Health inspection·October 17, 2019

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based observation, resident interview, visitor interview, and staff interview, the facility failed to maintain comfortable temperatures in the main dining room. This affected seven residents (#13, #30, #47, #6, #272, #59, and #51), as well as a visitor eating lunch in the main dining room. The facility identified 22 residents who were eating lunch in the main dining room. The facility census was 70. Findings include: Observation on 10/15/19 at 11:11 A.M. of the main dining room revealed Resident #13 wrapped in a fleece blanket. The blanket was pulled up to her chin. An interview was attempted with Resident #13, however the resident was not able to respond. Interview on 10/15/19 at 11:13 A.M. with Resident #30, #47 and #6 revealed they were cold and uncomfortable in the dining room. Resident #47 revealed it had been cold in the dining room for over a week and they had been wearing sweaters, and other layers to keep warm. Resident #47 reported they had told the staff, however it was still cold. Observation on 10/15/19 at 11:15 A.M. of the dining room thermostat revealed the temperature was 66 degrees Fahrenheit (F). Interview on 10/15/19 at 11:19 A.M. with Activities Director (AD) #200 verified the temperature in the dining room was 66 degrees (F). AD #200 revealed she did not have a key to unlock the plastic box to adjust the temperature. She was not sure who had the key. Interview on 10/15/19 at 11:23 A.M. with Resident #51, #59, #272, and a visitor revealed it was cold and uncomfortable in the dining room. Resident #59 revealed it had been too cold the dining room for a few days and she had to wear a jacket in the dining room. Resident #59 revealed she wore layers because she was told by staff there was nothing they could do about the temperature. Interview on 10/15/19 at 11:25 A.M. with Dietary Staff (DS) #106 revealed the maintenance staff were the only ones with a key to unlock the thermostat and adjust the temperature. DS #106 verified the dining room was cold and residents were uncomfortable. DS #106 revealed they were not able to make any adjustments themselves. Observation on 10/15/19 at 11:27 A.M. of the main dining room thermostat revealed the temperature was 67 degrees (F). Page 1 of 5 366149 366149 10/17/2019 Williams CO Hillside Country L 09 876 County Rd 16 Bryan, OH 43506

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Interview on 10/15/19 at 11:28 A.M. with Maintenance Staff (MS) #150 verified the maintenance staff were the only ones with a key for the dining room thermostat and the temperature was currently 67 degrees (F) in the main dining room. MS #150 revealed the thermostat had not been switched over from cool to heat yet. MD #150 made the adjustment. Observation on 10/15/19 at 5:07 P.M. of the main dining room revealed the thermostat revealed the temperature was 71 degrees (F). Interview on 10/17/19 at 11:20 A.M. with the Director of Nursing (DON) revealed there was no written policy for environmental temperatures. The DON revealed they followed the regulation requirements to maintain temperatures between 71 degrees and 81 degrees (F). 366149 Page 2 of 5 366149 10/17/2019 Williams CO Hillside Country L 09 876 County Rd 16 Bryan, OH 43506

F 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, review of the facility self reported incident (SRI), resident interview, staff interview, and review of facility policy, the facility failed to implement their abuse policy when an allegation of staff to resident abuse was alleged and not investigated thoroughly. This affected one (#46) of one resident reviewed for abuse The facility census was 70. Residents Affected - Few Findings include: Review of the medical record for Resident #46 revealed the resident was admitted to the facility on [DATE] with diagnoses including chronic kidney disease, Parkinson's Disease, and heart failure. Review of the Minimum Data Set (MDS) assessment completed on 08/19/19 revealed the resident was cognitively intact. Review of the SRI (#180721) dated 09/17/19 revealed Resident #46 reported Nursing Aide (NA) #107 had put him to bed and was a little rough. The SRI also alleged the NA turned off the resident's call light without responding to the resident's needs. Review of the facility's investigation revealed on 09/19/19 at 9:15 A.M. Resident #46 reported to the Director of Nursing (DON) #102 that NA #107 had put him to bed and that it was a little rough and was sat down on his privates. Resident #46 also revealed when the NA rolled him over he about rolled out of bed. Resident #46 revealed he did not believe the NA was trying to harm him, however felt the NA was rougher than the other staff. The facility investigation revealed there had been two staff who had reported Resident #46 felt NA #107 man-handled him and was very rough and had shoved him against the wall. There was no evidence the facility investigated the alleged physical abuse. Resident #46 and the resident's roommate were the only residents interviewed. Interview on 10/15/19 at 10:05 A.M. with Resident #46 revealed NA #107 had dropped him on the bed causing him pain. The resident revealed he had reported the incident to the facility. Interview on 10/17/18 at 11:49 A.M. with Administrator #100 and DON #102 confirmed a physical assessment for Resident #46 had not been completed after the alleged incident. DON #102 confirmed no other residents were interviewed regarding the alleged physical abuse other than Resident #46 and his roommate. Review of facility policy, Abuse and Neglect, effective 10/12/99 and last reviewed on 07/18/19, revealed the facility would thoroughly investigate all reports of alleged abuse and neglect. The facility policy revealed when there is an allegation of abuse by a staff member toward a resident the nurse will assess the resident for any injury. 366149 Page 3 of 5 366149 10/17/2019 Williams CO Hillside Country L 09 876 County Rd 16 Bryan, OH 43506

F 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, review of the facility self reported incident (SRI), resident interview, staff interview, and review of facility policy, the facility failed to investigate an allegation of staff to resident abuse thoroughly. This affected one (#46) of one resident reviewed for abuse The facility census was 70. Residents Affected - Few Findings include: Review of the medical record for Resident #46 revealed the resident was admitted to the facility on [DATE] with diagnoses including chronic kidney disease, Parkinson's Disease, and heart failure. Review of the Minimum Data Set (MDS) assessment completed on 08/19/19 revealed the resident was cognitively intact. Review of the SRI (#180721) dated 09/17/19 revealed Resident #46 reported Nursing Aide (NA) #107 had put him to bed and was a little rough. The SRI also alleged the NA turned off the resident's call light without responding to the resident's needs. Review of the facility's investigation revealed on 09/19/19 at 9:15 A.M. Resident #46 reported to the Director of Nursing (DON) #102 that NA #107 had put him to bed and that it was a little rough and was sat down on his privates. Resident #46 also revealed when the NA rolled him over he about rolled out of bed. Resident #46 revealed he did not believe the NA was trying to harm him, however felt the NA was rougher than the other staff. The facility investigation revealed there had been two staff who had reported Resident #46 felt NA #107 man-handled him and was very rough and had shoved him against the wall. There was no evidence the facility investigated the alleged physical abuse. Resident #46 and the resident's roommate were the only residents interviewed. Interview on 10/15/19 at 10:05 A.M. with Resident #46 revealed NA #107 had dropped him on the bed causing him pain. The resident revealed he had reported the incident to the facility. Interview on 10/17/18 at 11:49 A.M. with Administrator #100 and DON #102 confirmed a physical assessment for Resident #46 had not been completed after the alleged incident. DON #102 confirmed no other residents were interviewed regarding the alleged physical abuse other than Resident #46 and his roommate. Review of facility policy, Abuse and Neglect, effective 10/12/99 and last reviewed on 07/18/19, revealed the facility would thoroughly investigate all reports of alleged abuse and neglect. The facility policy revealed when there is an allegation of abuse by a staff member toward a resident the nurse will assess the resident for any injury. 366149 Page 4 of 5 366149 10/17/2019 Williams CO Hillside Country L 09 876 County Rd 16 Bryan, OH 43506

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 medical record review, staff interview, and facility protocol review, the facility failed to initiate the bowel protocol for one resident (#57) of two reviewed for constipation. The facility census was 70. Residents Affected - Few Findings include: Review of the medical record for Resident #57 revealed the resident was admitted to the facility on [DATE] with diagnoses including Alzheimer's disease, chronic kidney disease sage 4, and congestive heart failure. Review of the most recent Minimum Data Set (MDS) assessment dated [DATE] revealed the resident was severely cognitively impaired. Review of Resident #57's bowel documentation revealed the resident did not have a bowel movement for five consecutive days from 10/10/19 through 10/14/19. Review of Resident #57's Medication Administration Review (MAR) revealed Resident #57 did not receive a suppository or any other medication for constipation. Interview on 10/16/19 at 11:45 A.M. with Licensed Practical Nurse (LPN) #103 confirmed the bowel protocol should have been initiated for Resident #57 after three consecutive days of no bowel movement and it was not. Interview on 10/16/19 at 4:17 P.M. with the Director of Nursing (DON) #102 confirmed according to documentation, Resident #57 had not had a bowel movement for five consecutive days. The DON confirmed the facility's computer system flagged for the bowel protocol to be initiated for Resident #57, however it was not initiated by staff. Review of the Bowel Protocol, dated 10/17/19, revealed if there is no bowel movement for three days the facility is to administer bisacodyl suppository 10 milligrams (mg) rectally every other day as needed. 366149 Page 5 of 5