Health inspection·July 3, 2019

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, staff interview the facility failed to have the appropriate fall interventions in place for Resident #69. This affected one (Resident #69 of six reviewed for accidents). The facility census was 68. Findings include: A medical record review revealed Resident #69 was admitted to the facility on [DATE] with the diagnoses of nocturia, poly arthritis, generalized anxiety disorder, major depression, heart failure, over-active bladder, intraocular lens, and osteoporosis. Review of the quarterly Minimum data Set 3.0 assessment dated [DATE] revealed Resident #69 had intact cognition, required extensive assistance with transfers and bed mobility, and had a fall with major injury. Observations on 07/03/19 at 8:30 A.M., 10:30 A.M. and 1:00 P.M. revealed Resident #69 was in bed and did not have the floor mat in place on the right side of the bed. A review of a plan of care dated 02/05/19 revealed Resident #69 was at risk for future falls. Interventions included; would encourage to ask for help, observe for unsteadiness, have the call light within reach, toilet in advance of need every two hours, the bed against the wall to create more space in the bedroom, bright orange tape to the call light, a floor mat next to the bed and non-skid footwear at all times. Review of physician's orders dated 06/18/19 revealed Resident #69 was to have a floor mat next to her bed for safety. An interview on 07/03/19 at 1:33 P.M. Registered Nurse #320 indicated the fall mat should be by the resident's bed while she was in bed. RN #320 verified the fall mat was not on the floor while the resident was in bed. An interview on 07/03/19 at 1:37 P.M. State Tested Nurse Aide #395 indicated she had not placed the fall mat on the floor beside Resident #69 bed when she put her to bed. Page 1 of 2 366248 366248 07/03/2019 Apostolic Christian Home Inc 10680 Steiner Road Rittman, OH 44270

F 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interviews the facility failed to provide a rationale for not attempting a gradual dose reduction for Resident #48. This affected one resident (Resident #48 of five residents) reviewed for unnecessary medications. The facility census was 68. Findings include: A medical record review revealed Resident #48 was admitted to the facility on [DATE] with the diagnoses of displaced fracture of the left femur, sarcoidosis of the lung, chronic respiratory failure, spondylopathy, generalized anxiety, depression, and schizophrenia. Review of the quarterly Minimum data Set 3.0 dated 05/21/19 revealed the resident had intact cognition, no behaviors, and received anti-depressants, anti-anxiety and anti-psychotic medication. Review of the physician's orders dated July 2019 revealed Resident #48 was receiving 0.5 milligrams of lorazepam (anti-anxiety) every 12 hours, 20 milligrams of paroxetine (anti-depressant) daily and 8 milligrams of perphenazine (anti-psychotic) twice daily. Review of a pharmacy recommendation dated 05/01/19 revealed Resident #48 was on paroxetine 20 milligrams daily, thiothixene 10 milligrams three times daily, lorazepam 0.5 milligrams every 12 hours, and perphenazine 8 milligrams three times daily for Schizophrenia and depressive disorders. The physician response was disagree and a largely written NO! but did not write a rational. Review of the Antipsychotoic Drug Protocol dated 07/23/13 revealed it was the policy of the facility to encourage multidisciplinary efforts to determine factors responsible for resident behaviors changes and recommends consideration of alternate (non-drug) means of treating those factors. When a resident received an antipsychotic medications, the physician should attempt a gradual dose reduction, unless clinically contraindicated in an effort to discontinue those drugs. An interview on 07/02/19 at 5:10 P.M. the Director of Nursing verified there was not an rational documented to address the 05/01/19 pharmacy recommendation due to the numerous psychiatric notes concerning her behavior and medications changes. 366248 Page 2 of 2