Health inspection·March 27, 2025

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. Based on medical record review, policy review and interview, the facility failed to ensure advanced directives were accurate. This affected one resident (#2) of 24 residents reviewed for advanced directives. The census was 85. Findings include: Review of Resident #2's medical record revealed an admission date of 02/25/25 with diagnoses including epilepsy, atherosclerotic heart disease, cerebrovascular disease, hyperlipidemia, chronic obstructive pulmonary disease, schizoaffective disorder, angina, Parkinson's disease, and adult failure to thrive. Review of the electronic medical record revealed on admission, the resident had Do Not Resuscitate Comfort Care Arrest (DNRCCA) orders (this status means that while full medical care is provided before a cardiac or respiratory arrest, cardiopulmonary resuscitation and advanced life support measures are not initiated upon arrest. Instead the focus shifts to comfort measures). On 03/03/25 the physician orders included an order for the code status to be changed to a Do Not Resuscitate Comfort Care (DNRCC) (only comfort measures will be provided). Review of the paper chart revealed advance directives were the first document when opening the record. Resident #2's paper chart contained a signed DNRCCA form. Interview 03/25/25 at 11:53 A.M. with Registered Nurse (RN) #40 verified there was a discrepancy between the electronic record and paper chart. RN #40 verified the advance directives did not match. Review of the facility's Resident Rights, Treatment and Advance Directive policy dated 11/22/26 included copies of Advance Directives will be placed on the chart. Page 1 of 16 365975 365975 03/27/2025 Park Health Center 100 Pine Avenue St Clairsville, OH 43950

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 record review, observation and interview, the facility failed to ensure plans of care were updated to reflect the residents' preferences and medical needs. This affected two Residents (#26 and #133) of 22 residents reviewed. The census was 85 Findings include: 1. Review of Resident #26's medical record revealed an admission date 06/29/23 and readmission date of 05/02/24 with diagnoses including morbid severe obesity. chronic atrial fibrillation, dependence on renal dialysis, type 2 diabetes with diabetic neuropathy, chronic peripheral insufficiency, acquired absence of right great toe and other right toes. osteoporosis, hypothyroidism, gastro esophageal reflux disease. lymphedema, anemia, hyperlipidemia, insomnia, absence of other left toes, chronic kidney disease Stage 4 (severe), angina pectoris, hypoxemia, glaucoma and hypertension. Review of the resident's dialysis plan of care initiated 01/18/24 revealed the care plan not individualized and did not identify the resident having a fistula (a surgically created connection between an artery and a vein, typically in the arm, to facilitate hemodialysis by providing a large accessible blood vessel for needle access). Review of the 03/06/25 Annual Minimum Data Set Assessment (MDS) included the resident was independent for daily decision making, with no behaviors, no weight gain or loss, and received dialysis. Interview 03/24/25 at 6:56 P.M. with Resident #26 included he had a fistula in his right arm for dialysis. Interview 03/26/25 at 3:32 P.M. with Registered Nurse (RN) #64 verified the plan of care was not updated to reflect the resident had a fistula. RN #64 verified the dialysis plan of care did not include the specific type of dialysis access the resident had and was not specific to what services the resident would need. 2. Review of Resident #133 revealed an admission date of 12/14/21 and readmitted [DATE] with diagnoses including metabolic encephalopathy, anemia, type 2 diabetes and rheumatoid arthritis. Care Plans initiated on 12/16/21 included resident does not engage in group activities. Resident preferred doing activities their room including watching TV and socializing on the phone with family and staff and resident preferences for daily life and person-centered care that are important or somewhat important include: Choosing own bedtime , Choosing what clothes to wear. Having family or significant other involved in care discussions. Neither plan of care was revised between 12/16/21 and 03/25/25 to reflect the residents significant changes or preferences. Review of the 12/24/24 Significant Change MDS included the resident was moderately impaired for daily decision making, found little interest or pleasure in doing things and feeling tired or having little energy. There were no delusions. The resident had verbal behaviors four to six days of the look back period. It was somewhat important to him to take care of his personal belongings or things, very important to choose bath type, bed time, very important to have family and close friends involved in care, very important to listen to music, enjoy favorite activity, go outside when the weather is 365975 Page 2 of 16 365975 03/27/2025 Park Health Center 100 Pine Avenue St Clairsville, OH 43950

F 0657 good and very important to participate in religious activities. Level of Harm - Minimal harm or potential for actual harm The resident was readmitted from the hospital 03/22/25 on continuous tube feeding. Residents Affected - Few Observations 03/24/25 at 11:03 A.M. Resident #133 refused to be turned was screaming and the aide went to tell the nurse of refusal. On 03/25/25 at 11:53 A.M. Certified Nurse Aide #88 said he refused his catheter care. On 03/25/25 at 11:54 A.M. Licensed Practical Nurse #12 said he would not let her flush his gastrostomy tube. On 03/26/25 at 08:39 A.M. the resident was in bed sleeping. Interview 03/26/25 at 9:18 A.M. with CNA #90 revealed the resident usually refuses the carrots to contractured hands and was ongoing her. There were no observations of music, television, family, activities or clergy in the room. There were no observations of the resident out of bed. interview 03/25/25 03:06 P.M. with Activities #100 revealed the resident was a religious person. He use to get in the wheelchair and go to activities. He has not done much since he came back from the hospital. He had declined and doesn't seem to hold a conversation with them. Activities verified religion was important to the resident but had not been added to the resident's care plan until 03/25/25. Further interview revealed the care plan was not updated to reflect the resident was not getting out of bed and going to activities was not occurring. 365975 Page 3 of 16 365975 03/27/2025 Park Health Center 100 Pine Avenue St Clairsville, OH 43950

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 Based on observations, interview, and medical record review the facility failed to ensure residents were assisted with routine nail care and showers. This affected two (Resident #9 and #70) of three residents reviewed for Activities of Daily Living. The facility census was 85. Residents Affected - Few Findings include: 1. Review of Resident #9's medical record revealed an admission date of 02/01/20 with diagnoses that includes chronic obstructive pulmonary disease, hypertension and diabetes mellitus. Further review of Resident #9's medical record including the Minimum Data Set (MDS) 3.0 quarterly assessment with a reference date of 12/19/24 revealed Resident #9 had a moderately impaired cognition level, was dependent for bathing and set up assistance with personal hygiene. Review of the Certified Nurse Aide (CNA) Activities of Daily Living (ADL) Tasks revealed Resident #9 was provided a shower and nail care on 02/24/25, 03/01/25, 03/03/25, 03/06/25, 03/08/25, 03/13/25, 03/15/25, 03/19/25, 03/24/25 and 03/25/25. Review of Resident #9's plan of care revealed the resident required assistance with ADLs. Observation of Resident #9 on 03/24/25 at 9:28 A.M. revealed long, dirty and untrimmed fingernails. Interview with Resident #9 on 03/24/25 at 3:17 P.M. revealed staff do not cut or clean her fingernails. Additional observations of Resident #9's fingernails on 03/25/25 10:02 A.M. again revealed long, untrimmed and unclean fingernails. Interview with Resident #9 on 03/25/25 at 10:02 A.M. revealed it had been awhile since she last had any nail care completed. On 03/25/25 at 10:05 A.M. interview and observation of Resident #9's fingernails with CNA #80 verified the fingernails were long, untrimmed and unclean. CNA #80 indicated fingernails are to be trimmed and clean with each resident shower. 2. Review of Resident #70 revealed a 07/29/25 admission with diagnoses including Parkinson's disease, psychotic disorder with delusions, vitamin D deficiency, type 2 diabetes, and anxiety disorder. The admission shower preference sheet dated 07/29/24 indicated a preference for three to four showers a week. Review of the 01/27/25 Quarterly MDS revealed the resident was severely impaired for daily decision making, had hallucinations, delusions, rejection of care, physical and verbal behaviors, He had upper and lower functional impairment on both sides and dependent for bathing. Interview 03/24/25 at 11:47 A.M. with Resident #70's wife revealed the facility was not brushing his teeth, showering and completing dressing changes. He was supposed to be getting showers three 365975 Page 4 of 16 365975 03/27/2025 Park Health Center 100 Pine Avenue St Clairsville, OH 43950

F 0677 Level of Harm - Minimal harm or potential for actual harm times a week and he sometimes doesn't get two a week. They have been better since she brought it to their attention but still doesn't get enough. Review of the shower schedule revealed the resident was a Sunday, Wednesday, and Friday dayshift shower. Residents Affected - Few Review of the Certified Nurse Aide TASK in the electronic record revealed for the last 30 days there was no evidence of the resident receiving a shower between 03/16/25 and 03/23/25 or on 03/12/25. The facility brought a baths for the day sheet from 03/21/25 that indicated the resident received a bed bath on 03/21/25 not a shower as preferred. There was no explanation as he received a bed bath instead of a shower as preferred. Interview 03/26/25 at 8:59 A.M. with Certified Nurse Aide #80 revealed they leave it up to his wife to say if she wants him to be showered. Interview 03/27/25 at 12:19 P.M. with Registered Nurse #37 verified the resident did not receive a shower three times a week as preferred. This deficiency represents non-compliance investigated under Complaint Number OH00164054. 365975 Page 5 of 16 365975 03/27/2025 Park Health Center 100 Pine Avenue St Clairsville, OH 43950

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 medical record review and interview the facility failed to ensure an anticoagulant (Eliquis) medication was administered per orders after the resident received a new diagnoses of pulmonary embolism (blockage of the main artery to the lung or one of its branches). This affected one (Resident #76) of six reviewed for unnecessary medication review. Residents Affected - Few Findings included: Medical record review revealed Resident #76 was admitted to the facility on [DATE] with diagnoses including chronic atrial fibrillation, heart failure, cerebrovascular disease, and chronic obstructive pulmonary disease. On 03/18/25 pulmonary embolism was added to the diagnosis list. Review of Resident #76's progress note dated 03/16/25 revealed the nurse at the emergency room reported the resident was being admitted for a diagnosis of pulmonary embolism. Review of Resident #76's hospital record dated 03/16/25 revealed the cardiologist was called due to the resident having bilateral pulmonary embolism and potential right heart strain for consideration of thrombectomy. The resident and family decided not to further procedure with aggressive measures and wished to attempt conservative management. At this time recommended Eliquis if tolerated due to resident had significant hematuria on Eliquis in the past. Review of Resident #76's progress note dated 03/17/25 revealed the resident had returned to the facility via stretcher. Review of Resident #76 orders/Medication Administration Record dated 03/17/25 revealed Eliquis 5 milligrams (mg) one tablet two times daily (upon rise and bedtime). The bedtime dose was marked 9 (see nursing note). Review of Resident #76's medication administration progress note revealed on 03/17/25 at 10:44 P.M., Eliquis was not administered due to the medication was not available and on the way from pharmacy. Interview on 03/27/25 at 12:16 P.M., with Director of Nursing (DON) #70 confirmed Eliquis was not administer at bedtime on 03/17/24 and was available in the facility's contingency medication box, however the nurse never pulled the medication. The DON confirmed the resident was recently diagnosed on [DATE] with a pulmonary embolism. 365975 Page 6 of 16 365975 03/27/2025 Park Health Center 100 Pine Avenue St Clairsville, OH 43950

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. 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, review of operational manual, review of policy, review of statement, observation and interview the facility failed to ensure low air loss mattress was functioning properly. This affected one (Resident #240) of four residents reviewed for pressure ulcers. Residents Affected - Few Findings include: Medical record review revealed Resident #240 was admitted to the facility on [DATE] with diagnoses including pressure ulcers, peripheral vascular disease (PVD), metabolic encephalopathy, muscle weakness, anemia, and spondylolisthesis of lumbar region. Review of Resident #240's five-day Minimum Date Set (MDS) dated [DATE] revealed the resident was at risk for pressure and currently had two stage I pressure ulcers (skin intact with non-blanchable erythema) . The resident was substantial/maximal assist with rolling left to right, sit to lying and lying to sitting. Review of Resident #240's pressure ulcer assessment dated [DATE] revealed the resident was at high risk for pressure due to PVD and currently had pressure ulcers and moderate risk related to non-compliance, fracture, renal disease, edema, anemia, infection, low hemoglobin, head of bed elevated the majority of the time. Review of Resident #240 at risk for alteration in skin integrity related to edema, fragile skin, anemia, history of skin impairment, incontinence, mobility impairment, fracture, bruise, brain bleed, colon cancer, peripheral vascular disease, and history of redness under breast dated 03/13/25 revealed the intervention was a low air loss mattress with perimeters. Set according to weight, alternating pressure. Check functions every shift. Review of Resident #240's orders dated 03/13/25 revealed low air loss mattress with perimeters. Set according to weight, alternating pressure. Check functions every shift. Review of Resident #240's treatment administration record (TAR) dated 03/2025 revealed on 03/24/25 and 03/25/25 staff had signed off that the low air loss mattress was functioning. Observation on 03/24/25 at 10:17 A.M., and 12:46 P.M., revealed the residents low air loss mattress panel was blinking red indicating low pressure. The alarm was muted. The resident was lying in bed. Further observation at 12:46 P.M., revealed the facility's Wound Nurse #21 and visiting wound Nurse Practitioner #500 had entered the resident's room. Review of Resident #240's progress note dated 03/24/25 revealed the wound nurse practitioner was in house and assessed Resident #240. The was a new skin tear partial thickness wound to right arm. Wound care completed with autolytic debridement. Resident reported she must have bumped arm. Additional observation on 03/25/25 at 12:54 P.M. and 3:18 P.M., revealed Resident #240 was lying in bed. The panel was till flashing low pressure and the alarm was muted. 365975 Page 7 of 16 365975 03/27/2025 Park Health Center 100 Pine Avenue St Clairsville, OH 43950

F 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview and observation of Resident #240's mattress on 03/25/25 at 3:18 P.M., with Registered Nurse (RN) #35 reported she was not aware of any concerns with Resident #240 mattress. The RN confirmed the resident panel was blinking low pressure and the alarm had been silenced. The RN unmuted the alarm and the alarm started sounding. The RN reported she would have Medical Record #60 look at the mattress because he was the one that responsible for the mattress. The mattress was covered in a blue zipped cover and the resident was in bed therefore the RN nor the surveyor was not able to be visualized the cells to ensure all the cells were inflated or if there were any leaks in the mattress. The RN and Surveyor pressed on the mattress to ensure there was some air in the mattress. Interview on 03/25/25 at 3:39 P.M., with Medical Record #60 confirmed he was not aware Resident #240 low air low mattress was not functioning properly until now. MR #60 reported he just ordered a new mattress and it should be here tomorrow or Thursday. Interview on 03/25/25 at 3:57 P.M., with Wound Nurse (Licensed Practical Nurse (LPN)) #21 confirmed she had rounded with the Wound Nurse Practitioner yesterday 03/24/25 and didn't notice the low-pressure light was activated. The Wound Nurse confirmed the bed was not alarming. The resident had stage one pressure ulcers on her heels that were resolved yesterday. Interview on 03/25/25 at 4:27 P.M., with Director of Nursing (DON) #37 revealed the Administrator checked the mattress and changed out the malfunctioning pump. The DON reported the mattress did have some air in it and the new pump was working properly. Interview on 03/25/25 at 4:33 P.M., with the Administrator revealed he had switched out the pump and the resident reported she was not uncomfortable. Review of statement undated signed by the Wound Nurse Practitioner #500 confirmed she had evaluated the resident on 03/24/25 and did not detect the resident bottoming out in bed and the air mattress was inflated and the resident immersed properly. There was no evidence the Wound NP had noted the pump flashing/malfunctioning. Review of the Med Aire Plus 8 alternating pressure and low air loss mattress operator's manual undated revealed the mattress was designed to redistribute pressure, these systems offer a solution for the prevention and treatment of pressure ulcers and offers an optimal solution for pressure redistribution and microclimate control. The mattress redistribution mattress provided includes cell-on-cell design constructed of a base and air inflation cells. The air cells are eight inches in height and a static four inches air cell base. 10-inch-deep static perimeters surround the length of the mattress. The cover provided is a four-way stretch, low shear, vapor permeable, quilted cover easily zipped for removal and cleaning. The low-pressure indicator flickers when the pressure is below the pre-defined level. The audible/visible alarms turn on either when the pressure is low or the system fails to alternate. Press the mute button to mute the audible alarm. The alarm indicator will continue flickering. Re-press the Mute button to re-activate the audible alarm and to extinguish the Mute indicator. If low pressure examine if there is air leakage between the control unit and the mattress connection or from the air mattress tubes. Check the valves. Check the air-connecting tubes. Be sure no single cell was broken. DO NOT use any other control unit with this mattress system than the one provided by Drive. DO NOT change any components by yourself. If there was need for replacement or repair, always contact your 365975 Page 8 of 16 365975 03/27/2025 Park Health Center 100 Pine Avenue St Clairsville, OH 43950

F 0686 authorized Drive dealer or service center. Level of Harm - Minimal harm or potential for actual harm Review of the facility's policy titled Skin Assessment dated 12/02/15 and revised on 03/15/24 revealed the resident's response to preventative efforts and treatment interventions shall be monitored and approaches revised as appropriate. Residents Affected - Few 365975 Page 9 of 16 365975 03/27/2025 Park Health Center 100 Pine Avenue St Clairsville, OH 43950

F 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. 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 care was appropriate for a resident receiving dialysis services. This affected one (Resident #26) of one resident reviewed for dialysis. Residents Affected - Few Findings include: Review of Resident #26 revealed a 06/29/23 admission and readmission [DATE] with diagnoses including morbid severe obesity. chronic atrial fibrillation, dependence on renal dialysis, type 2 diabetes with diabetic neuropathy, chronic peripheral insufficiency, acquired absence of right great toe and other right toes. osteoporosis, hypothyroidism, gastro esophageal reflux disease. lymphedema, anemia, hyperlipidemia, insomnia, absence of other left toes, chronic kidney disease Stage 4 (severe), angina pectoris, hypoxemia, glaucoma and hypertension. Review of the resident's dialysis plan of care initiated 01/18/24 revealed the care plan was generic and did not identify the resident having a fistula. Review of the physician orders included 02/11/25 1200 milliliter (ml) fluid restriction dietary 550 ml and nursing 650 ml, enhanced barrier precautions every shift for vascath, keep dressing to right arm from fistula clean and dry. change every 12 hours as needed for wound care AND every shift for wound care, Dialysis every Monday-Wednesday-Friday at 5:15 A.M. Review of the physician orders revealed there were no orders to check right arm fistula for bruit and thrill and not to take blood pressures in the right arm. The resident did not have a vascath. Review of the 03/06/25 Annual Minimum Data Set Assessment (MDS) included the resident was independent for daily decision making, with no behaviors, no weight gain or loss, and received dialysis. Review of the March treatment record revealed staff were signing daily a dressing to right arm fistula. Interview 03/24/25 at 6:56 P.M. with Resident #26 included he had a fistula in his right arm for dialysis. There was not a dressing covering the fistula. He revealed the nurses do not check the site. Interview 03/26/25 at 3:32 P.M. with Registered Nurse (RN) #64 verified the plan of care was not updated to reflect the resident had a fistula. RN #64 verified the dialysis plan of care indicated a vas cath/or fistula and was not specific to what services the resident would need. Observation 03/25/25 at 06:15 P.M. revealed the resident did not have a dressing over the fistula in his right arm. The resident said he takes the dressing off the morning after dialysis. Interview 03/26/25 at 04:12 P.M. with Registered Nurse #37 verified the standard dialysis orders to check thrill and bruise and not to take blood pressure in right arm should have been ordered when the fistula was inserted in March 2024. Interview 03/26/25 04:16 P.M. with Registered Nurse #25 verified there was not an order to check thrill and bruise or for the blood pressure not to be taken on affected arm, She said she takes the dressing off the day after dialysis and verified they are signing off on the treatment sheet the dressing is always on. 365975 Page 10 of 16 365975 03/27/2025 Park Health Center 100 Pine Avenue St Clairsville, OH 43950

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, interview, and policy review the pharmacy failed to ensure medication were available timely for administration. This affected one (Resident #64) of three observed for medication administration, one (Resident #236) of two reviewed for urinary tract infections, and one (Resident #238) of one reviewed for respiratory infection. Findings included: 1. Medical record review revealed Resident #64 was admitted to the facility on [DATE] with diagnoses including type 2 diabetes mellitus and chronic kidney disease. Review of Resident #64's current orders revealed Ozempic subcutaneous solution pen-injector two milligrams (mg)/1.5 milliliters (ml) subcutaneously one time a day every Wednesday for diabetes. Observation on 03/26/25 at 7:38 A.M., of Resident #64 medication administration with Registered Nurse (RN) #92 revealed the resident Ozempic was not available to administer. The RN confirmed the Ozempic was only administered once a week on Wednesday and the medication should have been re-ordered last week and should have been available to administered today. Review of Resident #64's progress note dated 03/26/25 revealed pharmacy stated the Ozempic was re-ordered on 03/19/25 was too early to fill and did not send it. The physician was notified the scheduled dose today was unavailable and okay to give when available without ill effect. The pharmacy will ship stat today. Interview on 03/26/25 at 10:25 A.M., via email with the Director of Nursing (DON) #70 revealed there was an error with pharmacy stating it was too soon to fill when the nurse re-ordered it on 03/19/25. The DON reported she had spoken with the pharmacist who clarified that it was not too early to send and it would be sent stat today. The physician was notified and it was okay to administer when it arrives. 2. Medical record review revealed Resident #238 was admitted to the facility on [DATE] with diagnoses including obesity, diabetes, heart disease, and overactive bladder. Review of Resident #238's pneumococcal vaccine informed consent form dated 03/11/25 revealed the resident had consented for Prevnar 20. Review of Resident #238's medical record dated 03/11/25 to 03/27/25 revealed no evidence Resident had received the Prevnar 20. Review of Resident #238's orders and Medication Administration Record (MAR) dated 03/17/25, 03/22/25, 02/24/25, 03/25/26, and 03/26/25 revealed new orders were entered for Prevnar 20; however, it was never received from the pharmacy for administration. Interview on 03/26/25 at 10:31 A.M. with Director of Nursing (DON) #37 and #70 revealed the resident had tested positive for the flu, however finished treatment on 03/15/25. The DON's reported they were not aware why the resident had not received the Prevnar 20 yet and would have to look into it. 365975 Page 11 of 16 365975 03/27/2025 Park Health Center 100 Pine Avenue St Clairsville, OH 43950

F 0755 Level of Harm - Minimal harm or potential for actual harm Interview on 03/26/25 at 2:21 P.M., with DON #37 confirmed the Prevnar 20 had not been administered yet due to there was an issue with pharmacy, however pharmacy was to send tonight. Review of Resident #238's progress note dated 03/26/25 revealed DON #37 spoke to pharmacy and they would send Prevnar 20 in tonight's delivery. Residents Affected - Few Review of Resident #238's progress note dated 03/27/25 revealed pharmacy did not send Prevnar 20. Pharmacy notified and would send stat today. Interview on 03/27/25 at 8:27 A.M., with DON #37 revealed she would spoke to pharmacy and the Prevnar was supposed to be delivered last night. She would have to follow up to see why it was not delivered last night. Review of the facility's policy titled Immunization for Pneumonia, Influenza, and COVID-19 dated 07/03/23 revealed each resident would be offered the pneumococcal immunization. 3. Medical record review revealed Resident #236 was admitted to the facility on [DATE] at 2:22 P.M., with diagnoses including urinary tract infection, low back pain, muscle weakness, dementia, and depression. Review of Resident #236's admission orders dated 03/08/25 revealed the resident was ordered Cefpodoxime (antibiotic) 200 milligrams (mg) two tablets by mouth twice daily for three days for a urinary tract infection. Review of Resident #236' Medication Administration records revealed no evidence Cefpodoxime was administered on 03/08/24 at bedtime. On 03/09/25 the rise dose was marked as administered, however the Director of Nursing (DON) #70 confirmed on 03/27/25 at 10:22 A.M., the Cefpodoxime was not administered uprise on 03/09/25 due to the medication was not available. The bedtime dose was not administered on 03/09/25. On 03/10/25 the rise and bedtime dose was not administered. The resident received the first dose on 03/11/25 and completed the three-day order on 03/13/25. Review of Resident #236 progress notes dated 03/08/25 revealed the physician was notified the Cefpodoxime was not available and ordered from pharmacy. There was no documented evidence the physician was notified the medication was not available on 03/09/25 or 03/10/24. Review of Resident #236's infection note dated 03/11/25 revealed the resident was started on Cefpodoxime for urinary tract infection this morning. Interview on 03/27/25 at 9:01 A.M., with DON #70 originally reported she didn't know why the Cefpodoxime was not administered from 03/08/25 till 03/11/25. The surveyor requested evidence when the pharmacy sent the Cefpodoxime. The DON confirmed the Cefpodoxime was not in the facility's contingency medication box. Additional interview on 03/27/25 at 10:22 A.M., with DON #70 confirmed pharmacy did not send the Cefpodoxime until night of 03/10/25 and staff started the medication on 03/11/25. The DON confirmed the resident had missed one dose of Cefpodoxime on 03/08/25 and two doses on 03/09/25 and 03/10/25. The DON confirmed there was not documented evidence the physician was notified on 03/09/25 or 03/10/25 the antibiotic was not available or administered. 365975 Page 12 of 16 365975 03/27/2025 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 medical record review and interview the facility failed to ensure medication were administered per parameters. This affected one (Resident #76) of six reviewed for unnecessary medication review. Residents Affected - Few Findings included: Medical record review revealed Resident #76 was admitted to the facility on [DATE] with diagnoses including chronic atrial fibrillation, heart failure, cerebrovascular disease, and chronic obstructive pulmonary disease. On 03/18/25 pulmonary embolism was added to the diagnosis list. Review of Resident #76's cardiac plan of care dated 11/19/24 revealed to administer medication as ordered. Review of Resident #76's orders dated 03/2025 revealed the resident was ordered Midodrine 10 milligrams (mg) three times daily (rise, lunch, and bedtime) for hypotension. If the systolic greater than 110 do not give. Review of Resident #76's Medication Administration Record (MAR) dated 03/2025 revealed nurse had administered Midodrine on 03/02/25 at lunch and bedtime when the resident blood pressure was 114/70. On 03/03/25 the nurse had administered Midodrine upon rise when the resident blood pressure was 112/62 and lunch and bedtime when the residents blood pressure was 114/78 for both doses. On 03/04/25 staff administered Midodrine at lunch and bedtime when the residents blood pressure was 120/68 for both doses. On 03/23/25 the resident received rise, lunch, and bedtime dose of Midodrine when the resident blood pressure was 120/84 for all three doses. Interview on 03/27/25 at 12:16 P.M., with the Director of Nursing (DON) #70 confirmed the Midodrine was administered outside the parameters (systolic greater than 110) on 03/02/25 twice, 03/03/25 three times, 03/04/25 twice, and 03/23/25 three times. The DON confirmed she had reached out to the nurse and she had reported that she must have administered the medication if she had signed it off as administered. 365975 Page 13 of 16 365975 03/27/2025 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, policy and interview, the facility failed to ensure food was stored, and prepared under sanitary conditions. This affected all the resident's in the facility except Residents #8, #63, #133, #183, #185 and #189 who do not receive nutrition from the kitchen. The facility census was 83. Findings include: Initial tour of the kitchen 03/24/25 at 08:10 A.M. with [NAME] #18 revealed: - The walk in freezer had a bag of mixed vegetables and Charbroil burgers that had been entered and not resealed exposing the contents to the freezing air. - The walk in refrigerator had 58 individual cartons of [NAME] whole milk with a sell by date of 03/12/25. - There was leftover chili in the walk in refrigerator not dated. - The walk in refrigerator had a five pound carton of [NAME] Choice sour cream that expired 03/17/25. - The scoop was on the lid of a thickener container not contained in a case or bag. - There was dust on all four pipes over the stove cooktop on the ansel system. - The shelf over the cooktop was dusty and greasy Interview 03/24/25 at 8:32 A.M. with [NAME] #18 verified the outdated, unsealed, undated food as well as the scoup not contained in a sanitary manner and dusty shelf and ansel system. Review of the Food Storage-Labeling and Dating policy revised July 2018 included all food must have a date that includes the month, day and year on the package indicating the date in which it entered the facility. Items must be dated after opening with a open date and a use by date. The use by date will be seven days unless the original manufacturer expiration date is before seven days. Leftovers can be held for seven days. 365975 Page 14 of 16 365975 03/27/2025 Park Health Center 100 Pine Avenue St Clairsville, OH 43950

F 0881 Implement a program that monitors antibiotic use. 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, review of the Center for Disease Control (CDC), review of infection control log, interview, and policy review the facility failed to ensure resident's meet criteria for antibiotics treatment. This affected one (Resident #238) of one reviewed for respiratory infection. Residents Affected - Few Findings included: 1. Medical record review revealed Resident #238 was admitted to the facility on [DATE] with diagnoses including obesity, diabetes, heart disease, and overactive bladder. Review of Resident #238's respiratory care plan dated 03/07/25 revealed diagnostic studies as ordered. Review of Resident #238's progress note dated 03/07/25 revealed the resident stated she had been coughing since yesterday, with worsening today and new symptom of slight dizziness. New order had been obtained for cough syrup and flu swab. Review of Resident #238's laboratory testing dated 03/08/25 revealed Resident #238 tested positive for Influenza A. Review of Resident #238's progress note dated 03/08/25 revealed the resident had tested positive for Influenza A. The nurse practitioner was notified. New orders for doxycycline 100 mg twice a day for 7 days and Prednisone 5 mg one time a day for five days. Review of Resident #238's provider note dated 03/09/25 revealed Resident #238 was an [AGE] year-old female who was not feeling well per staff. Staff advised she had a low-grade temperature and had flu testing. The testing returned and the resident was positive for influenza A but no high fever. Resident will be started on doxycycline 100 milligrams (mg) twice daily for seven days and prednisone. The resident was congested and chest Xray was ordered to rule out pneumonia. Staff advised she had no body aches. Continue Tylenol and ibuprofen as needed for temperatures, body aches, influenza A, and low-grade fever. Review of the Resident #238's Medication Administration Record dated 03/2025 revealed Resident #238 had received doxycycline 100 mg twice a day for seven days for Influenza A from 03/09/25 to 03/15/25 and Prednisone 5 mg once a day for influenza A from 03/09/25 to 03/13/25. Review of Resident #238's paper and electronic medical record revealed no evidence a chest x-ray was obtained. Review of Resident #238's McGeer criteria for respiratory tract infection for influenza undated revealed staff had checked the resident met criteria as evidence by fever and new or increased cough. Per the criteria the resident must have a fever and at least three of the following to meet criteria (chills, new headache or eye pain, myalgias or body aches, malaise or loss of appetite, and sore throat. There was no evidence the resident had at least three additional criteria. Review of Resident #238's medical record dated 02/28/25 to 03/08/25 the resident had (chills, new headache or eye pain, myalgias or body aches, malaise or loss of appetite, and sore throat. 365975 Page 15 of 16 365975 03/27/2025 Park Health Center 100 Pine Avenue St Clairsville, OH 43950

F 0881 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident #238's temperatures dated 02/28/25 to 03/08/25 revealed the resident had one elevated temperature of 100.4 on 03/08/25. Review of the infection control log dated 03/2025 revealed Resident #238's date of onset of symptoms was 03/07/25. The resident had an upper respiratory infection and tested positive for Flu A and had congestion. The resident met criteria for antibiotic treatment. Review of the CDC flu guidelines dated 09/04/24 revealed the flu should not be treated with antibiotics. Antiviral drugs such as Tamiflu, Retenzas, Parivar, and Xofluza should be used and use precaution to protect others (hand hygiene, etc.) Review of the facility's policy titled Antibiotic Stewardship Program dated 11/28/27 revealed nursing staff shall assess residents who are suspected to have infection for symptoms. Laboratory testing shall be done in accordance with current standards of practice. McGeer criteria are sued to define infections and the Loeb minimum criteria are used to determine whether or not to treat an infection with antibiotics. Prescriptions for antibiotics shall specify the dose, duration, and indication for use. Reassessment of empiric antibiotics was conducted for appropriateness and necessity, factoring in results of diagnostic testing, laboratory reports, and/or changes in the clinical status of the resident. 365975 Page 16 of 16