a left hand splint at all times except for bathing Resident #25 confirmed she was not able to don the splint without assistance and no one had offered to place her splint on. Observation on 04/19/21 at 1:30 P.M. of Resident #25 revealed resident in the hallway in her wheelchair and was not wearing her hand splint. Interview on 04/19/21 at 1:30 P.M. with Licensed Practical Nurse (LPN) #104 confirmed Resident #25 was not wearing her splint. LPN #104 further confirmed the resident was supposed to wear the splint at all times to prevent further contracture to the left hand, but the facility did not have a written record of splint application Interview on 04/21/21 at 12:39 P.M. with Occupational Therapist (OT) #114 confirmed Resident #25 was discharged from therapy on 02/19/21 with recommendations to wear a left hand palmar grip splint at all times except for bathing and hygiene to prevent further contracture to her left upper extremity. OT #114 confirmed Resident #25 could not don the splint independently. Observation on 04/21/21 at 1:30 P.M. of Resident #25 revealed resident was in her room watching television and did not have her splint on. Interview on 04/21/21 at 1:30 P.M. with Resident #25 confirmed she did not have her splint on, and no one had offered to put the splint on her. Observation on 04/21/21 at 4:27 P.M. of Resident #25 revealed resident was wearing her left hand splint. Interview on 04/21/21 at 4:28 P.M. with State Tested Nursing Assistant (STNA) #40 confirmed she had placed Resident #25's splint on her left hand a couple hours prior to the interview on 04/21/21. STNA #40 confirmed the facility did not have a record of splint application for Resident #25. STNA #40 further confirmed Resident #25 was supposed to wear the splint at all times removing only for showering. Interview on 04/22/21 at 2:30 P.M. with the Director of Nursing (DON) confirmed Resident #25's medical record contained no documentation regarding donning and doffing of splint to left hand and/or regarding resident refusals of splint. 365889 Page 11 of 23 365889 04/22/2021 Lodge Nursing & Rehab Center 9370 Union Cemetery Road Loveland, OH 45140

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, staff interview and policy review, the facility failed to ensure fall interventions were in place in accordance with a resident's fall care plan. This affected one (#73) out of 19 residents reviewed for care planning. The facility census was 86. Findings include: Record review of Resident #73's chart revealed resident was admitted to the facility on [DATE] with the following diagnoses; encephalopathy, unspecified fracture of lower end of left radius initial encounter for closed fracture, Alzheimer's disease, unspecified dementia with behavioral disturbance, essential hypertension, generalized anxiety disorder, irritable bowel syndrome without diarrhea, and nutritional deficiency. Review of Resident #73's quarterly Minimum Data Sets (MDS) assessment dated [DATE] revealed resident to be severely cognitively impaired and required limited assistance with bed mobility, dressing, toileting, and personal hygiene. Resident #73 also required supervision with transfers and eating. Review of Resident #73's fall care plan dated 04/20/21 revealed resident was to have fall mats to both sides of the bed to reduce the risk of injury. Observation of the facility on 04/20/21 at 11:59 A.M. revealed Resident #73 was lying in a low bed with no fall mats to the side of the bed. Interview with the Director of Nursing (DON) on 04/20/21 at 11:59 A.M. verified Resident #73 was lying in bed with no fall mats to the side of the bed. The DON also verified Resident #73 was ordered to have fall mats to the side of his bed. The DON also verified Resident #73 care plan stated Resident #73 was to have fall mats to the side of his bed. The DON reported that Resident #73 had the fall mats to the side of his bed as intervention prior to 04/20/21 but the care plan and orders were all removed from the electronic record. Review of the undated facility's comprehensive care plans policy revealed it was the policy of the facility to develop and implement a comprehensive person centered care plan for each resident. Review of the facility's fall management policy dated January 2021 revealed each resident will be assessment for the risks of falling and will receive care and services in accordance with the level of risk to minimize the likelihood of falls. 365889 Page 12 of 23 365889 04/22/2021 Lodge Nursing & Rehab Center 9370 Union Cemetery Road Loveland, OH 45140

F 0694 Provide for the safe, appropriate administration of IV fluids 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 medical record review, staff interviews, review of facility policy, review of Licensed Practical Nurse (LPN) job description and review of online resources from Ohio Board of Nursing, the facility failed to ensure resident received ordered intravenous (IV) medications and accommodating IV flushes via peripherally inserted central catheter (PICC). Additionally, the facility also failed to ensure an LPN was appropriately licensed to administer IV medications when she recorded medications administered through a PICC line. This also affected one (#61) out of one residents reviewed for IV medications. The facility identified only one resident in the facility on IV medications. Facility census was 86. Residents Affected - Few Findings include: Review of the medical record for Resident #61, revealed an admission date of 03/22/21. Diagnoses include osteomyelitis of vertebra, multiple sclerosis (MS), pressure ulcer of sacral region, hypothyroidism, depressive disorders, colostomy, anxiety, flaccid neuropathic bladder, osteoporosis, and muscle weakness. Review of the most recently completed Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #61 was cognitively intact, had no behaviors, did not reject care, did not wander, was two person assist, dependent or required extensive assistance with activities of daily livings (ADL's). Section-O (special treatments, procedures, and Programs) revealed Resident #61 received intravenous (IV) medications. Review of physician orders for Resident #61 dated 03/22/21 revealed resident was ordered Sodium Chloride (Normal Saline) (NS) flush solution 0.9 percent; five milliliters (mL) via IV every eight hours (6:00 A.M., 2:00 P.M. and 10:00 P.M.) for PICC line maintenance via the saline administration saline heparin (SASH) method. Physician orders dated 03/22/21 revealed the resident was ordered Heparin (anticoagulant medication) flush solution ten units/mL; administer two mL via PICC line every eight hours (6:00 A.M., 2:00 P.M. and 10:00 P.M.) for PICC maintenance via SASH method. Physician orders dated 03/22/21 revealed resident was ordered Meropenem Solution (antibiotic) one gram (gm) IV via PICC every eight hours (6:00 A.M., 2:00 P.M. and 10:00 P.M.) for cellulitis related to osteomyelitis of vertebra, sacral and sacrococcygeal region. Review of the plan of care for Resident #61 dated 03/23/21 revealed resident had compromised skin integrity due to sacral osteomyelitis and received IV antibiotics. Interventions included administer medications as ordered. Review of March 2021 Medication administration records (MAR) for Resident #61 revealed no documented evidence resident received ordered Meropenem on 03/23/21 at 10:00 P.M. March 2021 MAR also revealed no documented evidence resident received ordered Sodium Chloride and Heparin PICC line flushes on 03/30/21 at 10:00 P.M. Review of April 2021 MAR for Resident #61 revealed no documented evidence resident received ordered Meropenem Solution IV medication on 04/12/21, 04/13/21 and 04/15/21 at 6:00 A.M. and 04/19/21 at 10:00 P.M. MAR also revealed no documented evidence resident received ordered Sodium Chloride 0.9 percent flush on 04/11/21, 04/12/21, 04/13/21 and 04/15/21 at 6:00 A.M. and 04/19/21 at 10:00 P.M. Review of he April 2021 MAR also revealed no documented evidence resident received Heparin flushes on 04/11/21, 04/12/21, 04/13/21 and 04/15/21 at 6:00 A.M., and 04/19/21 at 10:00 P.M. Further review of 365889 Page 13 of 23 365889 04/22/2021 Lodge Nursing & Rehab Center 9370 Union Cemetery Road Loveland, OH 45140

F 0694 Level of Harm - Minimal harm or potential for actual harm April 2021 MAR revealed LPN #87 documented she administered Meropenem Solution IV via PICC on 04/05/21, 04/06/21, 04/07/21, 04/08/21 at 6:00 A.M. and 04/04/21 04/05/21, 04/07/21 and 04/14/21 at 10:00 P.M. Review of the April 2021 MAR also revealed LPN #87 documented she administered Sodium Chloride 0.9 and Heparin flushes via IV PICC line on 04/05/21, 04/06/21, 04/07/21, 04/08/21 at 6:00 A.M., and 04/04/21 04/05/21, 04/07/21 and 04/14/21 at 10:00 P.M. Residents Affected - Few Review of nurse's progress notes for Resident #61 from 03/22/21 through 04/15/21 revealed no documented evidence the resident refused IV antibiotics and PICC line flushes or other reasons why resident missed her ordered antibiotic medications and PICC line flushes on the above dates and times. Nurses progress notes also revealed no documented evidence any additional staff member(s) administered IV medications on the dates listed above. Interview with Director of Nursing (DON) on 04/22/21 at 3:00 P.M. verified Resident #61's MAR revealed no documented evidence Resident #61 received ordered Meropenem Solution IV medication, Sodium Chloride and Heparin flushes on the dates and times recorded above. DON also verified LPN #87 documented she administered IV medications and IV flushes to Resident # 61 on the dates and times recorded above. DON further verified LPN #87 did not have a certification attached to her LPN license which permitted her to administer IV medications. Interview with LPN #87 on 04/22/21 at 4:01 P.M. verified her LPN license did not contain a certification for administering IV medications. LPN #87 further stated she did not administer the IV medications to Resident #61. LPN #87 stated she may have seen the doses were open on the electronic medical records (EMR) and clicked on them to close out the doses. LPN #87 stated she did not know who administered the IV medications and/or if the medications were administered when she documented they were given. Review of job description for LPN #87 dated 09/05/17 revealed staff nurses were responsible for providing total quality care to all residents in a professional and timely manner while meeting quality nursing practice standards and the standards of state and federal regulatory agencies. Review of online resources Ohio elicense Ohio Professional license at https://elicense.ohio.gov/oh_verifylicense revealed LPN #87 had an active, unrestricted LPN license for medications with no certifications for IV medications. Review of a facility policy titled Catheter Insertion and Care dated 12/01/13 revealed midline and central line IV catheters will be flushes to maintain patency; to prevent mixing of compatible medications and solutions; and to ensure entire dose of solution or medication is administered into the venous system. Policy also revealed under general guidelines, indicated staff were to consult State Nurse Practice Act for Registered Nurse (RN)/LPN scope of practice and functions. Review of 02/05/20 facility policy titled Medication Administration revealed medications will be administered in a safe and effective manner. 365889 Page 14 of 23 365889 04/22/2021 Lodge Nursing & Rehab Center 9370 Union Cemetery Road Loveland, OH 45140

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on record review, observation, staff interview, and review of the facility policy, the facility failed to document a count/reconciliation of controlled substances each shift. This had the potential to affect ten (#14, #23, #29, #48, #50, #55, #59, #69, #79 and #195) residents with controlled substance medications stored on the Shelter Unit Odd Cart. The census was 86. Findings include: Review of the controlled substance shift to shift count on 04/20/21 at 8:55 A.M. with Registered Nurse (RN) #107 revealed neither the off going nurse nor the oncoming nurse had signed the count for 04/20/21 at 7:00 A.M. for the Shelter Unit Odd Cart. Further review revealed there were 10 (#14, #23, #29, #48, #50, #55, #59, #69, #79 and #195) residents with controlled substances medications stored on the Shelter Unit Odd Cart. Interview on 04/20/21 at 9:09 A.M. with RN #107 confirmed the off going nurse had not signed the count for 04/20/21 at 7:00 A.M. and she had not signed the count at the beginning of her shift on 04/20/21. Interview on 04/22/21 at 2:34 P.M. with the Director of Nursing (DON) confirmed nurses were supposed to count and sign the controlled substance count sheet whenever the keys to the medication cart changed hands. Review of the facility policy titled Controlled Substance Storage dated August 2014 revealed at shift change or when keys are transferred a physical inventory of all controlled substances is conducted by two licensed nurses and is documented. 365889 Page 15 of 23 365889 04/22/2021 Lodge Nursing & Rehab Center 9370 Union Cemetery Road Loveland, OH 45140

F 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. Based on medical record review, staff interview, and review of medication information from Medscape, the facility failed to timely respond to and implement pharmacist drug regimen recommendations. This affected one (#3) of seven residents reviewed for unnecessary medications. The census was 86. Findings include: Review of the medical record for Resident #3 revealed an admission date of 11/16/18 with a diagnosis of diabetes mellitus. Review of the Minimum Data Set (MDS) assessment for Resident #3 dated 04/02/21 revealed resident was cognitively impaired and required extensive assistance of two staff with activities of daily living (ADL's). Review of the physician orders for Resident #3 revealed an order dated 10/20/20 for hydroxyzine three times daily routinely for itching. Review of the pharmacist recommendation dated 03/15/21 revealed the pharmacist noted resident had been receiving hydroxyzine routinely three times daily for itching since October 2020 and the medication was not recommended for use in the elderly. Further review of the recommendation revealed the medication should be discontinued or the dosage reduced. Review of the recommendation revealed on 03/20/21 the physician had noted agreement with the pharmacist recommendation and wrote to discontinue hydroxyzine. Review of the March 2021 Medication Administration Record (MAR) for Resident #3 revealed the resident received hydroxyzine three times daily in March 2021. Review of the April 2021 MAR for Resident #3 on 04/21/21 revealed the resident received hydroxyzine three times daily in April 2021. Interview on 04/21/21 at 5:00 P.M. with the Director of Nursing (DON) confirmed the facility had not implemented and acted on the pharmacist's recommendation and the attending physician's order to discontinue hydroxyzine for Resident #3. Review of medication information from Medscape revealed hydroxyzine may cause over sedation and confusion in the elderly and prescriber should start on lower doses and monitor closely and avoid use with elderly patients. 365889 Page 16 of 23 365889 04/22/2021 Lodge Nursing & Rehab Center 9370 Union Cemetery Road Loveland, OH 45140

F 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm Based on record review, staff interview, review of facility policy and review of medication information from Medscape, the facility discontinued a residents blood pressure medication without a physician's order to do so resulting in a significant medication error . This affected one (#3) of seven residents reviewed for unnecessary medications. The census was 86. Residents Affected - Few Findings include: Review of the medical record for Resident #3 revealed an admission date of 11/16/18 with a diagnosis of diabetes mellitus. Review of the Minimum Data Set (MDS) assessment for Resident #3 dated 04/02/21 revealed resident was cognitively impaired and required extensive assistance of two staff with activities of daily living (ADL's). Review of the care plan for Resident #3 dated 09/19/19 revealed resident was at risk for complications associated with cardiovascular status due to disease processes including congestive heart failure, hypertension, and atrial fibrillation. Interventions included the following: administer medications per physician order, coordinate care as needed with physician or pharmacy for medication review as needed, consult with cardiologist if clinically indicated. Review of the physician orders for Resident #3 revealed an order dated 10/20/20 for hydroxyzine three times daily routinely for itching and an order dated for hydralazine twice daily for hypertension (high blood pressure). Review of the pharmacist recommendation dated 03/15/21 revealed the pharmacist noted resident had been receiving hydroxyzine routinely three times daily for itching since October 2020 and the medication was not recommended for use in the elderly. Further review of the recommendation revealed the medication should be discontinued or the dosage reduced. Review of the recommendation revealed on 03/20/21 the physician had noted agreement with the pharmacist recommendation and wrote to discontinue hydroxyzine. Review of the March 2021 physician orders for Resident #3 revealed an order to discontinue hydralazine. Review of the nurse progress note for Resident #3 dated 03/21/21 revealed nurse informed the resident his hydralazine had been discontinued per physician order. Review of the March 2021 Medication Administration Record (MAR) for Resident #3 revealed resident received hydralazine twice daily until 03/20/21, but it was discontinued on 03/20/21. Resident #3 did not receive the physician ordered hydralazine from the date of it being discontinued on 03/20/21 through the time of the survey dated 04/21/21. Interview on 04/21/21 at 5:00 P.M. with the Director of Nursing (DON) confirmed the consultant pharmacist had recommended Resident #3's hydroxyzine be reduced or discontinued, and the attending physician wrote an order dated 03/20/21 to discontinue the hydroxyzine. DON confirmed the nurse discontinued hydralazine instead of the hydroxyzine for Resident #3 on 03/20/21 in error. 365889 Page 17 of 23 365889 04/22/2021 Lodge Nursing & Rehab Center 9370 Union Cemetery Road Loveland, OH 45140

F 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the facility policy titled Medication Administration dated 02/05/21 revealed residents would receive medications in a safe and effective manner. Review of medication information from Medscape at https://reference.medscape.com/drug/apresoline-hydralazine-342400 revealed hydralazine is used to treat severe essential hypertension, chronic hypertension, hypertensive crisis and congested heart failure. Hydralazine is used with or without other medications to treat high blood pressure. Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. Hydralazine is called a vasodilator. It works by relaxing blood vessels so blood can flow through the body more easily. Follow your doctor's instructions carefully. Use this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day. Keep taking this medication even if you feel well. Most people with high blood pressure do not feel sick. It may take up to several weeks before you get the full benefit of this drug. Do not stop taking this medication without consulting your doctor. Some conditions may become worse when the drug is suddenly stopped. Your dose may need to be gradually decreased. 365889 Page 18 of 23 365889 04/22/2021 Lodge Nursing & Rehab Center 9370 Union Cemetery Road Loveland, OH 45140

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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 medical record review, observations, staff interview, and review of the facility policy, the facility failed to discard expired medications and failed to ensure medication carts were free of loose unidentified pills in the drawers of the carts. This had the potential to affect the following 17 (#8, #14, #19, #23, #24, #28, #29, #43, #48, #59, #55, #59, #60, #69, #70, #79 and #192) residents who received medication from the Shelter Unit Odd Cart and the following 13 (#1, #61, #232, #233, #234, #235, #236, #237, #238, #239, #240, #241 and #242) residents who received medications from the East Odd Cart. In addition, the facility failed to store controlled substance medication under double lock. This had the potential to affect Resident #74. The census was 86. Findings include: 1. Observation on 04/20/21 at 9:42 A.M. with Registered Nurse (RN) #107 of the refrigerated medication storage in Shelter Unit medication room revealed an expired vial of pneumonia vaccine dated 09/26/20 for Resident #69. Interview on 04/20/21 at 9:42 A.M. with RN #107 confirmed the pneumonia vaccine for Resident #69 was expired and should have been discarded. 2. Observation on 04/20/21 at 9:55 A.M. of the Shelter Unit Odd Cart with RN #107 revealed the cart contained two loose unidentified pills, a red tablet, and a white tablet in the top drawer of the medication cart. Further observation revealed a vial of Levemir insulin for Resident #79 opened on 03/03/21; a box of house stock Bisacodyl laxatives suppositories with an expiration dated of November 2020; a bottle of house stock Calcium carbonate antacid tablets with an expiration date of March 2021; and a bottle of house stock oyster shell with an expiration date of February 2021. Interview on 04/20/21 at 9:58 A.M. with RN #107 confirmed the loose unidentified pills should be discarded. RN #107 confirmed once insulin has been opened it should be discarded in 28 days. RN #107 confirmed the expired Bisacodyl suppositories, calcium carbonate tabs, and oyster shell calcium tablets should be discarded once expired. The facility identified 17 (#8, #14, #19, #23, #24, #28, #29, #43, #48, #59, #55, #59, #60, #69, #70, #79 and #192) residents who received medication from the Shelter Unit Odd Cart. 3. Observation on 04/20/21 at 11:46 A.M. of the East Hall Odd Cart with Licensed Practical Nurse (LPN) #88 revealed the cart contained a loose unidentified white capsule in the top drawer of the medication cart. Further observation revealed a bottle of house stock aspirin with an expiration date of February 2021; a bottle of house stock allergy medication with an expiration date of June 2020; and a bottle of house stock oyster shell calcium with an expiration date of February 2021. Interview on 04/20/21 at 11:50 A.M. with LPN #88 confirmed the loose unidentified pill should be discarded. LPN #88 confirmed the expired aspirin, oyster shell calcium tablets, and allergy medication should be discarded once expired. The facility identified 13 (#1, #61, #232, #233, #234, #235, #236, #237, #238, #239, #240, #241 and #242) residents who received medications from the East Odd Cart. Review of the facility policy titled Medication Storage dated 02/25/20 revealed outdated medications or those without secure closures or labeling should be discarded. 365889 Page 19 of 23 365889 04/22/2021 Lodge Nursing & Rehab Center 9370 Union Cemetery Road Loveland, OH 45140

F 0761 Level of Harm - Minimal harm or potential for actual harm 4. Review of the medical record for Resident #74 revealed an admission date of 06/13/20 and a diagnosis of Alzheimer's Disease Review of the April 2021 physician orders for Resident #74 revealed an order for Ativan intensol liquid as needed. Residents Affected - Few Observation on 04/20/21 at 9:41 A.M. with RN #107 revealed Resident #74's Ativan intensol liquid was stored in the locked medication room in an unlocked refrigerator. Further observation revealed the Ativan was stored in an unattached plastic box with a numbered plastic breakaway lock that could be easily removed. The box was able to be opened and a gap of approximately one inch was observed through which the medication could possibly be removed and returned without disturbing the breakaway plastic lock. Interview on 04/20/21 at 9:41 A.M. with RN #107 confirmed Resident #74's Ativan was stored in a locked medication room in an unlocked refrigerator in an unattached plastic box with a numbered plastic breakaway lock that could easily be removed. RN #107 further confirmed the box was able to be opened with a gap of approximately one inch through which the Ativan could be possibly be removed and returned without disturbing the breakaway plastic lock particularly if a nurse had small and/or slender hands. Review of the facility policy titled Controlled Substance Storage dated August 2014 revealed controlled substance medications must be stored under a double lock system. Further review of the policy revealed controlled substance medications stored in a refrigerator should be stored in locked box in the refrigerator and the box should be attached to the inside of the refrigerator. 365889 Page 20 of 23 365889 04/22/2021 Lodge Nursing & Rehab Center 9370 Union Cemetery Road Loveland, OH 45140

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on record review, observation, staff interview, review of online resources, and policy review the facility failed to ensure staff performed proper hand hygiene during medication administration. This affected one resident (#240) of seven residents observed for medication administration. In addition the facility failed to ensure a nurse completed appropriate infection control techniques after she provided direct care to a resident in transmission based precautions/quarantined for COVID-19. This affected two residents (#196 and #245) of 24 reviewed for infection control. The facility census was 86. Residents Affected - Some Findings include: Review of the medical record for Resident #240 revealed an admission date of 04/06/21 with a diagnosis of diabetes mellitus. Review of the April 2021 physician orders for Resident #240 revealed an order for a blood sugar check and for an oral medication, midodrine (a medication to help low blood pressure) at noon. Observation of the medication administration on 04/20/21 at 11:37 A.M. for Resident #240 per Licensed Practical Nurse (LPN) #88 revealed the nurse donned gloves prior to checking the resident's blood sugar. Nurse obtained a drop of blood from the resident's finger using a lancet and placed the blood onto the glucose test strip. Immediately after checking the blood sugar LPN #88 removed her gloves and administered oral medication midodrine without performing hand hygiene prior to oral medication administration. Interview on 04/20/21 at 11:39 A.M., with LPN #88 confirmed she removed her gloves after checking Resident #240's blood sugar, had not performed hand hygiene and then directly administered oral medication to the resident. Review of the facility policy titled Hand Hygiene dated February 2021 revealed hand hygiene practices should be used consistently to minimize the risk of spreading and/or acquiring infections and hand hygiene should be performed after removing gloves and after contact with inanimate objects in the resident's room or environment. 2. During observation of wound care/dressing change on 04/21/21 at 1:58 P.M., for Resident #233 who was in transmission-based precautions (TBP) due to new admission/coronavirus (COIVD-19) quarantined revealed LPN #06 arrived at residents' rooms with a N95 mask and a face shield in place. LPN #06 donned a new disposable protective gown before she entered resident's rooms and had no surgical mask covering her N95 mask. Further observation revealed LPN #06 completed the dressing change, washed her hands in the resident's bathroom then doffed her contaminated protective gown and exited the residents' room at 2:10 P.M. Further observation revealed LPN #06 did not clean her face shield or change the N95 masks after she exited Resident #233 's room. Further Observation revealed LPN #06 had a small bedside table with her computer, various paper documents and wound supplies for wound care which she used to roll around between residents' rooms. Observation revealed LPN #06 continued to touch her face shield and her N95 mask to reposition it on her face. Continued observations revealed LPN #06 would place the face shield on top of her head where the nose pieces rested on her forehead to talk to surveyor and /or doff the face shield completely and place it on the bedside table. LPN #06 was observed to do this 365889 Page 21 of 23 365889 04/22/2021 Lodge Nursing & Rehab Center 9370 Union Cemetery Road Loveland, OH 45140

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some several times while talking with the surveyor. Further observation revealed LPN #06 donned her face shield, pushed the bedside table to Resident #196's room, knocked on door, used handle to open residents' doors and asked Resident and the visitor a question. LPN #06 used the door handle to close residents' door and pushed the bedside table to the main hallway near the phone. Observation revealed LPN #06 continued to touch her N95 mask to reposition it and her face shield, then she completely doffed the face shield and placed it on the bedside table to make a phone call. Further observation revealed LPN #06 finished the phone call, donned the face shield, repositioned her N95 mask and pushed the bedside table to Resident #245 room. Continued observation revealed LPN #06 knocked on door, used door handle to enter residents' room and interviewed the resident. During interview with the resident, LPN #06 was observed to place her left hand on resident's footboard, continued to wear the contaminated face shield and the same N95 mask when she provided care to Resident #233. Observation revealed LPN #06 exited resident #245's room and went to the main nurse's desk where she was observed to touch the main counter and other items. Interview with LPN #06 on 04/21/21 at 2:25 P.M. verified Resident #233 was in quarantine due to a new admission when she completed wound care. LPN #06 also verified she washed her hands then removed her contaminated gown after she provided direct care to a resident in quarantine. LPN #06 also verified the numerous breaks in infection control after she exited Resident #233's room. LPN #06 verified she should have washed her hands after she removed the contaminated gown but forgot the sequence. LPN #06 also verified she was not aware she should have either changed her N95 mask or wore a surgical mask over top of the N95 between residents. LPN #06 also stated she was also not aware she needed to clean her face shield after she provided direct care to a quarantined resident. Review of the CDC website titled Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2029 (COVID-19) Pandemic (https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html), updated 12/14/20, revealed HCP should perform hand hygiene before and after all patient contact, contact with potentially infectious material, and before putting on and after removing PPE, including gloves. Hand hygiene after removing PPE is particularly important to remove any pathogens that might have been transferred to bare hands during the removal process. Guidelines indicated HCP staff shall put on clean, non-sterile gloves upon entry into the patient room or care area, remove and discard gloves before leaving the residents room and immediately perform hand hygiene. Guidelines indicated HCP shall put on a clean isolation gown upon into the resident room or area and remove and discard the gown in a dedicated container for waste before leaving the resident's room. Review of Centers for Medicare and Medicaid Services (CMS) memo titled COVID-19 Long-Term Care Facility Guidance., dated 04/02/20, revealed all nursing homes shall ensure they are complying with all CMS and CDC guidance related to infection control. Review of 02/28/20 facility policy titled Hand Hygiene revealed hand hygiene practices should be used consistently to minimize the risk of spreading and/or acquiring infections. 365889 Page 22 of 23 365889 04/22/2021 Lodge Nursing & Rehab Center 9370 Union Cemetery Road Loveland, OH 45140

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on observation and staff interview, the facility failed to ensure the main laundry room dryers were free of lint build up. This had the potential to affect all residents who reside in the facility. Facility census was 86. Findings included: During observation of the laundry room on 04/22/21 at 2:33 P.M. with Maintenance Director # 78 revealed dryer #01 (far right) had a large build-up of lint in the front of the dryer where the lint trap was located. Observation revealed a large build-up of lint on top of the lint screen mechanisms, bottom of the drum and lint twisted around to the electric wires. Further observation revealed Dryer #03 (far left) had a hole in the dryer lint screen, a build-up of lint within the lint trap device and large build-up of lint within the vents leading out of the dryer. During interview with Maintenance Director #78 on 04/22/21 at 243 P.M. verified the lint build up in the dryers (#01 and #03) . Maintenance Director #78 stated he was responsible for the back of the dryers and Laundry staff was responsible for the front of the dryers where the lint traps were located. Maintenance Director #78 stated the facility had no log where they had checked or cleaned the front of the dryers where the lint trap was located. Interview with Laundry Staff #77 on 04/22/21 at 2:46 P.M. indicated laundry staff was able to clean off the lint from the screen by hand however they had no way to remove the lint off of the top of the lint trapping mechanism or off the electric wires. Laundry Staff #77 stated the facility had no log where they cheeked or cleaned the front of the dryers. Interview with the Director of Nursing (DON) on 04/22/21 at 3:00 P.M. indicated the facility had no policy for cleaning the lint areas of the dryers. 365889 Page 23 of 23