Health inspection·May 19, 2022

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 Based on medical record review, family and staff interviews, and review of facility policy, the facility failed to provide oral care to residents who were dependent upon staff for oral care. This affected one resident (#29) of one residents reviewed for Activities of Daily Living (ADLs). The facility census was 47. Residents Affected - Few Findings included: Review of the medical record for Resident #29 revealed an admission date of 03/01/18. Diagnoses included hypothyroidism, seizures, retention of urine, personal history of traumatic brain injury (TBI), dysphagia, abnormal posture, hypertension, anxiety, moderate intellectual disability, and cognitive communication deficit. Review of the annual Minimum Data Set (MDS) assessment, dated 04/08/22, revealed Resident #29 was severely cognitively impaired, required extensive assistance with Activities of Daily Living (ADLs), and did not reject care. Review of the plan of care, revised 12/28/20, revealed Resident #29 had an ADL self care performance deficit related to impaired balance, limited mobility, musculoskeletal impairment, TBI, seizures. Resident #29 refused care at times and could be resistive, combative, and refused to allow staff to brush teeth and shave at times. Interventions included if care refused, attempt again later and oral care daily and as needed. Additional review revealed Resident #29 had potential for oral/dental problems due to resistance to brushing and flossing teeth. Interventions included brush teeth after every meal and at bedtime and oral care per routine and as needed. Review of physician orders revealed Resident #29's teeth were to be brushed three times daily and flossed one time daily. Review of dentist progress notes dated 11/18/21 and 02/02/22 revealed Resident #29 had plaque build-up and needed to brush and floss teeth after each meal. Review of a dentist progress note dated 05/09/22 revealed Resident #29 had generalized plaque and needed to brush and floss after every meal and at bedtime. Review of State Tested Nurse Aide (STNA) documentation from 04/01/22 through 05/16/22 revealed Resident #29 was to have his teeth brushed and flossed after each meal, document refusals. Additional review revealed oral care was not documented as provided or refused on 04/01/22, 04/02/22, 04/08/22, 04/17/22, 04/23/22, 04/27/22, 05/03/22, and 05/04/22. Further review revealed not applicable was documented on 04/05/22, 04/06/22, 04/12/22, 04/26/22, 04/28/22, 05/02/22, 05/07/22, 05/08/22, and Page 1 of 3 366131 366131 05/19/2022 Bellevue Care Center One Audrich Square Bellevue, OH 44811

F 0677 05/12/22. Level of Harm - Minimal harm or potential for actual harm Review of nursing progress notes from 04/01/22 through 05/17/22 revealed no documentation Resident #29 refused ADL care, including oral care. Additional review of a note dated 05/09/22 revealed Resident #29 returned from a dental appointment and to encourage teeth brushing and flossing after each meal. Residents Affected - Few Interview on 05/16/22 at 11:42 A.M. of Resident #29's family member revealed the facility did not regularly brush the Resident's teeth. The family member stated she had to take Resident #29 to the dentist every two to three months to have his teeth cleaned because the facility did not adequately keep up with oral care. Interview on 05/17/22 at 9:03 A.M. of Licenses Practical Nurse (LPN) #565 revealed Resident #29 required extensive assistance for all care, including oral hygiene. LPN #565 stated Resident #29 could be resistive to care but staff just needed to re-approach a few minutes later and he would accept care. Interview on 05/17/22 at 9:13 A.M. of State Tested Nurse Aide (STNA) #508 revealed Resident #29 would resist oral care but would generally accept care if re-approached at a later time. Interview on 05/17/22 at 10:38 A.M. of STNA #512 revealed Resident #29 required extensive assistance with all areas of care, including oral care. While Resident #29 was not always cooperative with care, STNA #512 stated joking with the Resident was usually effective and Resident #29 would accept care. STNA #29 stated documentation of care provided to residents, including refusals of care, was documented in the resident's electronic medical records. Interview on 05/17/22 at 11:01 A.M. with the Director of Nursing (DON) revealed nursing staff would update resident physician orders based off any recommendations provided by the physician, including the dentist. The DON verified Resident #29's orders should have been updated to reflect the most recent dentist recommendation, dated 05/09/22, which included brushing and flossing after every meal and at bedtime. The DON stated nursing staff may have spoke with the dentist and received different orders, but she would have to look into whether that happened. The DON verified dental care was not documented as provided or refused by Resident #29 in the STNA documentation for the above identified dates or in nursing progress notes. The DON stated all care provided and refusals should be documented in the resident's electronic medical record (EMR) but she would have to check to see if staff had developed another way of documenting Resident #29's care or refusals of care. The DON also stated she would need to check if any additional orders had been provided by Resident #29's dentist. Follow up interview on 05/17/22 at 1:50 P.M. the DON verified no additional documentation was available related to Resident #29 being provided assistance with oral care or the resident refusing care. In addition, the DON verified there was no documentation of nursing staff contacting the dentist and/or received any other instructions different from the 05/09/22 dentist progress note. The DON stated the oral care physician order was discontinued because oral hygiene was care STNAs should be providing without a physician order. Review of facility policy titled, Morning Care/AM Care, revised 06/15/20, revealed morning care, including oral care, would be offered each day to promote resident comfort, cleanliness, grooming and general wellbeing. 366131 Page 2 of 3 366131 05/19/2022 Bellevue Care Center One Audrich Square Bellevue, OH 44811

F 0677 Review of facility policy titled, Evening Care/PM Care, revised 06/15/20, revealed evening care, including oral care, would be offered to residents to promote personal hygiene, comfort, relaxation, and safety. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 366131 Page 3 of 3