Health inspection·December 1, 2022

F 0604 Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review, and facility policy review the facility failed to ensure Resident #12 had a physician order for a physical restraint called a Merry Walker. This affected one Resident (#12) of one Resident (#12) reviewed for physical restraints. The facility census was 34. Residents Affected - Few Findings included: Review of Resident #12's medical record revealed she was initially admitted to the facility on [DATE] with the diagnoses of mild intellectual disabilities, hyperthyroidism, bipolar, and unspecified dementia. Review of Resident #12's quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed she was minimally cognitively impaired, walked in the room, walked in the corridor, and had locomotion off the unit with supervision and no setup or physical help from staff. Her locomotion on unit required supervision and setup help only. Review of Resident #12's physician orders revealed no order for a Merry [NAME] ( an adaptive device combining a chair and walker which has four wheels and plastic bars surrounding a resident's body so they can not get free from the device without physical help of staff. The device is for residents who are at risk for falling and would normally be placed in a wheelchair for mobility. It allows them to stand from the seat and walk independently from within the bars of the device ). Review of Resident #12's care plan dated 11/10/22 revealed she was noncompliant with fall interventions and the safety precaution intervention of a Merry [NAME] for ambulation throughout facility was initiated on 08/16/22. Observation on 11/28/22 at 3:59 P.M. of Resident #12 walking in facility hallway in a Merry Walker. Observation on 11/29/22 at 8:30 A.M. of Resident #12 sitting in her Merry [NAME] watching television. On 11/30/22 at 8:50 A.M. an interview with Licensed Practical Nurse (LPN) #233 revealed Resident #12 does use a Merry [NAME] for ambulation. After reviewing Resident #12's physician orders, LPN #233 verified there was no order for Resident #12 to have a Merry Walker. LPN #233 verified residents should not be in a Merry [NAME] without an order from the physician. Review of the facility policy titled, Restraint Guidelines, dated 01/01/16, revealed documentation Page 1 of 9 365922 365922 12/01/2022 Sienna Hills Nursing & Rehabilitation 73841 Pleasant Grove Road Adena, OH 43901

F 0604 for a restraint should have an order which has been transcribed to the treatment administration record. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 365922 Page 2 of 9 365922 12/01/2022 Sienna Hills Nursing & Rehabilitation 73841 Pleasant Grove Road Adena, OH 43901

F 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation and interview, the facility failed to provide Resident #25 with activities to meet their preferences and interests. This affected one Resident (#25) of one Resident reviewed for activities. The facility census was 34. Residents Affected - Few Findings include: Review of Resident #25's medical record revealed an admission date of 08/23/19 with diagnoses including dementia, anxiety and depression. Review of the annual Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed a severely impaired cognition level. Further review of the MDS assessment indicated Resident #25's activity interests included independent activities such as television and music. Review of the Annual Activity assessment, completed on 05/16/22, indicated Resident #25 preferred independent activities such as 1:1 visits. The assessment further identified Resident #25's favorite activities included television, people watching and sitting in the dining room observing other residents and activities. Review of the activity participation records for Resident #25 revealed no evidence of any 1:1 activities provided, no group activity participation and no evidence of any independent activities. Observations conducted intermittently throughout the annual survey on 11/28/22 and 11/29/22 revealed Resident #25 laying in bed without the television on nor any music playing in the room. Interview with Activity Director (AD) #206 on 11/30/22 at 9:40 A.M. verified no evidence of any activity participation and no activities provided for Resident #25 on 11/28/22 and 11/29/22. 365922 Page 3 of 9 365922 12/01/2022 Sienna Hills Nursing & Rehabilitation 73841 Pleasant Grove Road Adena, OH 43901

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review and facility policy review the facility failed to ensure staff used appropriate hand hygiene when providing incontinence care. This affected one Resident (#24) of one Resident reviewed for bladder and bowel incontinence. The facility census was 34. Findings included: Review of Resident #24's medical record revealed she was admitted to the facility on [DATE] with the diagnoses of Alzheimer's disease with early onset, essential hypertension, weakness, and hypothyroidism. Review of Resident #24's quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed she was rarely or never understood and was severely impaired with cognitive skills for daily decision making. Review of the Activity for Daily Living (ADL) assistance section revealed she was totally dependent on two plus persons for physical assistance. The MDS also revealed Resident #24 was always incontinent of bladder and bowel. Observation on 11/30/22 at 10:19 A.M. of incontinence care for Resident #24 provided by State Tested Nursing Assistant (STNA) #231 and STNA #225 revealed both STNA #231 and #225 did not wash their hands or use hand sanitizer prior to donning (putting on) gloves. Incontinence care was provided using proper technique. During and after completion of Resident #24's incontinence care, STNA #231 touched the handle on the bedside drawer twice, the bed controls, the over bed table, a hair brush, and a teddy bear while wearing the same gloves he had on to provide the incontinence care. After completion of the incontinence care, both STNA #231 and #225 doffed (removed) their gloves and used hand sanitizer. On 11/30/22 at 10:25 A.M. an interview with STNA #231 and STNA #225 verified neither one of them washed their hands or used hand sanitizer prior to donning their gloves. STNA #231 also verified he touched multiple items in the room with the same gloves he wore to provide incontinence care. Review of the facility policy titled, Hand Washing Guidelines, undated, revealed hands should be washed with soap and water or an antiseptic agent used before and after providing routine care and before putting on gloves. 365922 Page 4 of 9 365922 12/01/2022 Sienna Hills Nursing & Rehabilitation 73841 Pleasant Grove Road Adena, OH 43901

F 0695 Provide safe and appropriate respiratory care 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 observation, interview, record review, and facility policy review the facility failed to ensure oxygen was administered at the correct flow rate. This affected one Resident (#31) of one Resident reviewed for respiratory care. The facility census was 34. Residents Affected - Few Findings included: Review of Resident #31's medical record revealed he was admitted to the facility on [DATE] with diagnoses including essential hypertension, hyperlipidemia, and chronic obstructive pulmonary disease (COPD). Review of Resident #31's quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #31 was cognitively independent and did not receive oxygen. Review of Resident #31's physician order dated 11/25/22 revealed an order to administer oxygen at two liters per minute via a nasal cannula continuously to keep oxygen saturation above 92%. Review of Resident #31's oxygen saturations revealed saturations ranging from 92% to 98%. Review of Resident #31's care plan dated 11/17/22 revealed he was at risk for altered respiratory status related to the diagnosis of COPD and untreated lung cancer diagnosed in 2018. The goal of this care plan was Resident #31 would maintain a normal breathing pattern through the next review. One of the interventions was administer oxygen as ordered. Observation on 11/28/22 at 10:43 A.M. of Resident #31 lying in bed with his oxygen flow rate set at two-and-a-half liters per minute via a nasal cannula. Observation on 11/29/22 at 7:55 A.M. of Resident #31 lying in bed with his oxygen flow rate set at two-and-a-half liters per minute via a nasal cannula. On 11/29/22 at 11:02 A.M. an interview with Licensed Practical Nurse (LPN) #233 revealed the drive to breath for a resident with COPD was a lower oxygen saturation. Observation on 11/29/22 at 11:05 A.M. of Resident #31's oxygen flow rate with LPN #233 revealed a flow rate of two-and-a-half liters per minute via a nasal cannula. An interview with LPN #233 at the time revealed she was not sure what the oxygen should be flowing at and would like to review Resident #31's order for oxygen. On 11/29/22 at 11:09 A.M. an interview with LPN #233, revealed the oxygen flow rate for Resident #31 was not correct based on the order for two liters per minute via nasal cannula and should be lowered. Review of the facility policy titled, Oxygen Administration, undated, revealed adjust the oxygen delivery device so that it is comfortable for the resident and the proper flow of oxygen is being administered. 365922 Page 5 of 9 365922 12/01/2022 Sienna Hills Nursing & Rehabilitation 73841 Pleasant Grove Road Adena, OH 43901

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, facility record review and facility policy review the facility failed to ensure food was stored and prepared under sanitary conditions. This had the potential to affect all Residents living in the facility and receiving meals from the kitchen. The were no Residents identified by the facility as receiving nothing by mouth. The facility census was 34. Findings included: 1. Observation on 11/28/22 at 8:40 A.M. of meat in a plastic bag floating in water in the staff hand washing sink. The water was not running in the sink and the sink was plugged to make a pool of water. On 11/28/22 at 9:00 A.M. an interview with Dietary #213 verified the meat should not be thawed in a pool of water or in the staff hand washing sink. She reported the staff the evening before forgot to defrost the meat in the fridge and she was trying to thaw it quickly. Review of the facility policy titled, Food Handling Guidelines, undated, revealed thawing of frozen meat should be done in the following manners: under refrigeration at temperature below 41 degrees Fahrenheit, under potable running water at a temperature of 70 degrees Fahrenheit or below, as part of the conventional cooking process, or in a microwave only when the food will be immediately transferred to conventional cooking facilities as port of a continuous cooking process or when the entire, uninterrupted cooking process takes place in a microwave oven. 2. Observation on 11/28/22 at 8:41 A.M. of both ovens with charred, burned on food evidence the ovens had not been properly cleaned for some time. On 11/28/22 at 9:02 A.M. an interview with Dietary #213 verified the ovens were dirty and she wasn't sure when they were last cleaned. On 11/29/22 at 10:00 A.M. an interview with Dining Services Director (DSD) #204 verified the ovens were only cleaned once every three weeks and the ovens were dirty and needed cleaned. Review of the facility policy titled, Sanitation, undated, revealed ovens were to be free of spills. 3. Observation on 11/28/22 at 8:44 A.M. of Resident Assistant (RA) #228 entering the kitchen and walking past both hazard tape lines on the floor without her hair covered. She walked over to the steam table area which had ham, eggs, and hot cereals without coverings. An interview at the time with RA #228 verified she was not wearing a hair net and had never been told to wear a hairnet or to cover her hair when she was in the kitchen. On 11/28/22 at 8:45 A.M. an interview with Dietary #213 revealed all staff were to wear hair covering once past the second hazard tape line on the floor. Review of the facility policy titled, Personal Hygiene, undated, revealed hair must be kept clean and kept restrained with a hair net or cap covering all hair. 365922 Page 6 of 9 365922 12/01/2022 Sienna Hills Nursing & Rehabilitation 73841 Pleasant Grove Road Adena, OH 43901

F 0812 Level of Harm - Minimal harm or potential for actual harm 4. Observation on 11/19/22 at 9:30 A.M. of a 106 ounce can of corn with a dent on the edge of the can compromising the seal. An interview at the time with the DSD #204 revealed cans were checked upon delivery, and dented cans were supposed to be put in another room to be donated to a local food bank. She verified the can of corn was dented on the seal and was in the pantry to be used and not with the other items to be donated. Residents Affected - Many Review of the facility policy titled, Receiving, undated, revealed store damaged goods separately from non-damaged goods. 5. Observation on 11/29/22 at 12:30 P.M. of DSD #204 preparing puree. She pureed enchiladas following the recipe. DSD #204 then ran the processor through the chemical dishwasher. Once the dishwasher was done, the processor was placed on the counter to air dry. Observation on 11/29/22 at 12:55 P.M. of DSD #204 continuing the puree process using the processor she had run through the dishwasher. The processor was not dry. DSD #204 put rice in the processor and pureed it following a recipe. On 11/29/22 at 1:00 P.M. an interview with DSD #204 revealed she did not let the processor completely dry and should have to prevent potential contamination. She verified that all dishes are to air dry completely prior to use. 6. Observation on 11/29/22 at 12:35 P.M. of the large can opener with black, crusted food like substance on the puncture blade. An interview at the time with DSD #204 verified the can opener was dirty and it is not on the daily cleaning schedule. Review of the facility policy titled, Sanitation, undated, revealed can openers are to be clean. 365922 Page 7 of 9 365922 12/01/2022 Sienna Hills Nursing & Rehabilitation 73841 Pleasant Grove Road Adena, OH 43901

F 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and facility policy review, the facility failed to ensure an outdoor dumpster lid was completely covering the opening to the dumpster to protect from pest infestation. This had the potential to affect all 34 Residents living in the facility. The facility census was 34. Residents Affected - Many Findings included: Observation on 11/28/22 at 08:30 A.M. of the outdoor dumpster revealed one fourth of the lid was missing leaving the refuse open to air and pests. Observation on 11/29/22 at 12:30 P.M. of the outdoor dumpster revealed one fourth of the lid was missing leaving the refuse open to air and pests. On 11/29/22 an interview with Dining Services Director (DSD) #204 revealed the trash dumpster had been missing part of the lid for a few weeks and the facility probably should have notified the trash company of the broken lid. Review of the facility policy titled, Solid Waste Disposal, undated, revealed garbage containers would be covered at all times. 365922 Page 8 of 9 365922 12/01/2022 Sienna Hills Nursing & Rehabilitation 73841 Pleasant Grove Road Adena, OH 43901

F 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm Based on observation and interview the facility failed to ensure a kitchen oven was maintained in safe operating condition. This had the potential to affect all 34 Residents living in the facility. The facility census was 34. Residents Affected - Many Findings included: Observation on 11/28/22 at 8:40 A.M. of the left kitchen oven revealed the door of the oven had a piece of wood wedged into the top of it. An interview at the time of the observation with Dietary #213 revealed the oven door did not close properly so the piece of wood was used to wedge the oven door closed. On 11/29/22 at 10:00 A.M. an interview with Dining Services Director (DSD) #204 revealed the spring in the left oven door was not working correctly and a company came to fix it but ended up making it worse and the door would not close all the way. DSD #204 verified the broke oven door and revealed the facility had been using the piece of wood to wedge the oven door closed for over a week. DSD #204 verified using the piece of wood on a hot oven was not safe operating condition. 365922 Page 9 of 9