Health inspection·June 30, 2023

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. Based on medical record review, observation, and staff interview, the facility failed to ensure residents received services to prevent ongoing decline in range of motion (ROM). This affected one (#24) of three residents reviewed for contracture management/ROM. The facility census was 87. Findings include: Review of the medical record for Resident #24 revealed an admission date of 10/16/20 with diagnoses including dysphagia, polyarthritis, hemiplegia and hemiparesis, and cerebral infarction affecting left non-dominant side. Review of the Minimum Data Set (MDS) for Resident #24 dated 05/17/23 revealed the resident was cognitively impaired and required extensive assistance with activities of daily living (ADL's). Resident #24 was coded for functional impairment on both sides to upper and lower extremities. Review of the care plan for Resident #24 dated 10/09/20 revealed the resident may require assistance with ADL's, receive staff's extensive assistance to total care in completion of ADL care/functional needs. Mechanical lift was utilized for all transfer needs and resident used a reclining geri chair for out of bed mobility needs. Resident #24's cognition was impaired, and the resident had a history of stroke with left sided weakness and muscle weakness. Interventions included the following: provide assist for ADL's based on residents needs/abilities, provide necessary adaptive equipment to meet daily needs, therapy to screen and provide treatment as ordered, report any changes in ADL self-performance. Review of Restorative Nursing caseload list dated 06/30/23 revealed Resident #24 was not receiving restorative services. Observation on 06/30/23 at 12:19 P.M. of Resident #24 revealed the resident was compliant with peri care per State Tested Nursing Assistants (STNA's) #425 and #555. Resident #24 was compliant with Licensed Practical Nurse (LPN) #275 application of lotion to her feet. Further observation revealed Resident #24's feet appeared to have slight footdrop and bilateral hands appeared to be somewhat contracted. Observations of Resident #24 revealed staff did not perform ROM and there were no splints observed. Interview on 06/30/23 at 12:24 P.M. of STNA's #425 and #555 confirmed Resident #24 was not on a ROM program nor did she have any orders for splints. STNA's #425 and #555 confirmed if resident required ROM services they would be provided by therapy or the facility restorative aides. Page 1 of 2 366208 366208 06/30/2023 Residence at Huntington Court 350 Hancock Avenue Hamilton, OH 45011

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 06/30/23 at 12:25 P.M. of LPN #275 confirmed Resident #24's fingers appeared slightly contracted and resident appeared to have slight foot drop bilaterally. Interview on 06/30/23 at 1:42 P.M. of the Administrator confirmed Resident #24 had not been seen or screened by therapy in over two years. Administrator confirmed the facility had a restorative program which was overseen by the Director of Nursing (DON). Administrator confirmed the facility did not have policies regarding contracture management, range of motion services, and/or therapy screening and referrals. Interview on 06/30/23 at 1:50 P.M. with Certified Occupational Therapy Assistant (COTA) #680 who also served as therapy program manager for the facility, confirmed the facility had not written policy for screening residents for appropriateness for therapy. COTA #680 confirmed the therapy department relied on nursing staff to report significant changes which might indicate resident would benefit from therapy. COTA #680 confirmed the therapy department worked closely with the restorative aides and would assist with setting up programs including restorative ROM programs. COTA #680 confirmed Resident #24 had not been on therapy caseload in recent years. Interview on 06/30/23 at 1:57 P.M. with COTA #680 after observation of Resident #24 confirmed the resident's fingers appeared to be contracted and feet showed slight signs of foot drop. COTA #680 confirmed it would be more appropriate to have an Occupational Therapist (OT) evaluate Resident #24's upper extremities and a Physical Therapist (PT) to evaluate the lower extremities. Interviews on 06/30/23 at 2:04 P.M. with Restorative Aide (RA) #120 and at 2:11 P.M. with RA #260 confirmed Resident #24 was not currently receiving any restorative services and had not been on restorative caseload at any time they could recall. Interview on 06/30/23 at 2:19 P.M. of PT #685 confirmed he observed Resident #24 on 06/30/23 and felt her feet showed slight dorsiflexion but did not feel the resident required ROM or restorative services or therapy services at this time. Interview on 06/30/23 at 2:19 P.M. of OT #690 confirmed she observed Resident #24 on 06/30/23 and felt the resident's hands had limited range of motion and weakness. OT #690 confirmed Resident #24 would benefit from a formal OT evaluation to determine appropriate services to prevent further decline in ROM. Interview on 06/30/23 at 2:38 P.M. of the DON confirmed Resident #24's MDS was coded for functional impairment to upper and lower bilateral extremities. DON confirmed Resident #24 had not been on therapy or restorative nursing caseload for the past two years and her care plan did not include interventions to prevent ADL decline except for PT and OT to evaluate as needed. This deficiency represents non-compliance investigated under Complaint Number OH00143648. 366208 Page 2 of 2