Health inspection·December 28, 2019

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 observation, medical record review, staff interview and facility policy and procedure review the facility failed to ensure blood pressures and/or pulse were obtained for two residents (#2 and #15) prior to receiving antihypertensive medications as physician ordered. This affected one of four residents observed for medication administration and one of five residents reviewed for unnecessary medications. Residents Affected - Few Findings include: 1. Review of Resident #15's medical record revealed an admission date of 06/07/19 with the admitting diagnoses of hypertension, non-rheumatic mitral valve insufficiency and anxiety. Review of the plan of care dated 06/23/19 revealed he was at risk for complications related to the diagnoses of hypertension and the use of antihypertensive medications. Interventions included to administer antihypertensive medications as ordered and obtain blood pressure (BP) readings before administration of the antihypertensive medications and daily. Review of the resident's quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident had clear speech, understood others, made himself understood and had a moderate cognitive deficit as indicated by a Brief Interview for Mental Status (BIMS) score of 10. Review of the resident's monthly physician's orders for December 2019 revealed an order dated 06/07/19 for Lopressor (a medication used to lower BP) 25 milligrams by mouth twice a day with the special instructions to hold the medication if his pulse was less than 60 and/or systolic BP was less than 110 and/or diastolic BP was less than 60. Review of the November and December 2019 Medication Administration Record (MAR) revealed no documented pulse or BP prior to administering the medication Lopressor. On 12/28/19 at 9:06 A.M. observation of Licensed Practical Nurse (LPN) #150 administer Resident #15's morning medication revealed the LPN did not obtain a blood pressure or pulse for the resident prior to administering the medication Lopressor. On 12/28/19 at 10:48 A.M. interview with LPN #150 verified the resident's BP and pulse was not obtained prior to administering the residents medication Lopressor. 2. Review of Resident #2's medical record revealed an admission date of 10/26/16 with the admitting diagnoses of hypertension, Parkinson's disease and anxiety. Page 1 of 3 366107 366107 12/28/2019 Rest Haven Nursing Home 2274 McDermott Pond Creek Road McDermott, OH 45652

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the resident's plan of care dated 02/24/17 revealed she had the potential for hyper/hypotension related to diagnoses of hypertension and receiving antihypertensive medications daily. Interventions included to administer antihypertensive medications as ordered. Review of the resident's quarterly MDS dated [DATE] revealed the resident had unclear speech, usually understands others, usually makes herself understood and no cognitive deficit as indicated by a BIMS score of 13. Review of the resident's monthly physician's orders for December 2019 revealed an order dated 06/07/19 for Propranolol 10 mg by mouth twice a day with the special instructions to hold the medication if his pulse was less than 60 and/or systolic BP was less than 110 and/or diastolic BP was less than 60. Review of the November and December 2019 MAR revealed no documented pulse or BP prior to administering the antihypertensive medication Lopressor. On 12/28/19 10:48 AM interview with LPN #150 verified the resident's BP and pulse were not obtained prior to administering the medication Propranolol. Review of the facility's policy titled, Medication Administration, dated 01/15/19 revealed medications are administered by licensed nurses who are legally authorized to, as ordered by the physician and in accordance with professional standards of practice, in a manner to prevent contamination or infection. Vital signs shall be obtained and recorded as per physician's order. 366107 Page 2 of 3 366107 12/28/2019 Rest Haven Nursing Home 2274 McDermott Pond Creek Road McDermott, OH 45652

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, medical record review and staff interview, the facility failed to maintain acceptable standards of infection of control for one (Resident #73) during pressure ulcer dressing changes. This affected one of two residents reviewed for pressure ulcers. Residents Affected - Few Findings include: Review of Resident #73's medical record revealed an admission date of 12/23/19 with the admitting diagnoses of hypertension, peripheral vascular disease and diabetes mellitus. Review of the admission skin observation tool dated 10/23/19 revealed the resident was admitted to the facility with a Stage IV (Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often includes undermining and tunneling.) pressure ulcer to the right heel measuring 1.4 centimeters (cm) by 0.6 cm by 0.2 cm and a Stage I (An observable, pressure related alteration of intact skin, whose indicators as compared to an adjacent or opposite area on the body may include changes in one or more of the following parameters: skin temperature (warmth or coolness); tissue consistency (firm or boggy); sensation (pain, itching); and/or a defined area of persistent redness in lightly pigmented skin, whereas in darker skin tones, the ulcer may appear with persistent red, blue, or purple hues.) pressure ulcer to her left heel measuring 1.5 cm by 2.0 cm. Review of the resident's nursing admission screening/history dated 12/23/19 revealed the resident was admitted from the local acute care hospital with the diagnoses of urinary tract infection (UTI) for long term care placement. She was alert and oriented to her name only. She was noted to have both long and short term memory problems, confusion and displayed both hallucinations and delusions. The assessment indicated the resident was dependent on staff for activities of daily living. Review of the baseline plan of care dated 12/23/19 revealed the resident had skin impairment upon admission to the facility. Interventions included specialized pressure reduction boots, float heels off the mattress while in bed and low air loss mattress to her bed. Review of the resident's admission physician's orders dated 12/23/19 indicated orders for a low air loss mattress to her bed, encourage her to wear her heel protectors boots as much as she can tolerate, float heels off the mattress while in bed as she can tolerate and cleanse the area to her right heel with normal saline, pat dry, apply maxasorb alginate to wound bed only then cover with a foam dressing twice a day and as needed. On 12/27/19 at 2:39 P.M. observation of Registered Nurse (RN) #160 provide the physician ordered treatment to the resident's right heel pressure ulcer revealed she entered the resident's room and positioned the resident. She removed the specialized pressure reduction boot pulled her sock off. She washed her hands and donned a clean pair of gloves. She then removed the soiled dressing and placed it in the trash can. She cleansed the wound with normal saline and a 4X4 gauze pad, and patted it dry. She then cut a piece of calcium alginate and placed on the wound. She then covered with the wound with a foam dressing. She then removed her gloves and dated the dressing. She replaced the sock and reapplied the specialized pressure reduction boot. RN #160 verified she did not wash her hands or change her gloves after removing the soiled dressing. 366107 Page 3 of 3