Health inspection·January 19, 2023

F 0602 Protect each resident from the wrongful use of the resident's belongings or money. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, review of electronic mail (email) communications, resident and staff interviews and policy review, the facility failed to ensure a resident was free from misappropriation. This affected one (#13) of six residents reviewed for personal funds. The facility census was 82. Residents Affected - Few Findings include: Review of Resident #13's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses included but limited to personality disorder, schizophrenia, anxiety disorder and bipolar disorder. Review of the quarterly Minimum Data Set (MDS) assessment, dated 11/13/22, revealed the resident had intact cognition. The resident required supervision for bed mobility, transfers, ambulation. Interview on 01/18/23 at 3:02 P.M. with Resident #13 revealed she returned a helmet that didn't fit that she ordered and didn't get refunded the money into her account. Interview on 01/19/23 with Business Office Manager (BOM) #273 stated Resident #13 ordered a helmet and it didn't fit, Resident #13 returned the helmet. BOM #273 stated the helmet was purchased on the facility's credit card. BOM #273 stated that she has been trying to get a hold of corporate to reimburse Resident #13 and sent emails but didn't get any response. BOM #273 found out that the helmet was received, and the facility's credit card was credited the amount of the helmet totaling $73.95. Review of email dated 11/21/22 from BOM #273 to the corporate office revealed Resident #13 returned a helmet that was purchased on the facility's credit cared. BOM #273 inquired if there was a credit posted. Review of email dated 12/02/22 revealed that the facility's credit card was refunded $73.95 for the helmet. Review of the emails dated 12/07/22 and 12/28/22 revealed BOM #273 followed up with corporate office for the refund to be deposited in Resident #13's personal funds account with no reply as to when refund would be available for Resident #13. Interview on 01/19/23 at 10:06 A.M. with Chief Operating Officer #278 revealed that the ball was dropped, and Resident # 13 will get her money tomorrow. Review of the undated policy titled, Abuse Prohibition: Abuse, Neglect and Exploitation of Page 1 of 7 366067 366067 01/19/2023 Vista Care Center of Milan 185 S Main St Milan, OH 44846

F 0602 Level of Harm - Minimal harm or potential for actual harm Residents and Misappropriation of Property, indicated the intent of the facility is to prevent the abuse, mistreatment, or neglect of residents or the misappropriation of their belongings including the guidance to direct staff to manage any concerns or allegations of abuse, neglect, or misappropriation of property. Residents Affected - Few 366067 Page 2 of 7 366067 01/19/2023 Vista Care Center of Milan 185 S Main St Milan, OH 44846

F 0730 Observe each nurse aide's job performance and give regular training. Level of Harm - Potential for minimal harm Based on record review and staff interview, the facility failed to ensure the State Tested Nursing Assistants (STNA's) annual performance evaluations were completed as required. This affected two (#268 and #201) of six STNA personnel files reviewed and had the potential to affect all 82 residents residing in the facility. Facility census was 82. Residents Affected - Many Findings include: Review of the personnel file for STNA #268 revealed a hire date of 10/10/18. Review of the employee's personnel file revealed the annual evaluation for 2022 had not been completed. Review of the personnel file for STNA #201 revealed a hire date of 11/10/21. Review of the employee's personnel file revealed the annual performance evaluation had not been completed for 2022. On 01/19/23 at 9:35 A.M. interview with the Business Office and Human Resources #273 verified the annual performance evaluations for STNA #201 and #268 had not been completed as required. The facility confirmed the lack of annual performance evaluations for STNA's had the potential to affect all residents residing in the facility. 366067 Page 3 of 7 366067 01/19/2023 Vista Care Center of Milan 185 S Main St Milan, OH 44846

F 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interviews, the facility failed to ensure a resident was free from unnecessary medications when the resident received an antibiotic without an adequate indication for use. This affected one (#31) out of six residents reviewed for unnecessary medications. Facility census was 82. Residents Affected - Few Findings include: Review of Resident #31's medical record identified admission to the facility occurred on 04/19/18. Diagnoses include multiple sclerosis, anxiety, diabetes mellitus, urinary tract infection with extended spectrum beta lactamases (ESBL) resistance (06/08/22) and a history of Coronavirus Disease 2019 (COVID-19) on 12/27/22. Review of Resident #31's quarterly Minimum Data Set (MDS), dated [DATE], revealed the resident had scored a 15 out of 15 on the Brief Interview for Mental Status (BIMS) indicating the resident was cognitively intact. Resident #31 required extensive assist of one staff for bed mobility and dressing and extensive assist of two for transfers. Resident #31 did not ambulate and required supervision for eating. During the look back period Resident #31 did not receive an antibiotic. Review of physician progress notes dated 01/11/23 identified Resident #31 had concerns of nausea, vomiting, and altered mental status. The notes identified Resident #31 had chills, shortness of breath and pain with urination. The physician wrote orders for laboratory testing and urinalysis. Resident #31 was started on Cipro 500 milligrams (mg) for seven days. Review of the urinalysis test identified the laboratory received the sample on 01/11/23, which was collected using clean catch method identified it was under the review status. On 01/12/23 the urinalysis identified no infection and probable contamination. The records identified no evidence the physician was notified of the results on 01/12/23. Review of Resident #31 Medication administration records (MAR) for January 2023 identified the resident continued to received the Cipro on 01/19/23. Interview with the facility Director of Nursing (DON) on 01/18/23 at 1:17 P.M. confirmed there was no evidence the physician was notified of the urinalysis results on 01/12/23 that identified probable contamination. The interview confirmed Resident #31 remained on the antibiotic (Cipro) without indications for its use. 366067 Page 4 of 7 366067 01/19/2023 Vista Care Center of Milan 185 S Main St Milan, OH 44846

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 staff interview, the facility failed to ensure a resident was free from unnecessary psychotropic medications when as needed (PRN) medication orders for psychotropic drugs were not limited to 14 days. This affected one (#52) of six residents reviewed for unnecessary medications. The facility census was 82. Findings Include: Review of Resident #52's medical record revealed the resident was admitted to the facility on [DATE]. Diagnoses included schizoaffective disorder, bipolar, heart disease, anxiety, restlessness and agitation. Review of the quarterly Minimum Data Set (MDS) assessment, dated 11/13/22, revealed the resident had intact cognition. The resident required supervision for bed mobility, transfers, ambulation. Resident #52 was noted to have verbal behaviors, other behaviors, and rejection of care four to six days during the look back period. Review of the physicians' orders for January 2023 revealed Resident #52 had an order dated 10/27/22 for Ativan 0.5 milligram (mg) every eight hours as needed (PRN). Review of the medication administration record (MAR) for January 2023 revealed Resident #52 received the PRN Ativan on 01/01/23, 01/02/23, 01/04/23, 01/05/23, 01/06/23, 01/07/23, 01/09/23, 01/10/23, 01/11/23, 01/12/23, and 01/15/23 once a day as well as twice on 01/14/23 and 01/16/23. Review of both the electronic and hard chart revealed no evidence that Resident #52's PRN Ativan had a rationale for no stop date. Interview on 01/17/23 at 3:57 P.M. with the Director of Nursing (DON) verified that there was no stop date, and no rationale was documented in Resident #52's medical record for the continued use of the PRN Ativan. 366067 Page 5 of 7 366067 01/19/2023 Vista Care Center of Milan 185 S Main St Milan, OH 44846

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, resident and staff interviews and policy review, the facility failed to ensure an accurate and complete medical record was maintained related to urinary catheters usage. This affected one (#20) of three residents reviewed for accuracy of documentation. The facility census was 82. Findings include: Review of Resident #20's medical record revealed an admission date of 07/08/18. Diagnoses included urine hypoosmolality and hyponatremia, paranoid schizophrenia, obstructive reflux uropathy, chronic obstructive pulmonary disease, neuromuscular dysfunction of bladder, schizoaffective disorder bipolar, anxiety disorder, compulsive disorder, bipolar, hypothyroidism, flaccid neuropathic bladder, and anemia. Review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #20 was cognitively intact for daily decision making and required supervision for bed mobility, transfers, walking. locomotion, dressing, eating, toilet use and personal hygiene and had an indwelling urinary catheter. Review of physician orders revealed an order dated 08/26/22 for nursing to assist with changing from leg bag to drainage bag at bedtime and an order written on 12/03/22 for any issues with suprapubic catheter reported to urologist. Review of the care plan revealed an alternation in elimination related to obstructive neuropathy, urinary retention, neurogenic bladder, and benign prostatic hyperplasia with a goal to remain free of signs and symptoms of infection. Interventions included treatments as ordered, labs as ordered, monitor for adverse reactions, and to notify MD course of treatment for any complications. Review of Resident #20's treatment record from 12/01/22 to 01/18/23 revealed daily documentation at 8:00 P.M. of the leg bag being changed to a drainage bag for catheter care. Observations on 01/17/23 at 9:03 A.M. and 3:36 P.M., on 01/18/23 at 8:17 A.M. and on 01/19/23 at 10:32 A.M. revealed Resident #20 had a visible urinary drainage bag in the left front jean pocket. Interview on 01/18/23 at 10:15 A.M. with Licensed Practical Nurse (LPN) #251 verified Resident #20 did have an order for a leg bag. LPN #251 stated the resident refuses to have the urinary drainage system changed to a leg bag. LPN #251 further verified daily documentation related to the leg bag and drainage bag being changed daily. Interview with Resident #20 on 01/18/22 at 10:20 A.M. revealed the resident does not use a leg bag and refuses to have a leg bag placed each day. Interview on 01/18/23 at 3:45 P.M. with the Director of Nursing (DON) #257 verified Resident #20 refuses to use a leg bag and the daily documentation of the leg bag changed to a drainage bag at 8:00 P.M. should be documented as refused as the staff are not changing out the bags as ordered. Review of the facility's undated policy titled Documentation, stated resident's clinical record is a concise account of treatments and is necessary to include data needed to for identification and 366067 Page 6 of 7 366067 01/19/2023 Vista Care Center of Milan 185 S Main St Milan, OH 44846

F 0842 Level of Harm - Minimal harm or potential for actual harm communication with caregivers and family. The policy also stated the medical record is a legal document and the charting must address goals as outlined on the care plan and as ordered by the physician. This deficiency represents non-compliance investigated under Complaint Number OH00134861. Residents Affected - Few 366067 Page 7 of 7