Health inspection·September 29, 2022

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. Based on record review and staff interview the facility failed to ensure advance directives matched in the electronic health record and paper medical record. This affected one resident (#65) of 18 residents reviewed for advance directives. Findings include: Review of Resident #65's medical record revealed an admission date of 08/23/22 with diagnoses that included nontraumatic intracerebral hemorrhage in cerebellum, dysphagia and hypertension. Further review of the electronic health record (EHR) revealed physician's orders upon admission that Resident #65 had elected advance directives indicating she was a Do Not Resuscitate Comfort Care Arrest (DNRCC-A). Review of the paper medical record found no evidence of any advance directives in place and a Full Code identification paper was in place under the Advance Directives section of the paper medical record. On 09/26/22 at 3:00 P.M. Licensed Practical Nurse (LPN) #543 verified Advance Directives for Resident #65 did not match in the EHR and paper medical record. LPN #543 indicated Resident #65 should have a DNRCC-A form signed by the physician and the resident in the paper medical record, which was not there. Page 1 of 9 366152 366152 09/29/2022 West View Healthy Living 1715 Mechanicsburg Road Wooster, OH 44691

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Based on record review, facility policy and procedure review and interview the facility failed to ensure Resident #177's physician and the dietitian were notified of significant weight changes. This affected one resident (#177) of three residents reviewed for nutrition. Findings include: Review of Resident #177's medical record revealed an admission date of 09/12/22 with diagnoses including diabetes mellitus type two, chronic kidney disease, end stage renal disease and dependence on renal dialysis. Review of the admission Minimum Data Set (MDS) 3.0 assessment, dated 09/16/22 revealed the resident had intact cognition. Review of Resident #177's weighs revealed: On 09/14/22 weight of 169.7 pounds On 09/15/22 weight of 168.4 pounds On 09/17/22 weight of 172.8 pounds On 09/20/22 weight of 193.3 pounds On 09/22/22 weight of 174.1 pounds On 09/24/11 weight of 191.5 pounds On 09/27/22 weight of 192.0 pounds Review of Resident #177's nutrition note, dated 09/23/22 revealed no documentation related to the resident's recent weight fluctuations. Review of Resident #177's nursing notes revealed no evidence the physician or dietitian were notified or addressed the resident's weight fluctuations until 09/27/22. On 09/29/22 at 12:02 P.M. interview with the Director of Nursing confirmed there was no evidence the physician or dietitian were timely notified and addressed Resident #177's weight fluctuations until 09/27/22. Review of the facility policy titled Weight Assessment and Intervention, dated 05/15/19 revealed any weight change of five percent or more since the last weight assessment would be retaken the day for confirmation. If the weight was verified, nursing would immediately notify the dietitian in writing. Verbal notification must be confirmed in writing. A dietitian would respond within 24 hours of receipt of written notification. Review of the facility polity titled Nutrition (Impaired)/Unplanned Wight loss, dated 05/01/19 366152 Page 2 of 9 366152 09/29/2022 West View Healthy Living 1715 Mechanicsburg Road Wooster, OH 44691

F 0580 revealed the staff would report to the physician significant weight gains or losses or any abrupt or persistent change from baseline appetite or food intake. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 366152 Page 3 of 9 366152 09/29/2022 West View Healthy Living 1715 Mechanicsburg Road Wooster, OH 44691

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. Based on record review and staff interview the facility failed to ensure a Preadmission Screening and Review Review (PASARR) assessment was resubmitted for review after a new mental health diagnosis was added for Resident #14. This affected one resident (#14) of one resident reviewed for PASARR assessments. Findings include: Review of Resident #14's medical record revealed an admission date of 03/30/20 with admission diagnoses that included Parkinson's disease, atrial fibrillation and chronic kidney disease. Further review of the medical record revealed on 03/30/20 and 04/24/20 a PASARR review was completed which indicated the resident had no serious mental illness. Review of Resident #14's diagnosis list revealed on 03/20/22 a new diagnosis of psychotic disorder with hallucinations was added. On 06/28/22 a new diagnosis of dementia with behaviors was added. Further review of the medical record found no evidence of a PASARR being submitted after the new serious mental health diagnoses, psychotic disorder with hallucinations and dementia with behaviors were added. Interview with Social Services Designee (SSD) #534 on 09/28/22 at 10:50 A.M. revealed a new PASARR should be completed after a new mental health diagnosis was added. An additional interview with SSD #534 on 09/28/22 at 11:55 A.M. verified there was no evidence of any new PASARR completed for Resident #14 after the new mental health diagnosis on 03/20/22 or 06/28/22. 366152 Page 4 of 9 366152 09/29/2022 West View Healthy Living 1715 Mechanicsburg Road Wooster, OH 44691

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review, facility policy and procedure review and interview the facility failed to ensure proper infection control practices were followed during Resident #53's dressing change to prevent a wound infection. This affected one resident (#53) of four residents reviewed for pressure ulcers. Residents Affected - Few Findings include: Review of Resident #53's medical record revealed an admission date of 12/06/21 with diagnoses including paroxysmal atrial fibrillation, muscle weakness (generalized), and a Stage III pressure ulcer to left buttocks. Review of Resident #53's September 2022 physician's orders revealed an order to cleanse the resident's left buttock open area with house cleanser, pat dry, apply a nickel thick amount of Santyl (medicated ointment) topically to the wound bed, cover with Mesalt (wound dressing), place four by four gauze over area and secure with medipore tape. The dressing was to be changed daily. On 09/27/22 at 2:12 P.M. Licensed Practical Nurse (LPN) #419 was observed to complete Resident #53's dressing/wound care. LPN #419 placed a barrier down on the resident's bedside table and placed supplies on the barrier, she then washed her hands and applied gloves. Using her gloved right hand, LPN #419 grabbed the resident's half full trash can and pulled it closer to the bed. LPN #419 then used her right hand to remove the resident's old dressing and removed the Mesalt from the wound. LPN #419 then obtained wound cleanser and sprayed the wound cleaner on the sponge and used the sponge to clean the wound. LPN #419 used a clean sponge to dry the wound and surrounding area, removed her gloves, and washed hands. She then obtained new gloves, placed a nickel size amount of Santyl on sterile Q-Tip and placed the ointment on the residents wound. She then cut a small square of Mesalt and placed it over wound, covered the area with four by four gauze and secured with tape. After tape was on resident, she used a marker to write the date, time and her initials on the tape. On 09/27/22 at 2:24 P.M. interview with LPN #419 confirmed the above observation and verified proper hand washing and infection control was not followed during Resident #53's dressing change when she used the same gloved hands to touch the trash can and then remove the resident's dressing and clean the area/wound. Review of the facility policy, Hand washing/ Hand Hygiene, dated 08/20/19 revealed the use of soap and water or alcohol-based hand rub should be used after after handling used dressings. 366152 Page 5 of 9 366152 09/29/2022 West View Healthy Living 1715 Mechanicsburg Road Wooster, OH 44691

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. Based on record review and staff interview the facility failed to ensure Resident #65, who had a gastrostomy tube with enteral feeding, was provided water flushes as ordered by the physician. This affected one resident (#65) of one resident reviewed for enteral feedings. Findings include: Review of Resident #65's medical record revealed an admission date of 08/23/22 with admission diagnoses that included nontraumatic intracerebral hemorrhage in the cerebellum, dysphagia and gastrostomy. Review of the admission orders for Resident #65 revealed physician's orders which indicated the resident was to receive no nutritional sources by mouth (NPO) and was to receive enteral feedings via gastrostomy tube (feeding tube through the abdominal wall into the stomach). Further review of the admission physician's orders revealed an order for the enteral feeding product, Jevity 1.5 (nutritional supplement) 237 milliliters (ml) four times daily (QID) with 100 ml water flushes before and after the Jevity 1.5 was administered. Further review of the medical record revealed on 08/26/22, the enteral feeding order was clarified. The enteral feeding remained the same of Jevity 1.5 237 ml QID, but the water flush was not re-ordered into the physician's orders. Review of the Medication Administration Record (MAR) and Treatment Administration Record (TAR) revealed no evidence of any water flushes being administered as ordered on admission after 08/26/22. Interview with Registered Licensed Dietician (RDLD) #556 on 09/27/22 at 3:15 P.M. verified Resident #65 had not received any water flushes by gastrostomy tube since 08/26/22 when the admission orders were clarified and the water flushes were not re-ordered into the physician's orders. 366152 Page 6 of 9 366152 09/29/2022 West View Healthy Living 1715 Mechanicsburg Road Wooster, OH 44691

F 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review, facility policy and procedure review and interview the facility failed to obtain physician's orders for hemodialysis treatments for Resident #177 and failed to ensure the resident's hemodialysis access site was monitored/assessed for patency and/or complications. This affected one resident (#177) of one resident reviewed for hemodialysis. Residents Affected - Few Findings include: Review of Resident #177's medical record revealed an admission date of 09/12/22 with diagnoses including diabetes mellitus type two, chronic kidney disease, end stage renal disease and dependence on renal (hemo)dialysis. Review of the admission Minimum Data Set (MDS) 3.0 assessment, dated 09/16/22 revealed the resident had intact cognition. Review of Resident #177's care plan, dated 09/23/22 revealed the resident was at risk for air embolism, hypotension, muscle cramps, nausea, vomiting, headache, chest pain, fever, chills, and itching related to dependence on hemodialysis. Interventions included observe the resident's graft or fistula site every shift for presence of thrill and bruit, signs and symptoms of infection, and bleeding/bruising, and report any abnormal findings to physician and dialysis center. Review of Resident #177's September 2022 physician's orders revealed the resident's did not have an order to go hemodialysis and did not have an order to assess or monitor his dialysis access site (fistula). Review of Resident #177's September 2022 nursing notes revealed no evidence the facility was assessing the resident's dialysis access site every shift as noted in the 09/23/22 care plan. Review of Resident #177's Hemodialysis Communication forms revealed the resident's dialysis access site was only assessed on 09/14/22, 09/15/22, 09/17/22, 9/20/22 and 09/27/22 prior to leaving for dialysis. On 09/26/22 at 11:45 A.M. Resident #177 was observed to have a fistula to his left arm with a dressing covering. Interview with the resident at the time of the observation revealed he goes to dialysis three times a week on Tuesday, Thursday, and Saturday. The resident denied facility staff assessing his fistula site but stated the staff at dialysis did assess it when he was there. On 09/28/22 at 11:52 A.M. interview with Licensed Practical Nurse (LPN) #537 confirmed Resident #177 did not have hemodialysis orders or orders to assess his dialysis access site. The LPN confirmed there was no evidence of the resident's fistula being assessed each shift as it was care planned to do. LPN #537 denied assessing the site during her shift. On 09/28/22 at 12:12 P.M. interview with the Director of Nursing confirmed the above findings and revealed she would reach out to the physician to obtain orders. Review of the facility policy Care of a Resident with End-Stage Renal Disease, dated 09/2010 revealed residents with end-stage renal disease would be cared for according to currently reconized standards of care including the care of grafts and fistulas. 366152 Page 7 of 9 366152 09/29/2022 West View Healthy Living 1715 Mechanicsburg Road Wooster, OH 44691

F 0814 Dispose of garbage and refuse properly. Level of Harm - Potential for minimal harm Based on observation, facility policy and procedure review and interview the facility failed to properly dispose of garbage and refuse in outside dumpsters. This had the potential to affect all 72 residents residing in the facility. Residents Affected - Many Findings include: On 09/28/22 at 8:00 A.M. observation of the outside dumpsters revealed there was debris laying on the ground outside of the second dumpster and a garbage bag laying next to the third dumpster. On 09/28/22 at 8:03 A.M. interview with Maintenance #455 and Maintenance #548 confirmed the above findings. Review of the facility policy Food-related Garbage and Refuse Disposal,dated 06/30/19 revealed outside dumpsters would be kept free of surrounding litter. 366152 Page 8 of 9 366152 09/29/2022 West View Healthy Living 1715 Mechanicsburg Road Wooster, OH 44691

F 0881 Implement a program that monitors antibiotic use. Level of Harm - Minimal harm or potential for actual harm Based on review of the infection control tracking log and staff interview the facility failed to ensure monthly completion of the infection control tracking log. This had the potential to affect all 72 residents residing in the facility. Residents Affected - Many Findings include: Review of the Antibiotic Stewardship program revealed the facility would complete monthly tracking of resident antibiotic use/infection. However, the monthly antibiotic use tracking log form did not contain any evidence of location/room/unit of resident, signs and symptoms, x-ray and/or culture and results, healthcare acquired or community acquired infection, if the infection met antibiotic treatment criteria, resident isolation status if required and resolution date. In addition, review of the facility infection control tracking log revealed the last month recorded/completed was January 2020. The facility failed to provide any additional evidence of infection control tracking. On 09/29/22 at 11:20 A.M. interview with the Director of Nursing verified the facility was not completing a monthly infection log/tracking form with the name of the resident, location of resident, signs and symptoms, type of infection, x-ray and/or culture and results, healthcare acquired or community acquired, if an antibiotic used met treatment criteria, resident isolation status if required and resolution date. 366152 Page 9 of 9