Health inspection·June 8, 2023

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 observations, medical record review, resident and staff interviews, and policy review, the facility failed to assist residents who required assistance with activities of daily living (ADL) with showers and personal hygiene needs. This affected two (#19 and #39) of three residents reviewed for ADLs. The facility identified 70 residents who required assistance with bathing. The facility census was 73. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #19 revealed an admission date of 11/11/19. Diagnoses included atrial fibrillation, chronic obstructive pulmonary disease (COPD), anxiety, chronic kidney disease, and hypertension (HTN). Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 04/07/23, revealed Resident #19 had moderate cognitive impairment and required extensive staff assistance with personal hygiene and was dependent upon staff for bathing. Review of the ADL care plan revealed Resident #19 required extensive staff assistance for bathing and personal hygiene. Review of the bathing records from 05/01/23 to 06/06/23 revealed Resident #19 received a shower/bath three times on 05/23/23, 05/26/23, and 06/06/23. There was no documentation to support Resident #19 received any other showers/baths during this time period from 05/01/23 to 06/06/23. Review of the unit shower/bath schedule revealed Resident #19 was scheduled for showers/bathes on Tuesdays and Fridays. Interview on 06/05/23 at 10:22 A.M. with Resident #19 stated she doesn't get showers or baths as scheduled. Interview on 06/07/23 at 11:15 A.M. with Regional Registered Nurse (RN) #508 confirmed the medical record for Resident #19 revealed Resident #19 received a shower/bath on 05/23/23, 05/26/23, and 06/06/23. Regional RN #508 confirmed the medical record did not contain documentation to support Resident #19 received showers/bathes as scheduled from 05/01/23 to 06/06/23. 2. Review of the medical record for Resident #39 revealed an admission date of 10/25/22. Diagnoses included chronic obstructive pulmonary disease (COPD), atrial fibrillation, and hypertension (HTN). Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 04/14/23, revealed Resident Page 1 of 4 365896 365896 06/08/2023 Fox Run Manor 11745 Township Road 145 Findlay, OH 45840

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few #39 had moderate cognitive impairment and required extensive staff assistance with personal hygiene, and was dependent upon staff for bathing. Review of the care plan, dated 12/26/22, revealed Resident #39 had a self-care deficit related to poor health management. The goal of the care plan stated Resident #39 would be clean and well groomed. The interventions included Resident #39 required one person assist with grooming and hygiene. Review of the bathing records from 06/01/23 to 06/07/23 revealed Resident #39 received a shower/bath on 06/03/23 and 06/07/23. Observation and interview on 06/05/23 at 2:40 P.M. revealed Resident #39 with gray facial hair noted above Resident #39's upper lip. Resident #39 stated staff do not assist her with removing her facial hair. Subsequent observation on 06/06/23 at 3:20 P.M. revealed Resident #39's gray facial hair was noted above Resident #39's upper lip. Observation and interview on 06/07/23 at 8:16 A.M. revealed Resident #39 exiting the shower room with wet hair. Resident #39 still had gray facial hair above her upper lip. Resident #39 stated she just received a shower and staff did not offer to provide grooming needs for facial hair. Interview on 06/07/23 at 8:17 A.M. with State Tested Nursing Assistant (STNA) #435 confirmed she assisted Resident #39 with her shower that morning and that she did not provide Resident #39 with grooming care for her facial hair. STNA #435 stated staff were to provide grooming needs for residents on shower days. STNA #435 confirmed Resident #39 had gray facial hair above her upper lip. Review of the policy titled Quality of Policy/Activities of Daily Living, revised April 2016, revealed each resident will receive, and the facility will provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being in accordance with the comprehensive assessment and plan of care. The policy stated a resident who is unable to carry out ADLs will receive the necessary services to maintain good grooming, personal care, and oral hygiene. 365896 Page 2 of 4 365896 06/08/2023 Fox Run Manor 11745 Township Road 145 Findlay, OH 45840

F 0880 Provide and implement an infection prevention and control program. 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, observation, staff interview, review of facility policy, and review of Centers for Disease Control and Prevention (CDC) guidance the facility failed to implement transmission based precautions for a resident when positive for a multi-drug resistant organism (MDRO) and receiving wound care. This affected Resident #4 of seven reviewed for transmission based precautions. The census was 73. Residents Affected - Few Findings include: Review of Resident #4's medical record revealed an admission date of 12/31/18. Diagnoses included methicillin resistant staphylococcus aureus (MRSA) infection. Review of the physician orders revealed there was an order for culture drainage from left stump wound. Review of wound culture results dated 04/13/23 revealed light growth of MRSA. Further review of physician orders revealed no order for any transmission based precautions to be implemented on 04/13/23. Further review of the medical record revealed Resident #4 was discharged from the facility to a local hospital on [DATE] and returned to the facility on [DATE]. Review of the hospital records dated 05/19/23 revealed Resident #4 was treated by infectious disease consult and completed antibiotic treatment. No recrudescence (reoccurrence) of infection was noted. Review of the physician orders revealed an order dated 05/25/23 to cleanse open area on left stump (amputated leg), pack with iodoform, gauze, cover with army battle dressing (ABD), and secure with tape. Change daily and as needed (PRN). There were no orders for enhanced barrier precautions (EBP) upon return form the hospital on [DATE]. Review of a quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #4 was cognitively intact, required extensive assistance with personal hygiene, and total dependence with bathing. Resident #4 had a multi-drug resistant organism (MDRO) infection. Observation of Resident #4's room on 06/05/23 at 2:23 P.M. and 06/07/23 at 1:05 P.M. revealed no signs for any transmission based precautions/EBP or any personal protective equipment (PPE) at the entrance. Interview with Registered Nurse (RN) #508 on 06/07/23 at 2:02 P.M. confirmed transmission based precautions had not been implemented for Resident #4 who had a positive wound culture for MRSA on 04/13/23. Interview with the Director of Nursing (DON) on 06/08/23 at 8:18 A.M. revealed the hospital records stated Resident #4 had completed a course of antibiotics and no reoccurrence of MRSA was noted by infectious disease. The DON confirmed Resident #4 should have been place in EBP because he was receiving wound care and had a history of MRSA. Interview with Licensed Practical Nurse (LPN) #498 on 06/08/23 at 9:00 A.M. confirmed contact 365896 Page 3 of 4 365896 06/08/2023 Fox Run Manor 11745 Township Road 145 Findlay, OH 45840

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few precautions were not implemented for Resident #4 on 04/13/23 when a wound culture was positive for MRSA. EBP were also not implemented when Resident #4 returned from the hospital on [DATE] and continued with wound care. Review of the facility's policy titled MDRO Management, last revised August 2022, revealed it is the policy of the facility to follow established guidelines when caring for residents identified with specific MDROs. Contact precautions should be used for all residents infected or colonized with a MDRO. Review of the facility's policy titled Enhance Barrier Precautions, last revised August 2022, revealed it is the policy of the facility to use EBP to prevent transmission of MDROs from an infected or colonized resident through an infection control intervention designed to reduced transmission or resistant organisms that employs targeted gown and glove use during high contact resident care activities. EBP may be considered for the following situations: infection or colonization with a MDRO when contact precautions do not apply and with wounds and/or indwelling medical devices (e.g. central line, urinary catheter, feeding tube, tracheostomy/ventilator) regardless of MDRO colonization status. Review of the CDC website based on the current evidence, CDC continues to recommend the use of contact precautions for MRSA-colonized or infected patients. CDC will continue to evaluate the evidence on contact precautions as it becomes available. In addition, CDC continues to work with partners to identify and evaluate other measures to decrease transmission of MDROs in healthcare settings. MDRO transmission is common in skilled nursing facilities, contributing to substantial resident morbidity and mortality and increased healthcare costs. Enhanced Barrier Precautions (EBP) are an infection control intervention designed to reduce transmission of resistant organisms that employs targeted gown and glove use during high contact resident care activities. EBP may be indicated (when Contact Precautions do not otherwise apply) for residents with wounds or indwelling medical devices, regardless of MDRO colonization status and infection or colonization with an MDRO. EBP expand the use of PPE and refer to the use of gown and gloves during high-contact resident care activities that provide opportunities for transfer of MDROs to staff hands, and clothing. MDROs may be indirectly transferred from resident-to-resident during these high-contact care activities. Nursing home residents with wounds and indwelling medical devices are at especially high risk of both acquisition of and colonization with MDROs. The use of gown and gloves for high-contact resident care activities is indicated, when contact precautions do not otherwise apply, for nursing home residents with wounds and/or indwelling medical devices regardless of MDRO colonization as well as for residents with MDRO infection or colonization. Examples of high-contact resident care activities requiring gown and glove use for EBP include dressing, bathing/showering, transferring, providing hygiene, changing linens, changing briefs or assisting with toileting, device care or use: central line, urinary catheter, feeding tube, tracheostomy/ventilator, and wound care: any skin opening requiring a dressing. 365896 Page 4 of 4