Health inspection·April 26, 2022

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 observation, interview, record review and facility policy, the facility failed to ensure physician's orders were in place for wound care treatment for residents. This affected one ( Resident #18) of one residents reviewed for wound care. The facility census was 23. Residents Affected - Few Findings Include: Review of the medical record for Resident #18 revealed an admission date of 06/06/19 with diagnoses including malignant neoplasm of the brain with surgery, open wound to scalp and frontal lobe function deficit following cerebrovascular disease. Review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #18 had moderate cognitive impairment. Resident #18 required limited assistance of one staff person for activities of daily living. Resident #18 did not have any pressure areas but did require a non surgical dressing with or without topical medication other than to his feet. Review of the physician orders for 04/22 revealed there was not an order for treatment to the open area to Resident #18's scalp. Review of the Treatment Administration Record (TAR) for 04/22 revealed no documentation of treatment. However, the weekly skin assessment last completed on 04/23/22 by the Director of Nursing indicated the resident had a wound to his scalp measuring two centimeters (cm) by three cm from a surgical incision. The area had a treatment of honey gel and cover with a Band-Aid. Review of the nursing progress notes from 01/22 through 04/22 was silent on wound care and treatment. Review of the plan of care for at risk for impaired skin integrity/an open skin cancer lesion to head dated 05/21/20, revealed treatments per order and skin assessment as ordered. An observation of Resident #18 on 04/19/22 at 10:57 A.M., 04/20/22 at 9:19 A.M. and 1:40 P.M. revealed a Band-Aid in place to the top of his head. An interview on 04/20/22 at 11:10 A.M. with Registered Nurse (RN) #211 revealed the resident had a treatment to the top of his head. It was completed daily. An observation on 04/20/22 at 11:48 A.M. of wound care for Resident #18 revealed RN #211 washed hands, put on her gloves and removed the old Band-Aid from residents scalp. The wound was not bleeding. She placed the Band-Aid in her gloves, removed and washed her hands. RN #211 then put on her Page 1 of 5 366003 366003 04/26/2022 Crystal Care Center of Franklin Furnace 4734 Gallia Pike Franklin Furnace, OH 45629

F 0684 Level of Harm - Minimal harm or potential for actual harm gloves, had the honey gel in a medicine cup and a large Band-Aid on the over the bed table on a paper towel. RN #211 cleansed the area with wound cleanser, patted dry. The area had no drainage, redness or odor noted. RN#211 removed gloves, washed hands, put on new gloves and used a sterile swab to apply the honey gel to the wound. She then covered the wound with the large Band-Aid that was dated and initialed. RN #211 placed the trash in the can, removed gloves and washed hands. Residents Affected - Few An interview on 04/20/22 at 2:55 P.M. with the Director of Nursing (DON) revealed the DON completed the weekly skin/wound assessment which included the measurements and treatment. The DON confirmed there was not an order for the current treatment in the physicians orders or on the TAR. The DON said the wound was treated, but did not have documentation. Review of the facility policy titled Wound Care, dated 12/20 revealed wounds would be evaluated when observed and weekly until resolved. Wounds will be monitored for location, size (measure width, length, and depth), undermining, tunneling, exudates, necrotic tissue and presence or absence of granulation tissue and epitheliazation. 366003 Page 2 of 5 366003 04/26/2022 Crystal Care Center of Franklin Furnace 4734 Gallia Pike Franklin Furnace, OH 45629

F 0697 Provide safe, appropriate pain management 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 reviews and staff interviews, the facility failed to ensure residents pain medications were available for administration and failed to ensure ordered pain medication was administered as ordered. This affected one resident (#21) out of the two residents reviewed for pain management. The facility census was 23. Residents Affected - Few Findings include: Record review for Resident #21 revealed the resident was admitted to the facility on [DATE] and had diagnoses including osteoarthritis, nondisplaced fracture of the scapula and left shoulder, anxiety, obesity, and acquired absence of limb. Review of the admission Minimum Data Set (MDS) assessment, dated 03/06/22, revealed this resident had mildly impaired cognition. This resident was assessed to require extensive assistance from two staff members for bed mobility, transfers, and toileting. This resident was assessed to have occasional pain and to have received scheduled pain medication. Review of the care plan, dated 03/14/22, revealed this resident was at risk for pain. Interventions included to administer medication as ordered. Review of the physicians order, dated 02/24/22, revealed an order to administer one Percocet 10-325 milligram (mg) tablet every four hours for pain. Review of the Controlled Drug Use Record for Resident #21's Percocet 10-325 mg tablets revealed the last tablet was removed from a card for administration on 04/09/22 at 8:00 P.M. There was no documentation of the medication being available for administration from any other sources until 04/12/22 at 7:00 A.M. Review of the Controlled Drug Use Record for Percocet 5-325 mg tablets revealed the record contained a label containing Resident #21's name with a filled date of 04/11/22. The directions indicated to administer one tablet of Percocet 5-325 mg tablet every four hours for pain. The record contained hand written writing at the top of the sheet which read 2 tabs. Documentation on the record revealed two tablets had been pulled from the card every four hours from 04/12/22 at 7:00 A.M. through 04/14/22 at 8:00 P.M. to be administered to the resident. Review of the Medication Administration Record (MAR) for 04/2022 revealed on 04/11/22 at 4:00 P.M. and on 04/12/22 at 4:00 A.M. the residents Percocet 10-325 mg dose was documented as not being administered. All other scheduled doses of Percocet 10/325 mg were documented as being administered as ordered every four hours from 12:00 A.M. on 04/10/22 through 04/14/22 at 8:00 P.M. Interview with Resident #21 on 04/18/22 at 8:26 P.M. revealed the facility had run out of the residents ordered Percocet 10-325 mg tablets and the resident had not received the medication for approximately two days. Interview with Licensed Practical Nurse (LPN) #217 on 04/20/22 at 10:57 A.M. verified there was no record of the Percocet 10-325 mg tablets being available for administration to Resident #21 from 04/09/22 at 8:00 P.M. through 04/12/22 at 7:00 A.M. 366003 Page 3 of 5 366003 04/26/2022 Crystal Care Center of Franklin Furnace 4734 Gallia Pike Franklin Furnace, OH 45629

F 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview with the Regional Director of Clinical Services (RCDS) #300 on 04/20/22 at 1:12 P.M. verified the order for Resident #21 was for the resident to receive one tablet of Percocet 10-325 mg every four hours and the resident had received two tablets of Percocet 5-325 mg instead from 7:00 A.M. on 04/12/22 through 8:00 P.M. on 04/14/22. Interview with Registered Nurse (RN) #211 on 04/21/22 at 8:30 A.M. verified Resident #21 had not been administered scheduled Percocet 10-325 mg tablets for two days as the medication was unavailable. RN #211 verified the MAR contained inaccurate documentation of the administration of the Percocet 10-325 mg tablets on 04/10/22 and 04/11/22 as RN #211 had documented them as being administered in error. RN #211 verified RN #211 had hand-written 2 tabs on the top of the Controlled Drug Use Record for the residents Percocet 5-325 mg tablets which resulted in the resident receiving double the amount of ordered acetaminophen every four hours from 04/12/22 at 7:00 A.M. through 04/14/22 at 8:00 P.M. RN #211 verified the label on the Controlled Drug Use Record for the residents Percocet 5-325 mg tablet read to administer one every four hours. Review of the facility policy titled Medication Administration-General Guidelines, revised 11/2018, revealed medications were to be administered in accordance with the written orders of the prescribed. If a dose of regularly scheduled medication was not available, it was to be documented on the MAR along with an explanatory note. 366003 Page 4 of 5 366003 04/26/2022 Crystal Care Center of Franklin Furnace 4734 Gallia Pike Franklin Furnace, OH 45629

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews the facility failed to provide an appropriate diagnosis for the use of an antipsychotic. This affected one resident (Resident #17) out of five residents reviewed for unnecessary medications. The facility census was 33. Findings include: Record Review of Resident #17 revealed this resident was admitted to the facility on [DATE] with the following medical diagnoses: osteoarthritis, atherosclerotic heart disease, dementia, nicotine dependence, coronary angioplasty, COVID-19, mood disorder, benign prostatic hyperplagia, pain, diabetes mellitis, anxiety, depression, hypertension, gastro-esophageal reflux disease, urine retention, hyperlipidemia, and nutritional deficiencies. Review of the Minimum Data Set (MDS) assessment completed on 02/09/22 revealed this resident had moderate to severe cognitive impairments. Review of Physician Orders revealed this resident is receiving the following medications: Seroquel 25 milligrams (mg) 1 tablet by mouth daily for unspecified dementia with behavioral disturbances and Seroquel 25 mg 1 tablet by mouth daily at bedtime for unspecified dementia with behavioral disturbances. Interview with Regional Clinician #300 on 04/20/22 at 02:35 P.M. verified Unspecified Dementia with Behavioral Disturbance is not an acceptable diagnosis for the use of Seroquel. Also verified the resident takes this medication on a daily basis. 366003 Page 5 of 5