Health inspection·May 16, 2019

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. Record review revealed Resident #11 was admitted to the facility 07/10/06 with diagnoses including cerebral infarct (stroke), hemiplegia (paralysis on one side of the body), abnormality of gait and mobility, chronic heart failure, depression and anxiety disorder. Residents Affected - Some Review of a physician order dated 04/09/19 revealed Resident #11 was to have one half side rail for safety to both sides of the bed to enable bed mobility. Review of the facility Restraint Assessments dated 02/15/19, 03/29/19 and 04/08/19 revealed the resident used half side rails for bed mobility which did not limit her movement and were not considered a restraint. Review of the MDS assessment dated [DATE] revealed the facility coded Resident #11 as having a restraint in use, which was the daily use of side rails. Observations conducted on 05/13/19 10:40 A.M. revealed Resident #11 up in her room and she was self propelling about the room in her wheelchair. The half side rails were in the down position on her bed. Interview with Resident #11 at the time of the observation revealed staff raise the side rails when she is in bed to help her move and turn. Resident #11 stated she could move freely with the rails raised. During an interview on 05/16/19 at 9:01 A.M. with LPN #500, she stated she was trained to code all side rails on the MDS as restraints. LPN #500 confirmed Resident #11 had side rails used for bed mobility and verified they did not restrict her movement and were not restraints. LPN #500 confirmed the 03/27/19 MDS assessment was inaccurate related to restraints for Resident #11. 4. Record review revealed Resident #14 was admitted to the facility 01/14/13 with diagnoses that included epilepsy, chronic heart failure, dementia without behaviors, delusional disorder, muscle wasting and atrophy. The record indicated Resident #14 received hospice services as of 03/26/19. Review of a physician order dated 01/21/19 revealed half side rails for safety were ordered to both sides of the bed to enable bed mobility. This order was updated 04/12/19 for these side rails to be padded for safety for seizure precautions. Review of a significant change MDS assessment dated [DATE] revealed Resident #14 was dependent on staff for bed mobility and revealed the resident side rails on the bed daily and were a restraint. Review of the Restraint Assessments dated 02/14/19 and 04/05/19 revealed the resident had half side rails for bed mobility, turning, and positioning and were not a restraint. During an interview on 05/16/19 at 9:01 A.M., LPN #500 the nurse stated she was trained that all Page 1 of 4 366203 366203 05/16/2019 Orrville Pointe 230 South Crown Hill Road Orrville, OH 44667

F 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some side rails should be coded on the MDS as restraints. LPN #500 confirmed Resident #14 had side rails for bed mobility which did not restrict the resident's movements and were not restraints. LPN #500 confirmed the 04/01/19 MDS assessment was inaccurate related to restraints for Resident #14. 5. Resident #24 was admitted to the facility 12/20/18 with diagnoses that included dementia with behavioral disturbance, schizoaffective disorder, Alzheimer's disease, congestive heart failure, major depressive disorder, restlessness and agitation. Review of the MDS assessment dated [DATE] revealed the resident side rails daily and were listed as a restraint. There was a physician's order dated 03/30/19 for half side rails for bed mobility. Review of Restraint Assessments dated 01/21/19 and 04/19/19 revealed Resident #24 used half side rails for bed mobility, turning, and repositioning, and he was able to make his needs known. These assessments indicated the side rails were not a restraint. Observation on 05/14/19 at 10:54 A.M. revealed Resident #24 walked across the room from the bathroom and used the half side rail for support as he seated himself on the side of the bed. On 05/16/19 at 9:01 A.M., LPN #500 indicated she was trained that all side rails should be coded on the MDS as restraints. LPN #500 confirmed Resident #24 had side rails for bed mobility that did not restrict the resident's movements and were not restraints. LPN #500 confirmed the 04/18/19 MDS assessment was inaccurate related to restraints for Resident #24. Based on observation, record review, Resident Assessment Instrument (RAI) manual review, form review, and interview, the facility failed to accurately code the Minimum Data Set (MDS) assessments for five residents (Residents #5, #11, #14, #15, and #24) out of 13 residents reviewed for assessments. Findings include: 1. Resident #5 was initially admitted to the facility on [DATE] with diagnoses including bipolar disorder, major depressive disorder, dementia with behavioral disturbance, and epilepsy. Review of Resident #5's May 2019 physician orders included an order for padded half side rails secondary to a history of seizures. Review of Resident #5's admission MDS assessment, with an Assessment Reference Date (ARD) of 01/02/19, revealed Resident #5 utilized side rails as a physical restraint daily. Review of Resident #5's quarterly MDS assessment, with an ARD of 02/18/19, revealed Resident #5 had intact cognition and required staff supervision with bed mobility. The 02/18/19 quarterly MDS also indicated Resident #5 utilized side rails as a physical restraint daily. Resident #5's medical record revealed two restraint assessments, dated 01/04/19 and 02/19/19. Both assessments stated Resident #5 used half side rails for turning, positioning, and bed mobility. The side rails were padded for seizure precautions and Resident #5 was able to make his needs known. The assessments concluded the side rails were not considered a restraint for Resident #5 and indicated no restraints were in place. Review of the RAI manual defined a physical restraint as any manual method or physical or mechanical device, material or equipment attached or adjacent to the resident's body that the individual 366203 Page 2 of 4 366203 05/16/2019 Orrville Pointe 230 South Crown Hill Road Orrville, OH 44667

F 0641 cannot remove easily, which restricts freedom of movement or normal access to one's body. Level of Harm - Minimal harm or potential for actual harm Interview with Licensed Practical Nurse (LPN) #500 on 05/16/19 at 9:01 A.M. verified the RAI definition of a physical restraint and verified the side rails used for Resident #5 were for positioning and were not a restraint. LPN #500 stated they were trained to mark all side rails as physical restraints. Residents Affected - Some 2. Resident #15 was initially admitted to the facility on [DATE] with diagnoses including major depressive disorder, psychosis, chronic viral hepatitis c, and cerebral infarction (stroke). Review of Resident #15's May 2019 physician orders included an order for half side rails on both sides of the bed for bed mobility. Review of the MDS assessments dated 04/25/18, 07/24/18, 10/19/18, 01/16/19, 02/13/19, and 04/04/19 revealed Resident #15 utilized side rails as a physical restraint daily. The MDS assessment from 04/04/19 revealed Resident #15 had intact cognition and required extensive assist of one person with bed mobility. Resident #15's medical record revealed five restraint assessments since the last annual survey, dated 04/27/18, 07/27/18, 10/26/18, 01/17/19, 02/15/19 and 04/05/19. All five assessments stated Resident #15 used half side rails for bed mobility. Resident #15 was able to make his needs known and the assessments concluded the side rails were not considered a restraint for Resident #15 and no restraints were in place. Review of the RAI manual defined a physical restraint as any manual method or physical or mechanical device, material or equipment attached or adjacent to the resident's body that the individual cannot remove easily, which restricts freedom of movement or normal access to one's body. Staff interview with LPN #500 on 05/16/19 at 9:01 A.M. verified the RAI definition of a physical restraint and verified the side rails used for Resident #15 were for positioning. LPN #500 stated they were trained that all side rails had to be marked as physical restraints. 366203 Page 3 of 4 366203 05/16/2019 Orrville Pointe 230 South Crown Hill Road Orrville, OH 44667

F 0727 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. Based on record review and interview the facility failed to ensure a registered nurse was scheduled at least eight consecutive hours every day as required. This had the potential to affect all 32 residents residing in the facility. Findings include: Review of the posted staffing hours for May 2019 revealed the facility had a registered nurse (RN) in the building for five hours on 05/05/19 and for four hours on 05/11/19 and 05/12/19. During an interview with the Administrator on 05/15/19 at 8:20 A.M., the staffing hours for 2019 were reviewed. The Administrator verified they were aware of the requirement for an RN to be working in the facility each day for at least eight consecutive hours. The Administrator said they had an open RN position and were working to hire new RN staff. The Administrator said the director of nursing was working part of each weekend in addition to weekdays to provide an RN in the building each day. The Administrator confirmed the facility had been unable to provide an RN for eight consecutive hours on 05/05/19, 05/11/19 and 05/12/19 as required. 366203 Page 4 of 4