Health inspection·April 4, 2023

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Based on observation, Self-reported Incident (SRI) Number 233274 review, medical record review, interview and facility policy review the facility failed to protect residents from staff to resident physical abuse. This affected one resident (Resident #29) of one residents reviewed for abuse. The facility census was 42. Findings include: Review of Resident #29's medical record revealed an admission date of 12/30/22 with admission diagnoses that included chronic obstructive pulmonary disease, congestive heart failure, atrial fibrillation and hypertension. Further review of the medical record including the Minimum Data Set (MDS) 3.0 discharge assessment with a reference date of 02/19/23 indicated Resident #29 had a severely impaired cognition level. Review of the facility SRI #233274 with a created date of 03/23/23 revealed on 03/22/23 Resident #29 was found with bruising to her right and left cheeks. Further review of the SRI revealed an interview with Resident #29 was completed and a staff member squeezed her cheeks and told her to stop yelling. During the interview with Resident #29, the staff member who squeezed the resident's mouth was identified as Registered Nurse (RN) #300. An assessment completed of Resident #29 revealed two bruises, one to the left cheek and one to the right cheek which were circular and the size of finger tips. The accused staff member was removed from the schedule and facility pending investigation. The facility completed the investigation and unsubstantiated the allegation due to the accused staff member denying the allegation and no staff witnesses. The facility terminated RN #300 due to the allegation and the location and size of the bruising being similar to finger prints. Further review of the medical record revealed no documentation of the abuse allegation in the nurse progress notes on 03/22/23. Interview with Resident #29 on 04/03/23 at 9:40 A.M. revealed she was yelling for her call light and a nurse came in and told her to stop yelling. She added that she later started yelling again for her call light and the same nurse came in and squeezed her mouth shut and told her to stop yelling. The resident had no further issue with the incident and was satisfied with RN #300 being terminated. Observation at the time of the interview revealed a small faint circular bruise the size of a finger tip to her left cheek area. No evidence of bruising was noted to the right cheek area at this time. On 04/03/23 at 9:45 A.M. interview with Registered Nurse (RN) #103 verified Resident #29 was abused by a facility staff member on 03/22/23 when she squeezed Resident #29's left and right cheeks with Page 1 of 6 366241 366241 04/04/2023 Steubenville Country Club Manor 575 Lovers Lane Steubenville, OH 43953

F 0600 her fingers. RN #103 indicated the staff member was terminated. Level of Harm - Minimal harm or potential for actual harm Review of the facility policy Resident Neglect, Abuse, Misappropriation of Property and Injuries of Unknown Origin Policy Dated 03/22 revealed Abuse means knowingly causing physical and / or verbal harm, recklessly causing serious physical harm to a resident by physical contact with the R or by use of physical or chemical restraint, medication or isolation as punishment, for staff convenience, excessively, as a substitute for treatment or in amounts that preclude habilitation and treatment. Residents Affected - Few This deficiency represents non-compliance investigated under Master Complaint Number OH00141657. 366241 Page 2 of 6 366241 04/04/2023 Steubenville Country Club Manor 575 Lovers Lane Steubenville, OH 43953

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, orthopedic consult notes review, resident and staff interviews, the facility failed to ensure consult appointment notes were reviewed to ensure timely identification of pressure ulcers and implementation of wound care. This affected one resident (Resident #41) of three residents reviewed for wounds. The facility census was 42. Residents Affected - Few Findings include: Review of Resident #41's medical record revealed an admission date of 03/14/23 with admission diagnosis that included fracture to the left fibula. Review of the nursing admission assessment dated [DATE] identified the presence of a cast to the left lower leg. Review of the physician's admission orders revealed no evidence of circulation checks to the left lower leg. Review of weekly skin assessments completed on 03/21/23 and 03/28/23 found no evidence of any skin concerns or wounds. No evidence of any skin assessment or wound assessment was completed after 03/28/23. Review of the orthopedic consult appointment note dated 03/30/23 indicated Resident #41 was transitioned to a boot. Further instructions indicated to remove the boot for gentle ankle range of motion, evaluate eschar (necrotic tissue) on the bottom of the foot and refer to wound care for eschar. Review of the nursing notes for Resident #41 found no evidence of any documentation the resident went to an outside appointment or returned from the appointment. Further review of the nursing notes revealed no evidence of any wound identification or wound assessment following the orthopedic appointment. Observation of Resident #41 on 04/03/23 at 8:40 A.M. and again at 12:40 P.M. revealed a walking boot in place to the left lower leg. A bandage and wrap was observed on the left foot at this time. Interview with Resident #41 on 04/03/23 at 12:40 P.M. revealed on 03/30/23 she went to her orthopedic surgeon's office for an appointment to follow up on her fracture and remove her hard plaster cast. She further added when the cast was removed a wound was found to the bottom of her foot. She indicated she has not received any wound care or assessment since she returned to the facility after her appointment on 03/30/23 and she had been cleaning and wrapping the wound independently. Lastly, Resident #41 stated she provided the documentation from the orthopedic surgeon's office to the facility staff upon her return from the appointment. The resident denied any indication the pressure wound was developing while she was wearing her cast. A wound assessment completed by Registered Nurse (RN) #115 on 04/03/23 at 1:10 P.M. found an unstageable pressure ulcer (Full-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough (dead cells) or eschar) to the bottom of the left foot measuring 4.0 centimeters (cm) x 4.0 cm and covered with necrotic tissue. A note on the assessment indicated the wound was found on 03/30/23 after the cast removal during an appointment with orthopedist. On 04/03/23 at 1:35 P.M. interview with RN #115 verified a new wound to the bottom of Resident #41's left foot was discovered by the orthopedist when her hard cast was removed on 03/30/23 and had not been identified, assessed or wound care ordered at this time. RN #115 further verified there was no circulation checks for the left lower leg ordered after admission. 366241 Page 3 of 6 366241 04/04/2023 Steubenville Country Club Manor 575 Lovers Lane Steubenville, OH 43953

F 0686 This deficiency represents non-compliance investigated under Master Complaint Number OH00141657 and Complaint Number OH00141270. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 366241 Page 4 of 6 366241 04/04/2023 Steubenville Country Club Manor 575 Lovers Lane Steubenville, OH 43953

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 medical record review and staff interview the facility failed to ensure residents did not fall during wheelchair transportation and an investigation was completed following an accident . This affected one (Resident #3) of three residents reviewed for accidents. The facility census was 42. Findings include: Review of Resident #3's medical record revealed an admission date of 05/23/19 with diagnoses that included Alzheimer's disease with dementia, end stage heart failure and cerebrovascular accident with hemiplegia. Further review of the medical record including nursing progress notes revealed on 11/22/22 Resident #3 fell out of her wheelchair. Resident #3 hit her head and had bleeding from her right hand/thumb. The Physician was notified and advised to send to the emergency room for evaluation. Further review of the medical record revealed Resident #3 was admitted to the hospital with pneumonia. Further review of the medical record found no evidence of any fall investigation completed following the accident on 11/22/22. On 04/03/22 at 12:50 P.M. interview with Registered Nurse (RN) #115 indicated an investigation of the accident on 11/22/22 could not be located. She indicated on 12/25/22 a water line broke in the ceiling of her office and damaged many records/documents and this may have been damaged at that time. Further interview with RN #115 indicated Resident #3 was being transported in a wheelchair by a staff member when the staff member rolled over a floor threshold causing Resident #3 to fall out of the wheelchair. She indicated Resident #3 had poor positioning in the wheelchair and a new intervention following the accident was the use of a geri-chair (a large, padded chair that provides more space than a wheelchair to individuals with limited mobility) for positioning. This deficiency represents non-compliance investigated under Complaint Number OH00141270. 366241 Page 5 of 6 366241 04/04/2023 Steubenville Country Club Manor 575 Lovers Lane Steubenville, OH 43953

F 0770 Provide timely, quality laboratory services/tests to meet the needs of residents. Level of Harm - Minimal harm or potential for actual harm Based on medical record review and staff interview, the facility failed to ensure laboratory tests were completed as ordered by the physician. This affected one resident (Resident #3) of three residents reviewed for laboratory testing. The facility census was 42. Residents Affected - Few Findings include: Review of Resident #3's medical record revealed an admission date of 05/23/19 with diagnoses that included Alzheimer's disease with dementia, end stage heart disease and cerebrovascular accident with hemiplegia. Further review of the medical record revealed on 02/09/23 Resident #3 was diagnosed and treated for pneumonia. Following use of antibiotics to treat pneumonia, Resident #3 had symptoms of clostridium difficile (C-Diff). Laboratory testing on 02/23/23 indicated Resident #3 was positive for C-Diff. Resident #3 was initiated on antibiotics for treatment of C-Diff and placed on transmission based precautions at this time. Further review of the medical record revealed Resident #3 completed antibiotic treatment on 03/30/23 following the use of vancomycin (antibiotic) 125 milligrams (mg) four times daily. On 03/31/23 following completion of the antibiotics the physician ordered a repeat C-Diff laboratory test to determine if Resident #3 was clear of C-Diff. Review of the nursing progress notes on 04/01/23 revealed a note that indicated Resident #3 stool for occult blood was negative. No evidence was found the C-Diff repeat test was completed. Review of the laboratory request slip revealed staff had marked the test as a hemoccult stool test (determines presence of blood), rather than C-Diff test as ordered by the physician. Interview with Registered Nurse (RN) #115 on 04/03/23 at 12:50 P.M. verified Resident #3 had not been retested for C-Diff as ordered by the physician due to staff had completed the laboratory request slip incorrectly and requested a stool for occult blood test rather than a C-Diff test. This deficiency represents non-compliance investigated under Complaint Number OH00141270. 366241 Page 6 of 6