Inspection·May 11, 2023

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 record review, observation, and staff interview, the facility failed to ensure speech therapy recommendations were followed for a resident who was known to pocket her food and was at risk for aspiration. This affected one (#33) of three residents reviewed for aspiration risk. Residents Affected - Few Findings include: A review of Resident #33's medical record revealed she was admitted to the facility on [DATE]. Her diagnoses included dementia with behavioral disturbances and generalized anxiety disorder. A review of Resident #33's physician's orders revealed she was on a smooth, pureed textured diet. The diet order specified she was to receive lemon ice with every meal and every bite. The order originated on 04/28/23. A diet clarification order dated 04/28/23 revealed the resident was to have a smooth pureed diet. They were instructed to place lemon ice on the tip of the spoon for every bite of solid food to stimulate swallow and decrease pocketing/ holding of bolus. Speech therapy services ended on 05/04/23. A review of Resident #33's speech therapy discharge summary report for a date of service between 04/21/23 and 05/04/23 revealed the resident's diagnoses included dysphagia (difficulty swallowing). The discharge recommendations under strategies revealed the strategies were recommended to facilitate safety and efficiency. It was recommended the resident use the following strategies during oral intake: lemon ice as antecedent (a thing or event that existed before or logically proceeds another), rate modification, bolus size modifications, and alternation of liquids/ solids. On 05/11/23 at 11:48 A.M., an observation of the lunch meal service revealed Resident #33 was served her meal in the dining room. State Tested Nursing Assistant (STNA) #12 was observed to sit next to the resident and assist her and another resident with their meal. Resident #33 was noted to receive a pureed diet with a cup of frozen lemon ice on her tray. STNA #12 spoon fed the resident offering her the pureed vegetables and the pureed meat that was served on her tray. The STNA would alternate bites of food with drinks of the beverage that was served with her meal. She was not noted to use the lemon ice with each bite of food as directed by the speech therapist in the resident's physician's orders/ diet order clarification given on 04/28/23. Several bites were observed of the resident just being given bites of her food without the lemon ice as ordered. On 05/11/23 at 1:45 P.M., an interview with STNA #12 revealed Resident #33 was supposed to be on a pureed diet and received regular liquids with her meals. They had lemon ice on her tray for her and the resident had a tendency not to want to swallow. She stated the lemon ice was to be used if they noticed the resident was not swallowing her food. The resident was known to pocket her food a lot. (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 3 Event ID: 366260 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 366260 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Claymont Health and Rehabilitation 5166 Spanson Drive SE Uhrichsville, OH 44683 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)