Health inspection·November 20, 2018

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview and policy review the facility failed to ensure care plans were initiated. This affected two Residents (#12 and #35) of 19 reviewed for care plans. The census was 62. Findings include: 1. Medical record review for Resident #12 revealed an admission date of 10/20/17. Medical diagnoses included Parkinson's, thyroid disorder, and heart failure. Review of the quarterly Minimum Data Assessment (MDS) dated [DATE] revealed Resident #12 was cognitively intact. Review of physician orders for Resident #12 dated 10/19/18 revealed Levothyroxine 88 micrograms (mcg) one in the morning for thyroid disorder, Trihexyphendyl HCL give one mg every eight hours for Parkinson's and Xarelto (anticoagulant) to give 15 mg every day. Review of care plans for Resident #12 revealed none were initiated for Levothyroxine, Trihexphendyl HCL and Xarelto. Interview with the Director of Nursing (DON) on 11/20/18 at 3:00 P.M. revealed there was no care plans initiated for Levothyroxine, Trihexyphendyl HCL or Xarelto medications. 2. Medical record review for Resident #35 revealed an admission date of 07/24/18. Medical diagnoses included heart failure and Alzheimer's Disease. Review of the quarterly MDS dated [DATE] for Resident #35 revealed she was cognitively intact. Review of physician orders dated 04/26/18 for Resident #35 revealed Atorvastatin (to lower cholesterol) 20 mg to be taken at late evening. Review of care plans for Resident #35 revealed there was no care plan initiated for cholesterol medication. Interview with the DON on 11/20/18 at 3:00 P.M. revealed there was not a care plan initiated for cholesterol medication. Review of policy entitled Care Plans, Comprehensive Person-Centered dated 12/01/16 revealed a comprehensive, person-centered care plan that included measurable objectives and timetables to meet the Page 1 of 4 365974 365974 11/20/2018 Ohio Living Quaker Heights 514 West High Street Waynesville, OH 45068

F 0656 resident's physical, psychosocial, and functional needs is developed and implemented for each resident. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 365974 Page 2 of 4 365974 11/20/2018 Ohio Living Quaker Heights 514 West High Street Waynesville, OH 45068

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview the facility failed to ensure ensure an explanation was documented as to why a resident did not attend their care conference. This affected one (#35) of 24 residents reviewed for care conferences. The census was 62. Findings include: Medical record review for Resident #35 revealed an admission date of 07/24/18. Medical diagnoses included heart failure and Alzheimer's Disease. Review of the quarterly Minimum Data Set (MDS) dated [DATE] for Resident #35 revealed she was cognitively intact. Review of care conference for Resident #35 revealed on 12/06/17 there was no signature on the form for the resident. Further review revealed the resident representative was documented as a no call no show. For this care conference there was social services and a registered nurse at the meeting and the activities director was spoke to before the conference. Review of care conferences for Resident #35 revealed on 03/07/18 there was no signature on the form for the resident. Further review revealed the resident representative was documented as did not show. For this care conference there was social services and a registered nurse at the meeting and the activities director was spoken to before the conference. Review of care conferences for Resident #35 revealed on 05/30/18 there was no signature on the form for the resident. Further review revealed the resident representative was documented as did not show. For this care conference there was social services and a registered nurse at the meeting and the activities director was spoken to before the conference. Review of care conferences for Resident #35 revealed on 09/05/18 there was no signature on the form for the resident. Further review revealed the resident representative was documented as did not show. For this care conference there was social services and a registered nurse at the meeting and the activities director was spoken to before the conference. Interview with Resident #35 on 11/19/18 at 9:04 A.M. revealed she had not had a care conference. Interview with Social Services Designee (SSD) #179 on 11/19/18 at 1:39 P.M. revealed Resident #35 refused the care conferences and the family was a no call no show. She further revealed the resident did not sign the care conference sheets and she didn't have any documentation to prove the resident refused the conference. She stated she spoke to the activities director before the conferences to see if there was anything from activities that needed to be included in the conference. She stated therapy and dietary manager were not at the conferences and the nursing staff would speak for the state tested nursing aide if there was anything that needed to be discussed. 365974 Page 3 of 4 365974 11/20/2018 Ohio Living Quaker Heights 514 West High Street Waynesville, OH 45068

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 **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 a resident who was dependent on staff for personal hygiene received oral hygiene. This affected one Resident (#34) of 24 reviewed for activities of daily. The census was 62. Findings include: Residents Affected - Few Medical record review for Resident #34 revealed an admission date of 07/24/18. Medical diagnoses included cerebrovascular accident and Non-Alzheimer's Dementia. Review of quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #34 was cognitively intact. He was coded on the MDS as total dependence for personal hygiene. At attempt to observe Resident #34 on 11/18/18 at 10:46 A.M. revealed the door to his room was closed. An aide was in the room with him and stated he was receiving patient care. At 11:00 A.M. the resident was observed with yellowish substance on the bottom of his teeth and it was noted he had an odor coming from his mouth. Interview with State Tested Nursing Aide (STNA) #126 on 11/18/18 at 11:05 A.M. revealed she changed Resident #34, shaved, dressed, and washed his face. She verified his teeth were dirty and she did not brush them while providing care at 10:46 A.M. Interview with Resident #34 on 11/18/18 at 2:25 P.M. revealed the staff didn't brush his teeth very often. Review of policy entitled Routine Dental Care dated 04/01/07 revealed each resident will receive routine dental care. 365974 Page 4 of 4