Health inspection·December 28, 2023

F 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, medical record review, and review of the Diet Manual, the facility failed to provide a mechanically altered diet as ordered. This affected one (#15) of four residents (#12, #15, #16, and #17) who receive a mechanical soft diet. The facility census was 42. Findings include: Review of the medical record for Resident #15 revealed an admission date of 02/23/22, with diagnoses of dementia and dysphagia (difficulty swallowing). Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #15 had severely impaired cognition. Review of a physician order dated 09/06/22 revealed Resident #15 received a regular diet with mechanical soft textures and thin liquids. Review of the current care plan for Resident #15 she was at possible nutrition risk due to cognitive impairments, swallowing difficulty related to dysphagia, with need for altered texture diet. Interventions included providing the diet as ordered. Observation on 12/28/23 at 12:15 P.M., revealed Resident #15 sitting at the dining table in the common area of the secured unit. State Tested Nurse Aide (STNA) #102 placed a plate in front of Resident #15 with a chicken sandwich and a bowl of canned fruit. Observation of the chicken sandwich revealed an untoasted hamburger bun with pieces of chicken inside. The chicken was breaded, and was cut up and appeared to be large pieces of meat. Interview and observation on 12/28/23 at 12:17 P.M., with Speech Therapist (ST) #502 confirmed Resident #15's chicken appeared chopped. After further inspection, ST #502 stated the texture of the chicken was not appropriate for a mechanical soft diet due to the texture of the breading and the size of the pieces. Follow-up observation on 12/28/23 at approximately 12:20 P.M., with ST #502 revealed ST #502 asked the nurse to call the kitchen to send ground meat for Resident #14's sandwich. Interview on 12/28/23 at 12:40 P.M., with Dietary Aide #300 revealed she did not prepare the mechanical soft food, it was sent already prepared from the main kitchen. Page 1 of 4 366242 366242 12/28/2023 Otterbein Sunset Village 9640 Sylvania-Metamora Road Sylvania, OH 43560

F 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 12/28/23 at 1:49 P.M., with Dietary Manager #500 confirmed the cook did not prepare the mechanical soft chicken appropriately for lunch. Dietary Manager #500 stated he believed it was an oversight by the cook. Review of the facility's Diet Manual, dated 2006, revealed a mechanical soft diet included meats prepared in a soft, tender, ground, shredded, or chopped form. 366242 Page 2 of 4 366242 12/28/2023 Otterbein Sunset Village 9640 Sylvania-Metamora Road Sylvania, OH 43560

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, medical record review, staff interview, and review of policy, the facility failed to ensure staff wore appropriate personal protective equipment (PPE) when providing care to residents in Enhanced Barrier Precautions (EBP). This affected one (#14) of three residents reviewed for infection control. The facility identified ten current residents in EBP. The facility census was 42. Residents Affected - Few Findings include: Review of medical record for Resident #14 revealed an admission date of 04/26/23 with a readmission on [DATE]. Diagnoses included hemiparesis (one-sided muscle weakness) and ulcer of the foot. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #14 had intact cognition and required substantial/maximal assistance with bathing and dressing. Review of a physician order dated 09/22/23 revealed Enhanced Barrier Precautions - gloves and gown with treatment and/or care two times a day for open wound area related to ulcer of foot. Review of a physician order dated 12/28/23 revealed Enhanced Barrier Precautions - gloves and gown with treatment and/or care every shift. Review of the current care plan for Resident #14 revealed he had a surgical wound to his right heel. Interventions included enhanced barrier precautions. Observation on 12/28/23 at 10:09 A.M., revealed Resident #14's call light was lit. On the frame to his door was a sign identifying him as requiring EBP. Interview on 12/28/23 at 10:24 A.M., with Occupational Therapist (OT) #503 revealed a State Tested Nurse Aide (STNA) asked for his assistance in providing care to Resident #14. OT #503 stated he planned to clean and change Resident #14 before getting him out of bed. Observation on 12/28/23 at approximately 10:25 A.M., revealed OT #503 closing the door to Resident #14's room. Observation on 12/28/23 at 10:37 A.M., revealed STNA #100 entering Resident #14's room. Continued observation revealed OT #503 at Resident #14's bedside providing care, not wearing a gown. OT #503 left Resident #14's beside with two basins and entered the bathroom. Interview with OT #503 confirmed he was providing personal care to Resident #14 and was not wearing a gown. OT #503 stated he understood EBP to be in place due to risk of infection. Interview on 12/28/23 at approximately 4:00 P.M., with the Administrator confirmed the facility's policy revealed gloves and gowns should be worn during bathing, providing hygiene, and dressing residents in EBP. Review of the policy titled, Isolation Precautions Process, revised 08/01/22, revealed Enhanced Barrier Precautions include wearing gloves and gowns during high-contact resident care, including dressing, bathing/showering, and hygiene. 366242 Page 3 of 4 366242 12/28/2023 Otterbein Sunset Village 9640 Sylvania-Metamora Road Sylvania, OH 43560

F 0880 This deficiency represents non-compliance investigated under Complaint Number OH00149254. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 366242 Page 4 of 4