Health inspection·June 23, 2023

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 medical record review, resident interview, and staff interview, the facility failed to treat Resident #17 with dignity and respect by completing a urinary drug test without consent or physician's orders. This affected one (Resident #17) of three residents reviewed for dignity and respect. The facility census was 25. Findings included: Review of Resident #17's medical record revealed an admission date of 04/25/23. Diagnoses included paraplegia, chronic obstructive pulmonary disease, bipolar disease, and diabetes mellitus. Review of Resident #17's admission Minimum Data Set (MDS) assessment dated [DATE] revealed the resident was cognitively intact. She required extensive assistance for bed mobility, dressing, toilet use, and personal hygiene, and was totally dependent upon staff for transfers. Review of Resident #17's most recent care plan revealed the resident was prescribed antidepressant medications. There was no care plan regarding drug addiction. Further review of Resident #17's medical record revealed a urine drug test was completed on 05/17/23 by the Director of Nursing (DON). The test was recorded on a hand-written form and revealed the resident tested positive for amphetamines, cocaine, and opiates. Review of Resident #17's physician's orders revealed there was no order for the urine drug test completed on 05/17/23. Review of the urine drug test form dated 05/17/23 revealed the DON completed the form that came with the test kit. The resident information and results were handwritten, which included being positive for amphetamines, cocaine, and opiates. The urine sample was taken from a Foley catheter bag and was between 90 and 100 degrees Fahrenheit. The drug test was completed due to Resident #17's behavior was very tired, snoring, and difficult to arouse. Review of Resident #17's medical record revealed a serum blood drug test was ordered by the physician per the resident's request. Review of the serum blood drug test dated 05/18/23 revealed the results were negative for drugs. Review of the blood serum drug test completed on 05/18/23 revealed the physician ordered test was negative for drugs. Interview on 06/22/23 at 8:56 A.M. with Resident #17 revealed on 05/17/23, the DON informed the resident that a urine test was needed and drew a urine sample out of the resident's Foley catheter bag. Page 1 of 3 366002 366002 06/23/2023 Crestline Rehabilitation and Nursing Center 327 West Main Street Crestline, OH 44827

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few The DON failed to ask permission to run the test nor informed the resident the urine was being tested for drugs. The resident revealed on 05/17/23, the local police arrived at the facility after being called by the DON. The police searched the resident's husband in front of staff and other residents. Resident #17 stated the action was humiliating and embarrassing. She stated she cried for several days after. In addition, Resident #17 was awaiting a court case and was on parole. She stated the DON also notified the parole officer who visited the facility, but the resident was able to prove she was drug free by showing the parole officer the negative blood test results. Interviews on 06/22/23 at 10:24 A.M. and 2:02 P.M. with the DON verified she completed a urine drug test for Resident #17 without a physician's order. She ran the test due to being suspicious of the resident's actions due to going outside frequently with her husband. On the afternoon of 05/17/23, Resident #17 was observed being tired, sleeping, and was difficult to arouse, which she decided to complete a drug test. This deficiency represents non-compliance investigated under Complaint Numbers OH00143403 and OH00143388. 366002 Page 2 of 3 366002 06/23/2023 Crestline Rehabilitation and Nursing Center 327 West Main Street Crestline, OH 44827

F 0773 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, resident interview, staff interview, and review of facility policy, the facility failed to obtain a physician's order prior to completing a urine test. This affected one (Resident #17) of one resident reviewed for laboratory orders. The facility census was 25. Findings included: Review of Resident #17's medical record revealed an admission date of 04/25/23. Diagnoses included paraplegia, chronic obstructive pulmonary disease, bipolar disease, and diabetes mellitus. Review of Resident #17's admission Minimum Data Set (MDS) assessment dated [DATE] revealed the resident was cognitively intact. She required extensive assistance for bed mobility, dressing, toilet use, and personal hygiene and was totally dependent on staff for transfers. Review of Resident #17's medical record revealed a urine drug test was completed on 05/17/23 by the Director of Nursing (DON). The test was recorded on a hand-written form and revealed the resident tested positive for amphetamines, cocaine, and opiates. Review of Resident #17's physician orders revealed no orders for the urinary drug test completed on 05/17/23. Interview with Resident #17 on 06/22/23 at 8:56 A.M. revealed on 05/17/23 the DON informed the resident a urine test was needed and drew a urine sample out of the resident's Foley catheter bag. Interview with the DON on 06/22/23 at 10:24 A.M. and 2:02 P.M. verified she completed a urine drug test for Resident #17 without a physician's order. Review of the facility policy titled, Request For Diagnostic Services, revised April 2007 revealed all requests for diagnostic services must be ordered by the resident's attending physician. This deficiency is based on incidental findings discovered during the course of the investigation. 366002 Page 3 of 3