Health inspection·January 31, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and staff interview the facility failed to ensure urinary drainage bags for Residents #27, #40, and #62 were covered to maintain dignity. This affected three residents (#27, #40, and #62) of nine residents reviewed for dignity and respect. Findings include: 1. Review of the medical record revealed Resident #27 was admitted to the facility on [DATE]. Diagnoses included cellulitis, sepsis, fluid overload, hypertension, acute respiratory failure, bacteremia, traumatic ischemia of the muscles, falls, and adult failure to thrive. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #27 had intact cognition and had an indwelling urinary catheter. An observation on 01/25/24 at 9:40 A.M. revealed the urinary drainage bag of Resident #27 was uncovered, and the urine in the bag was visible from the hallway. The drainage bag was secured to the bed frame. On 01/25/2 at 9:46 A.M. an interview with Nurse #100 verified the urinary drainage bag of Resident #27 should be covered so the urine was not visible. 2. Review of the medical record revealed Resident #40 was admitted to the facility on [DATE]. Diagnoses included metabolic encephalopathy, acute kidney disease, obstructive and reflux uropathy, repeated falls, acute respiratory failure, atrial fibrillation, pneumonia, congestive heart failure, disorder of bilirubin metabolism, retention of urine, and elevated prostate specific antigen. There were no MDS assessments submitted at this time. An observation on 01/25/24 at 9:42 A.M. revealed the urinary drainage bag of Resident #40 was uncovered, and the urine in the bag was visible from the hallway. The drainage bag was secured to the bed frame. On 01/25/2 at 9:45 A.M. an interview with Nurse #105 verified the urinary drainage bag of Resident #40 should be covered so the urine was not visible. 3. Review of the medical record revealed Resident # 62 was admitted to the facility on [DATE]. Diagnoses of metabolic encephalopathy, anemia, cataract, hypertension, congestive heart failure, atrial Page 1 of 13 366298 366298 01/31/2024 Altercare of Nobles Pond, Inc 7006 Fulton Drive, NW Canton, OH 44718

F 0550 Level of Harm - Minimal harm or potential for actual harm fibrillation, chronic obstructive pulmonary disease, acute respiratory failure, depression, urinary tract infection, retention of urine, and pulmonary embolism. Review of the admission MDS assessment dated [DATE] revealed Resident #62 had moderately impaired cognition and had an indwelling urinary catheter. Residents Affected - Few An observation on 01/25/24 at 9:44 A.M. revealed the urinary drainage bag of Resident #62 was uncovered, and the urine in the bag was visible from the hallway. The drainage bag was secured to the bed frame. On 01/25/2 at 9:45 A.M. an interview with Nurse #105 verified the urinary drainage bag of Resident #62 should be covered so the urine was not visible. This deficiency represents non-compliance investigated under Complaint Number OH00150009. 366298 Page 2 of 13 366298 01/31/2024 Altercare of Nobles Pond, Inc 7006 Fulton Drive, NW Canton, OH 44718

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and staff interview the facility failed to maintain a clean sanitary environment for Resident #26. This affected one resident (#26) of three residents reviewed for facility sanitation. Findings include: Review of the medical record revealed Resident #26 was admitted to the facility on [DATE]. Diagnoses included displaced bimalleolar fracture of the right lower leg, falls, muscle weakness, abnormalities of gait, acute respiratory failure, COVID-19, thyrotoxicosis, acute pain due to trauma, hypertension, atherosclerotic heart disease, and osteoporosis. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #26 had intact cognition. She was dependent on staff for sitting up on the side of the bed and standing. She had not transferred at the time of the assessment. She was frequently incontinent of bladder and bowel. On 01/25/24 at 1:50 P.M. an interview with Resident #26 revealed when she was readmitted to the facility, she was placed in the room she was in now. She stated the grab bars on the bed were covered in something sticky and her daughter had to clean it off. She stated her toilet seat had feces on it. She stated she used the bedpan and had not used the toilet since she had been here. An observation at this time of the toilet seat revealed a tan substance smeared on the toilet seat, and there was also a bedpan sitting on the toilet seat with dried feces on it. On 01/25/24 at 2:20 P.M. an interview with Nurse #100 verified the toilet seat and bed pan in the bathroom of Resident #26 had feces on them. This deficiency represents non-compliance investigated under Complaint Number OH00149758. 366298 Page 3 of 13 366298 01/31/2024 Altercare of Nobles Pond, Inc 7006 Fulton Drive, NW Canton, OH 44718

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 review of the medical record and interview with the staff the facility failed to ensure showers were given to dependent Resident #26. This affected one resident (#26) of three residents reviewed for showers. Residents Affected - Few Findings include: Review of the medical record revealed Resident #26 was admitted to the facility on [DATE]. Diagnoses included displaced bimalleolar fracture of the right lower leg, falls, muscle weakness, abnormalities of gait, acute respiratory failure, COVID-19, thyrotoxicosis, acute pain due to trauma, hypertension, atherosclerotic heart disease, and osteoporosis. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #26 had intact cognition. She was dependent on staff for sitting up on the side of the bed and standing and required substantial/maximal assist with bathing/showering. She was frequently incontinent of bladder and bowel. Review of the shower documentation revealed there was no documentation Resident #26 had a bath or shower from 12/27/23 through 01/09/24. On 01/25/24 at 3:30 P.M. an interview with Family Member #300 revealed her mother had not had a bath or shower the first two weeks she was at the facility. She stated she had to complain to someone about it before she received a shower. On 01/31/24 at 10:30 A.M. an interview with the Administrator revealed he could not find any shower sheets or documented evidence of showers from 12/27/23 to 01/09/24 for Resident #26. This deficiency represents non-compliance investigated under Complaint Number OH00149758. 366298 Page 4 of 13 366298 01/31/2024 Altercare of Nobles Pond, Inc 7006 Fulton Drive, NW Canton, OH 44718

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 review of the medical record, review of the facility stock medications, and interview with the staff the facility failed to ensure medications were obtained timely and initiated as ordered for Residents #26, #65, and #57. This affected three residents (#26, #57, and #65) of nine residents reviewed for medication administration. Residents Affected - Some Findings include: 1. Review of the medical record revealed Resident #65 was admitted to the facility on [DATE]. Diagnoses included post hemorrhagic anemia, gastrointestinal hemorrhage, thrombocytopenia, vitamin D deficiency, diabetes, anxiety disorder, atherosclerotic heart disease, hypertension, nonalcoholic steatohepatitis (NASH), gout, low back pain, urinary tract infection, acute kidney disease, and osteoarthritis. She discharged home on [DATE]. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #65 had intact cognition. Review of the December 2023 Medication Administration Record (MAR) revealed Resident #65 did not receive her morning doses of amlodipine (blood pressure) five milligrams (mg) once daily, amoxicillin (antibiotic) 500 mg once daily, ascorbic acid (vitamin) 1000 mg once daily, cefdinir(antibiotic) 300 mg twice daily, cholecalciferol (vitamin) 5000 units once daily, furosemide (diuretic) 40 mg once daily, pantoprazole (acid reflux) 40 mg twice daily, ferrous sulfate (vitamin) 325 mg on Sunday and Wednesday, multivitamin once daily, carbidopa-levodopa (anti-Parkinson's) 25-250 mg three times daily, erythromycin (antibiotic) eye drops five mg per gram four times daily, and fluoxetine (antidepressant) 40 mg once daily on 12/24/23 due to the medications were unavailable. Review of the list of medications from the facility stock revealed amlodipine five mg once daily, amoxicillin 500 mg once daily ascorbic acid 1000 mg once daily, cefdinir 300 mg twice daily, cholecalciferol 5000 units once daily, furosemide 40 mg once daily, pantoprazole 40 mg twice daily, ferrous sulfate (vitamin) 325 mg on Sunday and Wednesday, and multivitamin once daily were available to be pulled from stock and administered to Resident #65 on 12/24/23. On 01/29/24 at 3:25 P.M. an interview with the Director of Nursing (DON) revealed it was an agency nurse who was working on 12/24/23 and she did not pull the medications from stock. She stated she would have to educate the agency nurses on pulling the needed medications from stock. 2. Review of the medical record revealed Resident #26 was admitted to the facility on [DATE]. Diagnoses included displaced bimalleolar fracture of the right lower leg, falls, muscle weakness, abnormalities of gait, acute respiratory failure, COVID-19, thyrotoxicosis, acute pain due to trauma, hypertension, atherosclerotic heart disease, and osteoporosis. Review of the admission MDS assessment dated [DATE] revealed Resident #26 had intact cognition. She was dependent on staff for sitting up on the side of the bed and standing. She had not transferred at the time of the assessment. She was frequently incontinent of bladder and bowel. Review of the physician's orders revealed Resident #26 had an order for cefdinir (antibiotic) 300 mg twice daily for urinary tract infection. 366298 Page 5 of 13 366298 01/31/2024 Altercare of Nobles Pond, Inc 7006 Fulton Drive, NW Canton, OH 44718

F 0684 Level of Harm - Minimal harm or potential for actual harm Review of the January 2024 MAR revealed Resident #26 was not administered her ordered cefdinir 300 mg twice daily on 01/11/24 or her morning dose on 01/12/24. Review of the list of medications from the facility stock revealed cefdinir 300 mg was available to be pulled and administered to Resident #26. Residents Affected - Some On 01/25/24 at 1:50 P.M. an interview with Resident #26 revealed she never received her antibiotic for her urinary tract infection before she had to go to the hospital on [DATE] for ankle surgery. On 01/29/24 at 3:25 P.M. an interview with the DON revealed it was an agency nurse who was working on 01/11/24 and she did not pull the medications from stock. She stated she would have to educate the agency nurses on pulling the needed medications from stock. 3. Review of the medical record revealed Resident #57 was admitted to the facility on [DATE]. Diagnoses included congestive heart failure, spinal stenosis, gastroparesis, hypertension, atrial fibrillation, diabetes, hypothyroidism, major depressive disorder, chronic apian, insomnia, fistula of intestines, Barrette's esophagus, diverticulitis, dementia, COVID-19, chronic obstruction pulmonary disease, and extended spectrum beta lactamase. Review of the Annual MDS assessment dated [DATE] revealed Resident #57 had intact cognition. Review of the January 2024 physician's orders revealed Resident #57 had an order for Exelon patches 9.5 milligrams once daily dated 02/23/21. Review of the January Medication Administration Record Revealed Resident#57 was not administered her Exelon patches (treatment of dementia) on 01/12/24 through 01/16/24. On 01/25/24 at 11:30 A.M. an interview with Resident #57 revealed her Exelon patches were missing for three days. She stated several nurses stated they would try to find them, but they never did. She stated she finally emailed the Administrator, and he got them reordered for her and they came in that day. On 01/31/24 at 10:41 A.M. an interview with the DON verified Resident #57 had not received her Exelon patches from 01/12/24 through 01/16/24 due to them not being reordered by the agency nurses working. This deficiency represents non-compliance investigated under Complaint Numbers OH00149758, OH00150009, and OH00150260. 366298 Page 6 of 13 366298 01/31/2024 Altercare of Nobles Pond, Inc 7006 Fulton Drive, NW Canton, OH 44718

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, review of the medical record and interview with staff the facility failed to timely treat a urinary tract infection for Resident #26 and failed to have a physician's order for indwelling urinary catheters for Residents #27 and #40. This affected one resident (#26) of three residents reviewed for medications and two residents (#27 and #40) of nine residents reviewed for physician's orders. Findings include: 1. Review of the medical record revealed Resident #26 was admitted to the facility on [DATE]. Diagnoses included displaced bimalleolar fracture of the right lower leg, falls, muscle weakness, abnormalities of gait, acute respiratory failure, COVID-19, thyrotoxicosis, acute pain due to trauma, hypertension, atherosclerotic heart disease, and osteoporosis. Review of the physician's orders revealed Resident #26 had an order for a bladder scan twice daily and to straight catheterize her if the bladder had more than 500 milliliters of urine dated 12/29/23. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #26 had intact cognition. She was dependent on staff for sitting up on the side of the bed and standing. She had not transferred at the time of the assessment. She was frequently incontinent of bladder and bowel. Review of the physician's progress note dated 01/08/24 revealed Resident #26 was complaining of brown foul-smelling urine, frequency, and dysuria since 01/06/24. The physician ordered Pyridium (a pain medication used to relieve urinary urgency, pain, and discomfort caused by urinary tract infection) 200 milligrams (mg) three times daily for two days and obtained a urine specimen. Review of the physician's orders revealed an order dated 01/08/24 for a urine culture and urinalysis and an order for Pyridium 200 milligrams three times a day. Review of the laboratory results for Resident #26 dated 01/10/24 revealed a urine specimen was obtained on 01/09/24 and sent to the laboratory. The results were a mixed microbiota. This could be due to the urine being contaminated. Review of the physician's orders revealed Resident #26 had an order for cefdinir (antibiotic) 300 mg twice daily for urinary tract infection dated 01/11/24. Review of the January 2024 Medication Administration Record (MAR) revealed Resident #26 was not administered her ordered cefdinir 300 mg twice daily on 01/11/24 or her morning dose on 01/12/24 and her Pyridium 200 milligrams was not started until the morning of 01/09/24. Review of the list of medications from the facility stock revealed cefdinir 300 mg was available to be pulled and administered to Resident #26. Review of the progress notes from 01/01/24 to 01/11/24 revealed no documentation Resident #26 was having any complaints of frequency, burning, or bloody urine. 366298 Page 7 of 13 366298 01/31/2024 Altercare of Nobles Pond, Inc 7006 Fulton Drive, NW Canton, OH 44718

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 01/25/24 at 1:50 P.M. an interview with Resident #26 revealed she never received her antibiotic for her urinary tract infection before she had to go to the hospital on [DATE] for ankle surgery. On 01/25/24 at 3:30 P.M. an interview with Family Member #300 revealed her mother had started to complain to the staff she was having trouble urinating on Saturday (01/06/24). She stated she went to the facility on Monday (01/08/24) and asked why nothing had been done yet. They had the Nurse Practitioner see her and she ordered a urine culture be done. She stated they finally got the culture on 01/09/24. She stated she does not think they would have done anything if she had not said anything. She stated her mother had blood in her urine. On 01/29/24 at 3:25 P.M. an interview with the Director of Nursing (DON) revealed it was an agency nurse who was working on 01/11/24 and she did not pull the antibiotic from stock. She stated she would have to educate the agency nurses on pulling the needed medications from stock. She stated the bladder scan order was because the resident had complained of urinary frequency. She stated the staff attempted to get a urine specimen, but the resident had a bowel movement in the bed pan also so they could not use the specimen. On 01/30/24 at 2:32 P.M. an interview with the Administrator verified the order for Pyridium was received on 01/08/24; however, it was not in the starter kit so it had to be delivered by pharmacy, and the tote did not come until 1:30 A.M. to 2:00 A.M. so they started it the following day. 2. Review of the medical record revealed Resident #27 was admitted to the facility on [DATE]. Diagnosis included cellulitis, sepsis, fluid overload, hypertension, acute respiratory failure, bacteremia, traumatic ischemia of the muscles, falls, and adult failure to thrive. Review of the clinical admission assessment dated [DATE] revealed Resident #27 had an indwelling urinary catheter. Review of the admission MDS assessment dated [DATE] revealed Resident#27 had intact cognition, and she had an indwelling urinary catheter. Review of the January 2024 physician's orders revealed Resident #27 did not have an order for an indwelling urinary catheter. Observation on 01/25/24 at 9:40 A.M. revealed Resident #27 had an indwelling urinary catheter. On 01/29/24 at 4:15 P.M. an interview with Regional Nurse Consultant #211 verified there was no order for an indwelling urinary catheter for Resident #27. 3. Review of the medical record revealed Resident #40 was admitted to the facility on [DATE]. Diagnoses included metabolic encephalopathy, acute kidney disease, obstructive and reflux uropathy, repeated falls, acute respiratory failure, atrial fibrillation, pneumonia, congestive heart failure, disorder of bilirubin metabolism, retention of urine, and elevated prostate specific antigen. There were no MDS assessments submitted at this time. Review of the clinical admission assessment dated [DATE] revealed Resident #40 had an indwelling urinary catheter. 366298 Page 8 of 13 366298 01/31/2024 Altercare of Nobles Pond, Inc 7006 Fulton Drive, NW Canton, OH 44718

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the January 2024 physician's orders revealed Resident #40 did not have an order for an indwelling urinary catheter. Observation on 01/25/24 at 9:42 A.M. revealed Resident #40 had an indwelling urinary catheter. On 01/29/24 at 4:15 P.M. an interview with Regional Nurse Consultant #211 verified there was no order for an indwelling urinary catheter for Resident #40. This deficiency is an incidental finding discovered during the complaint investigation. 366298 Page 9 of 13 366298 01/31/2024 Altercare of Nobles Pond, Inc 7006 Fulton Drive, NW Canton, OH 44718

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, medical record review, and staff interviews the facility failed to ensure aerosol masks and oxygen tubing were dated as to when they were last changed for Residents #27, #12, #42, #49 and #37, failed to place aerosol mask/mouthpieces in a protective barrier bag for Residents #27, #49 and #37, and failed to ensure the aerosol mask was cleaned for Resident #37. This affected five residents (#27, #12, #42, #49 and #37) of 19 residents with oxygen or aerosol treatments. Residents Affected - Some Findings include: 1. Review of the medical record revealed Resident #27 was admitted to the facility on [DATE]. Diagnoses included cellulitis, sepsis, fluid overload, hypertension, acute respiratory failure, bacteremia, traumatic ischemia of the muscles, falls, and adult failure to thrive. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #27 had intact cognition. An observation on 01/25/24 at 9:40 A.M. revealed the oxygen tubing and aerosol mask for Resident #27 were not dated as to when they were changed last, and the aerosol mask was lying directly on her bedside stand not stored in a protective barrier. An interview with Resident #27 at this time revealed her aerosol mask had not been changed for a while until last week when the nursing assistant came around and changed them for her. She stated it was really dirty prior to that. On 01/25/24 at 9:46 A.M. an interview with Nurse #100 verified the oxygen tubing and aerosol mask were not dated as to when they were changed last, and the aerosol mask was lying directly on her bedside stand not stored in a protective barrier for Resident #27. She stated they had a company come out to the facility and change them weekly. On 01/25/24 at 10:14 A.M. an interview with Oxygen Company Representative #200 revealed he came into the facility once a week. He stated he has a list of residents with oxygen on his tablet from the week prior, but he does go room to room checking for oxygen. He stated he does not go into rooms when the doors are closed or if he knows someone was receiving hospice. He stated he only changed out oxygen tubing not aerosol tubing, masks, and mouthpieces. Review of the facility policy titled Respiratory Treatment Oxygen dated 05/19/21 revealed the policy was to provide supplementary oxygen to the respiratory system through oxygen therapy while maintaining appropriate infection control measure to reduce the risk of transmission of infectious agent. Date all equipment being used, when not in use store in a dated plastic bag and change equipment every seven days. 2. Review of the medical record revealed Resident #12 was admitted to the facility on [DATE]. Diagnoses included congestive heart failure, acute gastroenteropathy due to Norwalk agent, acute respiratory failure, anxiety disorder, depression, atrial fibrillation, overactive bladder, and spinal stenosis. Review of the admission MDS assessment dated [DATE] revealed Resident #12 intact cognition and had 366298 Page 10 of 13 366298 01/31/2024 Altercare of Nobles Pond, Inc 7006 Fulton Drive, NW Canton, OH 44718

F 0695 oxygen therapy. Level of Harm - Minimal harm or potential for actual harm An observation on 01/25/24 at 9:55 A.M. revealed the aerosol mouthpiece and oxygen tubing for Resident #12 was not dated as to when it was changed last. Residents Affected - Some On 01/25/24 at 9:58 A.M. an interview with Nurse #101 verified the oxygen tubing and aerosol mouthpiece for Resident #12 were not dated as to when they were changed last. On 01/25/24 at 10:14 A.M. an interview with Oxygen Company Representative #200 revealed he came into the facility once a week. He stated he has a list of residents with oxygen on his tablet from the week prior, but he does go room to room checking for oxygen. He stated he does not go into rooms when the doors are closed or if he knows someone was receiving hospice. He stated he only changed out oxygen tubing not aerosol tubing, masks, and mouthpieces. Review of the facility policy titled Respiratory Treatment Oxygen dated 05/19/21 revealed the policy was to provide supplementary oxygen to the respiratory system through oxygen therapy while maintaining appropriate infection control measure to reduce the risk of transmission of infectious agent. Date all equipment being used, when not in use store in a dated plastic bag and change equipment every seven days. 3. Review of the medical record revealed Resident #4 was admitted to the facility on [DATE]. Diagnoses included anxiety disorder, chronic obstructive pulmonary disease, chronic respiratory disease, fibromyalgia, adult failure to thrive, COVID-19, dependent on supplemental oxygen, lung cancer, depression, headache syndrome, insomnia, atrial flutter and lymphedema. There was no MDS information submitted at this time. An observation on 01/25/24 at 9:57 A.M. revealed the oxygen tubing for Resident #42 was not dated as to when it was changed last. On 01/25/24 at 9:58 A.M. an interview with Nurse #101 verified the oxygen tubing for Resident #42 was not dated as to when it was changed last. On 01/25/24 at 10:14 A.M. an interview with Oxygen Company Representative #200 revealed he came into the facility once a week. He stated he has a list of residents with oxygen on his tablet from the week prior, but he does go room to room checking for oxygen. He stated he does not go into rooms when the doors are closed or if he knows someone was receiving hospice. He stated he only changed out oxygen tubing not aerosol tubing, masks, and mouthpieces. Review of the facility policy titled, Respiratory Treatment Oxygen, dated 05/19/21 revealed the policy was to provide supplementary oxygen to the respiratory system through oxygen therapy while maintaining appropriate infection control measure to reduce the risk of transmission of infectious agent. Date all equipment being used, when not in use store in a dated plastic bag and change equipment every seven days. 4. Review of the medical record reviewed Resident #49 was admitted to the facility on [DATE]. Diagnoses included Alzheimer's disease, dysphagia, chronic pain, anxiety disorder, dementia, COVID-19, major depressive disorder, and chronic kidney disease. 366298 Page 11 of 13 366298 01/31/2024 Altercare of Nobles Pond, Inc 7006 Fulton Drive, NW Canton, OH 44718

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of the quarterly MDS assessment dated [DATE] revealed Resident #49 had moderately impaired cognition. An observation on 01/29/24 at 8:15 A.M. revealed the aerosol mouthpiece for Resident #49 was lying directly on her bedside table without being placed in a protective barrier, and there was no date as to when it was last changed. On 01/30/24 at 8:20 A.M. an interview with Nurse #102 verified the aerosol mouthpiece for Resident #49 was lying directly on her bedside table without being placed in a protective barrier, and there was no date as to when it was last changed. On 01/25/24 at 10:14 A.M. an interview with Oxygen Company Representative #200 revealed he came into the facility once a week. He stated he has a list of residents with oxygen on his tablet from the week prior, but he does go room to room checking for oxygen. He stated he does not go into rooms when the doors are closed or if he knows someone was receiving hospice. He stated he only changed out oxygen tubing not aerosol tubing, masks, and mouthpieces. Review of the facility policy titled, Respiratory Treatment Oxygen, dated 05/19/21 revealed the policy was to provide supplementary oxygen to the respiratory system through oxygen therapy while maintaining appropriate infection control measure to reduce the risk of transmission of infectious agent. Date all equipment being used, when not in use store in a dated plastic bag and change equipment every seven days. 5. Review of the medical record revealed Resident #37 was admitted to the facility on [DATE]. Diagnoses included cerebral infarction, falls, dysphagia, diabetes anxiety disorder, seizures, benign prostatic hyperplasia, chronic obstructive pulmonary disease, hyperuricemia, acute respiratory failure, hemiplegia to the left side, and chronic kidney disease. Review of the quarterly MDS assessment dated [DATE] revealed Resident #37 had intact cognition. An observation on 01/29/24 at 1:45 P.M. revealed the aerosol mask for Resident #37 was lying directly on his window ledge not in a protective barrier. The aerosol mask was visibly dirty with a white powder buildup. There was no date on the aerosol mask as to when it was last changed. An interview at this time with Nurse #103 verified the aerosol mask for Resident #37 was lying directly on the window ledge not in a protective barrier, was not dated as to when it was last changed, and was visibly dirty. On 01/25/24 at 10:14 A.M. an interview with Oxygen Company Representative #200 revealed he came into the facility once a week. He stated he has a list of residents with oxygen on his tablet from the week prior, but he does go room to room checking for oxygen. He stated he does not go into rooms when the doors are closed or if he knows someone was receiving hospice. He stated he only changed out oxygen tubing not aerosol tubing, masks, and mouthpieces. Review of the facility policy titled, Respiratory Treatment Oxygen, dated 05/19/21 revealed the policy was to provide supplementary oxygen to the respiratory system through oxygen therapy while maintaining appropriate infection control measure to reduce the risk of transmission of infectious agent. Date all equipment being used, when not in use store in a dated plastic bag and change equipment every seven days. 366298 Page 12 of 13 366298 01/31/2024 Altercare of Nobles Pond, Inc 7006 Fulton Drive, NW Canton, OH 44718

F 0695 This deficiency represents non-compliance investigated under Master Complaint Number OH00150361. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 366298 Page 13 of 13