Health inspection·August 18, 2022

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on resident interview, medical record review, fall investigation review and staff interview the facility failed to implement fall interventions as ordered. This affected one (Resident #37) of three residents reviewed for accidents. The census was 40. Findings included: On 08/15/22 at 11:17 A.M., interview with Resident #37 revealed a fall last month during care with a staff member, and she slid off her bed and was lowered to the ground by the staff member. Review of Resident #37's medical record revealed an admission date of 01/27/21 with diagnoses that included Parkinson's disease and difficulty walking. Review of Resident #37's Minimum Data Set (MDS) 3.0 quarterly assessment with a reference date of 04/22/22 indicated Resident #37 had an independent cognition level and required two staff members for assistance with transfers. Review of Resident #37's nurse's notes revealed on 07/09/22 Resident #37 slid off the bed when sitting on the edge of the bed being assisted by staff with morning care. Review of the fall investigation completed following the fall on 07/09/22 revealed a State Tested Nurse Aide (STNA) was assisting Resident #37 with morning hygiene and dressing, when Resident #37 lost her balance and slid off the bed. The STNA lowered Resident #37 to the floor. A new intervention was implemented following the fall and indicated Resident #37 was to have two staff members assist with all care. Review of Resident #37's physician orders revealed on 07/18/22 a new physician's order in place indicating two staff members for all resident care. Review of the STNA Activities of Daily Living (ADL) Tasks revealed documentation of numerous days with one staff member providing dressing and hygiene assistance. Dressing assistance documentation indicated one staff member on 07/20/22 A.M., 07/21/22 P.M., 07/28/22 A.M., 08/01/22 A.M., 08/04/22 P.M., 08/05/22 A.M., 08/07/22 P.M., 08/08/22 A.M., 08/10/22 P.M., 08/11/22 A.M. and P.M., 08/12/22 P.M., 08/14/22 P.M., 08/15/22 A.M. and 08/16/22 A.M. and P.M. Personal hygiene documentation revealed one staff member assistance on 07/20/22 A.M., 07/21/22 A.M., 07/23/22 P.M., 07/24/22 A.M., 07/25/22 P.M., 07/26/22 P.M., 07/28/22 A.M., 07/29/22 A.M., 07/30/22 P.M., 07/31/22 A.M., 08/01/22 A.M. and P.M., 08/02/22 P.M., 08/03/22 P.M., 08/04/22 P.M., 08/05/22 A.M., 08/06/22 A.M., 08/07/22 P.M., 08/08/22 A.M. and P.M., 08/09/22 A.M. and P.M., 08/10/22 P.M., 08/11/22 P.M., 08/12/22 A.M. and P.M., Page 1 of 3 366190 366190 08/18/2022 Belmont Manor 51999 Guirino Drive St Clairsville, OH 43950

F 0689 08/14/22 P.M., 08/15/22 A.M. and P.M. and 08/16/22 A.M. and P.M. Level of Harm - Minimal harm or potential for actual harm On 08/17/22 at 10:05 A.M. interview with STNA #51 revealed Resident #37 was a two person assist with care, but one staff person can assist with dressing and hygiene. STNA #51 indicated one person can provide hygiene and dressing assistance if she is lying in bed. Residents Affected - Few On 08/17/22 at 10:10 A.M. interview with STNA #55 also revealed Resident #37 was a two person assist with care, but one staff person can assist with dressing and hygiene. On 08/17/22 at 10:15 A.M. interview with STNA #59 indicated Resident #37 was a two person assist with care, but one staff member will assist with dressing and hygiene. On 08/17/22 at 10:20 A.M. interview with the Director of Nursing verified Resident #37 had a physician's order in place for the resident to have two staff members assist during all care and STNA ADL Tasks documentation indicates one staff member providing assistance for dressing and hygiene. 366190 Page 2 of 3 366190 08/18/2022 Belmont Manor 51999 Guirino Drive St Clairsville, OH 43950

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure weights were obtained as ordered for Resident #16. This affected one (Resident #16) of two residents reviewed for weights. The facility census was 40. Residents Affected - Few Findings include: Review of the medical record for Resident #16 revealed an admission date of 06/28/22 with diagnoses including dementia, depression and diabetes mellitus. Review of the physician's order dated 06/28/22 for Resident #16 revealed an order for monthly weights. Review of the admission weight for Resident #16 revealed she weighed 107.1 pounds on 06/29/22. Review of the plan of care for Resident #16 dated 07/12/22 revealed she was underweight with a low body mass index. The staff were to weigh the resident per their policy and notify the physician of significant weight changes. Review of the nutritional assessment dated [DATE] revealed the most recent weight the facility had obtained was on 06/29/22 and was 107.1 pounds. Interview on 08/16/22 at 1:21 P.M. with Dietitian #500 verified the staff had not obtained monthly weights on Resident #16 and the last weight obtained was on 06/29/22. Review of the facility policy titled, Weight Policy, revised February 2022, revealed residents are to be weighed upon admission within 48 hours and then once a month or as ordered by the physician. 366190 Page 3 of 3