Health inspection·November 15, 2018

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, medical record review, and review of facility policy, the facility failed to provide a dignified dining experience for residents who required assistance with eating. This affected one (Resident #4) of the six residents seated at the assist table. The facility identified nine residents who required staff assistance with eating. The facility census was 29. Findings include: Review of Resident #4's medical record revealed an admission date of 09/02/18. Diagnoses included vascular dementia and dysphagia. Review of Resident #4's Minimum Data Set (MDS) assessment, dated 08/09/18 revealed the resident was severely cognitively impaired and was rarely or never understood. Resident #4 was on hospice and required extensive assistance with eating. Review of Resident #4's care plan updated 11/09/18 revealed supports for activities of daily living (ADL) and nutritional status. Resident #4 was to receive extensive encouragement and assistance at meals. Review of Resident #4's physician orders revealed a diet order dated 05/04/18 for mechanical soft foods. The order stated Resident #4 may have comfort foods as tolerated. Observation on 11/13/18 at 12:22 P.M. found Resident #4 in the dining room, seated at the assist table, eating canned fruit from a small bowl with her fingers. Two staff were seated at the table and did not assist or encourage Resident #4 to use utensils. Further observation on 11/13/18 at 12:24 P.M. found Resident #4 picked up a small bowl of a mechanical soft hot dog with [NAME] sauce. Resident #4 used her fingers and fingernails to try and take bites of the mechanical soft [NAME] dog. Resident #4 used her fingernails as scoops to try and get the soft food to her mouth. Resident #4 was successful with two of four attempts to get food to her mouth. Resident #4 then stopped trying and put the bowl of mechanical soft [NAME] dog down on the table. Resident #4 was observed looking around on the table and lifting up her empty bowl of fruit. Resident #4 appeared to be looking for additional food. Three staff were seated at the assist table and did not assist or encourage Resident #4 to use utensils. Interview on 11/13/18 at 12:31 P.M. with State Tested Nursing Assistant (STNA) #100 verified Resident #4 was eating her meal with her fingers and was not being assisted or encouraged to use utensils. STNA #100 stated Resident #4 received finger foods and the staff made sure Resident #4's food was Page 1 of 3 365996 365996 11/15/2018 Ohio Living Swan Creek 1650 Swan Creek Lane Toledo, OH 43614

F 0550 cut into bite size pieces so Resident #4 could feed herself. Level of Harm - Minimal harm or potential for actual harm Interview on 11/13/18 at 12:34 P.M. with [NAME] #110 verified Resident #4 received a mechanical soft diet and was provided a mechanical soft [NAME] dog as part of her lunch. The cook verified Resident #4 was not provided finger foods. Residents Affected - Few Review of the facility policy titled, The Person Centered Dining Approach dated 2013 revealed the person centered dining approach focused on each individual's needs related to food, nutrition, and dining. Each person was to be treated like a special person with focus on individualizing all interactions, intervention, and care including food, nutrition and dining. 365996 Page 2 of 3 365996 11/15/2018 Ohio Living Swan Creek 1650 Swan Creek Lane Toledo, OH 43614

F 0868 Have the Quality Assessment and Assurance group have the required members and meet at least quarterly Level of Harm - Potential for minimal harm Based on staff interview, policy review and review of meeting sign-in sheets, the facility failed to ensure the Director of Nursing (DON) and Medical Director or designee, attended the Quality Assessment and Assurance (QAA) Committee meetings at least quarterly. This had the potential to affect all 29 residents residing in the facility. Residents Affected - Many Findings include: Review of sign-in sheets for the facility's QAA Committee for the past four quarters, revealed the committee met on 01/19/18, 04/13/18, 07/13/18, and 10/12/18. Further review of the sign-in sheet for the third quarter meeting on 07/13/18, revealed neither the DON nor Medical Director, nor a designee of the Medical Director, attended the meeting. Interview on 11/15/18 at 2:14 P.M. with the Administrator and DON, confirmed neither the DON nor the Medical Director attended the third quarter QAA Committee meeting on 07/13/18. The Administrator further confirmed the QAA Committee did not meet at any other time during the third quarter of 2018. Review of a policy titled, Quality Assurance and Performance Improvement Policy, last revised 10/01/18, revealed the Medical Director or designee, Administrator and DON will serve as members, and attend quarterly meetings of the Quality Assurance and Performance Improvement Committee (formerly referred to by the facility as the QAA committee). 365996 Page 3 of 3