Health inspection·September 10, 2021

F 0625 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of the facility's policy, record review, and staff interview, the facility failed to provide a bed hold notice to a resident and/or the resident's family representative in a timely manner after discharge. This affected one (Resident #66) of three residents reviewed for discharges. The facility census was 64. Findings include: Record review for Resident #66 revealed the resident had been admitted to the facility on [DATE] and discharged to the hospital on [DATE]. Diagnoses for Resident #66 included cognitive loss, dementia, urinary incontinence, dehydration, falls, and a pressure ulcer. Review of the quarterly Minimum Data Set (MDS) assessment, dated 05/21/21, revealed the resident had impaired cognition. Review of Resident #66's signed admission agreement, dated 04/07/21, revealed Resident #66's signed a statement regarding bed holds stating in the event of transfer the resident would like to reserve his room for possible transfer back to the facility. Review of Resident #66's care plan, dated 04/2021, revealed a focus for the resident being a long term resident with no plans for discharge. Review of Resident #66's progress notes, dated 06/13/21, revealed the resident a change in condition, decreased response, and the nurse was unable to obtain vital signs. Per the note, the resident was transferred to the hospital. The resident's wife was notified of the change of condition and a verbal consent was obtained to send the resident to the hospital. The note, dated 06/13/21 at 6:40 P.M., revealed the resident had been admitted to the hospital. Further review of Resident #66's medical record revealed no notice of bed hold notification to the resident's family representative. Interview on 09/08/21 at 3:45 P.M. with the Director of Nursing (DON) verified the facility had not provided Resident #66 or his family representative a bed hold notice after his transfer to the hospital on [DATE]. Review of the facility's policy titled 'Bed Hold Prior to Transfer', dated 11/2020, revealed despite payer source all residents will be provided a bed hold notice from the facility. Page 1 of 3 366269 366269 09/10/2021 Wyandot County Skilled Nursing and Rehabilitation 7830 N St Hwy 199 Rr2 Upper Sandusky, OH 43351

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 medical record review, staff and resident interview, and review of the facility policies, the facility failed to complete a thorough fall investigation for Resident #6 to prevent further accidents. This affected one (Resident #6) of two residents reviewed for falls. The facility census was 64. Findings include: Review of medical record for Resident #6 revealed the resident was admitted to the facility on [DATE]. Diagnoses included hydronephrosis, diabetes mellitus type two, malignant neoplasm of bone and articular cartilage, major depressive disorder, and acute kidney failure. Review of the admission fall assessment completed 06/07/21, and subsequent fall assessments completed on 06/27/21, 08/16/21, and 09/07/21 revealed the resident was at moderate risk for falls. Review of the admission Minimum Data Set (MDS) assessment, dated 06/07/21, revealed the resident was cognitively intact. She required extensive assistance with two- person assistance for bed mobility, transfers, toileting, and personal hygiene. She was extensive assistance with one person for dressing. She had falls prior to admission and within the last two to six months prior to admission with no fractures related to the falls. Review of the care plan, dated 06/01/21, revealed the resident was a risk for falls related to deconditioning, history of falls at home, and weakness. On 6/27/21, she fell at bedside. There was no brakes used on the rollator and it moved away when attempting to sitting down. On 8/16/21, she fell from her recliner by sliding out of her chair while putting on her pants. Interventions included on 6/27/21 for the resident to call staff for any needs; she was re-educated on the importance of using her wheelchair and to always lock brakes and use all safety features to avoid injury. On 8/16/21, physical therapy was to complete and evaluation post fall; re-educated on the importance to call staff for all assistance needed to prevent future falls; anticipate and meet the resident's needs; be sure the resident's call light was within reach and encourage the resident to use it for assistance as needed. The resident needs prompt response to all requests for assistance, ensure the resident was wearing appropriate footwear when ambulating or mobilizing in the wheelchair and follow facility fall protocol. Review of the nursing notes revealed on 08/16/21 revealed the nurse was called to the resident's room. She was lying on her right side with legs bent at the knees and her right arm was under the resident, and her left arm was bent at the elbow and under her head. Resident stated she was getting her pants on and slid on her blanket. Resident reported she hit her head really hard and complained of head pain. Vital were taken, resident's son was notified, and a message was left. Transportation was called to have resident evaluated at emergency room. On 08/17/21 a new order for physical therapy to evaluate and treat. Physical therapy would see resident 12 times in four weeks. On 08/18/21, the resident was sitting up in her wheelchair alert and oriented times four. Bruising was periorbital bilateral eyes and forehead. The resident denies headache or any pain. Equal hand grasps and denies any dizziness. On 08/18/21, the resident placed ice on her forehead due to some swelling mainly over right eye. She denied pain. Resident had been up and about per her usual routine. On 08/19/21, the resident was resting quietly in her recliner. Facial bruising continues. She denies pain to the area. 366269 Page 2 of 3 366269 09/10/2021 Wyandot County Skilled Nursing and Rehabilitation 7830 N St Hwy 199 Rr2 Upper Sandusky, OH 43351

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the fall investigation, dated 08/16/21, revealed an incident report was completed with a fall risk assessment and pain assessment. Interventions were not addressed in the fall investigation to know if the current care plan interventions were in place at the time of the resident's fall. Furthermore, no witness statements were completed, and neuro checks were missing. Review of the hospital discharge, dated 08/16/21, revealed the resident receive a contusion of the forehead related to a fall and head injury. Interview on observation on 09/07/21 at 12:30 P.M. with Resident #6 revealed she was sitting in her chair and slipped out of her chair and her head hit the bed. She went to the emergency room to be treated. Her face still had remnants of facial bruising under her eyes and around her jaw bones. She denied any pain. Interview on 09/09/21 at 1:45 P.M. with the Director of Nursing verified the Incident Audit Report did not address current interventions and new interventions put into place after the fall on 08/16/21. Interview on 09/09/21 at 2:21 P.M. with Registered Nurse (RN) #123 verified the fall investigation on 08/16/21 was not a complete and thorough fall investigation. She further verified the fall investigation did not discuss the current fall interventions or address potential new interventions to prevent further falls. RN #123 revealed when a fall occurs, the resident would be assessed, complete a post-fall assessment, notify the physician and family, review the resident's care plan and update as indicated, document all assessment and actions and obtain witness statements. RN #123 verified the neuro checks where not completed after Resident #6 returned from the hospital on [DATE], and no witness statements were obtained regarding the fall. Review of the facility's policy titled Fall Prevention Program Policy revealed each resident will be assessed for the risks of falling and will receive care and services in accordance with the level of risk to minimize the likelihood for falls. When any resident experiences a fall, the facility will assess the resident, complete a post-fall assessment, complete an incident report, notify the physician and family, review the resident's care plan and update as indicated, document all assessments and actions, and obtain witness statements in the case of injury. Review of the facility's policy titled Policy and Procedure for Neuro Checks revealed when a resident fall and sustains a suspected head injury or the fall was unwitnessed by staff, neuro checks will be done every 15 minutes for one hour, then every 30 minutes for one hour then, every hour for four hours then, every four hours for 24 hours. 366269 Page 3 of 3