Health inspection·October 19, 2023

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, review of a list of psychotropic medications provided by the facility and interview, the facility failed to ensure Preadmission Screening and Resident Reviews (PASARRs) were up to date and accurate. This affected two residents (#30 and #37) of two residents reviewed for PASARR. The facility census was 76. Findings include: 1. Review of Resident #30's medical record revealed she was admitted to the facility on [DATE] with diagnoses including major depressive disordered (entered 02/18/22), bipolar disorder (entered 02/22/22), insomnia (entered 02/22/22), and generalized anxiety disorder (entered 11/08/22). Review of Resident #30's quarterly Minimum Data Set (MDS) 3.0 assessment, dated 09/18/23, revealed she was cognitively intact. Further review revealed she had active diagnoses of anxiety disorder, depression, and bipolar disorder. Review of Resident #30's physician order, dated 07/05/23, revealed she was prescribed clonazepam (an antianxiety agent) 0.5 milligrams (mg) to be administered one tablet by mouth two times a day for mood; a physician order, dated 07/05/23, revealed she was prescribed Paxil (an antidepressant agent) 20 mg to be administered one tablet by mouth one time a day for mood; and a physician order, dated 07/05/23, revealed she was prescribed lamotrigine (bipolar therapy agent for mood stability) 100 mg to be administered by mouth two times a day for mood. Further review of her physician orders revealed she had been on the lamotrigine since her admission on [DATE]. Review of Resident #30's October 2023 Medication Administration Record (MAR) revealed she had received the clonazepam, Paxil, and lamotrigine as ordered during the month of October. Review of Resident #30's most recent PASARR, dated 04/04/23, revealed under Section E: Indications of Serious Mental Illness, the boxes beside mood disorder and panic or other severe anxiety disorder was marked with an X. Further review of the same section revealed the boxes beside anti-depressant and an anti-anxiety medication. was marked with an X. However, the box beside mood stabilizers was not marked with an X. Review of Resident #30's Preadmission Screening and Resident Review Result Notice, dated 04/04/23, revealed she had no indication of serious mental illness and/or developmental disability. Interview on 10/16/23 at 1:09 P.M. with Social Services Designee #553 revealed the PASARR dated Page 1 of 11 365975 365975 10/19/2023 Park Health Center 100 Pine Avenue St Clairsville, OH 43950

F 0644 04/04/23 was Resident #30's most recent and up to date PASARR. Level of Harm - Minimal harm or potential for actual harm Interview on 10/17/23 at 10:18 A.M. with SSD #553 verified the most recent PASARR dated 04/04/23 was not accurate and up to date based on the current mental health medications of Resident #30 due to her being on the mood stabilizer lamotrigine. She also verified the PASARR should be updated whenever there is a diagnosis or mental health medication change. Further discussion revealed SSD #553 was provided a list of antianxiety, antidepressant, antipsychotics, and sedative-hypnotic medications, but not a list of mood stabilizer. Residents Affected - Few Review of the medication list titled, Psychotropic Agents by Drug Class, dated 12/17, revealed antianxiety agents, antidepressants, antipsychotics, and sedative-hypnotics were listed. However, medications used for mood stabilization were not provided. 2. Review of Resident #37's medical record revealed he was initially admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including dementia in other diseases classified elsewhere (entered 10/23/18), insomnia (entered 01/18/19), bipolar disorder (entered 10/20/22), and major depressive disorder (entered 09/25/23). Review of Resident #37's quarterly MDS 3.0 assessment, dated 09/25/23, revealed he was cognitively impaired. Further review revealed he had active diagnoses of depression, bipolar disorder, and non-Alzheimer's dementia. Review of Resident #37's most recent PASARR, dated 10/08/19, revealed under Section D: Indications of Serious Mental Illness, the box beside schizophrenia was marked with a check mark. Further review revealed bipolar, insomnia and dementia were typed in. The box beside of mood disorder was not check marked. Review of Resident #37's Notice of PASARR Level II Outcome, dated 10/10/19 revealed he was ruled out from further PASARR review. Interview on 10/17/23 at 10:13 A.M. with Social Services Designee #553 verified the most recent PASARR dated 10/08/19 was not accurate and up to date based on the active mental health diagnoses of Resident #37. She verified Resident #37 did not have an active diagnosis of schizophrenia and did have active diagnoses of bipolar disorder (entered 10/20/22) and depression (entered 09/25/23) which were both mood disorders. She also verified the PASARR should be updated whenever there is a diagnosis or mental health medication change. 365975 Page 2 of 11 365975 10/19/2023 Park Health Center 100 Pine Avenue St Clairsville, OH 43950

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, record review, facility policy review and interview the facility failed to ensure residents' masks and tubing for their noninvasive ventilation were cleaned every morning as ordered and failed to ensure documentation regarding cleaning was accurate. This affected two residents (#9 and #66) of five residents reviewed for respiratory care. The facility census was 76. Residents Affected - Few Findings included: 1. Review of Resident #9's medical record revealed she was admitted to the facility on [DATE] with diagnoses including chronic respiratory failure with hypoxia, type two diabetes, dependence on respirator, atherosclerotic heart disease, and morbid obesity with alveolar hypoventilation. Review of Resident #9's quarterly Minimum Data Set (MDS) 3.0 assessment, dated 07/20/23, revealed she was cognitively intact, had an active diagnosis of debility, cardiorespiratory condition, and received oxygen. Review of Resident #9's physician order, dated 07/22/22, identified she was to have her trilogy mask and all tubing cleaned with warm soapy water every morning and allowed to air dry. Review of Resident #9's respiratory Treatment Administration Record (TAR), dated October 2023, revealed Respiratory Therapy (RT) #600 documented she cleaned the trilogy mask and all tubing with warm soapy water on 10/16/23 and 10/17/23. Observation on 10/16/23 at 11:15 A.M. of Resident #9's trilogy mask revealed it was still connected to the tubing and the mask in a bag hanging above the trilogy machine. An interview at the time with Resident #9 revealed the mask and tubing was not washed that morning. She reported that when it was washed by the respiratory therapist only the mask was washed and not the tubing. Resident #9 revealed the mask was then left on a towel to air dry during the day. Resident #9 reported the evening respiratory therapist would then reassemble the mask and tubing prior to applying it for bed. Resident #9 verified her mask was not washed daily. Observation on 10/17/23 at 7:15 A.M. of Resident #9 lying in bed with the trilogy mask on and the machine operating. Observation on 10/17/23 at 10:45 A.M. of Resident #9's trilogy mask lying on a paper towel, drying after being washed, and the tubing was hanging in a bag on a shelf above her machine. Interview on 10/17/23 at 11:00 A.M. with RT #600 revealed she washed Resident #9's trilogy mask this morning. She revealed she did not clean Resident #9's mask on 10/16/23 because it was off when she came on duty and assumed the midnight shift respiratory therapist did it. She revealed she did not clean the tubing and did not realize the order included the cleaning of the tubing also. Interview on 10/18/23 at 10:55 A.M. with RT #600 verified she documented on Resident #9's respiratory TAR that she cleaned the trilogy mask and all tubing with warm soapy water on 10/16/23, but she didn't. She revealed the facility is looking to change the TAR system because it is set up for only day shift to document the cleaning of the trilogy mask and tubing and not night shift. She reported if the resident takes the mask off during the end of the night shift, there was no way for the night 365975 Page 3 of 11 365975 10/19/2023 Park Health Center 100 Pine Avenue St Clairsville, OH 43950

F 0695 shift respiratory therapist to document cleaning of the mask and tubing. Level of Harm - Minimal harm or potential for actual harm 2. Review of Resident #66's medical record revealed she was initially admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including heart failure, chronic obstructive pulmonary disease, shortness of breath, dependence on supplemental oxygen, and chronic respiratory failure. Residents Affected - Few Review of Resident #66's quarterly MDS 3.0 assessment, dated 09/21/23, revealed she was cognitively intact. Further review revealed she had active diseases of asthma or chronic lung disease and respiratory failure and received oxygen therapy while a resident. Review of Resident #66's physician order, dated 08/17/23, revealed her trilogy mask and all tubing was to be cleaned with warm soapy water every morning and as needed. The items were to be allowed to air dry. Review of Resident #66's respiratory TAR, dated October 23, revealed RT #600 documented she cleaned the trilogy mask and all tubing with warm soapy water on 10/16/23 and 10/17/23. Observation on 10/16/23 at 2:54 P.M. of Resident #66's trilogy mask connected to the trilogy machine and sitting on top of the oxygen concentrator. The mask was not in the bag and the mask and tubing had no signs of being cleaned. An interview at the time with Resident #66's revealed the trilogy mask and tubing was not washed that morning. Observation on 10/17/23 at 7:08 A.M. of Resident #66's trilogy mask connected to the trilogy machine and sitting on top of the oxygen concentrator. The mask was not in the bag and the mask and tubing had no signs of being cleaned. Observation on 10/17/23 at 10:38 A.M. of Resident #66's trilogy mask connected to the trilogy machine and sitting on top of the oxygen concentrator. The mask was not in the bag and had no signs of being cleaned. An interview at the time with Resident #66 revealed no staff had cleaned her mask or tubing on 10/16/23 or 10/17/23. Interview on 10/17/23 at 11:00 A.M. with RT #600 revealed she did not clean Resident #66's mask on 10/16/23 or 10/17/23 because it was off when she came on duty and assumed the midnight shift respiratory therapist did it. She revealed she did not clean the tubing and did not realize the order included the cleaning of the tubing also. Interview on 10/17/23 at 11:28 A.M. with RT #600 verified she documented on Resident #66's respiratory TAR that she cleaned the Trilogy mask and all tubing with warm soapy water on 10/16/23 and 10/17/23, but she didn't. Review of the facility policy titled, Non-Invasive Ventilation, revised 04/17/23, revealed the facility will properly provide non-invasive ventilation per the physician's order for residents that suffer from chronic respiratory failure, severe COVID, restrictive thoracic disorder, and neuromuscular disorders. 365975 Page 4 of 11 365975 10/19/2023 Park Health Center 100 Pine Avenue St Clairsville, OH 43950

F 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure medication orders were followed. This affected one resident (#20) of six residents reviewed for unnecessary medications. The facility census was 76. Residents Affected - Few Findings included: Review of Resident #20's medical record revealed he was admitted to the facility on [DATE] with diagnosis including chronic respiratory failure with hypoxia, essential hypertension, other specified peripheral vascular diseases, shortness of breath, and heart failure. Review of Resident #20's quarterly Minimum Data Set (MDS) 3.0 assessment, dated 08/22/23, revealed he was rarely/never understood and had short-term and long-term memory problems. Further review revealed he had active diagnoses of debility, cardiorespiratory conditions, coronary artery disease, heart failure and hypertension. Review of Resident #20's physician order, dated 09/27/23, identified he was to receive Midodrine HCL (an anti-low blood pressure agent used to raise the blood pressure) oral tablet three times a day for vasopressor. The medication was to be held for a systolic blood pressure (the top number of a blood pressure) above 100. Review of Resident #20's September Medication Administration Record (MAR) revealed the Midodrine HCL was administered on 09/28/23 at 6:00 A.M. with a systolic blood pressure of 101; on 09/29/23 at 6:00 A.M. when his systolic blood pressure was 120, and on 09/30/23 at 2:00 P.M. when his systolic blood pressure was 112. Review of Resident #20's October MAR revealed the Midodrine HCL was administered on 10/02/23 at 2:00 P.M. when his systolic blood pressure was 145, on 10/04/23 at 2:00 P.M. when his systolic blood pressure was 115, on 10/05/23 at 6:00 A.M. when his systolic blood pressure was 106, on 10/05/23 at 10:00 P.M. when his systolic blood pressure was 120,on 10/06/23 at 2:00 P.M. when his systolic blood pressure was 116, on 10/07/23 at 2:00 P.M. when his systolic blood pressure was 112, on 10/07/23 at 10:00 P.M. when his systolic blood pressure was 118, on 10/08/23 at 2:00 P.M. when his systolic blood pressure was 120, on 10/09/23 at 2:00 P.M. when his systolic blood pressure was 114, on 10/15/23 at 10:00 P.M. when his systolic blood pressure was 116, on 10/16/23 at 2:00 P.M. when his systolic blood pressure was 108, and on 10/17/23 at 2:00 P.M. when his systolic blood pressure was 120. Interview on 10/18/23 at 11:55 A.M. with Director of Nursing #543 verified Resident #20 had received the medication when his systolic blood pressure was above 100 and he should not have received the medication based on the order. Interview on 10/18/23 at 12:00 P.M. with Regional Clinical Manager #552 verified that since Resident #20 had a history of essential hypertension, he could have experienced complications if his blood pressure was above 100 and he received the vasopressor to raise his blood pressure even higher. Review of the facility policy titled, Unnecessary Drugs, dated 06/27/15, revealed unnecessary drugs are any drugs when used in excessive dose (including duplicate drug therapy); for excessive duration; without adequate monitoring; without adequate indications for use; or in the presence of adverse consequences which indicate the dose should be reduced or discontinued. 365975 Page 5 of 11 365975 10/19/2023 Park Health Center 100 Pine Avenue St Clairsville, OH 43950

F 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. Based on observation and interview, the facility failed to ensure food was prepared to the ordered consistency. This had the potential to affect five residents (#20, #26, #37,#42, and #130) of five residents who were ordered pureed meals. The facility census was 76. Findings included: On 10/17/23 at 11:30 A.M. Dietary #561 was observed preparing pureed (smooth consistency) chicken cordon bleu. Dietary #561 placed six chicken cordon bleu in the robot coup (industrial blender) and added chicken gravy. Dietary #561 pureed the chicken and after pureeing for approximately 60 seconds, tasted the puree, and reported it was ready to be served. This surveyor then tasted the chicken puree and had to chew pieces of the chicken, not providing a puree consistency. Dietary Manager #525 then tasted the chicken puree and verified she had to chew some. Dietary #561 continued to puree the chicken for an additional 30 seconds before the chicken reached a smooth consistency. 365975 Page 6 of 11 365975 10/19/2023 Park Health Center 100 Pine Avenue St Clairsville, OH 43950

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, record review and interview the facility failed to store food properly, check temperatures on cold items prior to serving them, and ensure the oven was clean. This had the potential to affect 72 of 72 residents who received meals from the kitchen. The facility identified four residents, Resident #5, #29, #63, and #68 who received nothing by mouth and did not receive food from the kitchen. The facility census was 76. Findings included: 1. Observation on 10/16/23 at 8:05 A.M. of the facility walk-in refrigerator revealed the following: One large foil pan of cubed potatoes not labeled or dated. A prepared side salad not dated. A two and one half pound bag of salad which had been opened, not dated when opened and it had a best by date of 10/08/23. A one pound bag of shredded lettuce which had been opened, not dated when opened and it had a best by date of 10/14/23. A container of sliced tomatoes not dated. Approximately one third of a tomato in a sandwich size zip lock bag not labeled or dated. Approximately four ounces of pepperoni in a one gallon size zip lock bag not labeled or dated. One large bag of cheddar cheese opened and not dated. One large bag of mozzarella cheese opened and not dated. One individual serving size of pureed brownie not sealed, labeled or dated. A one quart container of cherry pie filling dated 10/06/23. A 10 pound container of macaroni salad dated 09/27/23. A 10 pound container of southern style potato salad dated 10/09/23. A one gallon container of lemon pudding prepared on 09/29/23. A one half gallon container of vanilla pudding prepared on 10/05/23 and dated to be discarded on 10/11/23. Six hard boiled eggs in a sandwich size zip lock bag dated 09/30/23. 365975 Page 7 of 11 365975 10/19/2023 Park Health Center 100 Pine Avenue St Clairsville, OH 43950

F 0812 One case of hot dogs dated 09/29/23 and dated to be discarded on 10/06/23. Level of Harm - Minimal harm or potential for actual harm Interview on 10/16/23 at 8:20 A.M. with Dietary Manager (DM) #525 verified all of the food items noted above should not have been in the refrigerator. She verified items that were not labeled or dated should have been labeled and dated. She also verified items should have been sealed properly and items which had been opened or prepared were only good for six days from the open/preparation date and should have been discarded prior to today. Residents Affected - Many Review of the facility policy titled, Food Storage - Labeling and Dating, revised 07/18, revealed items must be dated after opening with an Open date and a Use by Date, unless specified in the table. The use-by-date will be seven days, (today +six), unless the original manufacturer expiration date is before the seven days (meaning, the food service operation may not exceed a manufacturer's use-by-date). All foods should be discarded prior to or on day seven. Further review revealed all items considered to be Leftovers shall be properly dated and labeled. The leftovers shall be cooled to 41 degrees and can be held up to seven days. The date of production is counted as Day one. All food should be properly labeled with the food name unless it is unmistakably recognized. All food should be securely closed to avoid being exposed to air. 2. Observation on 10/17/23 at 11:35 A.M. of the left oven revealed it was dirty with two large, charred food item areas. Interview on 10/17/23 at 12:00 P.M. with Dietary #561 verified the left oven was dirty with charred food items. Review of the Cleaning Check List, provided by DM #525 revealed the A.M. and P.M. cooks were to wipe down the ovens daily. Interview on 10/17/23 at 12:10 P.M. with DM #525 revealed the ovens were on the cleaning schedule for the kitchen, but the kitchen had been short staffed, and the ovens had not been cleaned for about six weeks. 3. Observation on 10/17/23 at 11:44 A.M. of food items being temperature checked prior to service revealed the facility temperature checked hot items but did not temperature the cold items. The review of food temperature logs, dated 08/06/23 to 10/17/23, revealed no documentation to support the cold food items, like milk, were temperature checked prior to service. Interview on 10/17/23 at 11:58 A.M. with DM #525 revealed the facility did not temperature check cold items. She verified cold items, especially dairy products, should be temperature checked prior to serving. 365975 Page 8 of 11 365975 10/19/2023 Park Health Center 100 Pine Avenue St Clairsville, OH 43950

F 0849 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. Based on record review and interview, the facility failed to ensure hospice visitation notes, assessments and communication were maintained in Resident #16's medical record. This affected one resident (#16) of one resident reviewed for hospice services. The facility census was 76. Findings include: Review of Resident #16's medical record revealed an admission date of 11/29/17 with diagnoses that included dementia, chronic obstructive pulmonary disease and congestive heart failure. Further review of the medical record including physician's orders revealed Resident #16 was admitted to hospice on 04/25/19. Review of the hospice records including visitation notes and assessments revealed the last visitation note and assessment in the medical record was from 07/05/23. On 10/18/23 at 8:25 A.M. interview with medical records (MR) #571 revealed she had not received any documentation from Resident #16's hospice provider for several months. MR #571 indicated she assumed Resident #16 was no longer on hospice services and did not ask or inform anyone of not receiving any hospice documentation. On 10/18/23 at 8:28 A.M. interview with Registered Nurse (RN) #610 verified Resident #16 remains on hospice services and staff members sign hospice staff members' electronic tablet to verify they were in the building with the resident for visitation services. On 10/18/23 at 8:33 A.M., interview with RN #543 verified no evidence of any hospice documentation including visits and assessments in the electronic medical record for Resident #16 since 07/05/23. 365975 Page 9 of 11 365975 10/19/2023 Park Health Center 100 Pine Avenue St Clairsville, OH 43950

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 observation, interview, resident record review, facility policy review and review Center for Disease Control (CDC) Guidelines, the facility failed to ensure proper personal protective equipment (PPE) was worn when care was provided to Resident #130 who was diagnosed with COVID-19. This had the potential to affect 39 (Resident #2, #3, #4, #5, #8, #9, #10, #11, #14, #15, #20, #21, #23, #24, #25, #26, #28, #30, #32, #33, #36, #37, #42, #45, #51, #53, #55, #56, #62, #63, #66, #67, #129, #130, #131, #132, #230, #229, and #231) of 39 residents residing on south wing without active COVID-19. The facility census was 76. Residents Affected - Some Findings included: Review of Resident #130's medical record revealed she was initially admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including pneumonia, dependence on supplemental oxygen, and chronic obstructive pulmonary disease. Review of Resident #130's physician order, dated 10/14/23, identified she was to be in droplet precautions every shift for COVID until 10/18/23. Observation on 10/16/23 at 9:05 A.M. of State Tested Nursing Assistant (STNA) #546 in the doorway of Resident #130 room with her N-95 mask top strap broken. She reported she was getting a new N-95 mask since one of the straps on hers had broken. STNA #546 was wearing an N-95 mask, an isolation gown, and gloves at the time. She did not have any eye protection on. There was signage on the wall outside of Resident #130's door which revealed she was in droplet isolation. The signage revealed to make sure eyes, nose and mouth were fully covered. STNA #546 donned (put on) a new N-95 mask and stepped back into Resident #130's room to continue with care. Observation on 10/16/23 at 9:06 A.M. of the isolation cart outside of Resident #130's room revealed surgical masks, N-95 masks, isolation gowns, gloves, shoe covers, hand sanitizer and biohazard trash bags. There was no eye protection or disinfectant/cleaner to use on non-disposable eye protection. Interview on 10/16/23 at 9:11 A.M. with DON #543 verified there was no eye protection or disinfectant/cleaner for non-disposable eye protection in the isolation cart outside of Resident #130's room and there should be. She verified staff should be wearing eye protection when entering a room of a resident on droplet isolation. Interview on 10/16/23 at 9:12 A.M. with STNA #546, after exiting Resident #130's room, verified she was not wearing any eye protection while caring for Resident #130 who was on droplet isolation secondary to COVID-19 infection. She reported she was not aware she needed to wear eye protection because there was not any in the isolation cart. Interview on 10/16/23 at 4:45 P.M. with DON #543 revealed the facility did not have a specific policy on what to wear for droplet isolation. She revealed the facility followed the CDC recommendations. Review of the facility policy titled, Standard and Transmission-based Precautions, revised 11/28/17, revealed it was the facility policy to take appropriate precautions, including isolation, to prevent transmission of infectious agents. Further review revealed droplet precautions refer to actions 365975 Page 10 of 11 365975 10/19/2023 Park Health Center 100 Pine Avenue St Clairsville, OH 43950

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some designed to reduce/prevent the transmission of pathogens spreading through close respiratory or mucous membrane contact with respiratory secretions. Review of the CDC documentation provided by the facility titled, Use of Personal Protective Equipment (PPE) When Caring for Patients with Confirmed or Suspected COVID-19, dated 03/30/20, revealed PPE must be donned correctly before entering the patient area (e.g., isolation room). Further review revealed donning (putting on the gear) included a face shield or goggles. 365975 Page 11 of 11