Health inspection·March 7, 2019

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, staff interview and policy review, the facility failed to ensure a resident's dignity was maintained by appropriately covering a urinary catheter collection bag for one (#153) of one resident reviewed for urinary catheters. The facility census was 50. Findings include Medical record review revealed Resident #153 was admitted to the facility on [DATE]. Diagnoses included dysphagia, Parkinson's disease, vascular disease, obstructive and reflux uropathy, Barrett's esophagus, depressive disorder, type two diabetes mellitus, hypothyroidism, hypertension, duodenal ulcer, and pneumonitis due to inhalation of food and vomit. Review of a physician order dated 02/20/19 revealed Resident #153 was ordered a urinary catheter for obstructive and reflux uropathy. Observation on 03/04/19 at 2:42 P.M. revealed Resident #153 had an uncovered urinary catheter bag. Observation on 03/05/19 at 12:48 P.M. also revealed Resident #153 had an uncovered urinary catheter drainage bag. Interview on 03/05/19 at 12:50 P.M., Licensed Practical Nurse (LPN) #17 verified Resident #153's urinary catheter bag was uncovered and should be covered. LPN #17 revealed she would provide Resident #153 with a new urinary catheter bag with a cover. Review of the policy titled Catheter Care, revised 12/2013, revealed no guidelines for staff to cover a urinary catheter bag. Page 1 of 5 366118 366118 03/07/2019 Elms Retirement Village Inc 136 S Main St Wellington, OH 44090

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. Based on observation, medical record review, staff interview, and review of facility policy, the facility failed to ensure fall interventions were in place for one (#3) of three sampled residents reviewed for accidents. The facility census was 50. Findings Included: Medial record review for Resident #3 revealed an admission date of 11/03/17. Diagnoses included history of falls, vascular dementia with behavioral disturbance, fracture of lower end left femur, and subsequent encounter for closed fracture with routine healing. Review of the physician orders dated 07/17/18 revealed Resident #3 was to have floor mats to bilateral sides of bed while occupied. Review of the care plan dated 12/10/18 revealed the resident had a potential for falls. Interventions included floor mats to bilateral sides of the bed. Observations on 03/04/19 at 9:17 A.M. and on 03/05/19 at 9:17 A.M. of Resident #3 in bed without bilateral floor mats. Interview on 03/05/19 at 9:20 A.M., License Practical Nurse (LPN) #17 verified the floor mat was not in place on both sides of the bed. LPN #17 indicated the mat was on one side of the bed only and should be on each side of the bed. Review of the facility policy titled Fall Management and Incident Interventions Protocol Intervention Protocol, dated 12/2013, indicated interventions will be implemented and evaluated in ordered to decrease the incidence of resident incident's including falls, as well as to minimize the risk of resident injury. 366118 Page 2 of 5 366118 03/07/2019 Elms Retirement Village Inc 136 S Main St Wellington, OH 44090

F 0727 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. Based on review of nursing schedules and staff interviews, the facility failed to ensure they used the services of a Registered Nurse (RN) for at least eight consecutive hours a day, seven days a week. This affected all 50 residents residing in the facility. Findings include: Review of the licensed nursing schedules for February 2019 and March 2019 identified a lack of a RN on 02/02/19, 02/03/19, 02/16/19, 02/17/19, 03/02/19, and 03/03/19. Interview on 03/05/19 at 3:25 P.M., State Tested Nurse Aide (STNA) #2, the facility scheduler, confirmed the facility did not have a RN employed to work every other weekend and verified the lack of an RN on duty on the above days. 366118 Page 3 of 5 366118 03/07/2019 Elms Retirement Village Inc 136 S Main St Wellington, OH 44090

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, staff interview and policy review, the facility failed to ensure a medication cart was locked. This had the potential to affect 26 residents (#1, #6, #10, #15, #17, #18, #19, #22, #23, #26, #27, #29, #33, #34, #35, #38, #40, #41, #42, #43, #48, #50, #51, #52, #53, and #153) with medications stored in the unlocked cart as identified by the facility. The facility census was 50. Findings include: Observation on 03/05/19 at 5:13 P.M. revealed the medication cart in the 300 Hall was unlocked and unattended. Interview on 03/05/19 at 5:14 P.M., Registered Nurse (RN) #73 verified she had left the medication cart unlocked and unattended. Interview on 03/06/19 at 2:26 P.M. with the Administrator revealed medications for 26 residents (#1, #6, #10, #15, #17, #18, #19, #22, #23, #26, #27, #29, #33, #34, #35, #38, #40, #41, #42, #43, #48, #50, #51, #52, #53, and #153) were stored in the unlocked medication cart. Review of the facility policy titled Medication Storage, last revised 12/2013, revealed medication carts should remained locked until medication was needed for current use. 366118 Page 4 of 5 366118 03/07/2019 Elms Retirement Village Inc 136 S Main St Wellington, OH 44090

F 0926 Have policies on smoking. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review, resident interview, staff interview and policy review, the facility failed to follow secure resident smoking materials per the facility policy. This affected one (#29) of two residents the facility identified as smokers. The facility census was 50. Residents Affected - Few Findings include Medical record review revealed Resident #29 had an admission date 01/18/18. Diagnoses included chronic obstructive pulmonary disease, depressive disorder, anxiety, hypertension, and Parkinson's disease. Review of the annual Minimum Data Set (MDS) assessment, dated 01/10/19, revealed Resident #29 used tobacco. Observation on 03/04/19 at 11:44 A.M. revealed four packs of cigarettes and two lighters were present on Resident #29's bedside table. Interview on 03/04/19 at 11:44 A.M., Resident #29 revealed a family member had brought him the cigarettes. Interview on 03/04/19 at 11:48 A.M., License Practical Nurse (LPN) #17 verified Resident #29 had four packs of cigarettes and two lighter present in his room. LPN #17 revealed resident were not allowed to have smoking materials in their rooms. LPN #17 then removed the cigarettes and lighter from the room. Review of the policy titled Smoking, last revised 10/2014, revealed residents would not be permitted to keep lighters, matches, or any tobacco products in their rooms. These products would be stored in designated areas. 366118 Page 5 of 5