Health inspection·March 7, 2024

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. 3. Review of the medical record for Resident #129 revealed an admission date of 02/22/24 with diagnoses including diabetes mellitus type two, hypertension, non-Hodgkin's lymphoma with metastasis to the bones and fracture of the shaft of the right humerus. Review of the plan of care for Resident #129 initiated 02/22/24 revealed it did not include care and treatment regarding the cast to the resident's right arm. Review of the Medication Administration Record (MAR) and the Treatment Administration Record (TAR) for Resident #129 dated February 2024 and March 2024 revealed they did not include care related to the resident's cast to the right arm, circulation checks or skin checks. Review of the MDS for Resident #129 dated 02/25/24 revealed the resident was cognitively impaired and required assistance from staff for activities of daily living (ADLs.) Review of the nurse progress note for Resident #19 dated 02/29/24 timed at 11:50 A.M. revealed the resident returned from the orthopedic physician appointment with no new orders. The note did not include monitoring of Resident #129 skin, circulation or edema to right hand. Observations on 03/04/24 at 9:16 A.M. and on 03/06/24 at 11:33 A.M. of Resident #129 revealed the resident's lower right arm was in a cast with edema noted to the resident's fingers on the right hand. Interview on 03/06/24 at 3:12 A.M. with Licensed Practical Nurse (LPN) #140 confirmed Resident #129 was admitted with a cast to lower right arm and the resident's fingers were swollen. LPN #140 confirmed there were no orders to monitor the circulation, skin or edema to the resident's right hand. Interview on 03/06/24 at 3:25 P.M. with the DON confirmed Resident #129's care plan did not include interventions related to the resident's cast care or circulation and skin check for the right hand. Based on medical record review, staff interviews, and observation, the facility failed to ensure development and implementation of comprehensive resident care plans. This affected three (Residents #3, #12, #129) of 15 residents reviewed for care plans. The facility census was 29. Findings include: 1. Review of the medical record for Resident #3 revealed an admission date of 09/06/05 with diagnoses including heart failure, dementia, and presence of cardiac pacemaker. Page 1 of 4 366003 366003 03/07/2024 Crystal Care Center of Franklin Furnace 4734 Gallia Pike Franklin Furnace, OH 45629

F 0656 Level of Harm - Minimal harm or potential for actual harm Review of the quarterly Minimum Data Set (MDS) assessment for Resident #3 dated 01/10/24 revealed this resident was moderately cognitively impaired. Review for the care plan for Resident #3 initiated 09/06/05 revealed it did not include care and monitoring of the resident's pacemaker. Residents Affected - Few Interview on 03/06/24 at 2:45 P.M. with the Director of Nursing (DON) confirmed Resident #3 had a pacemaker in place but was unsure how often pacemaker checks were to be conducted. The DON further confirmed Resident #3's care plan did not outline the care and services the facility was to provide for the resident's pacemaker. 2. Review of the medical record for Resident #12 revealed an admission date of 06/06/19 with diagnoses including bipolar disorder, paranoid schizophrenia, schizoaffective disorder, and psychotic disorder with delusions. Review of the quarterly MDS assessment for Resident #12 dated 12/28/23 revealed the resident was mildly cognitively impaired. Review of the physicians' orders for Resident #12 revealed an order dated 03/06/24 for Tagamet 400 milligrams (mg) to be administered daily for sexual behaviors. Review for the care plan for Resident #12 initiated 06/06/19 revealed it did not include the resident's sexual behaviors and/or use of Tagamet for sexual behaviors. Interview on 03/06/24 at 2:45 P.M. with the DON confirmed Resident #12 exhibited negative sexual behaviors which were being managed with the medication, Tagamet. The DON further confirmed Resident #12's care plan did not include the resident's sexual behaviors and the care and services the facility was to provide regarding management of the negative sexual behaviors. 366003 Page 2 of 4 366003 03/07/2024 Crystal Care Center of Franklin Furnace 4734 Gallia Pike Franklin Furnace, OH 45629

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 Based on medical record review, observation, and staff interview the facility failed to ensure care and services were provided to residents with casts to the extremities. This affected one (Resident #129) of one residents with a cast and 13 sampled residents. The facility census was 28. Residents Affected - Few Findings include: Review of the medical record for Resident #129 revealed an admission date of 02/22/24 with diagnoses including diabetes mellitus type two, hypertension, non-Hodgkin's lymphoma with metastasis to the bones and fracture of the shaft of the right humerus. Review of the plan of care for Resident #129 initiated 02/22/24 revealed it did not include care and treatment regarding the cast to the resident's right arm. Review of the Medication Administration Record (MAR) and the Treatment Administration Record (TAR) for Resident #129 dated February 2024 and March 2024 revealed they did not include care related to the resident's cast to the right arm, circulation checks or skin checks. Review of the MDS for Resident #129 dated 02/25/24 revealed the resident was cognitively impaired and required assistance from staff for activities of daily living (ADLs.) Review of the nurse progress note for Resident #19 dated 02/29/24 timed at 11:50 A.M. revealed the resident returned from the orthopedic physician appointment with no new orders. The note did not include monitoring of Resident #129 skin, circulation or edema to right hand. Observations on 03/04/24 at 9:16 A.M. and on 03/06/24 at 11:33 A.M. of Resident #129 revealed the resident's lower right arm was in a cast with edema noted to the resident's fingers on the right hand. Interview on 03/06/24 at 3:12 A.M. with Licensed Practical Nurse (LPN) #140 confirmed Resident #129 was admitted with a cast to lower right arm and the resident's fingers were swollen. LPN #140 confirmed there were no orders to monitor the circulation, skin or edema to the resident's right hand. Interview on 03/06/24 at 3:25 P.M. with the DON confirmed Resident #129's care plan did include interventions related to the resident's cast care or circulation and skin check for the right hand. 366003 Page 3 of 4 366003 03/07/2024 Crystal Care Center of Franklin Furnace 4734 Gallia Pike Franklin Furnace, OH 45629

F 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. Based on record review, staff interview, and review of the facility policy the facility failed to ensure the physician provided a response to consultant pharmacist recommendations. This affected one (Resident #4) of five residents reviewed for unnecessary medications. The facility census was 28. Findings include: Review of the medical record for Resident #4 revealed an admission date of 09/02/23 with diagnoses including dementia, anxiety, depression and unspecified psychosis. Review of the physician orders for Resident #4 dated March 2024 revealed the resident was ordered Seroquel (antipsychotic) 50 milligrams (mg) by mouth for agitation. Review of the Minimum Data Set (MDS) assessment for Resident #4 dated 12/14/23 revealed resident had moderate cognitive impairment. Review of the consultant pharmacist's recommendation for Resident #4 dated 01/30/24 revealed the resident was receiving Seroquel for a diagnosis of agitation and it was recommended to consider changing to an appropriate diagnosis or titration off the medication. The physician signed the recommendation on 02/17/24 but did not document acceptance or denial of the pharmacy recommendation. Interview on 03/05/24 at 12:42 P.M. with the Director of Nursing (DON) confirmed the physician did not document a response to the pharmacy recommendation for Resident #4 dated 01/30/24. Review of the facility policy titled Pharmacy Recommendations revised January 202 revealed the consultant pharmacist performed a comprehensive review of each resident's medication regiment routinely as required by regulations. The DON or the Assistant Director of Nursing (ADON) would review the recommendations with the physician and Medical Director as soon as practical but no later than 30 days. Any urgent recommendations must be addressed immediately. The DON would track the recommendations and ensure any changes were implemented into the medical record. 366003 Page 4 of 4