Health inspection·September 7, 2023

F 0551 Give the resident's representative the ability to exercise the resident's rights. Level of Harm - Minimal harm or potential for actual harm Based on record review and interviews with staff, the physician and the local ombudsman, the facility failed to follow up with a resident's Power of Attorney's concerns/grievances related to the resident's care. This affected one resident (#12) out of three residents reviewed. The facility census was 48. Residents Affected - Few Findings include: Review of the medical record for Resident #12 revealed a readmission date of 04/30/23. Diagnoses included diabetes mellitus, protein caloric malnutrition, neuromuscular, dysfunction of bladder, aphasia, depression, Parkinson's disease, and heart disease. Review of most recent Minimum Data Set (MDS) assessment 3.0 dated 08/01/23 for Resident #12, revealed the resident had severe cognitive deficits and was nonverbal. Assessment revealed the resident received hospice services. Review of the Healthcare Power of Attorney (POA) dated 08/07/20, revealed Resident #12 and Resident #12's two children established the Healthcare POA. Resident #12 delegated her daughter as agent number one and the resident's son as agent number two. Review of the facility documents titled Resident/Family Concern/Grievance Form dated 07/20/23 to 09/05/23, revealed several concerns/grievances were presented to the facility from the Resident #12's POAs. There was no documented evidence the concern/grievances were resolved for the following concerns generated from Resident #12's POAs: On 07/20/23 at 12:06 P.M, on 07/31/23 at 7:09 A.M., on 08/03/23 at 6:57 P.M., on 08/03/263 at 12:26 P.M., on 08/10/23 at 3:56 P.M., on 08/11/23 at 12:31 P.M., on 08/14/23 at 11:31 A.M., on 08/16/23 at 9:13 A.M., on 08/23/23 at 10:46 A.M., on 08/27/23 at 7:48 P.M. and on 09/05/23 at 7:53 P.M. Review of progress notes from 07/23/23 through 08/14/23 for Resident #12, revealed no documented evidence the POA's concerns had been addressed and/or resolved. Interview with the administrator on 09/05/23 at 1:11 P.M., revealed he had spoken to Resident #12's POAs several times but failed to document any of their conversations. Administrator stated he was following the advice of their corporate office and did not follow up with the family when they expressed their concerns. The administrator noted he signed the concern/grievance forms; however, he did not complete any follow up and/or document any resolution to the POAs concerns. Interview with the Social Services Designee (SSD) #100 on 09/05/23 at 12:00 P.M., revealed Resident #12's family was very involved; however, the resident's POAs had been banned from the facility by Page 1 of 2 366236 366236 09/07/2023 Good Shepherd Village 422 North Burnett Road Springfield, OH 45503

F 0551 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the county sheriff's office with a do not trespass order. The POAs completed a form titled Resident/Family Concern/Grievance Form and submitted them to the facility via email. SSD #100 confirmed she initiated the forms and forwarded them the Administration; however, she never received a disposition for the concerns. Interview with Ombudsman #200 on 09/06/23 at 1:10 P.M., revealed she was very familiar with Resident #12 and her family and the POA's requests. The Ombudsman had notified the facility staff multiple times and made several in-person visits to the facility to explain why they should be accommodating the POAs wishes, but the facility would not accommodate the POA's wishes regarding Resident #12. Interview with Regional Clinical Manager (RCM) #122 on 09/06/23 at 2:33 P.M., revealed when a resident chose to be admitted and signed the agreement, that gave the facility authorization to act in their best interest and did not have to follow the POAs requests. RCM #122 stated she felt Resident #12's POAs were not acting in the resident's best interest. RCM #122 stated Resident #12 eats well in the dining room and her wounds were healing and if the facility followed all of the instructions from the POAs, Resident #12 would be in her room around the clock and never come out. RCM #122 noted Resident #12's son watches the video cameras in her room around the clock. Interview with Resident #12's POA on 09/06/23 at 4:00 P.M., revealed her brother (the second POA) had been ordered to stay off the premises early in the spring of 2023, then two weeks later the former Director of Nursing (DON) issued a do not trespass order against her and as a result, she cannot see her mother. The POA stated her sister-in-law goes to the facility daily to check on Resident #12. The POA wishes the facility and the POAs could come to an agreement on the care of the Resident #12. The POA reported the facility staff refused to listen to their requests and failed to provide feedback as to why they are not following the care requests for Resident #12. Interview with Physician #205 on 09/07/23 at 12:30 P. M. revealed she had contacted the family multiple times per their requests. She was aware the family wanted the resident to be in her room and up in a chair to eat all her meals and due to a history of aspiration, the resident being in her room unattended during mealtimes would be detrimental to the resident. Physician #205 was not aware the POAs had made several complaints to the facility administration and had not received any documentation explaining the care plan. Physician #205 indicated the facility administration asked her to discontinue providing care for Resident #12; however, she believed it was not necessary and unethical. Physician #205 suggested the facility and the family should be able to come to an agreement on the care that satisfies the family and the facility. This deficiency represents non-compliance investigated under Complaint Number OH00145290. 366236 Page 2 of 2