Health inspection·July 2, 2024

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, resident interview, staff interview and review of facility policy, the facility failed to ensure timely incontinence care for two (#84 and #102) of three residents reviewed for incontinence care. The facility census was 116. Findings include: 1. Review of the medical record for Resident #84 revealed an admission date of 08/31/21. Diagnoses included chronic obstructive sleep apnea, osteoarthritis, dementia, major depressive disorder, hypertension, ulcerative colitis and vitamin D deficiency. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #84 was cognitively impaired. Resident #84 required moderate assistance for toilet hygiene, personal hygiene, mobility and transfers. Resident #84 was frequently incontinent of urine and always incontinent of bowel. Review of the care plan dated 09/17/21 revealed Resident #84 had an activities of daily living (ADLs) self-care deficit. Interventions included: staff to provide extensive assistance with personal hygiene, bathing, toilet use and transfers. Further review revealed on 02/08/22, the care plan was revised to include frequent bladder incontinence. Interventions included: check resident for continence, offer assistance when incontinent, monitor for urinary tract infection, use verbal reminders for bathroom use and to place urinal/bedpan within reach of Resident #84. Observation on 07/02/24 at 10:51 A.M. of Resident #84 revealed the resident was sitting in a wheelchair in the middle of the hallway. Resident #84 appeared angry and in a loud voice stated, I cannot get anyone to help. Resident #84 went on to state he had a bowel movement and no one cared that he needed help or that he was sitting in feces. Observation on 07/02/24 at 10:58 A.M. revealed State Tested Nurse Aide (STNA) #300 assisted Resident #84 to the bathroom. Continued observation of incontinence care provided to Resident #84 by STNA #300 revealed when the brief was removed, stool dropped onto the floor in front of the toilet and the resident had dark brown stool down the upper inner thigh and up the back. The stool had hardened and required STNA #300 to scrub the skin of Resident #84 with a soap and water to remove the dried stool. Concurrent interview with STNA #300 verified Resident #84 had not been provided incontinence care since the beginning of her shift, which began at 6:30 A.M. (nearly 4.5 hours earlier), and confirmed the resident had been sitting in the stool for some time based on the appearance of the dried stool on the resident's skin. Page 1 of 2 366068 366068 07/02/2024 Orchard Villa 2841 Munding Drive Oregon, OH 43616

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 2. Review of the medical record for Resident #102 revealed an admission date of 07/06/22. Diagnoses included chronic respiratory failure, chronic obstruction pulmonary disease, bipolar disorder, type II diabetes mellitus, schizoaffective disorder, heart failure and anxiety disorder. Review of the quarterly MDS assessment dated [DATE] revealed Resident #102 was cognitively intact, required moderate assistance for oral care and maximal assistance for toilet hygiene, lower body dressing and personal hygiene. Resident #102 was frequently incontinent of urine and always incontinent of bowel. Review of the care plan dated 07/12/22 revealed Resident #102 had an ADLs self-care deficit related to activity intolerance, limited mobility and decreased range of motion. Interventions included to monitor and report changes in physical functioning, staff to assist with ADLs, provide extensive assistance with toilet use and dressing, provide total care for bathing and refer to physical therapy and occupational therapy as needed. Interview on 07/02/24 at 8:41 A.M. with Resident #102 revealed the last time the resident was provided incontinence care was at approximately 2:00 A. M. Resident #102 stated at shift change, the night aide told the day aide she had just cleaned the resident up. Resident #102 stated that was incorrect and asked for assistance. Resident #102 stated she was told care would have to wait until after breakfast. Resident #102 stated she did not appreciated lying in a wet brief and a wet bed. Observation on 07/02/24 at 9:46 A.M. of incontinence care provided for Resident #102 by STNA #305 revealed a strong urine odor when the brief was removed. Resident #102 had reddened skin, with peeling skin on the left upper buttock. STNA #305 applied barrier cream and told Resident #102 the nurse would be notified of the skin condition. Interview on 07/02/24 at 9:55 A.M. with STNA #305 verified Resident #102 had not been checked or changed since the beginning of her shift at 6:30 A.M. (3.25 hours earlier). Review of the facility policy titled Incontinence Care, dated 11/30/23, revealed incontinence care is provided to keep residents skin dry and clean and to prevent irritation and odor. Soiled skin areas are to be cleansed with soap and water and dried thoroughly. This deficiency represents non-compliance investigated under Complaint Number OH00154772. 366068 Page 2 of 2