Health inspection·February 3, 2022

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 Based on observation, medical record review, and interview the facility failed to monitor circulatory status of a resident who had an edematous (swollen) left foot and studies indicating a thrombus (blood clot). This affected one (Resident #97) of 17 residents observed for evidence of edema. Residents Affected - Few Findings include: Observations on 02/01/22 at 8:38 A.M. and 11:06 A.M. and on 02/02/22 at 7:50 A.M. and 12:20 P.M. revealed Resident #97 sitting on the side of his bed with his legs dangling off the side of the bed and his feet on the floor. Review of Resident #97's medical record revealed a diagnosis of a fracture of the left femur. On 12/30/21 an order was written for a venous ultrasound of the left lower extremity due to increased edema. Venous doppler results dated 12/31/21 indicated there appeared to be a thrombus (a blood clot formed in situ within the vascular system of the body and impeding blood flow) in the left gastrocnemius vein (The gastrocnemius vein is considered a deep muscular vein of the calf.) There was no evidence of circulatory assessments related to the thrombus. On 02/03/22 at 10:55 A.M., the Director of Nursing (DON) verified she was unable to locate any evidence of circulatory checks and stated she understood the concern of circulatory checks not being completed for a resident with a blood clot. Page 1 of 4 366306 366306 02/03/2022 Valley Oaks Care Center 500 Selfridge Street East Liverpool, OH 43920

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. Based on observation, medical record review and staff interview the facility failed to ensure range of motion services were provided for residents identified with a limitation in joint mobility. This affected one (Resident #26) of two residents reviewed for range of motion services. The facility census was 46. Findings include: Review of Resident #26's medical record revealed an admission date of 10/18/15 and a readmission date of 09/18/19 with diagnoses that included Alzheimer's disease with dementia and congestive heart failure. Review of the Minimum Data Set (MDS) 3.0 assessment with a reference date of 12/31/21 indicated Resident #26 had limitation in range of motion to both upper and lower extremities. Further review of the medical record including a hospice recertification completed on 12/31/21 indicated Resident #26 had contractures to the bilateral legs and hands. Further review of the medical record found no evidence of any splint device use or any restorative services for joint mobility. No documentation was found to indicate a reason for joint mobility services not provided. Interview with the Director of Nursing on 02/03/22 at 8:55 A.M. verified Resident #26 had limitation in joint mobility to bilateral hands and legs, does not receive any joint mobility services and there was no documentation to indicate a reason for not providing joint mobility services. 366306 Page 2 of 4 366306 02/03/2022 Valley Oaks Care Center 500 Selfridge Street East Liverpool, OH 43920

F 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. Based on medical record review and staff interview the facility failed to ensure monthly pharmacy reviews identified physician orders were not being followed regarding acetaminophen administration. This affected one (Resident #12) of five residents reviewed for monthly pharmacy reviews. The facility census was 46. Findings include: Review of Resident #12's medical record revealed an admission date of 07/13/16 with diagnoses that included Alzheimer's disease with dementia, osteoarthritis and epilepsy. Review of the physician's orders revealed current orders for acetaminophen (analgesic) 650 milligram (mg) three times daily and Norco (hydrocodone and acetaminophen analgesic) 5 mg - 325 mg four times daily. A total of 3250 mg of acetaminophen was administered daily. Review of the Medication Administration Record (MAR) revealed acetaminophen and Norco administered daily as ordered for a total of 3.25 gm of acetaminophen administered each day. An additional physician's order indicated to not exceed 3 grams (gm) of acetaminophen daily. Review of monthly pharmacy recommendations revealed no indication the acetaminophen dosage exceeding physician orders was identified by the reviewing pharmacist. Interview with the Director of Nursing on 02/02/22 at 1140 A.M. verified Resident #12 received 3.25 gm of acetaminophen on a daily basis and monthly pharmacy recommendations did not address the acetaminophen dosage exceeding physician orders. 366306 Page 3 of 4 366306 02/03/2022 Valley Oaks Care Center 500 Selfridge Street East Liverpool, OH 43920

F 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm Based on medical record review and staff interview the facility failed to ensure physician orders were followed regarding acetaminophen dosage. This affected one (Resident #12) of five residents reviewed for medication use. The facility census was 46. Residents Affected - Few Findings include: Review of Resident #12's medical record revealed an admission date of 07/13/16 with diagnoses that included Alzheimer's disease with dementia, osteoarthritis and epilepsy. Review of the physician's orders revealed current orders for acetaminophen (analgesic) 650 milligram (mg) three times daily and Norco (hydrocodone and acetaminophen analgesic) 5 mg - 325 mg four times daily. A total of 3250 mg of acetaminophen was administered daily. Review of the Medication Administration Record (MAR) revealed acetaminophen and Norco administered daily as ordered with 3.25 gm of acetaminophen administered each day. An additional physician's order indicated to not exceed 3 grams (gm) of acetaminophen daily. Interview with the Director of Nursing on 02/02/22 at 8:40 A.M. verified Resident #12 received 3.25 gm of acetaminophen on a daily basis despite the physician's order to not exceed 3 gm per day. 366306 Page 4 of 4