Health inspection·April 15, 2021

F 0582 Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. Level of Harm - Minimal harm or potential for actual harm Based on medical record review and staff interview, the facility failed to provide an Advanced Beneficiary Notice (ABN) after skilled services were discontinued and the resident remained in the facility. This affected three (#20, #48, and #60) of four residents reviewed for ABN notices. The facility identified eight residents who were discharged from skilled services and remained in the facility. The facility census was 83. Residents Affected - Few Findings include: Review of a facility form titled, Beneficiary Notice-Residents discharged Within the Last Six Months, undated, revealed Resident #20's skilled services were discontinued 11/30/20. Further review of medical and financial records revealed the resident remained in the facility and lacked evidence ABN's were issued. Review of a facility form titled, Beneficiary Notice-Residents discharged Within the Last Six Months, undated, revealed Resident #20's skilled services were discontinued 11/30/20, Resident #48's skilled services were discontinued 01/21/21 and Resident #60's skilled services were discontinued 03/06/21.Further review of medical and financial records revealed the resident remained in the facility and lacked evidence ABN's were issued. Review of a facility form titled, Beneficiary Notice-Residents discharged Within the Last Six Months, undated, revealed Resident #20's skilled services were discontinued 11/30/20, Resident #48's skilled services were discontinued 01/21/21 and Resident #60's skilled services were discontinued 03/06/21. Further review of medical and financial records revealed the resident remained in the facility and lacked evidence ABN's were issued. Interview on 04/13/21 at 1:35 P.M. with Director of Rehab (DOR) #52 confirmed Resident #20, Resident #48, and Resident #60 did not received an ABN as required. She stated the facility did not have a policy for ABN's. Page 1 of 4 366313 366313 04/15/2021 Scioto Pointe 740 Canonby Place Columbus, OH 43223

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. Based on medical record review, interview with facility staff, and review of facility policy, the facility failed to refer residents with a newly evident mental health diagnosis to the Ohio Department of Mental Health (ODMH) to be screened for potential additional services. This affected two (#50 and #56) of three residents reviewed for appropriate screening referrals. The census was 83. Findings include: Review of Resident #50's medical record revealed he admitted to the facility 11/17/09. His pre-admission screening and resident review (PASARR) dated 11/17/09 revealed he had a traumatic brain injury. Further review of his medical record revealed he was diagnosed with schizophrenia 10/14/20. No new screening or referral was completed. Review of Resident #56's medical record revealed he admitted to the facility 08/15/19, with a traumatic brain injury. His pre-admission screening dated 04/01/19 revealed he had no mental health disorders. Review of Resident #56's medical record revealed he received a new diagnosis of unspecified mood disorder 12/15/19, psychosis 01/21/20, epilepsy 10/14/20, and anxiety 02/17/21. There was no evidence a Resident Review, or referral was made after the new mental health diagnoses. Interview on 04/14/21 at 9:28 A.M., with Social Service Designee #102 confirmed referrals were not made as required for Resident #50 and Resident #56 after receiving new mental health diagnoses. Review of a facility policy titled, Admissions from other Healthcare Facilities, undated, revealed PASRR's would be completed as appropriate. The facility did not have any other PASRR policy. 366313 Page 2 of 4 366313 04/15/2021 Scioto Pointe 740 Canonby Place Columbus, OH 43223

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 record review, observation, and interview, the facility failed to ensure non-skid strips were implemented as ordered/care planned. This affected two (#19 and #12) of two residents reviewed for falls. The census was 83. Findings include: 1. Review of the medical record for Resident #19 revealed an admission date of 05/22/17 with diagnoses including cerebral infarction, vascular dementia, and schizophrenia. Review of the quarterly minimum data set assessment dated [DATE] revealed Resident #19 was cognitively intact. Review of the fall risk assessment dated [DATE] revealed Resident #19 is at high risk for falls. Review of Resident #19's active physician orders revealed an order dated 03/02/20 for resident to have non-skid strips in front of the her bed to ensure safety. Review of Resident #19's comprehensive care plan revealed a focus of resident is at risk for falls with interventions including non-skid strips on floor at the bedside. Review of the census records for Resident #19 revealed she has not changed rooms since 03/26/21. Observation of Resident #19's room on 04/14/21 at 9:50 A.M. revealed no non-skid strips were present next to her bed. Interview with Resident #19 on 04/14/21 at 9:50 A.M. revealed no non-skid strips have been next to her bed since she moved to her current room. Interview with Director of Nursing (DON) on 04/14/21 at 9:58 A.M. verified Resident #19 did not have any non-skid strips next to her bed. 2. Review of Resident #12's medical record revealed she admitted to the facility 10/15/18. Diagnoses included epilepsy, chronic pain, and panic disorder. Review of Resident #12's care plan dated 01/23/21 revealed she was at risk for falls related to a history of falls, impaired balance, impaired mobility, and unsteady gait. Her interventions included non skid strips on the floor at bedside . Observations on 04/13/21 at 2:37 P.M., 04/14/21 at 8:22 A.M., and 04/14/21 at 11:02 A.M. revealed the non-skid strips on the floor to the left of her bed were torn and were no longer secured to the floor. They were folded onto each other. Interview on 04/14/21 at 11:03 A.M., with Registered Nurse #28 confirmed Resident #12's non-skid strips were not secured to the floor and posed as a potential tripping hazard. 366313 Page 3 of 4 366313 04/15/2021 Scioto Pointe 740 Canonby Place Columbus, OH 43223

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review, policy review and staff interviews, the facility failed to follow infection control guidelines when staff did not perform hand hygiene after removing soiled dressing during wound care. This affected one resident (#25) of three residents reviewed for skin breakdown. The facility census was 83. Residents Affected - Few Findings include: Review of the medical record for Resident #25 revealed an admission date of 07/18/13, with diagnoses dementia, peripheral vascular disease, and stage two pressure ulcer. Review of physician's orders dated April 2021 revealed to cleanse open area to left great toe with normal saline, pat dry, apply skin prep to surrounding area (allow to dry), place Calcium Alginate inside of wound bed (place a drop of normal saline on top of Calcium Alginate to moisten it) cover with small island dressing, change every three days and as needed until healed. Review of care plan revealed Resident #25 had a stage two area to left great toe and intervention included to provide treatment per physicians order. Observation was conducted on 04/13/21 at 2:16 P.M., with Licensed Practical Nurse (LPN) #41 perform wound care for Resident #25. LPN #41 gathered supplies, provided a clean barrier, provided privacy and washed her hands. LPN #41 then applied clean gloves and removed top outer dressing to Resident #25's top of left great toe. LPN #41 then placed normal saline on inner packing dressing for easier removal. After removing the soiled dressings, LPN #41 did remove her gloves and applied a new pair of clean gloves and did not perform any hand hygiene. LPN #41 then proceeded to clean the area with normal saline, and patted dry. LPN #41 then changed her gloves and applied skin prep to surrounding wound. LPN #41 changed her gloves and cut alginate dressing to size and applied to wound bed with a drop of normal saline, changed gloves and then covered wound with border dressing. LPN #41 did perform hand washing after wound dressing change was completed. Interview was conducted on 04/14/21 at 2:38 P.M., with LPN #41 and she verified she changed her gloves after removing soiled dressing however only performed hand antisepsis by washing hands at start and end of dressing change. Review of undated policy titled Dressing Policy revealed the purpose is to provide guidelines for the application of dry, clean dressings. Steps included to clean bedside table, establish a clean field, perform hand antisepsis, put on clean gloves and loosen tape and remove soiled dressing. Perform hand antisepsis. Open dry dressing, label tape or dressing with date, time, initials, open any other products. Perform hand antisepsis. Put on clean gloves. Cleanse the wound with ordered cleanser and use dry gauze to pat the wound dry. Apply the ordered dressing and secure with tape or bordered dressing per order. Remove gloves and perform hand antisepsis. 366313 Page 4 of 4