Health inspection·October 23, 2023

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, and staff interview, the facility failed to ensure urinary intermittent straight catheterization was provided in accordance with physician orders. This affected one (#01) of three sampled residents reviewed for urinary catheterization. Facility census 52. Findings include: Review of the medical record for Resident #01, revealed the resident was admitted to the facility on [DATE] with the diagnosis including, non-pressure chronic ulcer to back, paraplegia, type 2 diabetes mellitus, osteomyelitis, pressure ulcer of sacral region, varicose veins with ulcer to lower extremity, and hypertension. Review of the Minimum Data Set (MDS) assessment 3.0 dated 08/27/23 for Resident #01, revealed the resident was assessed with intact cognition, able to make needs known, dependent on staff for activities of daily living, utilized an ostomy and required intermittent catheterization. Review of the physician orders dated 08/14/23 for Resident #01, revealed the resident was ordered to be catheterized via a straight catheter (device used to empty the bladder) every six hours and as needed (PRN) due to paralysis and urinary retention. The orders dated 08/15/23 revealed the staff would document urinary output every shift. Review of the August 2023 treatment administration records (TARs) for Resident #01 revealed no documented evidence the facility provided the resident with a straight catheterization (cath) every six hours as ordered. The TARs indicated the resident did not receive a straight cath every six hours as ordered on the following dates: 08/15/23, 08/16/23, 08/18/23 08/19/23 08/21/23, 08/22/23, 08/24/23, 08/26/23, 08/27/23, 08/28/23 and 08/31/23. The TARs on those dates were marked with an x for the missed procedures. The TARs indicated no straight cath was performed for the entire day on 08/17/23 and no documented evidence a straight cath was performed on 08/20/23 (day shift), 08/23/23 (night shift), and 08/30/23 (night shift). The TARs also indicated no urinary output was recorded on 08/17/23 (day and night shifts), 08/23/23 (day and night shifts) and 08/30/23 (night shift) Review of the September 2023 TARs for Resident #01, revealed the resident was only scheduled for straight cath once during the day shift and once during the night instead of the ordered every six hours. The TARs indicated the resident did not receive a straight cath every six hours as ordered from 09/01/23 through 09/22/23 when the orders were discontinued. The TARs revealed no documented evidence the resident received a straight cath on 09/10/23 (night shift), 09/15/23 (day shift), 09/18/23 (night shift), and 09/21/23 (day shift). The TARs also indicated no urinary output was recorded for Page 1 of 4 366097 366097 10/23/2023 Fulton Manor Nursing & Rehab C 723 South Shoop Avenue Wauseon, OH 43567

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the resident on 09/03/23 (night shift), 09/08/23 (day shift), 09/10/23 (night shift), 09/15/23 (day shift) 09/16/23 (day shift), 09/18/23 (night shift) and 09/21/23 (day shift) Interview with Director of Nursing (DON) on 10/23/23 at 11:25 A.M. confirmed Resident #01 was not provided with intermittent urinary catheterization every six hours as ordered by the physician and confirmed the resident's urinary output was not recorded as ordered. This deficiency represents non-compliance investigated under Complaint Number OH00146874. 366097 Page 2 of 4 366097 10/23/2023 Fulton Manor Nursing & Rehab C 723 South Shoop Avenue Wauseon, OH 43567

F 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** THE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NON-COMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Residents Affected - Few Based on medical record review, staff interview, review of facility policy and facility documentation, the facility failed to ensure medications were administered without significant errors. This affected one (Resident #01) of the six residents reviewed for medication administration. The facility census 52. Findings include: Review of the medical record for Resident #01, revealed the resident was admitted to the facility on [DATE] with the diagnosis including, non-pressure chronic ulcer to back, paraplegia, diabetes mellitus, osteomyelitis, pressure ulcer of sacral region, varicose veins with ulcer to lower extremity, and hypertension. Review of the Minimum Data Set (MDS) assessment 3.0 dated 08/27/23 for Resident #01, revealed the resident was assessed with intact cognition, able to make needs known, dependent on staff for activities of daily living, utilized an ostomy, required intermittent catheterization and received antibiotics. Review of the physician orders dated 08/15/23 for Resident #01, revealed the resident was ordered to receive intravenous (IV) antibiotic administration of Cefepime HCL one gram (gm) in 50 milliliters (ml) every eight hours. Review of the nurse's notes dated 09/13/23 at 3:56 P.M. for Resident #01 and authored by Registered Nurse (RN) #200, revealed the resident was given an incorrect IV antibiotic this morning and was discovered by this nurse. The physician was notified and ordered to continue giving the ordered antibiotic as scheduled and continue monitoring the resident for adverse reactions. Review of a facility document titled Employee Coaching Form dated 09/14/23 was provided to RN #201 due to giving the incorrect antibiotic to Resident #01 on 09/13/23. Review of a facility document titled Incident Review dated 09/15/23 at 6:41 P.M., revealed a medication error was recorded for Resident #01. The documented noted on 09/13/23 at 2:30 P.M., RN #200 went into Resident #01's room to hang the scheduled IV antibiotic, Cefepime HCL one gm/50 ml and upon removal of the previous bag hung by third shift nurse (RN #201), RN #200 noticed it was the wrong dose, wrong medication, and the wrong patient's name on the bag. Resident #01 was given Ceftriaxone two grams (gms) /100 ml and the entire medication had already been infused. The physician was unaware of the situation and was notified at 3:00 P.M. The physician noted if there were no adverse reactions from the resident, continued with the scheduled IV antibiotics and to continue monitoring the resident for any adverse effects. Review of the facility policy titled Medication Administration Policy revised on 09/19/23, revealed medications shall be administered only upon the order of a physician or other licensed independent practitioner who is authorized to provide care to the resident. The person administering the medication will verify the accurate medication, dosage, route of administration, appropriate time for administration, and correct resident. 366097 Page 3 of 4 366097 10/23/2023 Fulton Manor Nursing & Rehab C 723 South Shoop Avenue Wauseon, OH 43567

F 0760 Level of Harm - Minimal harm or potential for actual harm Interview with the Director of Nursing (DON) on 10/23/23 at 11:25 A.M., verified Resident #01 received the wrong IV antibiotic which resulted in a medication error. The DON stated corrective action was taken following the incident. The deficiency was corrected on 09/29/23 after the facility implemented the following corrective actions. Residents Affected - Few On 09/13/23 at 3:00 P.M., the physician was notified of the medication error and no new orders were obtained. On 09/14/23, RN #201 received an Employee Coaching due to giving Resident #01 an incorrect antibiotic. On 09/19/23, the facility revised their medication administration policy to include medication packages to be electronically scanned which will perform a double check to indicate if the correct medications are being dispensed. After scanning the medications, the nurse administering the medication may remove it from the packaging and prepare it as necessary to be given to the resident. The nurse then returns to the electronic medication administration record (MAR) and electronically signs all medications that were provided and accepted by the resident. On 09/21/23, 10/12/23, and 10/17/23, medication administration observation and audits were conducted by the DON. On 09/28/23, all facility nurses were given in-service training in the prevention of medication errors and the medication administration policy, including six rights and three checks. On 10/23/23 between 7:51 A.M. and 8:32 A.M., observation of medication administration with Licensed Practical Nurse (LPN) #300 and RN #204 noted medications were given to three residents (#04, #05, and #06) in accordance with the physician orders. On 10/23/23 at 1:14 P.M., an interview with LPN #300 confirmed attending in-service training related to medication error prevention. On 10/23/23 at 1:20 P.M., an interview with RN #205 confirmed attending in-service training related to medication error prevention. This deficiency represents non-compliance investigated under Complaint Number OH00146874. 366097 Page 4 of 4