Health inspection·October 18, 2023

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. Based on record review, review of self-reported incident report (SRI) tracking number 239957, and interview, the facility failed to ensure a comprehensive, resident-centered care plan related to resident behaviors was maintained. This affected one (Resident #1) of three residents reviewed for abuse. The facility census was 29. Findings include: Review of the medical record for Resident #1 revealed an admission date of 08/05/22. Diagnoses included Down syndrome, morbid obesity, urethral stricture, and impulse disorder. Review of Resident #1's plan of care, dated 08/23/22, revealed the resident received psychotropic medication related to behaviors of agitation and combativeness (flailing arms during personal care and hitting himself during personal care) due to impulse control problems. Interventions included administering medication as ordered and monitoring for target behaviors: agitation, aggression, combativeness, verbal outbursts, and throwing food and drinks onto floor. Review of the annual Minimum Data Set (MDS) assessment, dated 07/21/23, revealed the resident had moderately impaired cognition. The assessment indicated no behaviors nor rejection of care. The resident was totally dependent on two staff members to assist with bed mobility, transfers, toileting, and personal hygiene. Review of the facilities self-reported incident (SRI) tracking number 239957, discovery date 10/08/23, revealed Resident #1 reported to nursing staff that STNA #99 had struck him with her hand the previous night when she came into his room to ask him to turn off his television (tv) because it was too loud. An investigation was immediately initiated. STNA #99 was immediately suspended until the completion of the investigation. Resident #1 was assessed and found to have a mark on his chest that matched his own hand print. During the assessment, Registered Nurse (RN) #100 asked Resident #1 to place his hand over the mark and she confirmed that the resident's hand matched the outline of bruise. During interview with the Administrator, STNA #99 denied hitting the resident as alleged and denied turning off his tv. STNA #99 stated that she did go to his room to remind him that people were sleeping and not to be so loud as he had been yelling at the tv and could be heard down the hall. The resident's guardian and the local sheriff's department were notified. The facility unsubstantiated the allegations due to inconclusive evidence of abuse. Review of Resident #1's skin assessment, dated 10/08/23 at 7:15 P.M., revealed a bruise located on the chest which measured 8.5 centimeters (cm) x 17 cm x 0 depth. Page 1 of 2 365922 365922 10/18/2023 Sienna Hills Nursing & Rehabilitation 73841 Pleasant Grove Road Adena, OH 43901

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During interview and observation on 10/17/23 at 11:10 A.M., Resident #1 stated STNA #99 yelled at him and slapped him on the chest because his tv was too loud. Resident #1 further stated that he wanted to be with his dad and didn't want to be in the facility. The resident denied any further incidents of abuse and stated that he felt safe in the facility. Observation revealed a circular, quarter-sized bruise, yellowish purple in color, and located approximately one inch above the xiphoid process (a small cartilaginous process located in the inferior segment of the sternum) in the middle of the resident's chest. Resident #1 denied pain or discomfort from the bruised area. During interview on 10/17/23 at 9:20 A.M., Registered Nurse (RN) #100 stated that she was notified by STNA #105 on 10/08/23 that Resident #1 alleged a staff member had hit him on the previous night shift. The resident did not know the STNA's name but provided a physical description of the STNA. The resident was assessed, and a bruise was observed in the shape of a hand, in the center of the resident's chest. The resident's hand was placed inside the mark and appeared to match the size and shape of the bruise. The resident did not complain of pain. The Director of Nursing (DON) was notified immediately. RN #100 stated that she had never witnessed any abuse while working in the facility. During interview on 10/17/23 at 12:25 P.M., the DON stated the facility investigation could not substantiate the alleged abuse and it was determined by the evidence that Resident #1's bruise located on his chest was the result of the resident hitting himself while watching wrestling on the night of the alleged incident. The DON confirmed the care plan did not reflect behaviors of hitting himself while watching wrestling, although the facility was aware of the self-hitting behavior during wrestling tv shows prior to the alleged incident. This deficiency is an incidental finding discovered during the course of the investigation. 365922 Page 2 of 2