Health inspection·November 9, 2022

F 0695 Provide safe and appropriate respiratory care for a resident when needed. 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, observations, staff interview and review of the facility's policy, the facility failed to ensure residents oxygen tubing was changed according to the physicians orders and the facility policy. This affected one (#15) of one resident reviewed for oxygen use. The facility census was 24. Residents Affected - Few Findings include: Review of the medical record for Resident #15 revealed the resident was admitted to the facility on [DATE]. Diagnoses included cerebral palsy, epilepsy, muscle weakness, hyperlipidemia, spondylosis without myelopathy, hypertension, personality disorder, fibromyalgia, and major depressive disorder. Review of the physician orders dated 06/28/21 revealed Resident #15 was to have oxygen tubing change weekly on concentrator. Review of Resident #15's medication administration record (MAR) revealed the residents oxygen tubing was to be changed weekly on Saturdays. The MAR documented Resident #15's oxygen was marked as changed on 11/05/22. Observation on 11/07/22 at 11:36 A.M., revealed Resident #15's oxygen tube was dated as being changed on 10/29/22. Observation on 11/09/22 at 10:15 A.M., revealed Resident #15's oxygen tube was dated as being changed on 10/29/22. Interview on 11/09/22 at 12:48 P.M., revealed Licensed Practical Nurse (LPN) #20 verified Resident #15's oxygen tubing was dated as being changed on 10/29/22. Interview on 11/09/22 at 1:00 P.M., with the Director of Nursing (DON) verified Resident #15's oxygen tubing is supposed to be changed according to physician orders which is weekly. The DON verified Resident #15's MAR indicated the oxygen tubing was changed on 11/05/22; however, the oxygen tubing was dated 10/29/22. Review of the facility's policy titled Oxygen Therapy, no date, revealed oxygen tubing must be dated/initialed and changed weekly per the oxygen company. Page 1 of 3 366197 366197 11/09/2022 Gardens at St Henry The 522 Western Avenue Saint Henry, OH 45883

F 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. 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 review of facility policy, the facility failed to ensure a resident was free from the unnecessary medications regarding the use of an antibiotic medication without an adequate indication for use. This affected one (#17) of six residents reviewed for unnecessary medications. The census was 24. Residents Affected - Few Findings include: Review of Resident #17's medical record revealed an admission dated of 01/06/22. Diagnoses listed included epilepsy, dysphagia, aphasia, blindness, and multiple sclerosis. Review of a quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #17 was severely cognitively impaired, required extensive staff assistance with activities of daily living (ADL's), and did not have a urinary tract infection (UTI) in the last 30 days. Review of MDS assessments dated 01/13/22, 04/11/22, 07/12/22, and 09/30/22 revealed Resident #17 had not had a UTI within the last 30 days of those assessments. Review of physician orders revealed an order dated 09/14/22 for Bactrim DS (antibiotic) 800-160 milligrams (mg), give one tablet by mouth (PO) one time a day every Monday, Wednesday, and Friday for monitoring. Further review of physician orders revealed an order dated 03/08/22 for Macrodantin Capsule (antibiotic) 50 mg via gastronomy tube (G-tube) one time a day for prophylactically. The order was discontinued on 09/14/22. Review of medication administration revealed Resident #17 received Macrodantin 50 mg daily starting on 03/09/22. Resident #17 continued to receive Macrodantin 50 mg daily through 09/14/22. Bactrim DS 800-160 mg was started on 09/16/22 and continued to be given through 11/07/22. Review of progress notes dated 03/08/22 revealed a new order was received for Macrodantin 50 mg daily indefinitely prophylactically for a history of an UTI. Review of a facsimile dated 09/12/22 revealed Macrodantin was suggested to be changed to Bactrim by Resident #17's neurologist. Review of physician progress notes dated 03/01/22, 04/05/22, 05/03/22, 06/07/22, 07/05/22, 08/02/22, and 09/06/22 revealed no documentation for the justification of continued use of an antibiotic for an UTI. Further review of Resident #17's medical record revealed no documentation of any UTI's or symptoms of UTI from admission [DATE] through 11/07/22. Interview with the Director of Nursing (DON) 11/09/22 08:35 A.M. confirmed there was no documented justification for the continued use antibiotic for Resident #17. The DON confirmed that Resident #17 has not had any signs of an UTI since admission to the facility. The DON confirmed the the continued use of Resident #17's antibiotic had not been addressed with Resident #17's primary care physician 366197 Page 2 of 3 366197 11/09/2022 Gardens at St Henry The 522 Western Avenue Saint Henry, OH 45883

F 0757 through the facility's antibiotic stewardship program. Level of Harm - Minimal harm or potential for actual harm Review of the facility's undated policy titled Antibiotic Stewardship Program revealed residents without proof of review of infection symptoms prior to the initiation of an antibiotic will be reviewed for antibiotic holiday, culture and sensitivity results will be obtained/reviewed for sensitivity. The results of the testing ant eh recommendation for treatment will be discussed with the primary care physician (PCP) to ensure antibiotics are utilized in a responsible effective manner. Prescribers will be required to document dose, duration, and indication for all antibiotic use. Residents Affected - Few 366197 Page 3 of 3