Health inspection·August 16, 2018

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, staff and resident interview and policy review the facility failed to ensure a resident with limited range of motion received range of motion services. The facility did not indicate the reason the resident was not receiving services. This affected one (Resident #8) of one resident reviewed for positioning and mobility. The facility census was 84 . Findings include: Medical record review revealed Resident #8 was admitted on [DATE]. Diagnoses included multiple sclerosis, diabetes mellitus type two, hypothyroidism, hypertension, anemia, neuromuscular dysfunction of the bladder, and polyneuropathy. Review of the minimum data set assessment admission assessment for functional limitation in range of motion dated 05/04/18 revealed Resident #8 had an upper extremity impairment on one side and lower extremity impairments on both sides. Further review of the admission assessment revealed Resident #8 was cognitively intact. Review of referral therapy screens dated 05/09/18 revealed Resident #8 had limited range of motions in the bilateral lower extremities and limited range of motion of the right upper extremity. Resident #8 was recommended for occupational therapy (OT) for wheel chair positioning only. There was no recommendation for physical therapy or restorative services. Review of an OT note dated 05/23/18 revealed Resident #8 had completed 50% of normal range of motion in right upper and lower extremities and 25% of normal range of motion in left upper and lower extremity. Review of an occupational therapy discharge summary note dated 06/20/18 revealed Resident #8 received services for wheel chair positioning. There were no recommendations for restorative services. Review of an interdisciplinary patient review form dated 08/08/18 revealed Resident #8 had no changes in range of motion or contractures. There were no recommendations for restorative services including active or passive range of motion. Review of an interdisciplinary patient review form dated 08/15/18 revealed Resident #8 had no worsening contracture or change in status. Staff would continue to monitor for contracture management and declines related to comorbidities on a regular basis. There were no recommendations for physical therapy or restorative services including active or passive range of motion. Page 1 of 3 366166 366166 08/16/2018 Brethren Care Village Health Care Center 2000 Center St Ashland, OH 44805

F 0688 Level of Harm - Minimal harm or potential for actual harm Review of Resident #8's physician orders from 04/27/18 through 08/14/18 revealed no orders for restorative services. Observations on 08/14/18 at 1:05 P.M. and 08/15/18 at 8:31 A.M. revealed Resident #8 was unable to use her right arm and hand. Resident #8 had contractures of the bilateral lower extremities. Residents Affected - Few Interview on 08/14/18 at 1:25 P.M. with the restorative Registered Nurse (RN) #300 revealed Resident #8 had not been referred for restorative services. Interview on 08/14/18 at 1:32 P.M. with restorative State Tested Nursing Assistant (STNA) #100 revealed Resident #8 was not on her list of residents who received restorative services for range of motion. Interview on 08/15/18 at 12:55 P.M. with Resident #8 revealed staff had not offered her any restorative services. Resident #8 revealed staff had not performed active or passive range of motion. Resident #8 further revealed she would be willing to participate in restorative exercises and range of motion services if offered. Interview on 08/16/18 at 8:22 A.M. with the Physical Therapy Director (PTD) #80 revealed Resident #8 had not experienced any decline in range of motion. Further interview with PTD #80 revealed there had been no recommendations for restorative services or range of motion for Resident #8. Review of the Restorative policy dated 11/25/13 revealed residents who showed impairment or decline would be referred to the therapy department for screening by a member of the nursing team. The therapist treating the resident would assess the progress being made and determine the need for restorative programs once therapy has ended. Further review of the policy revealed restorative programs included toileting, splinting, dining, ambulation, transfers, bed mobility, communication, grooming, passive range of motion, active range of motion and prosthesis device wearing for amputations. 366166 Page 2 of 3 366166 08/16/2018 Brethren Care Village Health Care Center 2000 Center St Ashland, OH 44805

F 0883 Develop and implement policies and procedures for flu and pneumonia vaccinations. 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 interviews, review of facility policy and procedures and review of Center for Disease Control (CDC) guidelines the facility failed to ensure one (Resident #52) of five sampled residents was offered the flu and pneumococcal vaccine in the past year. The census was 84. Residents Affected - Few Findings include: Review of Resident #52's medical record identified admission to the facility occurred on 08/31/11. Diagnosis included tremor, anxiety, chronic obstructive pulmonary disease (COPD) and bipolar disorder. Resident #52 was over [AGE] years of age. Further review of the medical record revealed in 2011, Resident #52 received pneumococcal polysaccharide vaccine (PPSV23). There was no evidence Resident #52 was offered any additional pneumococcal vaccines. Interview with the facility Director of Nursing (DON) on 08/15/18 at 1:54 P.M. confirmed there was no evidence in the medical record of any additional pneumococcal vaccines for Resident #52 since 2011. Review of the facilities pneumococcal vaccination policy dated 04/25/16 identified each resident will be offered the pneumococcal vaccinations in reference to the CDC Guidelines. Review of the CDC guidelines dated 11/30/15, which was attached to the facilities policy identified timing for pneumococcal vaccines for adults 65 years or older, that have received one dose of PPSV23 and no doses of PCV13 (new pneumococcal vaccine) should receive one dose of PCV13 at least one year after the dose of PPSV23. 366166 Page 3 of 3