Health inspection·September 26, 2019

F 0676 Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, review of the medical record, review of restorative notes and staff interview the facility failed to provide restorative programs as ordered for Residents #40 and #46. This affected two residents (Resident #40 and #46) of three reviewed of mobility and range of motion. Residents Affected - Few Findings include: 1. Review of the medical record revealed Resident #40 was admitted to the facility on [DATE] with diagnoses of diabetes, major depression, pulmonary embolism, dementia, and lack of coordination. Review of the plan of care dated 07/18/19 revealed Resident #40 had a non-weight bearing status and had generalized weakness. The resident was at risk for decline in strength and function. Interventions included passive range of motion (PROM) to her upper and lower extremities six to seven days a week for a total of 15 minutes per day. Review of the quarterly Minimum Data Set 3.0 assessment dated [DATE] revealed Resident #40 had severely impaired cognition, required extensive assistance of two staff members for bed mobility, toilet use and total assistance of two staff members for transferring. Review of the September 2019 physician's orders revealed Resident #40 had an order dated 07/18/19 for restorative range of motion (ROM) for 15 minutes six to seven days per week. Review of the July 2019 restorative nursing program documentation revealed Resident # 40 received restorative nursing on 07/18/19, 07/24/19, 07/25/19, 07/28/19, 07/29/19, and 07/30/19. Review of the August 2019 restorative nursing program documentation revealed Resident # 40 received restorative nursing on 08/02/19, 08/05/19, 08/07/19, 08/08/19, 08/12/19, 08/14/19, 08/15/19, 08/16/19, 08/17/19, 08/18/19, 08/20/19, 08/22/19, 08/24/19, 08/29/19, 08/30/19, and 08/31/19. Review of the September 2019 restorative nursing program documentation revealed Resident # 40 received restorative nursing on 09/01/19, 09/02/19, 09/06/19, 09/09/19, 09/12/19, 09/13/19, 09/15/19, 09/16/19, 09/19/19, and 09/22/19. 2. Review of the medical record revealed Resident #46 was admitted to the facility on [DATE] with diagnoses of contracture of the left and right hands, Parkinson's disease and dementia. Review of the significant change Minimum Data Set assessment dated [DATE] revealed Resident #46 had severely impaired cognition, required total assistance of two staff members for bed mobility, transfer, and toilet use. The resident had upper and lower extremity impairment to both sides. Review of the September 2019 physician's orders revealed Resident #46 had an order dated 07/17/19 Page 1 of 4 366284 366284 09/26/2019 Amherst Meadows Skilled Nursing and Rehab 1610 First Street NE Massillon, OH 44646

F 0676 for PROM to bilateral upper and lower extremities for 15 minutes daily for six to seven days a week. Level of Harm - Minimal harm or potential for actual harm Review of the plan of care dated 07/30/18 revealed Resident #49 had impaired physical mobility due to decline in ROM and stiffness related to Parkinson's disease. The interventions included PROM to all extremities six to seven days a week for a total of 15 minutes per day. Residents Affected - Few Review of the July 2019 restorative nursing documentation revealed Resident #46 received restorative nursing on 07/04/19, 07/05/19, 07/08/19, 07/17/19, 07/18/19, and 07/23/19. Review of the August 2019 restorative nursing documentation revealed Resident #46 received restorative nursing on 8/04/19, 08/06/19, 08/15/19, 08/21/19, 08/24/19, and 08/31/19. Review of the September 2019 restorative nursing documentation revealed Resident #46 received restorative nursing on 09/01/19, 09/04/19, 09/06/19, 09/14/19, 09/15/19, and 09/17/19. Observation on 09/25/19 from 9:40 A.M. to 10:12 A.M. revealed State Tested Nursing Assistant (STNA) #718 performing PROM to Resident #46. STNA #718 preformed two sets of PROM to the resident's elbow, knees and his hips. An interview 09/25/19 at 11:55 A.M with Licensed Practical Nurse #815 verified the nursing assistant only provided PROM to the elbows, knees and hips of Resident #46. LPN #815 stated he was very rigid and verified there was no documentation indicating he was unable to perform the PROM exercises. LPN #815 verified Residents #40 and #46 had not been receiving PROM six to seven days a week as ordered and care planned. LPN #815 stated she had hired two new restorative aides but one did not show up this week. She also indicated the restorative aides did get pulled to the skilled unit quite a bit to work but the other STNAs were aware they were to pick up the restorative programs in their absence. An interview on 09/26/19 at 11:24 A.M. with restorative STNA #718 indicated she worked four-10 hour days and was pulled to the floor to work quite a bit and was unable to complete the restorative programs; however, she indicated the STNAs were aware they were to pick up the restorative programs when she was not doing them. 366284 Page 2 of 4 366284 09/26/2019 Amherst Meadows Skilled Nursing and Rehab 1610 First Street NE Massillon, OH 44646

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation and staff interview the facility failed to pass ice water in a sanitary manner on the 300 Hall. This had the potential to affect 19 residents ( #14, #59, #28, #39, #30, #62, #49, #79, #65, #10, #51, #46, #79, #6, #69, #36, #93, #16, and #38) residing on the 300 Hall. Facility census was 83. Findings include: Observation on 09/23/19 at 11:06 A.M. revealed State Tested Nursing Assistant (STNA) #709 passing ice water down the 300 Hall. Glasses of ice water were pre-poured on top of a two tiered cart which was uncovered. The uncovered glasses were left unattended in the hall as STNA #709 entered resident rooms to deliver the ice water. An interview on 09/23/19 at 11:15 A.M. with STNA #709 indicated they always passed ice water this way but she would ask about the proper way to pass ice water. At 11:30 A.M. STNA #709 stated she was suppose to use the metal ice cart with a lid to pass ice one room at a time but she was in a hurry and did not do it the proper way. 366284 Page 3 of 4 366284 09/26/2019 Amherst Meadows Skilled Nursing and Rehab 1610 First Street NE Massillon, OH 44646

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on review of infection control logs, interviews, and policy review, the facility failed to notify the appropriate government agencies upon an outbreak of influenza in March 2019 for ten confirmed cases of influenza (Residents #5, #12, #27, #32, #45, #73, #77, #81, #82, and #83) and fourteen suspected cases of influenza (Residents #33, #35, #42, #44, #48, #56, #57, #70, #76, #79, #84, #85, #86, and #87). The current facility census was 83 residents. Residents Affected - Some Findings include: Review of the facility monthly infection control logs on 09/25/19 at 3:00 P.M. with Registered Nurse (RN) #814 and Licensed Practical Nurse (LPN) #823 revealed from 03/24/19through 04/11/19, the facility had 24 residents who presented with signs and symptoms of influenza which included chills, loss of appetite, and fever. Nasal swab tests were conducted on the 24 residents with ten returning positive (Residents #5, #12, #27,#32, #45, #73, #77, #81, #82, and #83) and fourteen returning negative (Residents #33, #35, #42, #44, #48, #56, #57, #70, #76, #79, #84, #85, #86, and #87). All residents who were tested for influenza were given prophylactic doses of Tamiflu (a medicine totreat influenza). RN #814 and LPN #823 were unable to state whether or not the appropriate government agencies were notified at the time of the influenza outbreak. Interview with the Director of Nursing (DON) on 09/26/19 at 1:20 P.M. verified the facility did not contact the local or state health department of the influenza outbreak.The DON stated she had telephoned the local health department to verify they had not been notified of the outbreak. Review of the Centers for Disease Control and Prevention Guidance for Influenza Outbreak Management in Long-Term Care and Post-Acute Care Facilities dated 02/12/19 revealed The local public health and state health departments should be notified of every suspected or confirmed influenza outbreak in a long-term care facility, especially if a resident develops influenza while on or after receiving antiviral chemoprophylaxis. The guidance indicated a confirmed or suspected outbreak included two or more ill residents. Review of the facility's policy titled Outbreak of Communicable Diseases, revised August 2014, revealed an outbreak of influenza was defined as anything exceeding the endemicrate, or a single case if unusual for the facility. The policy indicated the Administrator would be responsible for telephoning a report to the health department and forwarding Communicable Disease Report Cards as required. Review of the facility's policy titled Infection Prevention and Control Committee, revised July 2016, indicated the duties of the committee was to notify government agenciesof reportable contagious or infectious disease. Review of facility's policy titled Infection Prevention and Control Program, revised August 2016, revealed outbreak management was a process which consisted of determiningthe presence of an outbreak and reporting the information to the appropriate public health authorities. 366284 Page 4 of 4