Health inspection·April 27, 2023

F 0550 Level of Harm - Potential for minimal harm Residents Affected - Many Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on observation and interview the facility to provide a dignified dining experience by using disposable plates, cups and cutlery for meals over an extended period of time. This had the potential to affect all 81 residents residing in the facility. Findings include: On 04/23/23 from 8:00 A.M. to 9:00 A.M. observations of the breakfast meal revealed residents on all three halls were being served and eating their morning meal on Styrofoam plates, drinking from Styrofoam cups, and eating with plastic utensils. On 04/23/23 from 8:00 A.M. to 1:35 P.M. interviews with State Tested Nursing Assistant (STNA) #187, STNA #207, STNA #210, and Registered Nurse (RN) #152 verified residents were being served meals using disposable plates/cups and cutlery. The staff interviewed reported this practice was not dignified or homelike for the residents. On 04/23/23 from 8:15 A.M. through 10:15 A.M. interviews with residents, Resident #34, #57, #58, #62, and #65 revealed concerns related to eating on disposable dinnerware. The residents reported they had been eating on Styrofoam plates for a while and thought the facility should buy a new dishwasher. The residents stated they felt routinely eating from Styrofoam and using plastic was not dignified. On 04/23/23 at 8:50 A.M. interview with Dietary [NAME] #178 revealed the dishwasher had not worked for about three months and it was due to an issue with the water softener not working and calcification. She reported the facility had been using disposable items to serve meals for a few months and verified it did not feel like a home environment or dignified. She reported the kitchen staff used the three-compartment sink to wash, rinse, and sanitize the trays, coffee cups, special adaptive eating equipment for residents, and the hot plate lids. She reported there were not enough staff to hand wash all the reusable dinnerware. She reported the food was placed on the disposable plate, covered with foil, and then covered with the plate insulating lid. During the interview, Dietary [NAME] #178 reported she would not want her grandmother to have to eat off of disposable plates. On 04/23/23 from 11:10 A.M. to 12:09 P.M. observation of the lunch meal revealed all residents were again served on Styrofoam plates, covered with aluminum foil and then covered with insulated plate cover for service. On 04/23/23 at 11:10 A.M. interview with Dietary Coordinator (DC) #191 revealed the dishwasher had not worked since February 2023. She reported she felt terrible because the residents did not have a Page 1 of 16 366215 366215 04/27/2023 Lanfair Center for Rehab & Nsg Care Inc 1590 Chartwell Street Lancaster, OH 43130

F 0550 Level of Harm - Potential for minimal harm Residents Affected - Many homelike environment and dignity when it came to dining. She reported she did not have enough staff to hand wash the reusable dishes. She reported the facility did not provide additional staff to hand wash the reusable dishes in the three-compartment sink when the dishwasher broke. On 04/23/23 at 12:26 P.M. interview with RN #215 revealed eating on Styrofoam was not a homelike environment or dignified for the residents. This deficiency represents non-compliance investigated under Complaint Number OH00141718. 366215 Page 2 of 16 366215 04/27/2023 Lanfair Center for Rehab & Nsg Care Inc 1590 Chartwell Street Lancaster, OH 43130

F 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm Based on review of facility self-reported incidents (SRIs), facility policy review and interview the facility failed to ensure all incidents of abuse and/or neglect were thoroughly investigated. This affected two residents (#18 and #89) of two residents reviewed for abuse/neglect. Residents Affected - Few Findings include: 1. Review of facility SRI, tracking number 233107, dated 03/16/23 revealed Resident #18's family member expressed concern that her brother was not getting showered on his assigned day. This resident resided on the Speret Hall which was a memory care unit where all the residents were cognitively impaired. Review of the facility investigation revealed it was not thorough regarding neglect/mistreatment. Review of the staffing record for the Speret Hall for 03/16/23 revealed Registered Nurse (RN) #211, State Tested Nursing Assistant (STNA) #158, and STNA #170 were working when the alleged incident occurred. Review of the investigation revealed the three staff assigned to the unit were not interviewed. There was a total of five staff interviewed who were not working on the Speret Hall. Five cognitive residents residing on other units were also interviewed. There were no residents residing on Speret Hall interviewed because they were cognitively impaired. Further review of the investigation revealed a skin assessment was completed on only the involved resident, Resident #18 and review of shower documentation was only completed for Resident #18 when there were 20 residents residing on the Speret Hall. Interview on 04/26/23 at 11:08 A.M. with the Administrator verified he did not interview any of the staff working the Speret Hall as part of the investigation for SRI tracking number 233107. He also verified he only looked at the shower documentation for the involved resident (#18) and not any of the other 19 residents residing on Speret Hall to determine any type of trends or other concerns. 2. Review of facility SRI, tracking number 231156 , dated 01/17/23 revealed Resident #89 reported an allegation of physical and sexual abuse. Review of the facility investigation revealed it was not thorough regarding physical and sexual abuse. Review of the staffing record revealed there were three staff members working the Pleasantville - Long hall on 01/17/23, which included Licensed Practical Nurse (LPN) #114, LPN #131, and State Tested Nursing Assistant (STNA) #199. Review of the investigation revealed only one staff member, LPN #114, was interviewed regarding the incident. There was no documentation to support LPN #131 or STNA #199 were interviewed. There was documentation to support five staff on other units were interviewed. Further review of the investigation revealed six residents were interviewed, including involved resident #89. However, there were a total of 16 residents on the unit. Review of the cognition of these residents revealed they were moderately cognitively intact and there were nine cognitively intact residents on the unit who were not interviewed. Interview on 04/26/23 at 11:08 A.M. with the Administrator verified he only interviewed one of three staff working the Pleasantville - long hall for SRI #231156. He verified he interviewed two of 366215 Page 3 of 16 366215 04/27/2023 Lanfair Center for Rehab & Nsg Care Inc 1590 Chartwell Street Lancaster, OH 43130

F 0610 five moderately impaired residents on the unit when there were nine cognitively intact residents on the unit. Level of Harm - Minimal harm or potential for actual harm On 04/26/23 at 11:45 A.M. interview with the Administrator revealed he felt he followed the facility policy to extent he needed to. Residents Affected - Few Review of the facility undated policy titled Abuse, Mistreatment, Neglect, Injuries of Unknown Source, and Misappropriation of Resident Property, revealed under the investigation section that there should be an interview of the resident, the accused, and all witnesses. Witnesses generally include anyone who witnessed or heard the incident came in close contact with the resident the day of the incident (including other residents, family members); and employees who worked closely with the accused employee(s) and/or alleged victim the day of the incident. This deficiency represents an incidental finding investigated under Complaint Number OH00141718. 366215 Page 4 of 16 366215 04/27/2023 Lanfair Center for Rehab & Nsg Care Inc 1590 Chartwell Street Lancaster, OH 43130

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on observation, record review, facility policy and procedure review and interview the facility failed to provide adequate and planned interventions (including one on one observation) for Resident #39 as care planned related to the resident's fall risk and safety needs. This affected one resident (#39) of three residents reviewed for staffing. Findings include: Review of Resident #39's medical record revealed an admission date of 02/01/17 with diagnoses including unspecified focal traumatic brain injury with loss of consciousness, unspecified dementia, unspecified psychosis not due to a substance or known physiological condition, unsteadiness on feet, seizures, hypertension, and right total knee replacement recently. Review of Resident #39's quarterly Minimum Data Set (MDS) 3.0 assessment, dated 03/31/23, revealed the resident was severely cognitively impaired. The resident also needed extensive assistance of two staff for transfers. Review of Resident #39's care plan (initiated 04/17/19) revealed on 04/19/23 the care plan was updated to reflect an intervention of one on one with staff. On 04/23/23 at 8:20 A.M. interview with Registered Nurse (RN) #152 revealed she thought there should be additional staff. She reported Resident #39 was to receive one to one observation but there was no one assigned to observe her. She reported Resident #39 had recently had multiple falls and short-term memory issues related to forgetting about her knee surgery. On 04/23/23 from 8:20 A.M. to 8:40 A.M. observation revealed no staff one on one observing Resident #39 continuously as care planned. On 04/23/23 at 12:10 P.M. State Tested Nursing Assistant (STNA) #148 was observed sitting outside Resident #39's room. She reported there had not been enough staffing to do the one on one observation until 11:00 A.M. and verified no staff had been assigned to do the one on one until 11:00 A.M. On 04/23/23 at 2:55 P.M. interview with the Director of Nursing (DON) revealed Resident #39 was to be on one on one observations around the clock since her last fall on 04/19/23. He revealed Resident #39 had seven falls since 03/23/23 with her last fall being on 04/19/23. On 04/23/23 at 3:05 P.M. interview with RN #152 verified there were no staff assigned for one on one observation of Resident #39 until 11:00 A.M. on this date due to a lack of staff. On 04/23/23 at 3:30 P.M. interviews with STNA #101 and STNA #143 revealed RN #152 had offered to do one on one observation of Resident #39 while they both passed out breakfast. STNA #101 reported that technically no one was assigned the one on one observation of Resident #39. STNA #143 revealed RN #152 said she would take her medication cart down the hall and outside of Resident #39's room. STNA #143 revealed RN #152 said she would keep an eye on her while she was passing medications on that end of the hall. STNA #143 reported an STNA went to do the one on one observation at 11:00 A.M. because RN #152 was coming off the hall to the nurses' station. 366215 Page 5 of 16 366215 04/27/2023 Lanfair Center for Rehab & Nsg Care Inc 1590 Chartwell Street Lancaster, OH 43130

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 04/23/23 at 3:41 P.M. interview with RN #152 revealed both STNAs were needed to pass breakfast so she offered to take her medication cart down the hall to watch Resident #39. She reported she knew Resident #39 was to have one on one observation due to recent falls with injury. She reported she did not have constant observation of Resident #39 due to needing to enter rooms to provide medication to residents on the hall. During the interview, RN #215 verified since there were no staff assigned to one on one observation of Resident #39 and Resident #39 was not provided with consistent observation, there was no true one on one observation of the resident as care planned the morning of 04/23/23. On 04/24/23 at 10:34 A.M. interview with the Director of Nursing (DON) revealed he did have an extra STNA on the schedule for 04/23/23 but the extra STNA was not assigned specifically to the duty of one on one for Resident #39. He reported RN #152 should have assigned the one on one observation to one of the STNAs but did not. He reported RN #152 should not have directed STNAs #101 and #143 to both do AM care and pass out breakfast. Review of the facility undated policy titled, Care Plan - Use of revealed the care plan shall be used in developing the resident's daily care routine. This deficiency represents non-compliance investigated under Complaint Number OH00141956 and Complaint Number OH00141718. 366215 Page 6 of 16 366215 04/27/2023 Lanfair Center for Rehab & Nsg Care Inc 1590 Chartwell Street Lancaster, OH 43130

F 0802 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. Based on observation, record review and interview the facility failed to ensure staff who were assisting in the kitchen were properly trained. This had the potential to affect all 81 residents residing in the facility and receiving food from the kitchen. Findings include: On 04/23/23 at 11:10 A.M. interview with Dietary Coordinator (DC) #191 revealed the kitchen was short staffed a position and Housekeeping #177 was helping in the kitchen. On 04/23/23 at 12:00 P.M. Housekeeping #177 was observed using the three-compartment sink to wash, rinse, and sanitize insulated plate covers. He had washed, rinsed and sanitized six insulated plate covers when this surveyor asked if the sanitizing water had been checked for concentration levels. The employee's response was no. This surveyor then requested the sanitizer water be tested for concentration. DC #191 tested the sanitizer, and the result was 100 to 200 parts per million (PPM). The sanitizer water did not have the appropriate level of chemical to sanitize which DC #191 verified at the time. DC #191 asked Housekeeping #177 how many pumps of sanitizer did you use? and Housekeeping #177 replied three pumps. DC #191 informed Housekeeping #177 that he should have used eight pumps of sanitizer in the water. DC #191 verified the third sink compartment sanitizer level was not strong enough to sanitize. She also verified Housekeeping #177 had never been trained in the kitchen or on how many pumps of sanitizer needed to be in the sanitizing water. Review of the Job Description, Checklist for Orientation of Dietary Aide, dated 12/01/12 revealed staff working in the position should be oriented to the sanitation and infection manuals. Review of the undated Dietary Aide Job Description of Duties revealed the Dirty End Dish Room Aide was to drain and clean the three-compartment sink and sanitizing solution should be between 200-400 PPM per product directions. This deficiency represents non-compliance investigated under Complaint Number OH00141718. 366215 Page 7 of 16 366215 04/27/2023 Lanfair Center for Rehab & Nsg Care Inc 1590 Chartwell Street Lancaster, OH 43130

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 observation, record review and interview the facility failed to ensure the kitchen was clean, food temperatures were checked prior to serving, and dish sanitizer was at the appropriate level to prevent contamination and/or food borne illness. This had the potential to affect all 81 residents residing in the facility and receiving food from the kitchen. Findings include: 1. On 04/23/23 at 8:50 A.M. observation of the range oven on the right revealed it had a black charred substance in the bottom of the oven. Interview with Dietary [NAME] #178, at the time, revealed the oven on the right did not work correctly and had not been used for a year. There was also food like substance and a white lime-like substance splattered on the steamer to the left of the cook top. Interview at the time with Dietary [NAME] #178 verified the oven, and the side of the steamer were dirty. Review of the facility policy titled, Operation and Cleaning Procedures revised 03/2022 revealed all areas of the kitchen shall be cleaned on a daily basis to insure proper sanitation in the operations. Review of the form titled Dietary Cleaning Checklist, dated 03/2022 revealed range ovens were to be clean and free of debris and the steamer is clean inside and out and free of lime build up. 2. On 04/23/23 at 11:24 P.M. interview with Dietary Coordinator (DC) #191 revealed the evening cook does not always document food temperatures as required. She reported she watches the evening cook do temperature checks when she is present in the evening, but she is not always present. She verified that if temperatures were not logged then there was no way to confirm food items were cooked to safe temperatures and held at appropriate minimum temperatures during service. Review of food temperature logs dated January 2023, February 2023, March 2023 and April 2023 confirmed food temperatures were not always taken prior to food leaving the kitchen and being served to residents. Review of the documentation revealed food temperatures were not obtained for breakfast on 03/01/23, 03/29/23, 04/06/23 or 04/14/23, for lunch on 03/29/23, 04/06/23, or 04/14/23 or for dinner on 03/04/23, 03/10/23, 03/11/23, 03/17/23, 03/18/23, 03/19/23, 03/25/23, 03/26/23, and 03/30/23. Sixteen out of 333 meals did not have their temperatures assessed. This results in 12.9% of meals with no temperature documentation for March 2023. Review of the facility undated policy titled, Tray line Food Temperatures and Guidelines revealed all food shall be held on the serving line at proper temperatures to promote optimum palatability, ensure food safety and prevent food borne illness. Serving line food temperatures shall be documented at the beginning of each meal just prior to serving and at the completion of each meal. The cook of designee shall be responsible for recording the serving line food temperatures at each meals. 3. On 04/23/23 at 12:00 P.M. Housekeeping #177 was observed using the three-compartment sink to wash, rinse, and sanitize insulated plate covers. He had washed, rinsed and sanitized six insulated plate covers when this surveyor asked if the sanitizing water had been checked for concentration levels. The employee's response was no. This surveyor then requested the sanitizer water be tested for concentration. DC #191 tested the sanitizer, and the result was 100 to 200 parts per million (PPM). The 366215 Page 8 of 16 366215 04/27/2023 Lanfair Center for Rehab & Nsg Care Inc 1590 Chartwell Street Lancaster, OH 43130

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many sanitizer water did not have the appropriate level of chemical to sanitize which DC #191 verified at the time. DC #191 asked Housekeeping #177 how many pumps of sanitizer did you use? and Housekeeping #177 replied three pumps. DC #191 informed Housekeeping #177 that he should have used eight pumps of sanitizer in the water. DC #191 verified the third sink compartment sanitizer level was not strong enough to sanitize. She also verified Housekeeping #177 had never been trained in the kitchen or on how many pumps of sanitizer needed to be in the sanitizing water. Review of the Job Description, Checklist for Orientation of Dietary Aide, dated 12/01/12 revealed staff working in the position should be oriented to the sanitation and infection manuals. Review of the facility undated policy titled, Manual Ware Washing revealed the third sink (sanitizing tank) shall have pans submerged. This tank shall contain water with the approved sanitizing agent at the proper concentration according to manufacturer's direction. Further review revealed sanitizer shall be checked and recorded prior to each use and the recommended sanitization concentration should be 200 to 400 ppm concentration. This deficiency represents non-compliance investigated under Complaint Number OH00141718. 366215 Page 9 of 16 366215 04/27/2023 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, review of facility training records, facility policy and procedure review and interview the facility failed to ensure appropriate signage was on the main entrance and staff entrance doors regarding a COVID-19 outbreak and what Personal Protective Equipment (PPE) should be worn, failed to ensure appropriate PPE was worn by staff in the facility, failed to ensure proper signage and isolation supplies were outside of Resident #43's room who tested positive for COVID-19 and was on airborne isolation, failed to ensure appropriate PPE was worn when caring for COVID-19 positive Resident #37 on airborne isolation, and failed to ensure proper hand hygiene was performed to prevent the spread of infection. This affected three residents (#41, #43 and #37) and had the potential to affect all 81 residents residing in the facility. Residents Affected - Many Findings include: 1. On 04/23/23 at 7:55 A.M. upon entrance to the facility, interview with Medical Records #179 revealed the facility was in outbreak mode for COVID-19. However, observation at this time revealed no signage revealing the facility was in COVID-19 outbreak mode. There was a sign in the lobby which was to inform people entering the facility of the county transmission level for COVID-19 which was turned around and facing away from the entrance. On 04/23/23 at 1:07 P.M. observation of the staff entrance, with Registered Nurse (RN) #215, revealed no signage to inform the staff what the country COVID-19 transmission level was, or PPE should be worn in the facility. Observation also revealed there were no masks available for the staff to use/apply upon arrival. An interview (on 04/23/23 at 1:07 P.M.) with Dietary Coordinator #191 revealed the Administrator discussed the county COVID-19 transmission levels at every Friday morning meeting at 9:00 A.M. but there was no signage put up for staff to know what the level was or what PPE to wear. She also verified staff had to walk into the center of the facility by the main entrance to obtain a mask if needed. On 04/23/23 at 2:15 P.M. a printed paper sign was observed taped to the facility entrance door revealing the facility was in COVID-19 outbreak mode and recommended all visitors to wear a mask. On 04/23/23 at 2:15 P.M. interview with Receptionist #215 revealed the signage on the door informing visitors the facility was in COVID-19 outbreak mode was placed on the door around 11:30 A.M. She also verified the facility had been in outbreak mode for about four weeks. On 04/23/23 at 2:25 P.M. interview with Medical Records #170 revealed there had not been an outbreak sign on the front door of the facility until today at 11:30 A.M. Review of the facility undated protocol titled, Coronavirus (COVID-19) Protocol revealed the county positivity rate/transmission rate would be checked every week and communicated to department heads who would educate their direct reports. 2. On 04/23/23 at 8:12 A.M. interview with Medical Records #179 in the memory care unit revealed the county level of COVID-19 transmission was orange but the facility was in outbreak mode. On 04/23/23 at 8:12 A.M. State Tested Nursing Assistant (STNA) #150 and Licensed Practical Nurse 366215 Page 10 of 16 366215 04/27/2023 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 (LP)N #134 were observed on the Speret Hall assisting dementia residents in the common area. Neither employee were observed wearing a face mask or eye protection. Interviews at the time with STNA #150 and LPN #134 verified they were not wearing any PPE. STNA #150 revealed she was not wearing a mask because she did not think she needed to. She reported there was COVID-19 in the building but not the memory care unit. Residents Affected - Many Observation on 04/23/23 at 8:12 A.M. of STNA #210 on Speret Hall assisting with residents, wearing a surgical mask but no eye protection. Interview at the time with STNA #210 verified she was wearing a mask but no eye protection. She revealed she did not think she needed to wear eye protection. Interview on 04/23/23 at 8:13 A.M. with LPN # 134 revealed there was no need to wear a mask due to the county COVID-19 transmission level being orange. She then verified the facility was actively in a COVID-19 outbreak. Interview on 04/23/23 at 8:20 A.M. with Registered Nurse (RN) #152 revealed there was a concern with staff wearing appropriate PPE after observing STNA #148 enter Resident #37's room, who was in airborne isolation due to testing COVID-19 positive, without the appropriate PPE. She verified STNA #148 wore only a surgical mask and goggles. RN #152 verified STNA #148 should have been wearing an N95 mask, eye protection, gown, and gloves when entering Resident #37's room due to the resident being in airborne isolation. Interview on 04/23/23 at 8:45 A.M. with Medical Records #179 revealed the county level of COVID-19 transmission was now elevated to red and every staff member in the building should be wearing a snug fitting mask and eye protection. On 04/23/23 at 9:00 A.M. STNA #150 and LPN #134 were observed without any type of mask or eye protection while providing care to residents on the Speret Hall. Interview at that time with STNA #150 and LPN #143 revealed they did not know the county COVID-19 transmission rate was red or that they needed to wear a well-fitting mask and eye protection. They did know the facility was in COVID-19 outbreak mode. Interview on 04/23/23 at 9:10 A.M. with Medical Records #179 revealed she had gone to the other units to inform staff the county COVID-19 transmission level was red but had not made it to the Speret Hall to inform those staff of the correct PPE to wear. Interview on 04/23/23 at 9:12 A.M. with the Director of Nursing (DON) verified his staff should be wearing a well-fitted mask and eye protection not only due to the facility being in COVID-19 outbreak mode but because the county COVID-19 transmission level was the red level - high. Interview on 04/24/23 at 10:06 A.M. with the Administrator revealed even though the county transmission level for the county was yellow from 04/07/23 to 04/13/23 and orange from 04/14/23 to 04/20/23, there was a COVID-19 outbreak in the facility and staff should have been wearing the appropriate PPE. He reported any staff in a patient care area should have been wearing a surgical mask and goggles. He reported that if staff were in an isolation area, then the staff were to wear the appropriate PPE for the type of isolation. Review of an in-service held on 04/04/23 revealed staff were trained in COVID-19 infection control practices and hand washing. LPN #143, STNA #148, and STNA #150's signatures were on the training sign-in. 366215 Page 11 of 16 366215 04/27/2023 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 - Many Review of facility undated policy titled, Coronavirus (COVID 19) revealed infection control recommendations included the following: education on how to keep residents, visitors, and staff safe by using the correct infection control practices including proper hand hygiene and selection and use of PPE, and don recommended PPE based on the facility's PPE protocol. Review of the facility undated protocol titled Coronavirus (COVID-19) Protocol revealed staff would be required to wear eye protection when the county's positivity/transmission rate was High (red) when in patient care areas. Patient care areas were described as areas in the facility where a staff member was likely to come into contact with a resident. Further review revealed during COVID outbreak, staff would wear a well-fitting mask in the facility (excluding times when an N95 mask is required). Staff would wear eye protection when in quarantine/isolation rooms, COVID testing staff/residents and when the county's positivity rate/transmission rate was high (red) when in patient care areas. 3. Review of Resident #43's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses including unspecified cirrhosis of the liver, essential hypertension, type two diabetes and chronic obstructive pulmonary disease. Review of Resident #43's COVID-19 test results, dated 04/14/23 revealed the resident had tested positive for COVID-19. Review of Resident #43's physician's orders revealed an order, dated 04/14/23 for airborne precautions due to COVID positive. The resident was to remain in isolation precautions until 04/24/23. Observation of resident rooms on 04/23/23 at 8:20 A.M. on the Pleasantville Hall revealed droplet isolation signage on the doors for three residents, Resident #17, #37, and #39. There was no isolation cart outside of Resident #43's room. RN #152 verified there should be an isolation cart outside of Resident #43's room. She stated, Maybe someone put it inside the room. This surveyor and RN #152 looked inside the room and it was not in the room. There was an isolation cart outside of Resident #4's room but this resident was not in isolation and there was no signage on the door. Observation on 04/23/23 at 8:20 A.M. revealed Resident #43 had no signage or isolation cart outside her room. Review of the list provided by the facility, revealed three residents were on airborne isolation: Resident #37 was on airborne isolation for COVID, Resident #39 was on airborne isolation for COVID, and Resident #43 was on airborne isolation for COVID. Interview on 04/23/23 at 2:55 P.M. with the Director of Nursing (DON) revealed Resident #43 went on airborne isolation for COVID on 04/14/23 and should come out of isolation on 04/25/23. He revealed someone must have took the sign off the door and removed the isolation cart from outside her room. He reported he did not know who did this, but stated it was wrong. He verified without signage, individuals entering the room would not know the isolation status of the resident. He reported Resident #17 came out of isolation on 04/22/22 and no one removed the isolation sign or isolation cart when it should have been removed. Review of facility undated policy titled Coronavirus (COVID 19) revealed infection control recommendations include the following: post signage at door entrance of isolation and quarantine rooms to alert staff on what PPE is required upon entering the room and set the PPE supplies at the entry of the door so they are readily available. 366215 Page 12 of 16 366215 04/27/2023 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 4. Review of Resident #37's medical record revealed he was admitted to the facility on [DATE] with diagnoses including bacteremia, generalized muscle weakness, and severe sepsis with septic shock. Review of Resident #37's COVID-19 test results, dated 04/14/23 revealed the resident was positive for COVID-19. Residents Affected - Many Review of Resident #37's physician's orders revealed an order, dated 04/14/23 for the resident to be on isolation airborne precautions due to COVID positive until 04/24/23. Observation on 04/23/23 at 8:30 A.M. revealed STNA #148 entered Resident #37's room wearing a surgical mask and goggles. She covered Resident #37 up with his blanket and then removed the breakfast tray from the room. Upon exiting the room, STNA #148 did not do hand hygiene, change her mask, or clean her goggles. She walked down the hallway carrying the breakfast tray and passed Resident #27 who was sitting in the hallway eating his breakfast. She then placed the breakfast tray on the dietary cart sitting at the end of the hallway. STNA #148 put her surgical mask in a red trash can in the hallway and then entered the restroom. Upon exiting, this surveyor questioned her about what PPE she should have worn into the airborne isolation room of Resident #37. STNA #148 verified she did not wear the appropriate PPE when entering Resident #37's room and providing care. She reported she should have been wearing an N95 mask, eye protection, a gown, and gloves. She verified the only correct PPE she wore into the room was her eye protection. When STNA #148 was asked about cleaning her eye protection upon exiting an airborne isolation room she responded, I cleaned them with soap and water in the bathroom. She verified she did not know they needed to be cleaned with a disinfectant cleaner that killed COVID-19. She then applied a new surgical mask and continued to provide care to residents. Review of the facility undated protocol titled, Coronavirus (COVID-19) Protocol revealed staff would wear N95 masks in quarantine/isolation rooms. Further review revealed eye protection would be cleaned when exiting a resident's room when in quarantine/isolation room. Staff would wear gowns when entering quarantine/isolation rooms and dispose of them or place them in the laundry receptacle prior to leaving the room. 5 On 04/24/23 at 1:38 P.M. STNA #199 and LPN #131 were observed providing incontinence care to Resident #41. The resident was observed sitting on the toilet in the shower room on Speret Hall. When Resident #41 reported she was finished, STNA #199 ,who had already washed her hands and applied gloves, cleaned Resident #41 from front to back using peri care disposable cloths. STNA #199 used four cloths total. STNA #199 assisted Resident #41 with pulling up her pants and then discarded her gloves. STNA #199 did not wash her hands. She proceeded to assist Resident #41 to her room by holding the transfer belt around Resident #41's waist. Registered Nurse (RN) #215 took over assisting Resident #41 down onto her bed as STNA #199 walked back up the hallway and into the shower room after touching the doorknob to the shower room. She washed her hands in the shower room and then exited to the hallway. An interview at that time with STNA #199 verified she should have washed her hands after removing her gloves and prior to leaving the shower room with Resident #41. Review of the facility undated policy titled Hand Washing/Hand Hygiene revealed it was the facility's policy to provide guidelines to employees for proper and appropriate hand washing and hygiene techniques that would aide in the prevention of the transmission of infections. Review of the facility undated policy titled Perineal Care revealed after completion of perineal care staff were to remove gloves and discard into designated container. Wash and dry hands thoroughly. 366215 Page 13 of 16 366215 04/27/2023 Lanfair Center for Rehab & Nsg Care Inc 1590 Chartwell Street Lancaster, OH 43130

F 0880 This deficiency represents non-compliance investigated under Complaint Number OH00141956. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many 366215 Page 14 of 16 366215 04/27/2023 Lanfair Center for Rehab & Nsg Care Inc 1590 Chartwell Street Lancaster, OH 43130

F 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review and interview the facility failed to maintain the dishwasher, ice machine, range ovens and water softener in good working condition. This had the potential to affected all 81 residents residing in the facility. Residents Affected - Many Findings include: 1. Interviews on 04/23/23 from 8:00 A.M. to 1:35 P.M. with State Tested Nursing Assistants (STNAs) #187, #207, and #210, Licensed Practical Nurse (LPN) #131, and Registered Nurse (RN) #152 revealed concerns regarding the dishwasher and ice machine not working in the kitchen. They felt residents should not be eating on disposable dinnerware for so long. Interviews on 04/23/23 from 8:15 A.M. through 10:15 A.M. with Resident #34, #57, #58, #62, and #65 revealed concerns related to the dishwasher not working and having to eat on disposable dinner ware. Interview on 04/23/23 at 8:50 A.M. with Dietary [NAME] #178 revealed the ice machine had not worked for about six months. She reported she thought it stopped working secondary to the water softener not working and it ruined the filtration system. Dietary [NAME] #178 reported she was told the next ice machine would have to have a different filtration system. She reported the dishwasher had not worked for about three months and was due to the same issue of the water softener not working and there was calcification. She reported the kitchen staff used the three-compartment sink to wash, rinse, and sanitize the trays, coffee cups, special adaptive eating equipment for residents, and the hot plate lids. She reported there were not enough staff to hand wash all the reusable dinnerware. She also reported the ovens in the range did not work properly. She reported the standing double oven was used. The top one was used to cook and the bottom one was used to keep items warm. Observation on 04/23/23 at 8:50 A.M. of the dishwasher, kitchen ice machine, and ovens in the range revealed they were not in working order. Interview on 04/23/23 at 10:37 A.M. with Registered Nurse (RN) #215 revealed Maintenance Coordinator #219 revealed to her the water softener was installed in November of 2022. She reported it had never worked correctly. When it was put in and did not work, the company said they needed to order parts and the facility never heard back from them. Interview on 04/23/23 at 11:10 A.M. with Dietary Coordinator (DC) #191 revealed the dishwasher had not worked since February 2023 and the ice machine even longer. Observation on 04/23/23 at 12:00 P.M. of Housekeeping #177 using the three-compartment sink to wash, rinse, and sanitize insulated plate covers. Interview on 04/23/23 at 1:13 P.M. with Maintenance Coordinator #151 revealed the dishwasher stopped working in February 2023 and he was not sure when the ice machine stopped working. He reported both items needed to be replaced. He reported the water softener not working had an effect on the dishwasher and ice machine because the water was hard and caused calcification. He verified he knew nothing about the ovens not working in the range. During the interview on 04/23/23 at 1:13 P.M. Maintenance Coordinator #151 revealed the water 366215 Page 15 of 16 366215 04/27/2023 Lanfair Center for Rehab & Nsg Care Inc 1590 Chartwell Street Lancaster, OH 43130

F 0908 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many softener was working, but it had issues and replacement parts could not be located. The facility put in a new water softener about one year ago and it had never worked correctly. He reported the water softener not working had an effect on the dishwasher and ice machine because the water is hard and caused calcification. He reported he had no record of any communication to the company who put the water softener in but knew he had spoken with them at least twice. He reported he knew not having a water softener was hard on the equipment by he never thought about how it could make the residents' skin dry and itchy. He verified that was not good care for the residents. Interview on 04/23/23 at 1:22 P.M. with Dietary Coordinator #191 revealed she had attempted to speak once to the company who put the water softener in. She reported her corporate boss had come to the facility and she called the company. She reported the company could not release any information to her because her corporation did not have a contract with the company, and they reported the maintenance department would have to call them. She reported all of her kitchen equipment which had water running through it, the dishwasher, ice machine, and steamer, was a mess due to the calcification of the hard water. She reported that her staff were having skin breakdown on their arms due to washing dishes in the hard water. Review of an invoice dated 02/27/23 revealed the dishwasher could not be repaired. Review of the facility Purchasing Alert Form (PAF), dated 03/27/23 revealed the current dishwasher had been tagged and unfixable. Two companies had provided quotes for removal and installation. This PAF was recommended by the facility administrator on 03/27/23 and approved by the regional vice president on 04/03/23 and the past president on 04/06/23. The form revealed the administrator was to follow-up to the PAF within two weeks of approval with either the work has been scheduled (provide details) or the work has been completed (provide date et.). There was no documentation of the administrator's follow-up to the PAF. The follow-up should have been completed by 04/20/23. Interview on 04/24/23 at 7:30 A.M. with the Administrator revealed he did not follow up with the PAF within two weeks because the company had to have time to get the dishwasher and he had not heard from them. Interview on 04/24/23 at 10:42 A.M. with the Administrator revealed he was aware of the water softener not working but was not aware that no one was addressing it. Interview on 04/25/23 at 2:22 P.M. with the Administrator revealed he knew there were problems with the water softener from November to January and he knew there were still problems with it but did not know the severity of the situation. Review of facility policy titled Maintenance Department, updated 11/2019 revealed the department would do ongoing monitoring of the facility for areas needing repair and, if needed, would report to the administrator for approval of the needed repairs. This deficiency represents non-compliance investigated under Complaint Number OH00141718. 366215 Page 16 of 16