Health inspection·November 7, 2022

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observations, family interview, resident interview, staff interview, and review of the facility's meal time policy, the facility failed to ensure residents were provided their meals in a timely manner and according to their preference. This affected one (Resident #54) of one resident reviewed for choices. The facility census was 76. Findings include: Review of Resident #54's medical record revealed an admission date of 06/03/22. Diagnoses included dementia, Parkinson's Disease, and COVID-19. Review of Resident #54's Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #54 was cognitively intact. Resident #54 displayed no behaviors during the review period. Review of Resident #54's care plan 10/31/22 revealed supports and interventions for testing positive 10/26/22 for COVID-19, Parkinson's disease, and nutritional risk. Interventions for nutritional risks included the use of a plate guard and Kennedy cup (lightweight spillproof drinking cup) with meals, diet as ordered, monitor intakes, and staff to provide assistance with cutting up food when needed. Review of the physician orders dated 06/03/22 revealed Resident #54 was on a liberalized diabetic diet, regular texture, and thin regular liquids consistency. An order dated 06/24/22 from speech therapy revealed recommendations for a plate guard and a Kennedy cup during meals. Observations on 10/31/22 from 12:19 P.M. to 12:51 P.M. of the hallway lunch trays for Resident #54's hall revealed five meals were transported from the serving kitchen on an uncovered, non-insulated metal cart. At 12:32 P.M., an observation revealed the residents who ate in the dining room had completed their meals and were going back to their rooms. Five hall trays continued to be on an uncovered, non-insulated cart on Resident #54's hallway. At 12:35 P.M., observation of the open food cart on Resident #54's hallway revealed the food was on insulated bases with insulated covers. Resident #54's lunch was found to be on the cart. At 12:37 P.M., an aide was filling the resident's water pitchers but not passing out trays. Five resident meals, including Resident #54's lunch meal, continued to be on the meal cart in the hallway. At 12:42 P.M., five hall trays were undelivered and still on the cart. At 12:47 P.M., State Tested Nursing Assistant (STNA) #520 began to deliver hall trays to the residents. At 12:51 P.M., STNA #520 and Medication Aide (MA) #515 had distributed four of the five meal trays to the residents. Resident #54's tray remained on the cart. Page 1 of 8 365973 365973 11/07/2022 Birchaven Retirement Village 15100 Birchaven Lane Findlay, OH 45840

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 10/31/22 at 12:54 P.M. with Resident #54 and her husband revealed they were not happy with how long it took to get Resident #54's meals. Resident #54's husband stated it had been that way for some time. He reported they told the staff she wanted to eat at a regular meal time like 12:00 P.M. noon, but nothing had changed and Resident #54 regularly received her meals an hour or more after everyone else. Resident #54 agreed with her husband and reported she was hungry and had not gotten her lunch yet. Resident #54 and her husband stated her meal was often cold by the time she got it. Observation on 10/31/22 at 1:01 P.M. of the meal cart revealed Resident #54's lunch continued to be the only lunch remaining on the cart. Interview on 10/31/22 at 1:08 P.M. with STNA #520 verified Resident #54 had not been provided her meal yet. STNA #520 did not provide Resident #54 her lunch and walked down the hallway away from the cart. Interview and observation on 10/31/22 at 1:12 P.M. with STNA #528 verified Resident #54's lunch was still on the hall cart and had not been delivered. STNA #528 applied personal protective equipment and entered Resident #54's room with the meal tray. STNA #528 asked Resident #54 if she wanted her to warm up the food. Resident #54 shook her head no saying she was hungry and it was fine. Interview on 10/31/22 at 3:27 P.M. with Resident #54 verified it was after 1:00 P.M. before she got her lunch and she had been very hungry. Resident #54 stated she didn't want to wait that long to get her meals but they were always that late or later. Observation on 11/01/22 at 12:39 P.M. revealed a meal cart was not used to deliver meals on Resident #54's hallway. Hospitality Aide (HA) #478 was observed delivering meals to resident rooms as they were plated from the serving kitchen. Observation on 11/01/22 at 1:18 P.M. revealed Resident #54 was provided her lunch meal tray. This was approximately 45 minutes after the first hall tray was delivered on Resident #54's hall and over an hour past Resident #54's preferred meal time. Review of the facility's policy titled Meal Times revealed lunch was to be served on Resident #54's hallway at 12:00 P.M. The policy stated meal times were open and were to follow the Person Centered Care Model. 365973 Page 2 of 8 365973 11/07/2022 Birchaven Retirement Village 15100 Birchaven Lane Findlay, OH 45840

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 observations, resident interview, medical record review, and staff interview, the facility failed to ensure timely and adequate care was provided to a resident who was exhibiting symptoms of an eye irritation and/or infection. This affected one (Resident #60) of three residents reviewed for infections. The facility census was 76. Residents Affected - Few Findings include: Review of Resident #60's medical record revealed an admission date of 03/29/18. Diagnoses included cerebral infarction, cognitive communication deficit, and peripheral vascular disease. Review of Resident #60's Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #60 was cognitively intact. Resident #60 required extensive assistance from staff with dressing and personal hygiene. Resident #60 displayed no behaviors during the review period. Review of Resident #60's care plan revised 09/27/22 revealed Resident #60 had a potential to demonstrate verbally and physically aggressive behaviors and a behavior of picking at sores on his skin. Review of Resident #60's physician orders from 10/01/22 to 11/03/22 revealed no orders for eye drops or treatments. Observation on 10/31/22 at 10:02 of Resident #60 revealed his right eye was red, watering, and there was a dark yellow puss like build up in the corner of his eye. Interview on 10/31/22 at 10:06 A.M. with Resident #60 revealed he was alert and aware. Resident #60 reported he was having trouble seeing out of his eye, pointing to his right eye. Resident #60 stated it got 'goopy' stuff in it a lot. Observation on 11/01/22 at 8:42 A.M. of Resident #60 revealed he was dressed, clean and was seated up in his wheelchair in his room. Resident #60's right eye was red and watering but there was no puss or buildup noted. Observation on 11/01/22 at 11:43 A.M. of Resident #60 revealed he was seated in the dining room sitting at at table with one other resident. Resident #60 was observed closing his right eye while he fed himself. Observation on 11/01/22 at 12:42 P.M. of Resident #60 revealed an aide was assisting him back to his room after he was done with lunch. Resident #60's right eye was watering and red. Interview on 11/02/22 at 9:16 A.M. with Registered Nurse (RN) #543 verified Resident #60 had no current treatment for his eyes and had no eye infection she was aware of. RN #543 reported Resident #60 kept his eyes closed whenever she was in his room so she was not able comment on if there was any redness or signs of infection. Interview on 11/02/22 at 3:54 P.M. with State Tested Nursing Assistant (STNA) #526 verified Resident #60's eyes were red and irritated. STNA #526 reported Resident #60 would often scratch and pick all over his body. He would have dirt, skin, and feces under his fingernails and would refuse to clean 365973 Page 3 of 8 365973 11/07/2022 Birchaven Retirement Village 15100 Birchaven Lane Findlay, OH 45840

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few his nails or wash his hands. He would then rub his eyes and they would get red and irritated. STNA #526 reported his eyes issues come and go and they would let nursing know so they could get eye drops. STNA #526 stated the nurses provided the eye drops and not the aides. Interview and observation on 11/03/22 at 10:19 A.M. with Resident #60 revealed he was alert and aware. Resident #60 stated his right eye had been red and watery for a couple months. He stated they were not giving him drops or anything. Observation of Resident #60's right eye revealed it was red. It was not draining and had no yellow buildup. Interview on 11/03/22 at 10:22 A.M. with Licensed Practical Nurse (LPN) #513 verified Resident #60 had no new orders for eye drops. LPN #513 went down to Resident #60's room and evaluated his eyes. LPN #513 verified Resident #60's right eye was red and irritated. Resident #60 told LPN #513 his eye had been draining and it itched a little bit. LPN #513 said she would let Resident #60's physician know and see if she would be able to get him some eye drops or something to help. 365973 Page 4 of 8 365973 11/07/2022 Birchaven Retirement Village 15100 Birchaven Lane Findlay, OH 45840

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm Based on observation, medical record review, and staff interview, the facility failed to ensure physician orders were followed for Resident #55's wound care. This affected one resident (#55) of one resident reviewed for pressure ulcers. The facility identified three residents with pressure ulcers. The facility census was 76. Residents Affected - Few Findings include: Review of the medical record for Resident #55 revealed an admission date of 12/10/11. Diagnoses included unstageable pressure ulcer (slough and/or eschar: known but not stageable due to coverage of wound bed by slough and/or eschar) on the right heel (dated 08/01/22), metabolic encephalopathy, fracture of right tibia and medial malleolus, and diabetic mellitus type II with diabetic neuropathy. Review of Resident #55's physician order dated 09/27/22 revealed to apply Dakin's (half strength) solution 0.25 % sodium hypochlorite to the wound every day shift. The order did not specify the location of the wound. Observation on 11/02/22 at 6:50 A.M. revealed Registered Nurse (RN) #632 held the right leg of Resident #55 while RN #543 removed the old dressing, using wound wash to loosen the old dressing. After removing the dressing, she removed the gloves and applied clean ones, without performing hand hygiene. RN #543 wiped the wound with betadine and then washed the wound with a soapy washcloth, rinsed with a clean wet washcloth and patted it dry with a dry towel. She applied a dry ABD pad and secured it in place with self-adherent cohesive bandage. Interview 11/02/22 at 7:15 A.M. with RN #543 revealed RN #543 reviewed the physician order in the electronic record and verified she had not followed the physician order. Subsequent review of the medical record revealed a progress note, written on 10/31/22 by the orthopedic surgeon, revealed to Continue with daily Dakin's wet to dry with ace wrap. Continue with off loading Prevalon Boot while at rest. Follow up in two weeks. There was no physician order to apply an ace wrap or the off loading Prevalon Boot. Interview on 11/02/22 at 1:38 P.M. with Assistant Director Of Nursing #481 verified the orthopedic surgeon's recommendations were not implemented and there were no physician orders to implement the ace wrap and off loading Prevalon Boot while at rest. 365973 Page 5 of 8 365973 11/07/2022 Birchaven Retirement Village 15100 Birchaven Lane Findlay, OH 45840

F 0732 Post nurse staffing information every day. Level of Harm - Potential for minimal harm Based on observation and staff interview, the facility failed to ensure the nursing staff information was posted daily in a prominent area and kept current, as required. This had the potential to affect all 76 residents residing in the facility. Residents Affected - Many Findings include: Observation on 10/31/22 at 1:33 P.M. with the Director of Nursing (DON), revealed the daily staff posting in the front entrance was dated 10/29/22. The DON verified the daily schedule staff posting was not current and stated each nurse's station has the current daily posting. Observation and interview on 10/31/22 at 1:35 P.M. with Registered Nurse (RN) #541 revealed the E and F hall daily staff posting was blank. RN #541 verified the daily staff posting was blank and said the night shift staff were in charge of filling the form in. Observation and interview on 10/31/22 at 1:38 P.M. with Licensed Practical Nurse (LPN) #564 revealed the G hall form for the nurse staff posting was lying on the desk, out of view of anyone looking for it. LPN #564 verified the nurse staff posting was not visible to the residents and families. 365973 Page 6 of 8 365973 11/07/2022 Birchaven Retirement Village 15100 Birchaven Lane Findlay, OH 45840

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on medical record review and staff interview, the facility failed to ensure accurate and complete medical records were kept for residents regarding injuries. This affected one (Resident #52) of 20 residents reviewed for medical record accuracy. The facility census was 76. Findings include: Review of the medical record for Resident #52 revealed an admission date of 12/04/19. Diagnoses included Alzheimer's disease. Review of a physician order dated 10/29/22 revealed Resident #52 required a daily dressing change to her left hand, including nine steri strips (a wound closure strip), a non-adherent pad, and tegaderm (a transparent bandage). Review of the progress notes for Resident #52 dated 10/29/22 revealed a family member was notified regarding a skin tear to Resident #52's left hand. Further review of the progress notes revealed no additional information regarding the circumstances surrounding the development of Resident #52's skin tear. Review of the Skin and Wound Evaluation document dated 10/29/22 revealed Resident #52 had an in-house acquired skin tear to her left dorsum measuring 4.5 centimeters (cm) in length and 0.7 cm in width. No information regarding the circumstances of the event leading to the skin tear were included in the document. Review of the Wound Evaluation dated 10/29/22 revealed a photograph and measurements of Resident #52's skin tear to her left dorsum. No additional information regarding the circumstances around the event were documented. Interview on 11/01/22 at 9:07 A.M. with the Assistant Director of Nursing (ADON) #480 confirmed the progress notes, Skin and Wound Evaluation document, and the Wound Evaluation did not include any documentation regarding the circumstances surrounding the development of Resident #52's skin tear. 365973 Page 7 of 8 365973 11/07/2022 Birchaven Retirement Village 15100 Birchaven Lane Findlay, OH 45840

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, medical record review, review of the Centers for Disease Control and Prevention (CDC) guidance, and staff interview, the facility failed to ensure staff completed proper hand hygiene during a dressing change. This affected one resident (Resident #55) of one resident reviewed for wound care. The facility census was 76. Residents Affected - Few Findings include: Review of the medical record for Resident #55 revealed an admission date of 12/10/11. Diagnoses included unstageable pressure ulcer (slough and/or eschar: known but not stageable due to coverage of wound bed by slough and/or eschar) on the right heel (dated 08/01/22), fracture of right tibia and medial malleolus, and diabetic mellitus type II with diabetic neuropathy. Review of the physician's order dated 09/27/22 revealed to apply Dakin's (half strength) solution 0.25 % sodium hypochlorite to the wound every day shift. The order did not specify the location of the wound. Observation on 11/02/22 at 6:50 A.M. revealed Registered Nurse (RN) #632 held the right leg of Resident #55 while RN #543 removed the old dressing, using wound wash to loosen the old dressing. After removing the dressing, she removed the gloves and applied clean ones, without performing hand hygiene. RN #543 wiped the wound with betadine and then washed the wound with a soapy washcloth, rinsed with a clean wet washcloth and patted it dry with a dry towel. She applied a dry ABD pad and secured it in place with self-adherent cohesive bandage. Interview on 11/02/22 at 7:08 A.M. with RN #543 verified she had not preformed hand hygiene between removing gloves and reapplying clean ones. Review of the CDC guidance titled Hand Hygiene Guidance, last reviewed 01/30/20, revealed the Core Infection Prevention and Control Practices for Safe Care Delivery in All Healthcare Settings recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) include the following strong recommendations for hand hygiene in healthcare settings. Healthcare personnel should use an alcohol-based hand rub or wash with soap and water for the following indications which included immediately after glove removal. Healthcare facilities should require healthcare personnel to perform hand hygiene in accordance with CDC recommendations. 365973 Page 8 of 8