Health inspection·April 4, 2022

F 0568 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Properly hold, secure, and manage each resident's personal money which is deposited with the nursing home. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, financial record review, staff interview and facility policy and procedure review the facility failed to maintain accurate and timely accounting practices for services received and charged to Resident #3. This affected one resident (#3) of six residents whose financial records were reviewed. Findings Include: Record review revealed Resident #3 was admitted to the facility on [DATE] with diagnoses including Alzheimer's disease, sepsis, type II diabetes mellitus, chronic kidney disease, osteoarthritis, hypertension, major depressive disorder, anxiety disorder, psychosis, dementia, mood disorder, dysphagia and cognitive communication deficit. Review of the Minimum Data Set (MDS) 3.0 assessment, dated 03/11/22 revealed the resident was cognitively impaired. Review of Resident #3's financial records, dated 03/01/21 to 12/31/21 revealed the following beauty shop invoices and subsequent charges documented within the quarterly bank statements (the facility reported there could be up to a one month lag time between the invoiced/dated service and when the money was taken out of Resident #3 bank account): Review of the March 2021 to May 2021 beauty shop invoices revealed the resident utilized the beauty shop on the following dates: 03/18/21, 03/25/21, 04/01/21, 04/08/21, 04/15/21, 04/22/21, 04/28/21, 05/06/21, 05/13/21 and 05/27/21. Review of the April 2021 to June 2021 bank statements revealed the following charges from the beauty shop: 04/06/21 two charges of $13.00, 04/19/21 two charges of $13.00, 06/07/21 a charge of $13.00 and on 06/15/21 two charges of $13.00. In summary for March through June 2021, there were 10 beauty shop invoices and the resident was charged seven times on her bank statements; there were no charges in May 2021. Review of June 2021 to August 2021 beauty shop invoices revealed the resident utilized the beauty shop on the following dates: 06/03/21, 06/17/21, 06/24/21, 06/30/21, 07/08/21, 07/15/21, 07/22/21, 07/29/21, 08/05/21, 08/19/21 and 08/26/21. Review of July 2021 to September 2021 bank statements revealed the resident was charged $13.00 for beauty shop services on 07/06/21, twice on 07/23/21, twice on 08/05/21 and three times on 09/08/21. Page 1 of 5 366215 366215 04/04/2022 Lanfair Center for Rehab & Nsg Care Inc 1590 Chartwell Street Lancaster, OH 43130

F 0568 On 07/19/21 there was a $39.00 charge. Level of Harm - Minimal harm or potential for actual harm In summary from June to August 2021 there were 11 beauty shop invoices and the resident was charged 11 times on her bank statements, which included the $39.00 charge for three combined visits to the beauty shop. Residents Affected - Few Review of September 2021 beauty shop invoices revealed the resident utilized the beauty shop on the following dates: 09/01/21, 09/09/21, 09/21/21 and 09/30/21. Review of October 2021 bank statements revealed one charge, dated 10/08/21 for $13.00. In summary, there were four beauty shop invoices (dated 09/2021) and the resident was charged one time (10/08/2021) on her bank statement. In total, during the review period of beauty shop invoices and subsequent bank statement invoices, Resident #3 received beauty shop services 25 times and was charged by the facility (within one month of the invoice date) a total of 19 times. There were no notes within the invoices or banking records to indicate which dates on the banking records were associated with specific invoices. On 03/31/22 at 12:05 P.M. interview with Activities Staff (AS) #15 revealed the individual who typically does the billing and financial tracking was on vacation, so she was willing to assist with review of Resident #3's financial records. AS #15 confirmed it was very confusing to determine which invoice was charged to Resident #3's records and which were not. She confirmed when going through each invoice and trying to find the corresponding charge on the banking records, there were multiple months between an invoice of when the beauty services were performed, and when the charge was actually taken out of Resident #3's bank account. AS #15 confirmed there were times the invoices might be late getting to the receptionist (who submits the invoices), the receptionist may not be in the facility and it's delayed in getting to the corporate financial individuals, or a variety of other reasons they many not be charged to Resident #3's financial account in a timely manner. AS #15 revealed it should take between two to four weeks for the receptionist to submit the invoices to the corporate financial staff; and she confirmed that did not occur on multiple occasions with Resident #3's financial account. Review of the undated facility Resident Financial Management System (RFMS) training manual revealed the facility was to enter the withdrawal record, resident identification number, description source code (based on facility source code key), and the total amount charged onto the resident's financial record. Within the procedure manual, there was no specific timeline as to when the debits and/or credits should be recorded on the resident's financial record. 366215 Page 2 of 5 366215 04/04/2022 Lanfair Center for Rehab & Nsg Care Inc 1590 Chartwell Street Lancaster, OH 43130

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm 2. On 03/30/22 at 8:30 A.M. Registered Nurse (RN) #60 was observed to administering medications to Resident #13. RN #60 prepared Resident #13's medications by placing a tablet of Fexofenadine (medication used for allergies) 180 milligrams (mg) tablet, Glucosamine Chondroitin 500 mg/400 mg tablet, Rena Vite tablet,and a Vitamin C 500 mg tablet from facility stock bottles into her bare hand and then placing the medications into a clear plastic medication cup. The RN administered the medications to Resident #13. Residents Affected - Some On 03/30/22 at 8:56 A.M. interview with RN #60 verified she placed the medications in her bare hand and administered the medications to the resident. Review of the facility policy titled Medication Administration General Guidelines, dated 05/2020 revealed medications were administered as prescribed in accordance with good nursing principles and practices and only by persons legally authorized to do so. Based on observation, record review, facility policy and procedure review, review of guidance from the Centers for Disease Control (CDC) and interview the facility failed to maintain adequate and acceptable infection control practices during medication administration for Resident #13 and for Resident #232 who was in isolation to prevent the spread of infection including COVID-19. Observations during medication administration revealed medications were handled by the nurse with bare hands when administering to Resident #13 and two State Tested Nursing Assistants (STNAs), STNA #43 and STNA #58 were observed to enter Resident #232's room, a resident who was in droplet isolation precautions for COVID-19 without applying all required personal protective equipment (PPE) including gown and gloves. This affected two residents (#13 and #232) and had the potential to affect all facility residents excluding 19 residents residing on the secured memory care unit which had dedicated staff. The facility census was 79. Findings Include: 1. Review of Resident #232's medical record revealed an admission date of 03/23/22 with diagnoses including cerebral infarction (stroke), Parkinson's Disease, aphasia, disorientation, Type II diabetes mellitus without complications and heart disease. Review of the Clinical admission Documentation assessment, dated 03/23/22 revealed Resident #232 was alert and oriented to self, place and time. The resident had clear speech and was understood by others as well as was able to understand others with clear comprehension. Resident #232 walked occasionally without assistance for very short distances. The resident had slightly limited mobility and made frequent but slight changes in body position independently. There was no Minimum Data Set (MDS) 3.0 assessment completed as of this date as Resident #232 was a new admission (on 03/23/22). Review of the physician's orders for March 2022 revealed Resident #232 had an order, dated 03/23/22 for droplet precautions per facility protocol for seven days with a stop date on 03/30/22 if the resident was asymptomatic (no symptoms) of COVID-19 and had a negative point of care (POC) COVID-19 test. Review of progress notes, from 03/23/22 to current revealed on 03/24/22 at 3:14 A.M., 03/25/22 at 366215 Page 3 of 5 366215 04/04/2022 Lanfair Center for Rehab & Nsg Care Inc 1590 Chartwell Street Lancaster, OH 43130

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 3:48 A.M., 03/26/22 at 1:52 A.M., 03/26/22 at 12:14 P.M., 03/27/22 at 1:06 A.M., 03/27/22 at 11:34 A.M., 03/28/22 at 2:40 A.M., 03/29/22 at 12:07 A.M., 03/30/22 at 12:26 A.M., and 03/30/22 at 2:10 P.M. staff documented Resident #232 was noted to be on droplet precautions (for COVID-19) per facility protocol. On 03/28/22 at 11:42 A.M. observation of the lunch meal revealed STNA #43 entered Resident #232's room to deliver a lunch tray without first applying (donning) a gown or gloves. The STNA was wearing an N95 mask and goggles. There was a sign posted on Resident #232's door that indicated the resident was under droplet precautions. There was a cart with all needed personal protective equipment (PPE), including gowns and gloves outside the resident's door. STNA #43 carried the meal tray into Resident #232's room, placed it on the resident's bedside table, and moved the table within the resident's reach. STNA #43 exited Resident #232's room and then used hand sanitizer to clean her hands. STNA #43 continued to deliver meal trays to four additional resident rooms of residents who were not in any type of isolation precautions. On 03/28/22 at 11:47 A.M. interview with STNA #43 confirmed the STNA had entered Resident #232's room and delivered the meal tray without applying a gown or gloves. STNA #43 stated she did not pay attention to the sign posted on the door or the PPE cart placed outside the resident's room. STNA #43 stated, That is my fault. I was just trying to get it done. STNA #43 confirmed she should have applied a gown and gloves before entering the room due to Resident #232 being in droplet isolation precautions for COVID-19. On 03/29/22 at 4:45 P.M. STNA #58 was observed in Resident #232's room without a gown or gloves on. The STNA was wearing an N95 mask and goggles during the observation. STNA #58 was observed assisting Resident #232 with being repositioned in a recliner chair. The STNA lifted each of the resident's legs and placed them in a more comfortable position for the resident and also placed the resident's call light button in the resident's lap. STNA #28 exited the resident's room and used hand sanitizer to clean her hands. Resident #232 was in droplet isolation precautions at the time of the observation. On 03/29/22 at 4:55 P.M. interview with STNA #58 confirmed she had entered Resident #232's room without applying all required PPE including a gown and gloves. STNA #28 confirmed the resident was under droplet isolation precautions and stated she had forgotten to apply the appropriate PPE prior to entering the resident's room. On 03/29/22 at 5:07 P.M. interview with Regional Nurse #235 revealed Resident #232 had received a Johnson & Johnson COVID-19 vaccination but had not received a booster vaccination. It was the facility policy to place any resident who was not up to date with all of their vaccinations and booster shots (for COVID-19) in quarantine and droplet isolation precautions. Review of the facility undated policy titled COVID 19 Testing revealed the policy included residents who were not up to date with vaccines with or without COVID-19 symptoms admitted or readmitted from the hospital would be placed in Transmission Based Precautions (quarantine). Residents in quarantine for admission/readmission who remained asymptomatic may be removed from quarantine after day seven with a negative test done 48 hours prior to discontinuing quarantine. Review of guidance from the CDC titled Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes, updated 02/02/22 revealed in general, all residents who are not up to date with all recommended COVID-19 vaccine doses and are new admissions and 366215 Page 4 of 5 366215 04/04/2022 Lanfair Center for Rehab & Nsg Care Inc 1590 Chartwell Street Lancaster, OH 43130

F 0880 readmissions should be placed in quarantine, even if they have a negative test upon admission, and should be tested as described in the testing section above; COVID-19 vaccination should also be offered. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 366215 Page 5 of 5