Health inspection·December 13, 2023

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff and resident interviews, the facility failed to provide assistance with activities of daily living by not offering a resident showers. This affected one (#10) of three residents reviewed for personal hygiene. The facility census was 96. Residents Affected - Few Findings include: Review of medical record for Resident #10 revealed admission date of 05/25/23. Diagnoses included heart attack, stage four kidney disease, congestive heart failure, peptic ulcer and anxiety. The resident remains at the facility. Review of Resident #10's quarterly Minimum Data Set (MDS) dated [DATE] revealed he required extensive two person assistance for bed mobility, transfers, toileting and supervision for eating. Resident #10's Brief Interview Mental Status (BIMS) was not assessed. Review of Resident #10's care plan for Activities of Daily Living Deficit initiated 05/25/23 documented intervention to provide extensive assistance with bathing. Further review of Resident #10's electronic medical records revealed no documentation of showers/bed baths being offered/ provided. Interview on 12/11/23 at 1:20 P.M. with Resident #10 revealed he did refuse showers, but not bed baths. Resident #10 stated the staff did not offer them (bed baths) to him and added he would like one. Interview on 12/12/23 with the Administrator revealed staff had attempted to give Resident #10 a shower, however he refused due to anxiety of having water pouring on his head due to past occurrences in the military. The Administrator acknowledged water would not cascade over Resident #10's head during a bed bath. The Administrator verified there was no documentation bed baths/showers had been offered or refused. This deficiency represents non-compliance investigated under Complaint Number OH00148920. Page 1 of 4 366100 366100 12/13/2023 Centerville Post Acute 1001 Alex Bell Road Centerville, OH 45459

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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observations and staff and resident interviews, the facility failed to accurately assess, monitor and/or document resident with bruising. This affected two ( #10 and #11) of three residents reviewed for skin breakdown. The facility census was 96. Residents Affected - Few Findings include: 1. Review of medical record for Resident #10 revealed admission date of 05/25/23. Diagnoses included heart attack, stage four kidney disease, congestive heart failure, peptic ulcer and anxiety. The resident remains at the facility. Review of Resident #10's quarterly Minimum Data Set (MDS) dated [DATE] revealed he required extensive two person assistance for bed mobility, transfers, toileting and supervision for eating. Resident #10's Brief Interview Mental Status (BIMS) was not assessed. Observation and interview on 12/12/23 at 1:20 P.M. of Resident #10 revealed multiple, scattered bruising on both of the resident's arms. Resident #10 stated the bruises were due to his blood thinners and old, thin skin. Review of Resident #10's progress note dated 12/06/23 revealed both arms were assessed to have healing bruises which were attributed to compression sleeves. Resident #10 was documented to have no concerns. Review of 12/03/23 and 12/10/23 skin assessment revealed no documentation or assessment of bruising. 2. Review of medical record for Resident #11 revealed admission date of 10/16/23. Diagnoses included hemiplegia non-dominant following stroke, asthma, malignant breast cancer with bone metastasis and dementia. The resident remains at the facility. Review of Resident #11's admission Minimum Data Set (MDS) dated [DATE] revealed a BIMS score of 12 indicating impaired cognition. She required supervision for bed mobility, moderate assistance for transfers, and eating. Review of Resident #11's progress notes and skin assessments from 11/28/23 to 12/07/23 revealed no documentation of bruising. Observation on 12/11/23 at 10:24 A.M. of Resident #11 revealed a healing circular bruise to the upper, proximal aspect of her right arm. Further observations revealed three small, healing bruises were noted to Resident #11's left forearm. Interview on 12/12/23 at 2:52 P.M. with Unit Manager (UM) #32 verified he observed bruising of both arms of Resident #10, and there was no documentation or assessment of bruising on the 12/03/23 or 12/10/23 skin assessment. UM #32 acknowledged there was no accurate description or measurement of the bruises for Resident #10. UM #32 also verified he observed bruising of Resident #11, and there was no documentation or assessment of bruising on the 11/28/23 to 12/07/23 skin assessment. UM #32 acknowledged there was no accurate description or measurement of the bruises for Resident #11. UM #32 366100 Page 2 of 4 366100 12/13/2023 Centerville Post Acute 1001 Alex Bell Road Centerville, OH 45459

F 0684 Level of Harm - Minimal harm or potential for actual harm shared the facility had a policy for skin care management but did not have a policy for skin assessments or wound management. This deficiency is based on incidental findings discovered during the course of this complaint investigation. Residents Affected - Few 366100 Page 3 of 4 366100 12/13/2023 Centerville Post Acute 1001 Alex Bell Road Centerville, OH 45459

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observations, staff interviews and review of facility policy, the facility failed to ensure fall interventions were implemented per the residents care plan. This affected two (#10 and #12) of three residents reviewed for falls. The facility census was 96. Findings include: 1. Review of medical record for Resident #10 revealed admission date of 05/25/23. Diagnoses included heart attack, stage four kidney disease, congestive heart failure, peptic ulcer and anxiety. The resident remains at the facility. Review of Resident #10's quarterly Minimum Data Set (MDS) dated [DATE] revealed he required extensive two person assistance for bed mobility, transfers, toileting and supervision for eating. Resident #10's Brief Interview Mental Status (BIMS) was not assessed. Review of Resident #10's care plan revealed the resident was at risk for falls. There was an intervention initiated 08/23/23 for a low bed. Review of Resident #10's progress notes dated 08/28/23 revealed the resident was found on the floor, laying on his right side after sliding from the bed. Review of Resident #10's fall investigation dated 08/28/23 fall revealed an intervention for low bed was initiated. Observation on 12/11/23 at 11:50 A.M. revealed Resident #10's bed was not in the lowest position. This was verified at 11:54 A.M. by State Tested Nursing Assistant (STNA) #35. 2. Review of medical record for Resident #12 revealed admission date of 08/08/23. Diagnoses included hemiplegia following stroke, heart failure, depression, and anemia. The resident was remains in the facility. Review of Resident #12's quarterly MDS dated [DATE] revealed a BIMS score of 12 indicating impaired cognition. He required set up for eating, maximum assistance for toileting, bed mobility and no documentation of transfers. Review of Resident #12's care plan revealed the resident was a fall risk due to history of falls with an intervention initiated on 09/25/23 to have the bed in lowest position while in bed. Observation on 12/11/23 at 8:42 A.M. revealed Resident #12 appeared to be sleeping and laying on his back. Further observations of Resident #12 revealed the bed was not in the lowest position. This was verified with Registered Nurse (RN) #27 at 8:45 A.M. Review of the facility fall policy last reviewed 06/08/22 documented Staff would identify pertinent interventions to try and prevent subsequent falls. This deficiency represents non-compliance investigated under Complaint Number OH000148920. 366100 Page 4 of 4