Health inspection·November 9, 2022

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on resident and staff interview, observation, and record review, the facility failed to ensure a resident's care plan was developed related to dental needs and range of motion of the right upper extremity. This affected one (Resident #58) of 17 residents reviewed for care plans. The facility census was 69. Finding include: Review of the medical record for Resident #58 revealed an admission date of 09/03/21. Diagnoses included cerebral infarction, hemiplegia and hemiparesis, dysphasia, diabetes, cognitive communication deficit, hypertension and anxiety. Review of the annual Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #58 was cognitively intact. Resident #58 was noted to have an impairment on one side for upper and lower extremity. 1. Review of Resident #58's physician orders dated 03/04/22 revealed an order for the dentist may treat as needed. Review of the plan of care dated 08/10/22 revealed Resident #58 had impaired dentition and was at risk for oral problems of pain, infection, difficulty chewing or swallowing with interventions to complete oral assessment and refer to the dentist as needed. provide all necessary items for oral care as needed and provide oral care at least daily and more frequently as needed. The care plan had no mention of significant bleeding from the mouth. Review of the progress notes dated 10/04/22 revealed the nurse was notified by the aide regarding Resident #58 having bleeding from her mouth on her lips, chin and cheek. Resident #58 was assessed and found blood in her mouth. Resident #58 was referred to see the dentist and the nurse practitioner was informed. Observation and interview on 11/07/22 at 9:38 A.M. revealed Resident #58 had blood that had run down her face from the corner of her mouth down her chin and dripped on her chest, shirt and bedding. Resident #58 stated she had gum issues and at times will having increased bleeding of her mouth. Interview and observation on 11/07/22 at 9:43 A.M. with Registered Nurse (RN) #253 revealed Resident #58 had a history of bleeding from her mouth and Resident #58 was seen by the dentist. RN #253 then went to resident's bedside and asked Resident #58 if her mouth bleeding was common and if she saw the dentist. Page 1 of 4 366198 366198 11/09/2022 Golden Years Nursing Center 2436 Old Oxford Road Hamilton, OH 45013

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 11/08/22 at 4:20 P.M. with Social Services (SS) #242 revealed she was not aware of Resident #58's bleeding prior to 11/07/22. Resident #58 saw the dentist on 10/06/22 and the dentist mentioned increased calcium on the teeth and mouth bleeding would be expected. SS #242 stated the dentist requested Resident #58 to have assistance with oral hygiene. Interviews on 11/09/22 at 9:47 A.M. with State Tested Nursing Aide (STNA) #212 and STNA #233 stated Resident #58's oral bleeding was common. Interview on 11/09/22 at 10:30 A.M. with the Director of Nursing (DON) confirmed oral bleeding was not documented in Resident #58's care plan. 2. Review of the physician orders dated 03/04/22 revealed Resident #58 had an order to apply resting hand splint to her right upper extremity daily. The resting hand splint should be worn at all times when out of bed as Resident #58 can tolerate it. Review of the plan of care dated 08/10/22 revealed Resident #58's care plan did not include any mention of an impairment to resident's right upper extremity or wrist and provided no guidance or plan related to receiving therapy or wearing a splint. Review of Resident #58's progress notes dated 11/07/22 revealed it stated to apply resting hand splint to right upper extremity daily. Resting hand splint was to be worn at all times when out of bed. Observation and interview on 11/07/22 at 9:38 A.M. with Resident #58 revealed she had a contracture-like hand deformity with fingers curled inward. Resident #58 was not wearing any hand device or splint. Resident #58 stated she had hand issues for a while and she was working with therapy for a splint as the previous brace was not comfortable. Resident #58 stated her new brace was kept in the therapy gym. Interview on 11/08/22 at 9:35 A.M. with RN #224 stated she was unsure if Resident #58 should be wearing a splint and the splint of the shelf was the only one she was aware of. Interview on 11/08/22 at 10:17 A.M. with Occupational Therapist (OT) #305 revealed therapy staff were working with the splint. OT #305 revealed they were working to fabricate the brace and increase residents' tolerance. Interview on 11/09/22 at 9:47 A.M. with Certified Occupational Therapy Assistant (COTA) #310 revealed she had been working with resident about three weeks with a new brace. COTA #310 revealed Resident #58 has increased her tolerance to about three hours. COTA #310 revealed she works with Resident #58 three days each week on wearing the brace. Interview on 11/09/22 at 10:30 A.M. with DON confirmed a physician order was in the chart to don and doff the brace daily and Resident #58 should wear it at all times while tolerated. The DON confirmed there was no mention of a splint or a hand deformity in Resident #58's care plan. 366198 Page 2 of 4 366198 11/09/2022 Golden Years Nursing Center 2436 Old Oxford Road Hamilton, OH 45013

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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on staff interview, review of the facility's policy and contract, and medical record review, the facility failed ensure ongoing communication with Resident #43's dialysis center regarding dialysis care and services. This affected one (Resident #43) of one resident reviewed for dialysis. The facility identified two residents who receive dialysis. The facility census was 69. Residents Affected - Few Findings include: Review of the medical record for Resident #43 revealed an admission date of 02/26/21. Diagnoses included diabetes mellitus and chronic kidney disease. Review of the annual Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #43 was cognitively intact and required extensive assistance of two staff members for mobility and transfers. Review of the plan of care dated 07/25/22 revealed Resident #43 received dialysis treatments three times weekly for chronic kidney disease. Interventions included to assist with transfers to and from dialysis, maintain communication with dialysis staff and physician, and monitor laboratory values and report results to physician. Subsequent review of Resident #43's medical record from 06/01/22 to 11/07/22 revealed there was no documentation of routine communication forms kept on record to indicate the dialysis center and the facility were routinely communicating to one another regarding Resident #43. There was one communication form dated 11/07/22 that was found during this time period. Interview on 11/08/22 at 9:40 A.M. with the Director of Nursing (DON) and Corporate Nurse #30 revealed the facility sends out dialysis communication forms with Resident #43 when he leaves the facility for dialysis, but the facility does not keep a record. The DON and Corporate Nurse #30 verified the dialysis center does not typically complete their section and return the form to the facility. Subsequent interview on 11/08/22 at 1:40 P.M. with Corporate Nurse #30 verified the only documentation in Resident #43's medical record the facility had regarding communication with dialysis was from 11/07/22. Review of the facility's policy and dialysis contract titled LTC (long term care) Facility Outpatient Dialysis Services Coordinated Agreement, dated 05/27/21, revealed the facility and dialysis agreement have a mutual obligation for collaboration of care. Both parties shall ensure there was documented evidence of collaboration of care and communication between the LTC and the dialysis unit. 366198 Page 3 of 4 366198 11/09/2022 Golden Years Nursing Center 2436 Old Oxford Road Hamilton, OH 45013

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, and medical record review, the facility failed to ensure narcotic medications were securely stored in the medication room refrigerators. This affected one of two medication rooms observed for medication storage. The facility had three medication rooms. This affected two (#4 and #50) of two residents prescribed narcotic medications which required refrigeration. The facility census was 69. Findings include: 1. Review of Resident #50's medical record revealed the resident was admitted to the facility on [DATE]. Review of the medical record revealed Resident #50 had physician orders for narcotic medications including Morphine Sulfate two milligrams (mg) per milliliter (ml) solution give 0.25 ml sublingually every four hours as needed for pain. 2. Review of Resident #4's medical record revealed the resident was admitted to the facility on [DATE]. Review of the medical record revealed Resident #4 had physician orders for narcotic medications including Morphine Sulfate two mg per ml solution give 0.25 ml sublingually every two hours as needed for pain. Observation on 11/08/22 at 1:52 P.M. revealed the 200-Hall medication room's refrigerator had locked a narcotic box on a removable shelf which contained two unopened bottles of Roxanol (liquid morphine) for Residents #4 and #50. Interview on 11/08/22 at 1:56 P.M. with Registered Nurse (RN) #239 verified the refrigerator shelf contained a locked box with narcotic medications for Residents #4 and #50 and the locked box was not permanently affixed. 366198 Page 4 of 4