Health inspection·January 25, 2024

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure physician notification was completed related to weight changes. This affected one (Resident #38) of one resident reviewed for weight gain. The facility census was 107. Findings included: Record Review revealed Resident #38 admitted to the facility on [DATE] with diagnoses including cirrhosis of liver, congestive heart failure, hypo-osmolality and hyponatremia, chronic kidney disease, and respiratory failure. Review of the physician orders revealed Resident #38 had an order dated 10/12/23 to call the physician if Resident #38 has a three-pound weight gain or more (overnight); an order started on 10/08/23 for a 2,000 milliliter (ml) fluid restriction, 360 ml with each meal, 300 ml from 7:00 P.M. to 7:00 A.M., 360 ml 7:00 A.M. to 3:00 P.M. and 260 ml from 3:00 P.M. to 7:00 P.M.; an order starting on 11/06/23 for Bumex (diuretic) oral tablet two milligrams one tablet in the evening and one tablet in the morning; and an order started on 11/09/23 for spironolactone (diuretic) oral tablet 25 milligrams in the morning. Review of Resident #38's weights revealed Resident #38 had a 5.4-pound weight gain on 01/10/24 and a 3.1-pound weight gain on 01/18/24. Review of a fax cover sheet dated 01/10/24 to Physician #260's office revealed Resident #38 had a 5.4 pound weight gain from 01/09/24 to 01/10/24. There was no fax received confirmation. Interview on 01/24/24 at 10:03 A.M. with Dietician #257 revealed he saw Resident #38 back in December 2023 and Resident #38 had a huge weight gain. Dietician #257 stated Resident #38's weight fluctuates and on 01/23/24, Resident #38 gained five pounds. Dietician #257 revealed Resident #38 is on daily weights and weight fluctuations are likely due to fluid. Dietician #257 stated Resident #38 takes two milligrams of Bumex (a diuretic) twice daily in addition to spironalactone 25 milligrams. Interview on 01/24/24 at 3:38 P.M. with Nurse #400 from Physician #260's office revealed the facility had not notified the office of any weight gains of three pounds or more as far back as 01/10/24. Nurse stated #400 stated the facility is really bad at communicating with Physician #260's office regarding any changes. Review of a policy titled Physician/Responsible Party Notification dated 08/23/23 revealed nursing Page 1 of 14 366200 366200 01/25/2024 Hennis Care Centre of Bolivar 300 Yant Street, NW Bolivar, OH 44612

F 0580 Level of Harm - Minimal harm or potential for actual harm services shall notify the resident's physician when deemed necessary or appropriate in the best interest of the resident and notification should be made within 24 hours unless it is an emergency. Additionally, the nurse will document any changes regarding the resident's medical condition or status. Residents Affected - Few 366200 Page 2 of 14 366200 01/25/2024 Hennis Care Centre of Bolivar 300 Yant Street, NW Bolivar, OH 44612

F 0645 PASARR screening for Mental disorders or Intellectual Disabilities 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 Pre-Assessment Screenings (PAS) were accurately completed upon admission for Resident #71 and Resident #81. This affected two (Resident #71 and #81) of three residents reviewed for PAS. The facility census was 107. Residents Affected - Few Findings included: 1. Record review revealed Resident #71 admitted to the facility on [DATE] with diagnoses including acute and chronic respiratory failure, chronic obstructive pulmonary disease, type II diabetes, depression (mood disorder), and congestive heart failure. Additional diagnoses were added on 06/12/23 for dementia with behaviors. Review of a PAS completed on 04/03/23 revealed no indication Resident #71 had a diagnosis of a mood disorder and potential need of review for serious mental illness. 2. Record review revealed Resident #81 admitted to the facility on [DATE] with diagnoses including effusion of left knee, dorsalgia, and major depressive disorder (mood disorder). Review of a PAS completed on 06/01/23 revealed no indication Resident #81 had a diagnosis of a mood disorder and potential need of review for serious mental illness. Interview on 01/24/24 at 12:20 P.M. with Social Worker (SW) #213 confirmed Resident #71 and Resident #81's PAS did not indicate the potential need for screening for a serious mental illness based on having a diagnosis of mood disorder. SW #213 stated the hospital completed the PAS and she was unaware they needed to be reviewed for accuracy and updated as needed. Review of a policy dated 04/26/17 titled Pre-admission Screening and Resident Review (PASRR) revealed the PAS process requires all applicants to Medicaid-certified nursing facilities be given a preliminary assessment to determine whether they might have a serious mental illness or developmental disability. 366200 Page 3 of 14 366200 01/25/2024 Hennis Care Centre of Bolivar 300 Yant Street, NW Bolivar, OH 44612

F 0685 Assist a resident in gaining access to vision and hearing services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation and interview, the facility failed to ensure glasses were obtained in a timely manner for Resident #81. This affected one (Resident #81) of one residents reviewed for vision services. The facility census was 107. Residents Affected - Few Findings included: Record Review revealed Resident #81 admitted to the facility on [DATE] with diagnoses including effusion of left knee, dorsalgia, and major depressive disorder. Review of a quarterly minimum data set completed on 09/08/23 revealed Resident #81 had adequate vision with corrective lenses and had intact cognition. Review of the care plan initiated on 06/03/23 revealed Resident #81 had impaired visual function related to wearing glasses. Review of the list for an eye doctor visit on 08/31/23 revealed Resident #81 was seen by the eye doctor. Review of vision consult documentation from 08/31/23 revealed Resident #81 was diagnosed with macular degeneration, dry eye syndrome, and astigmatism with a plan to order glasses to wear constantly to improve vision. Review of a care conference note dated 12/05/23 revealed the glasses had been ordered for Resident #81. Review of the list for an eye doctor visit on 01/12/24 revealed Resident #81 was seen by the eye doctor. Review of vision consult documentation from 01/12/24 revealed Resident #81 was diagnosed with macular degeneration, dry eye syndrome, and astigmatism with a plan to order glasses to wear constantly to improve vision. Interview on 01/22/24 at 2:56 P.M. with Resident #81 revealed she requested to see the eye doctor upon admission to the facility but had to wait to see the eye doctor that comes to the facility instead of going to an office visit. Resident #81 confirmed she still did not have the glasses that were ordered for her. Interview on 01/23/24 at 3:19 P.M. with Licensed Practical Nurse (LPN) #222 revealed if someone is in need of seeing the eye doctor, the social worker would be notified. Interview on 01/24/24 at 8:09 A.M. with Registered Nurse (RN) #210 revealed if a resident was having a new onset of vision problems, the social worker would be notified to arrange an appointment for the resident in need. Interview on 01/24/24 at 3:09 P.M. with Social Worker (SW) #213 revealed Resident #81's glasses had been ordered from the eye doctor who provided in-house services for the facility on 08/31/23. Due to the glasses already being ordered, SW #213 stated she did not want to send Resident #81 to another eye doctor. SW #213 stated she was unsure why the glasses took so long to arrive, but the eye doctor brought the glasses to Resident #81 on 01/12/24. SW #213 stated the glasses were not right and needed to be sent back at the time of the appointment so new ones could be ordered. SW #213 confirmed Resident #81 does not have glasses. Review of an email from 12/15/23 at 1:06 P.M. provided by SW #213 revealed SW #213 did reach out to 366200 Page 4 of 14 366200 01/25/2024 Hennis Care Centre of Bolivar 300 Yant Street, NW Bolivar, OH 44612

F 0685 the eye doctor for an update on Resident #81's glasses. Level of Harm - Minimal harm or potential for actual harm Review of a policy titled, Effective Communication dated 02/28/20 revealed for residents who are blind or have vision loss, a referral may be made to an optometrist as needed. Residents Affected - Few 366200 Page 5 of 14 366200 01/25/2024 Hennis Care Centre of Bolivar 300 Yant Street, NW Bolivar, OH 44612

F 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on observation, medical record review, policy review and staff interview the facility failed to ensure residents received medications as ordered by the physician. This resulted in a medication error rate of 8% with two medication errors out of 25 medications administered. This affected one (Resident #34) of three residents observed for medication administration. The facility census was 107. Residents Affected - Few Findings include: Review of Resident #34's medical record revealed an admission date of 09/23/22 with diagnoses that included diabetes mellitus, congestive heart failure and chronic kidney disease. Further review of Resident #34's medical record including medication administration record (MAR) and physician's orders revealed orders for guaifenesin 600 mg and stress tab with zinc (multivitamin with minerals). Observation of medication administration for Resident #34 on 01/23/24 at 8:10 A.M. with Registered Nurse (RN) #201 revealed administration of guaifenesin (expectorant) 400 milligrams (mg) and zinc (vitamin supplement) 50 mg. Interview with RN #201 on 01/23/24 at 8:40 A.M. verified she administered 400 mg of guaifenesin instead of 600 mg as ordered by the physician and administered zinc 50 mg instead of a stress tab with zinc. Review of the facility policy titled Medication Administration with a revision of 01/21/21 indicated; medications shall be administered in accordance with established policies, verify the order on the residents medication administration record by checking it against the doctors order, check the label on the medication three times before administering it to make sure you'll be giving the prescribed medication and drugs shall be administered in accordance with the written orders of the attending physician. 366200 Page 6 of 14 366200 01/25/2024 Hennis Care Centre of Bolivar 300 Yant Street, NW Bolivar, OH 44612

F 0791 Provide or obtain dental services for each resident. 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 arrange dental consults as ordered and complete oral assessments as part of the resident's comprehensive dental care. This affected one (Resident #81) of one resident reviewed for dental services. The facility census was 107. Residents Affected - Few Findings included: Record review revealed Resident #81 was admitted to the facility on [DATE] with diagnoses including effusion of left knee, dorsalgia, and major depressive disorder. Review of the quarterly minimum data set completed on 12/09/23 revealed Resident #81 had no broken or loosely fitting full or partial dentures or mouth or facial pain, discomfort or difficulty chewing and had intact cognition. Review of care plan initiated on 06/03/23 revealed Resident #81 had potential for infection related to maintaining some or all of natural teeth. Interventions included a monthly oral assessment. Review of the dental consent form dated 06/13/23 revealed Resident #81 had declined dental services. Review of Long Term Care Evaluation dated 10/07/23 revealed Resident #81 wore an upper partial and the oral examination was not completed. Review of Long Term Care Evaluation dated 01/07/24 revealed Resident #81 wore an upper partial and the oral examination was not completed. Review of the dental consent form dated 01/09/24 revealed Resident #81 consented to receiving dental services. Review of the dental consult form dated 01/09/24 revealed Resident #81 had a need to consult with an oral surgeon related to a torus (a bony growth in the roof of the mouth) with a suspicious lesion which would make it impossible to fabricate a denture. The consult stated Resident #81 had slight discomfort and her speech and swallowing were affected. Review of a nursing note completed by [NAME] Clerk #238 on 01/24/24 at 1:25 P.M. revealed a voicemail was left with an oral surgeon regarding a consult. Interview on 01/23/24 at 3:19 P.M. with Licensed Practical Nurse (LPN) #222 verified there is not an assessment for nurses to complete regarding broken teeth, loose dentures, or other oral issues. Interview on 01/24/24 at 8:05 A.M. with Resident #81 revealed the roots to a tooth that had come out still needed to be removed but would not be able to until the bone in the roof of her mouth was taken care of first. Interview on 01/24/24 at 8:09 A.M. with Registered Nurse (RN) #210 revealed oral assessments are completed but they are not documented. Interview on 01/24/24 at 3:02 P.M. with [NAME] Clerk #238 revealed she was notified on 01/24/24 about Resident #81 needing a referral to an oral surgeon and was given the information by RN #227. [NAME] Clerk #238 stated if an order is made for a consult to be scheduled, it should be acted on 366200 Page 7 of 14 366200 01/25/2024 Hennis Care Centre of Bolivar 300 Yant Street, NW Bolivar, OH 44612

F 0791 promptly. Level of Harm - Minimal harm or potential for actual harm Interview on 01/24/24 at 3:09 P.M. with Social Worker (SW) #213 revealed the order for Resident #81 to have a consult with the oral surgeon was given on 01/12/24. Residents Affected - Few Interview on 01/24/24 at 4:58 P.M. with RN #227 revealed she had been trying to contact an oral surgeon regarding Resident #81 starting sometime around when the order was given but did not have documentation regarding her attempts. Interview on 01/24/24 at 5:06 P.M. with Director of Nursing (DON) revealed oral assessments may be completed by the dietician. DON stated the last oral assessment completed by the dietician was on 06/04/23. DON confirmed the Long-Term Care Evaluations did have a section regarding oral assessments, including the identification of lesions. The DON confirmed Resident #81's care plan stated she would receive a monthly oral assessment. Interview on 01/25/24 at 10:19 A.M. with Speech Therapist (ST) #242 revealed she was not made aware by staff the dentist stated Resident #81 was having difficulty with swallowing and speech related to her torus. ST #242 stated she became aware of Resident #81's torus by another therapy staff member and looked at it out of her own curiosity but did not complete an evaluation for swallowing for Resident #81 due to the concern being a structural issue that would not be fixed by therapy. ST #242 stated Resident #81 did not express any concerns about speech or swallowing issues. ST #242 stated a nurse informed her today Resident #81 had began complaining of difficulty swallowing. Review of a policy titled Mouth Care/Oral Hygiene dated 06/17/19 revealed during oral care, observations should be made for any abnormalities and reported to the nurse. Review of a policy titled Dental Services dated 08/22/17 revealed in the event there are circumstances leading to a delay in a prompt dental referral, the facility will provide documentation assuring the residents ability to still eat and drink while awaiting dental services, as well as the circumstances that lead to the delay in the referral. Additionally, emergency dental care will be handled promptly including any problem of the oral cavity that requires immediate attention by a dentist. 366200 Page 8 of 14 366200 01/25/2024 Hennis Care Centre of Bolivar 300 Yant Street, NW Bolivar, OH 44612

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on interview, observation, and review of facility policy, the facility failed to ensure that food was stored under sanitary conditions. This had the potential to affect all residents in the facility. The facility was 107. Findings include: During the kitchen tour on 01/22/24 at 8:30 A.M. the following items were noted to not be labeled or dated. In the walk-in refrigerator, one pan of spaghetti sauce, one pan of cooked pasta, one container of banana peppers, two containers of cherry tomatoes, one bag of cooked hard-boiled eggs, one container of olives, one container of carrots, one container of olives, one container of bacon bits, one container of cucumbers, one container of shredded lettuce, and several individual sized servings of potato salad in Styrofoam bowls with lids. In addition, there was raw meat juice from ribs dripping over packages of ready to eat deli turkey and two trays of raw chicken that were not completely covered. At the time of observation, an interview with Chef #300 verified the above findings. In the walk-in freezer the following items were unlabeled and undated: one bag of green beans, one bag of corn, one bag of cauliflower, and one bag of diced carrots. At the time of observation, an interview with Chef #300 verified the above findings. In the reach in refrigerator, the following items were not labeled or dated: several pre-scooped fruit cups in Styrofoam covered serving bowls, one container of relish, one partially cut cucumber, and one container of chocolate pudding. At the time of observation, an interview with Chef #300 verified the above findings. In the dry storage area, the following items were not labeled and dated: five bags of pasta, one container of peanut granules, two bowls of pre-poured cereal in Styrofoam bowls with lids, and one bin of popcorn kernels with a broken lid. At the time of observation, an interview with Chef #300 verified the above findings. Review of the facility policy titled Food Safety and Sanitation, dated 01/13/23, indicated stored food would be handled to prevent contamination and growth of pathogenic organisms, opened food packages would be marked to indicate the open date, and all time and temperature control for safety foods, including leftovers, would be labeled, covered, and dated when stored. 366200 Page 9 of 14 366200 01/25/2024 Hennis Care Centre of Bolivar 300 Yant Street, NW Bolivar, OH 44612

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on review of restorative nursing documentation, staff interview, resident interview, and review of facility policy, the facility failed to ensure restorative nursing services were documented accurately. This affected three residents (#30, #71, and #82) of three residents reviewed and had the potential to affect all 59 residents identified by the facility as receiving restorative nursing services for range of motion and ambulation. The facility census was 107. Findings include: 1. Review of the medical record for Resident #30 revealed an admission date of 07/25/23 with diagnoses including cerebral infarction, hemiplegia and hemiparesis affecting right dominant side, type two diabetes mellitus, rhabdomyolysis, and morbid obesity. Review of the care plan, dated 07/26/23, revealed Resident #30 had limited physical mobility related to weakness, self-care deficit, neurological deficits, cerebral infarction, and rhabdomyolysis. Interventions included restorative active range of motion to bilateral upper and lower extremities for 10 to 15 repetitions two times per day, six to seven days per week, and for at least 15 minutes per day (added 11/03/23). Review of the quarterly Minimum Data Set (MDS) Assessment, dated 10/31/23, revealed Resident #30 had moderate cognitive impairment. The assessment indicated Resident #30 required maximal assistance or total dependence for mobility and did not receive any restorative nursing services or therapy services at the time of the assessment. Review of the nurse aide documentation for restorative nursing services for November 2023 through January 2024 revealed there was no documentation for services provided on 11/12/23, 11/19/23, 11/20/23, and 12/11/23. In addition, restorative services were not applicable for 74 out of 163 documented instances and one refusal was documented. On 01/25/24 at 11:46 A.M., interview with Registered Nurse (RN) #302 stated restorative services were provided by State Tested Nurse Aides (STNAs) and she was aware of STNAs documenting resident refusals as not applicable instead of a refusal. On 01/25/24 at 12:32 P.M., interview with RN #301 verified documentation of restorative services for Resident #30 was not completed as it should have been. Review of facility policy titled Restorative Nursing, dated 07/26/17, revealed nurses and nursing assistants were responsible for restorative nursing services and services would be provided per the plan of care. 2. Review of the medical record for Resident #71 revealed an admission date of 04/03/23 with diagnoses including history of falling, fibromyalgia, muscle weakness, type two diabetes mellitus, and dementia. Review of the care plan, dated 04/04/23, revealed Resident #71 had limited physical mobility related to weakness, fibromyalgia, edema, history of cellulitis, and needing assistance with active range of motion due to tremors, weakness, and debility. Interventions included restorative active range of 366200 Page 10 of 14 366200 01/25/2024 Hennis Care Centre of Bolivar 300 Yant Street, NW Bolivar, OH 44612

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some motion to bilateral lower extremities for 15 to 20 repetitions one to two times per day, six to seven days per week, and for at least 15 minutes per day (added 07/27/23). Review of the nurse aide documentation for restorative nursing services for September 2023 through January 2024 revealed there was no documentation for services provided on 09/28/23, 10/11/23, 10/14/23, 11/03/23, 11/11/23, 11/12/23, 11/14/23, 11/20/23, 12/04/23, 12/05/23, 12/09/23, 12/10/23, 12/11/23, 12/13/23, 12/14/23, 12/23/23, 12/24/23, 12/25/23, 12/26/23, 12/28/23, 12/29/23, 01/09/24, 01/15/24, 01/16/24, 01/20/24, and 01/21/24. In addition, restorative services were not applicable for 40 out of 143 documented instances, Resident #71 was not available for two instances, and five refusals were documented. Review of the quarterly Minimum Data Set (MDS) Assessment, dated 01/09/24, revealed Resident #71 had mild cognitive impairment. Resident #71 was dependent on staff for mobility and received restorative services four out of the previous seven days prior to the assessment. On 01/25/24 at 11:46 A.M., interview with Registered Nurse (RN) #302 stated restorative services were provided by State Tested Nurse Aides (STNAs) and she was aware of STNAs documenting resident refusals as not applicable instead of a refusal. On 01/25/24 at 1:08 P.M., interview with RN #305 verified STNAs would document refusals as not applicable instead of a refusal. RN #305 also confirmed the documentation of restorative services for Resident #71 was incomplete. Review of facility policy titled Restorative Nursing, dated 07/26/17, revealed nurses and nursing assistants were responsible for restorative nursing services and services would be provided per the plan of care. 3. Review of the medical record for Resident #82 revealed an admission date of 08/01/22 with diagnoses including type two diabetes mellitus, morbid obesity, hypotension, anxiety, and depression. Review of the care plan, dated 03/14/23, revealed Resident #82 had limited physical mobility related to weakness, self-care deficit, activity intolerance, and impaired cognition. Interventions included restorative active range of motion to bilateral lower extremities two times per day, six to seven days per week, and for at least 15 minutes per day (added 06/04/23), and restorative ambulation one to two times per day, six to seven times per week, and for at least 15 minutes per day as tolerated (added 06/04/23). Review of the quarterly Minimum Data Set (MDS) Assessment, dated 11/09/23, revealed Resident #82 had moderate cognitive impairment. Resident #82 required partial or moderate assistance for mobility and received restorative services for six out of the previous seven days prior to the assessment. Review of the nurse aide documentation for restorative active range of motion for September 2023 through January 2024 revealed there was no documentation for services provided on 10/02/23, 10/21/23, 10/23/23, 10/24/23, 11/04/23, 11/13/23, 11/17/23, 11/18/23, 11/19/23, 11/22/23, 12/02/23, 12/06/23, 12/09/23, 12/10/23, and 12/11/23. In addition, restorative services were not applicable for 83 out of 211 documented instances, Resident #82 was not available for one instance, and there were eight refusals documented. On 01/25/24 at 11:46 A.M., interview with Registered Nurse (RN) #302 stated restorative services 366200 Page 11 of 14 366200 01/25/2024 Hennis Care Centre of Bolivar 300 Yant Street, NW Bolivar, OH 44612

F 0842 Level of Harm - Minimal harm or potential for actual harm were provided by State Tested Nurse Aides (STNAs) and she was aware of STNAs documenting resident refusals as not applicable instead of a refusal. On 01/25/24 at 12:24 P.M., interview with RN #301 verified documentation of restorative services for Resident #82 was not completed as it should have been. Residents Affected - Some Review of facility policy titled Restorative Nursing, dated 07/26/17, revealed nurses and nursing assistants were responsible for restorative nursing services and services would be provided per the plan of care. 366200 Page 12 of 14 366200 01/25/2024 Hennis Care Centre of Bolivar 300 Yant Street, NW Bolivar, OH 44612

F 0881 Implement a program that monitors antibiotic use. 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, policy review, and interview, the facility failed to ensure ordered antibiotics were reviewed and/or only administered with adequate indications for use. This affected three (Residents #69, #72 and #101) of seven residents reviewed for antibiotic use. The facility census was 107. Residents Affected - Few Findings include: 1. Review of Resident #69's medical record revealed diagnoses including left hip fracture and dementia. Resident #69 had documentation from the hospital dated 12/17/23 indicating she had surgery to repair her left hip. The physician documented Resident #69 would be placed on doxycycline (antibiotic) 100 milligrams (mg) twice a day for ten days given the high risk at a skilled nursing facility. Upon admission to the facility on [DATE], an order was written for doxycycline 100 mg twice a day for nine days. A history and physical completed at the facility 12/21/23 by the physician indicated Resident #69 was on antibiotics for surgical prophylaxis and would continue to be evaluated for her tolerance. A note by the Certified Nurse Practitioner dated 12/19/23 acknowledged Resident #69 was on the antibiotic prophylactically until 12/28/23. Review of the facility's antibiotic stewardship policy dated 01/28/20 revealed use of antibiotics prophylactically were not addressed. During an interview on 01/25/24 at 12:47 P.M., Licensed Practical Nurse (LPN) #205, the Infection Control preventionist, stated she reviewed antibiotic stewardship for antibiotics ordered in the facility. When residents were admitted with antibiotics she just made sure the physician or nurse practitioners addressed the use of the antibiotics but she did not evaluate to determine if the residents met the criteria for infection. LPN #205 verified the facility's antibiotic stewardship policy did not address the use of antibiotics ordered for prophylactic purposes. Registered Nurse (RN) #305, who was present, stated Resident #69's white blood count (WBC - lab indicator of possible infection) was elevated prior to admission. The WBC on 12/16/23 was 12.32 and on 12/17/23 was 12.45. After discussing the need to review antibiotics ordered on admission or after consults to determine if residents met criteria for infection, LPN #205 stated she understood she needed to do so and to follow up if there was no evidence residents met McGeer's criteria for infection. On 01/25/24 at 1:09 P.M., LPN #205 stated both the nurse practitioner and physician had reviewed the use of the antibiotic. However, she did not speak to them about the use of the antibiotic in the absence of an actual infection. 2. Review of Resident #101's medical record revealed diagnoses included right hip fracture and chronic leukemia of B cell type. Notes from a follow up orthopedic doctor dated 12/12/23 indicated Resident #101 had some mild redness surrounding her incision line and slight skin irritation from the bandage adhesive. Staples were removed without complication. Because of the redness surrounding the incision, a recommendation was made for bactrim DS (antibiotic) one tablet every 12 hours for ten days. During an interview on 01/25/24 at 12:47 P.M., LPN #205 verified the antibiotic was ordered and Resident #101 did not meet the criteria for infection. LPN #205 verified she did not address the use of the antibiotic with the prescribing physician. 366200 Page 13 of 14 366200 01/25/2024 Hennis Care Centre of Bolivar 300 Yant Street, NW Bolivar, OH 44612

F 0881 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 3. Review of Resident #72's medical record revealed an admission date of 08/19/21 with diagnoses that included Alzheimer's disease with dementia, diabetes mellitus type II, schizoaffective disorder and delusional disorder. Further review of the medical record identified a medication order on 08/11/23 which indicated cefdinir (antibiotic) 300 milligrams (mg) twice daily for seven days was initiated for dysuria. Further review of Resident #72's medical record revealed on 08/11/23 the resident was evaluated by the nurse practitioner (NP). Review of the NP's evaluation indicated the resident was evaluated due to right flank pain. The evaluation indicated the resident voiced a history of kidney stones. The NP indicated pain likely related to renal calculus (kidney stone) versus pyelonephritis (infection). A urinalysis with culture and sensitivity would be completed and once collected would initiate cefdinir 300 mg twice daily for seven days. Review of the urinalysis with culture and sensitivity revealed the urine sample was obtained on 08/11/23 and results received on 08/14/23. Further review of the urinalysis revealed no evidence of any type of infection with culture and sensitivity not indicated. Review of Resident #72's medication administration record (MAR) revealed cefdinir 300 mg administered beginning on 08/11/23 evening and discontinued on 08/14/23 afternoon. The resident received eight doses of cefdinir as ordered by the NP. Review of the facility antibiotic assessment for the appropriate use and indication of infections revealed the antibiotic did not meet criteria for use. Review of the facility monthly infection control log revealed the antibiotic was started prior to urinalysis results were obtained and antibiotic was discontinued once the results were obtained. A follow up NP evaluation was conducted on 08/15/23. Review of the NP's progress note indicated the urinalysis was negative for infection and cefdinir was discontinued. Interview with Licensed Practical Nurse (LPN) #205 verified Resident #72 was initiated on cefdinir prior to having urinalysis results, received eight doses of cefdinir and did not meet criteria for use of the antibiotic. Review of the facility policy Antibiotic Stewardship dated 01/28/20 indicated the facility has implemented practices to improve antibiotic use, including: completion of a surveillance form which follows McGeer's Criteria (criteria used to determine appropriate use of antibiotics) 366200 Page 14 of 14