Health inspection·July 13, 2023

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of the medical record and staff interview the facility failed to ensure the responsible party for Resident #10 was notified of medication changes. This affected one resident (Resident #10) of three reviewed for notification of change. The facility census was 48. Findings included: Review of the medical record revealed Resident #10 was admitted to the facility on [DATE]. Diagnoses included quadriplegia, contractures, dysphagia, COVID-19, vascular dementia, protein-calorie malnutrition, schizophrenia, constipation, cervicalgia, osteoporosis, scoliosis, paralytic syndrome, major depressive disorder, kyphosis, anxiety disorder, intentional harming self with firearm discharge, and allergic rhinitis. Review of the Minimum Data Set 3.0 assessment dated [DATE] revealed Resident #10 had moderately impaired cognition. She required total assistance of two staff for bed mobility, transfers, toilet use and one staff for dressing, eating and personal hygiene. Review of the physician's orders dated 02/01/23 revealed Resident #10 had orders for her Depakote 500 milligrams to be increased from twice daily to three times daily and her Exelon patch increased from 9.5 milligrams in 24 hours to 13.3 milligrams in 24 hours. Review of the progress notes from 01/31/23 to 02/07/23 revealed no documentation the responsible party for Resident #10 was notified of her medication changes. On 07/12/23 at 12:17 P.M. an interview the Director of Nursing revealed the brother of Resident #10 was her responsible party. She indicated he absolutely would not let them change her medication in any way. She stated Resident #10 had increased screaming and behaviors at night so they increased her Depakote and Exelon patch. She stated her brother and sister were both notified when the changes were made by the psychiatrist. She stated the brother came into the facility screaming because her medications were changed and he was not notified. She explained to him he was left a voice message about the medication changes. She stated she sat down with him and the went over all of her medication and they were changed back to what they were prior to the changes and he stated he did not want the psychiatrist to see her anymore. She stated she was not aware of her being lethargic. On 07/12/23 at 1:50 P.M. an interview with the Director of Nursing verified there was no documentation the responsible party for Resident #10 was notified of her medication changes on 02/01/23. Page 1 of 4 366087 366087 07/13/2023 Vista Center, The 100 Vista Drive Lisbon, OH 44432

F 0580 Level of Harm - Minimal harm or potential for actual harm Review of the undated facility policy titled, Status Change in Resident Condition-Notification, revealed the facility would promptly notify the resident, their attending physician and responsible party of changes in the resident's condition or status. This deficiency represents non-compliance investigated under Complaint Number OH00143569. Residents Affected - Few 366087 Page 2 of 4 366087 07/13/2023 Vista Center, The 100 Vista Drive Lisbon, OH 44432

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 review of the medical record, review of laboratory results and interview with staff the facility failed to ensure laboratory tests were obtained as ordered for Resident #10 and the physician was notified of the laboratory results. This affected one resident ( Resident #10) of three reviewed for change in condition. The facility census was 48. Findings included: Review of the medical record revealed Resident #10 was admitted to the facility on [DATE]. Diagnoses included quadriplegia, contractures, dysphagia, COVID-19, vascular dementia, protein-calorie malnutrition, schizophrenia, constipation, cervicalgia, osteoporosis, scoliosis, paralytic syndrome, major depressive disorder, kyphosis, anxiety disorder, intentional harming self with firearm discharge, and allergic rhinitis. Review of the Minimum Data Set assessment 3.0 dated 06/09/23 revealed Resident #10 had moderately impaired cognition. She required total assistance of two staff for bed mobility, transfers, toilet use and one staff for dressing, eating and personal hygiene. Review of the physician's orders dated 07/03/23 revealed Resident #10 had an order for a Depakote (seizure and mood disorder medication) level, complete blood count, comprehensive metabolic panel, lipid panel, thyroid stimulation hormone, and vitamin D level dated 07/03/23. Review of the order placed in the laboratory's website dated 07/03/23 from Resident #10 revealed she was to have a complete blood count, Comprehensive metabolic panel, lipid panel, thyroid stimulation hormone, and vitamin D level. It was collected on 07/05/23. Review of the progress notes from 07/01/23 to 07/05/23 revealed no documentation of any laboratory results obtained on 07/03/23, physician notification or response. Review of the laboratory results dated [DATE] revealed her mean corpuscular volume (mcv) was high at 97.6 (normal was 79.0 to 95.0), her mean corpuscular hemoglobin concentration (mchc) was low at 31.9 (normal was 32.2 to 35.3), her neutrophils number was high at 6.33 (normal was 1.56 to 6.13), her monocytes number was high at 1.22( normal was 0.24 to 0.86), her platelets were low at 137 ( normal was 183 to 369) her creatinine was low at 0.42 ( normal was 0.50 to 0.80), her total protein was high at 8.4 (normal was 5.7 to 8.2), and her high-density lipoprotein (HDL cholesterol) was high at 76 (normal was 40-60). There were no Depakote level results documented. On 07/12/23 at 1:35 P.M. an interview with the Director of Nursing verified the Depakote level order 07/03/23 was never obtained. She stated they would notify the physician. On 07/13/23 at 1:48 P.M. an interview with the Administrator revealed the laboraory tests for Resident #10 were collected on 07/05/23 at 1:47 A.M., reported to the facility on [DATE] at 11:27 P.M. the nurse reviewed the results and placed them in the physcian's folder for him to review. On 07/13/23 at 3:35 P.M. an interivew with the Director of Nursing verified there was no documetaton the physcian was notified of Resident #10 laboratory results from 07/05/23. 366087 Page 3 of 4 366087 07/13/2023 Vista Center, The 100 Vista Drive Lisbon, OH 44432

F 0773 This deficiency represents non-compliance identified during the investigation of Complaint Number OH00143569. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 366087 Page 4 of 4