Health inspection·June 13, 2023

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 record review, staff interviews and policy review, the facility failed to ensure medications were administered as ordered. This affected one (#11) of three residents reviewed reviewed for medication administration. The facility census was 101. Findings include: Review of medical record for Resident #11 revealed admission date of 05/04/23. Diagnoses included acute respiratory failure with hypoxia, chronic kidney disease stage three (of four) and acute on chronic congestive heart failure. The resident was hospitalized on [DATE] and did not return. The admission Minimum Data Set (MDS) dated [DATE] revealed Resident #11 had a Brief Interview Mental Status (BIMS) score of six out of 15 indicating impaired cognition. Resident #11 required extensive two-person assistance for bed mobility, transfers, toileting supervision for eating. Resident #11 was documented as frequently incontinent of urine and bowel during the lookback period. A care plan relative revealed Resident #11 had potential for alteration in nutrition and hydration status as evidenced by therapeutic diet and fluid restriction initiated 05/15/23. Interventions included to accommodate food preferences as able, heart healthy, regular texture 2000 milliliter/day fluid restriction, monitor for signs and symptoms of dehydration, ad encourage consumption of fluids within the parameters of the fluid restriction. At risk for dehydration initiated 05/15/23 related to diuretics interventions included monitor for signs and symptoms of dehydration (poor skin integrity, new onset of confusion, abnormal lab values), offer water/ice chips every shift within the parameters of the fluid restrictions and monitor lab work. Review of Resident #11's physician order revealed the staff received orders for the resident to receive Molnupiravir (antiviral) Oral Capsule 200 milligrams twice a day for five days, with a start date of 05/10/23 to treat Coronavirus Disease 2019 (COVID-19). Further review of Resident #11's May 2023 Medication Administration Record (MAR) revealed the first dose on 05/10/23 for the 6:00 A.M. to 11:00 A.M. time had an H documented. The review revealed Resident #11 received nine doses of the Molnupiravir rather than the full 10 doses. Interview on 06/13/23 at 1:32 P.M. with the Director of Nursing (DON) revealed Resident #11's Molnupiravir was marked as held on 05/10/23 because the resident was sent to the emergency room. The DON confirmed Resident #11 did not receive the medication upon returning later in the day. The DON confirmed Resident #11's Molnupiravir end date was not extended; therefore, the resident did not receive the full five days of medication. Page 1 of 3 365984 365984 06/13/2023 Kingston of Miamisburg 1120 South Dunaway Street Miamisburg, OH 45342

F 0755 Level of Harm - Minimal harm or potential for actual harm Record review of the facility policy for Administering Medications approved 02/23 revealed medications must be offered in accordance with orders. This deficiency represents non-compliance investigated under Complaint Number OH00143114. Residents Affected - Few 365984 Page 2 of 3 365984 06/13/2023 Kingston of Miamisburg 1120 South Dunaway Street Miamisburg, OH 45342

F 0808 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interviews and policy review, the facility failed to ensure a residents physician ordered diet was implemented as prescribed. This affected one (#11) of three residents reviewed for therapeutic diets. The facility census was 101. Findings include: Review of medical record for Resident #11 revealed admission date of 05/04/23. Diagnoses include acute respiratory failure with hypoxia, chronic kidney disease stage three (of four), acute on chronic congestive heart failure. The resident was hospitalized on [DATE] and did not return. The admission Minimum Data Set (MDS) dated [DATE] revealed Resident #11's had a Brief Interview Mental Status (BIMS) score of six out of 15 indicating impaired cognition. Resident #11 required extensive two-person assistance for bed mobility, transfers, toileting supervision for eating. Resident #11 was documented as frequently incontinent of urine and bowel during the lookback period. A care plan relative revealed Resident #11 had potential for alteration in nutrition and hydration status as evidenced by therapeutic diet and fluid restriction initiated 05/15/23. Interventions included to accommodate food preferences as able, heart healthy, regular texture 2000 milliliter/day fluid restriction, monitor for signs and symptoms of dehydration, ad encourage consumption of fluids within the parameters of the fluid restriction. At risk for dehydration initiated 05/15/23 related to diuretics interventions included monitor for signs and symptoms of dehydration (poor skin integrity, new onset of confusion, abnormal lab values), offer water/ice chips every shift within the parameters of the fluid restrictions and monitor lab work Review of the admission orders for Resident #11 revealed an order for a low sodium/salt diet. Fluid intake no more than 2000 milliliters (ml) a day. Further record review of the physician orders dated 05/07/23 revealed an order for Resident #11 to be on a regular diet with a 2000 ml fluid restriction. Interview on 06/13/22 at 1:32 P.M. with the Director of Nursing (DON) verified Resident #11 admission orders were for a heart healthy diet or a low sodium/salt diet. The DON shared the dietician was off at the time of Resident #11's admission and the diet tech and nurse did not catch the order. The DON confirmed Resident #11 received a regular diet versus a low sodium/salt diet as physician ordered. Review of the facility policy for Diet approved on 08/19/21 revealed diets will be offered as ordered by the physician. This deficiency represents non-compliance investigated under Complaint Number OH00143114. 365984 Page 3 of 3