Health inspection·June 1, 2023

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and staff interview, with facility failed to ensure residents received adequate and timely assistance with grooming. This affected one (Resident #1) of two residents reviewed for activities of daily living. The facility census was 39. Residents Affected - Few Findings include: Review of the medical record revealed Resident #1 was admitted on [DATE]. Diagnoses included chronic kidney disease stage 4, acute kidney failure, hypertensive heart disease with heart failure, contracture left and right hand, hypothyroidism, and essential (primary) hypertension. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #1 was moderately cognitively impaired. Resident #1 required total dependence for personal hygiene. Review of the care plan dated 02/13/17 revealed Resident #1 needed support of staff for activities of daily living (ADLs) completion and interventions included to provide assistance for ADLs. Further review of the medical record revealed no documentation showing Resident #1 had his nails trimmed. Observation on 05/30/23 at 10:51 A.M. revealed Resident #1's fingernails were long, jagged, and dirty with dark discoloring underneath the nail. Observation on 05/31/23 at 1:45 P.M. revealed Resident #1's fingernails were long, jagged, and dirty with dark discoloring underneath the nail. Interview on 05/31/23 at 9:20 A.M. with State Tested Nursing Assistant (STNA) #230 revealed Resident #1 required assistance with personal hygiene. Interview on 05/31/23 at 1:48 P.M. with the Administrator verified Resident #1's nails were long, dirty, and required trimming. Page 1 of 4 366252 366252 06/01/2023 Meadows of Leipsic 901 East Main Street Leipsic, OH 45856

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and staff interview, the facility failed to apply hand splints as ordered and failed to implement interventions for a resident with bilateral hand contracture's. This affected one (Resident #15) of one resident observed for the use of hand splints. The facility's census was 39. Residents Affected - Few Findings include: Review of Resident #15's medical record revealed an admission date of 03/20/17. Diagnoses included cerebral palsy, intellectual disabilities, and phalanax fracture. Review of Resident #15's quarterly Minimum Data Set (MDS) dated [DATE] revealed the resident was rarely understood and had impairments of the bilateral upper extremities. Review of Resident #15's most recent care plan revealed interventions to follow physical therapy and occupation therapy orders. Resident #15 was to have rolled up washcloths (one washcloth for each hand) in each palm/hand to decrease tightness and skin breakdown. The resident was to use washcloths when in bed (at night and during any naps during the day) due to a diagnosis of cerebral palsy. Review of Resident #15's physician order dated 03/28/19 revealed the resident required bilateral resting hand splints should be applied he was in the wheelchair. The splints should be off when in bed. Review of of Resident #15's Occupational Therapy Plan of Care notes dated 03/01/19 revealed the resident had bilateral resting hand splints due to increased risk of contracture's from stiffness and tone. Observation on 05/30/23 at 8:45 A.M. revealed Resident #15 was sitting in his wheelchair in his room watching television. The resident had no splints nor washcloths in place. Observation on 05/30/23 at 11:02 A.M. revealed Resident #15 did not have hand splints nor washcloths applied. Interview on 05/30/23 at 11:07 A.M. with Registered Nurse #221 verified Resident #15 failed to have the physician ordered hand splints in place and the splints were available and located in the resident's room. Further observation on 06/01/23 at 9:02 A.M. revealed Resident #15 still did not have hand splints nor washcloths applied. 366252 Page 2 of 4 366252 06/01/2023 Meadows of Leipsic 901 East Main Street Leipsic, OH 45856

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, review of the meal ticket, review of the menu, observation, and staff interview, the facility failed to ensure diets were provided as ordered. This affected one (Resident #1) of one resident reviewed for nutrition. The facility census was 39. Residents Affected - Few Findings include: Review of the medical record revealed Resident #1 was admitted on [DATE]. Diagnoses included chronic kidney disease stage 4, acute kidney failure, hypertensive heart disease with heart failure, hyperlipidemia, and essential (primary) hypertension. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed the resident was moderately cognitively impaired. Review of Resident #1's care plan dated 08/16/21 revealed interventions in place to follow diet as ordered by physician as protein, sodium, potassium and phosphorous intake may need to be regulated based on kidney function. Review of the dietician progress note dated 05/17/23 revealed Resident #1 continued on a regular, regular/thin diet with double portion protein. Intakes mostly 76-100%, decreased at times with no significant changes in weight. Review of dietary orders dated 04/27/22 revealed Resident #1's diet was prescribed as regular, regular texture, and thin liquids. Special instructions included double protein at mealtimes. Review of Resident #1's weights dated the last six months revealed no significant weight fluctuations. Review of the lunch menu dated 05/31/21 revealed the menu included fried chicken sandwich, tater tots, California vegetable blend, tossed salad, and dessert. Observation on 05/31/23 at 1:52 P.M. of Resident #1's lunch tray included one serving of the protein (one chicken sandwich). Review of the meal ticket dated lunch 06/01/23 revealed Resident #1 was to be provided with double protein/double portions. Observation on 06/01/23 at 12:10 P.M. of Resident #1's lunch tray revealed one portion of protein (chili), one grilled cheese sandwich, and tossed salad. Interview on 06/01/23 at 12:14 P.M. with Licensed Practical Nurse (LPN) #278 verified Resident #1 only received one portion of protein at the lunch meal. 366252 Page 3 of 4 366252 06/01/2023 Meadows of Leipsic 901 East Main Street Leipsic, OH 45856

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, staff interview, and policy review, the facility failed to ensure dietary staff were provided beard protectors while working in the kitchen. This affected all 39 residents who resided in the facility and received food from the kitchen. The facility census was 39. Findings include: Observation on 05/30/23 at 8:27 A.M. revealed [NAME] #205 had a full beard and mustache approximately one inch long and was working in the kitchen. The [NAME] was not wearing a beard protector. Interview with [NAME] #205 on 05/30/23 at 8:32 A.M. verified that he did not wear a beard protector while working as they were not provided for staff. Interview with the Director of Food Services on 05/30/23 at 8:35 A.M. revealed the facility did not have beard protectors in stock and she would look into purchasing. Review of the facility policy titled, Hair Restraint, dated 11/30/21 revealed food employees shall wear hair restraints such as hats, hair coverings or nets, beard restraints, and clothing that covers body hair, that are designed and worn to effectively keep their hair from contacting exposed food; clean equipment, utensils, and linens; and unwrapped single-service and single-use articles. 366252 Page 4 of 4