Health inspection·October 24, 2023

F 0744 Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia. 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, observation, resident interview, and staff interview, the facility failed to develop and implement appropriate interventions for a resident with dementia. This affected one (#16) of three residents reviewed for dementia care. The facility census was 53. Residents Affected - Few Findings include: Review of Resident #16's medical record revealed an admission date of 04/19/21. Diagnoses included bipolar disorder, vascular dementia, depression, dysphasia, and vitamin deficiency. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #16 was cognitively impaired and was rarely, if ever, understood. Resident #16 required extensive assistance with bed mobility, limited assistance with transfers, and supervision for walking in the hallways. Review of the plan of care dated 09/11/23 revealed Resident #16 had impaired cognition and wandering behaviors. Interventions included assess risk factors, family conferences to discuss residents attempts to leave, involve in activities of choice, redirect as needed and stop sign at frequented exits. The plan of care plan did not address interventions related to Resident #16 wandering into other resident rooms and sleeping in their chairs and beds. Review of nursing progress notes from 08/01/23 to 10/23/23 revealed Resident #16 regularly wandered the unit and could usually be redirected. Interview on 10/23/23 at 11:30 A.M. with Resident #14 revealed Resident #16 constantly wandered into resident rooms and would sleep in other resident's chairs and beds. Interview on 10/23/23 at 11:45 A.M. with Resident #7 revealed Resident #16 wandered the secured unit and would enter other resident's rooms and sleep in their bed and chair. While Resident #7 had a velcro stop sign across her door, she stated the sign did not discourage Resident #16 from wandering into her room. Interviews on 10/23/23 from 4:21 P.M. to 4:30 P.M. with State Tested Nursing Aide (STNA) #66 and Licensed Practical Nurse (LPN) #99 revealed they were unaware Resident #16 wandered into other resident rooms, believed the resident only wandered in the common areas, and were unaware of any interventions to address Resident #16's wandering. Interview on 10/23/23 at 4:30 P.M. with LPN #95 revealed Resident #16 wandered into other resident Page 1 of 4 366170 366170 10/24/2023 The Sanctuary at Tuttle Crossing 4880 Tuttle Road Dublin, OH 43017

F 0744 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few rooms, but was usually easily redirected. LPN #95 stated staff attempted to monitor Resident #16, but the resident's wandering was constant. Observations from 9:50 A.M. to 4:50 P.M. revealed Resident #16 had wandered constantly throughout the day and went into residents rooms on several occasions, requiring staff redirection. Resident #16 was not engaged in activities and would be directed to sit on her own in the common area, where she would remain for 30 to 45 seconds before getting up and wandering again. No activities were observed on the unit until approximately 4:00 P.M. Interview on 10/23/23 at 4:55 P.M. with the Director of Nursing (DON) and Corporate Nurse (CN) #100 revealed Resident #16 had known wandering behaviors and stated the resident had plan of care interventions related to going in other resident rooms. Upon review of the plan of care, the DON acknowledged an entry related to wandering into other resident rooms was not entered until today (10/23/23). The DON and CN #100 revealed Resident #16 had interventions in place for staff redirection and activity involvement to decrease wandering and confirmed the activities were scarce on the secured unit. CN #100 verified there were no activities offered to potentially engage Resident #16 and decrease wandering behavior until approximately 4:00 P.M. CN #100 and the DON verified, while they were uncertain Resident #16 would participate in activities, more opportunities should be offered to engage the resident. This deficiency represents non-compliance investigated under Complaint Number OH00146837. 366170 Page 2 of 4 366170 10/24/2023 The Sanctuary at Tuttle Crossing 4880 Tuttle Road Dublin, OH 43017

F 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and staff interview, the facility failed to ensure therapeutic diets were served according to physician order. This affected one (#19) of three residents reviewed for diet order and preferences. The facility identified five residents with physician ordered pureed diets. The facility census was 53. Findings include: Review of Resident #19's medical record revealed an admission date of 07/08/22. Diagnoses included parkinson's disease, metabolic encephalopathy, malnutrition, dementia, atrial fibrillation, adult failure to thrive, and kidney disease. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #19 was moderately cognitively impaired. Review of the plan of care dated 09/27/23 revealed Resident #19 had a nutritional problem. Interventions included food preferences from family, informed consent waiver signed by resident, menu in room per family request, offer substitutes as requested, and serve diet as ordered. Review of a physician order dated 09/20/23 revealed Resident #19 was on a regular diet, pureed consistency. Review of a facility Dining and Nutrition Informed Choice Documentation, dated 02/22/23, revealed Resident #19 and the resident's representatives were educated on the medical recommendation for Resident #19 to have a nothing by mouth (NPO - no oral intake) diet. The education included information on food texture options and the potential risks and benefits of each diet texture. Resident #19 chose to accept the risks of a pureed diet with thin liquids and the document was signed by the resident/representative, Director of Nursing (DON), the Dietary Manager (DM), and physician. Observation on 10/24/23 at 11:51 A.M. of lunch meal service revealed Resident #19 was served a regular texture grilled cheese sandwich, applesauce, and a cookie. Further observation of Resident #19's meal ticket revealed the resident received pureed texture meals. Concurrent interview with State Tested Nurse Aide (STNA) #66 verified Resident #19's meal ticket indicated the resident received a pureed diet and the resident was served a regular texture sandwich and cookie. STNA #66 stated Resident #19 frequently received grilled cheese sandwiches, which were not of pureed consistency. Interview on 10/24/23 at 12:01 P.M. with the DON and Corporate Nurse (CN) #100 revealed Resident #19 and family signed a waiver that stated he could eat any food texture. Review of the waiver, with the DON, confirmed the document indicated an NPO diet was recommended, education was provided on the risks and benefits of each diet texture, and the resident/representative chose a pureed diet with thin liquids. The DON and CN #100 verified the document did not indicate any variances from a pureed texture diet. Interview on 10/23/23 at 12:10 P.M. with DM #72 verified Resident #19 was frequently served grilled cheese sandwiches, which were not pureed consistency. DM #72 stated the kitchen did not have a copy of the waiver signed by the resident/representative and had just been told by management to give 366170 Page 3 of 4 366170 10/24/2023 The Sanctuary at Tuttle Crossing 4880 Tuttle Road Dublin, OH 43017

F 0805 Resident #19 grilled cheese sandwiches. Level of Harm - Minimal harm or potential for actual harm This deficiency represents non-compliance investigated under Complaint Number OH00146837. Residents Affected - Few 366170 Page 4 of 4