Health inspection·October 15, 2021

F 0567 Honor the resident's right to manage his or her financial affairs. Level of Harm - Minimal harm or potential for actual harm Based on medical record review, staff and resident interview, review of the resident's funds account, and review of the facility's policy, the facility failed to ensure the residents were able to get cash from their funds accounts held by the facility. This affected six (#9, #24, #36, #59, #62, and #74) of six residents reviewed for personal funds accounts. The facility identified 80 residents who have personal funds account with the facility. The facility census was 81. Residents Affected - Some Finding include: 1. Medical record review for Resident #9 revealed an admission date of 02/21/20. Review of the quarterly Minimum Data Set (MDS) assessment, dated 07/01/21, revealed she was cognitively intact. 2. Medical record review for Resident #24 revealed an admission date of 03/09/19. Review of the quarterly MDS assessment, dated 07/14/21, revealed he was cognitively intact. Interview with Resident #24 on 10/04/21 at 10:42 A.M. revealed he wasn't able to get cash because the facility denied he could take out cash for any transactions. 3. Medical record review for Resident #36 revealed an admission of 08/04/16. Review of the quarterly MDS assessment, dated 08/10/21, revealed she was cognitively intact. Interview with Resident #36 on 10/04/21 at 3:53 P.M. revealed she wasn't able to get any cash out of her personal funds account. 4. Medical record review for Resident #59 revealed an admission date of 03/17/21. Review of the quarterly MDS assessment, dated 08/27/21, revealed she was cognitively intact. 5. Medical record review for Resident #62 revealed an admission date of 08/26/21. Review of the admission MDS assessment, dated 09/07/21, revealed he was cognitively intact. Interview with Resident #62 on 10/24/21 at 2:28 A.M. revealed he thought he had $200.00 in his personal funds account but he was not able to get any cash out of the account. 6. Medical record review for Resident #74 revealed an admission date of 06/13/19. Review of the quarterly MDS assessment, dated 09/08/21, revealed he was cognitively intact. Interview with Resident #74 on 10/04/21 2:16 P.M. revealed there was money put into his account, but he wasn't able to get any cash out of the account. Page 1 of 20 366313 366313 10/15/2021 Scioto Pointe 740 Canonby Place Columbus, OH 43223

F 0567 Level of Harm - Minimal harm or potential for actual harm Interview with the Business Office Manager (BOM) #312 on 10/07/21 at 12:42 P.M. revealed she worked from home last year when the pandemic hit. She revealed when she returned to the facility the administration and nursing had changed everything about giving out cash to the resident. Cash was not given to the residents for anything until just recently if a resident went out of the facility and wanted cash to spend then it was permitted to be given to them. She said it was to protect the residents from COVID-19. Residents Affected - Some Interview with the Administrator on 10/07/21 at 1:10 P.M. revealed he changed the personal funds to no cash being handed out to the residents. He said it was one less thing that was touched by the residents. He revealed the resident could still buy stuff from the store in the facility but couldn't get the cash. Review of the facility's undated policy titled Management of Resident's Personal Funds revealed the facility will manage the personal funds of residents who request the facility to do so. The resident may withdraw his or her request for the facility to manage his or her personal funds at any time by submitting a notice to the Administrator. 366313 Page 2 of 20 366313 10/15/2021 Scioto Pointe 740 Canonby Place Columbus, OH 43223

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 Based on record review, staff interview, and observations, the facility failed to provide a resident with adequate assistance with dressing. This affected one (#40) of three residents reviewed for activities of daily living. The facility identified 42 residents who require assistance from staff or were dependent on staff for assistance with dressing. Residents Affected - Few Findings include: Review of the medical record for Resident #40 revealed an admission date of 12/29/16. Diagnoses included schizoaffective disorder, anxiety disorder, obsessive-compulsive behavior, and bipolar disorder. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 08/03/21, revealed the resident had moderately impaired cognition for daily decision making ability. Resident #40 required extensive assistance from one staff member for dressing. Review of the nursing progress notes for Resident #40 from 10/04/21 thorough 10/07/21 revealed no documentation related to the resident refusing to change her clothing or complete daily personal hygiene. Observation of Resident #40 from 10/04/21 through 10/07/21 revealed the resident wearing the same yellow shirt and pants on all four days. Interview on 10/07/21 at 3:47 P.M. with State Tested Nursing Assistant (STNA) #322 revealed Resident #40 was independent when it came to changing her own clothing. STNA #322 verified Resident #40 had been wearing the same clothing for the last four days. Interview on 10/07/21 at 3:00 P.M. with the Director of Nursing (DON) confirmed Resident #40 had been wearing the same yellow shirt and yellow pants for the last four days. The DON also confirmed Resident #40's quarterly MDS assessment, dated 08/03/21, indicated the resident required extensive assistance from one staff member for dressing. 366313 Page 3 of 20 366313 10/15/2021 Scioto Pointe 740 Canonby Place Columbus, OH 43223

F 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm 2.) Review of the medical record for Resident #44 revealed a admission date of 09/03/14. Diagnoses included schizoaffective disorder, dementia without behavioral disturbances, and major depressive disorder. Residents Affected - Few Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 08/17/21, revealed Resident #44 was noted to have a severely impaired cognition for daily decision making ability, and experienced disorganized thinking. Resident #44 was noted to display verbal behavioral symptoms directed towards others and not towards others one to three days a week. Resident #44 required total dependence on one staff member for bed mobility, and locomotion on and off the unit. Review of the plan of care, dated 05/28/17 for Resident #44, revealed the resident was at risk for impaired psychosocial well-being related to conflict with staff, strong identification with past roles. Interventions included to administer medication as ordered, monitor mood affect and behavior, and monitor level of activity participation. Review of the undated plan of care for Resident #44 revealed the resident presented with altered mood state which may adversely affect participating in activities of interest. Interventions included to perform activity assessment, promote the following activities per residents preferences, crafts, cooking, gardening, conversation with others, bingo, funs with food, getting her hair done, coloring, hanging out with friends, small activities outside of room as needed, and to encourage to come out of room to participate in activity of interest. Review of Resident #44's activity assessment, dated 08/17/21, revealed the resident was at risk for social isolation during COVID-19. Resident enjoys rummy, bingo, ice cream social, music programs, coffee hour, movies, music, chat sessions, church, sitting in the sun, and animals. Review of Resident #44's activity log for October 2021 revealed no log had been completed or maintained to reflect any activities had been provided. Request and review of Resident #44's activity log for September 2021 revealed no log had been completed for this month. There was one on one visit forms completed for 09/03/21 when the resident came to the dinning room for nails and drinks. A form completed on 09/06/21 when the resident came to the dining room for Bingo. On 09/12/21 the resident came to the dinning room for music and to sit on the patio. On 09/13/21, the resident was noted to be sleeping. On 09/20/21, a book was read to the resident. On 09/27/21, the resident was assisted to the dining room for bingo when she changed her mind and sat on the patio for fresh air. Observations from 10/04/21 thorough 10/07/21 of Resident #44 revealed the resident was resting quietly in her bed, or sitting in a wheelchair located in her room, placed in front of the television. Resident #44 was not observed outside of her room during this four-day period. Observation on 10/06/21 at 4:00 P.M. revealed residents sitting in the dinning room participating in Bingo. Resident #44 was not observed in the dinning room at this time. Interview on 10/06/21 at 5:00 P.M. with Activity Director #364 confirmed Bingo was noted to be a activity of interest for Resident #44 and this resident had not been invited to participate in that activity. Activity Director #354 also confirmed Resident #44 had spent all of her time in her room the 366313 Page 4 of 20 366313 10/15/2021 Scioto Pointe 740 Canonby Place Columbus, OH 43223

F 0679 last four days and had not participated in any of the group activities the facility had. Level of Harm - Minimal harm or potential for actual harm Review of the facility's undated policy titled Activity Program revealed the activity program designated to meet the needs of each resident are available on a daily basis. Activities are scheduled seven days a week and residents are given an opportunity to contribute to the planned, preparation, conduction, cleanup, and critique of the program. Residents Affected - Few Based on observation, medical record review, resident and staff interview, and review of the facility's policy, the facility failed to provide meaningful activities to the residents. This affected two (#38 and #44) of five residents reviewed for activities. The facility census was 81. Findings include: 1.) Review of the medical record for Resident #38 revealed an admission date of 10/27/15. Diagnoses included nicotine dependence, mood disorder, COVID-19, schizophrenia, mood disorder, epilepsy, major depressive disorder, restless leg syndrome, and bipolar disorder. Review of the quarterly Minimum Data Set (MDS) assessment, dated 07/20/21, revealed the resident had intact cognition. She was independent on bed mobility, transfers, eating, toileting, personal hygiene, and bathing. She required supervision for dressing. Review of the care plan, dated 11/24/19, revealed Resident #38 was at risk for decreased participation in activities related to resident refusal. Interventions included to perform activity assessment quarterly and as needed, promote the following activities for Resident #38 preferences, sports/footfall, music, watching movies, bingo, thirsty Thursday, arts and crafts, conversation with others, going outside, and visiting her grandson. Offer and encourage special events that included meals, decorations, celebrations and or music as needed. Monitor resident's satisfaction with individualized independent and group activities as needed. Review of the activities progress note, dated 07/30/21 for Resident #38, revealed current activity pursuits identifies leisure activities of interest; pursues activities when visitors were present; scheduled programs for Resident #38 to increased for social isolation during COVID-19 distancing precautions. She continued to pursue interest in bingo, movies, and popcorn. Resident #38 accepted snacks daily from snack cart three to four times a week. She attended group activities one to two times a week watching TV/movies, listening to music, social visits, indoor/outdoor walks, coffee time, social events. She was actively involved in these activities. Resident #38 enjoyed going outside to smoke and going on outings with her boyfriend. Review of the activities log, dated 09/2021, revealed the resident only participated in news television, talking and conversation and smoking every day. She attended thirsty Thursday one time. There was no indication of refusal of activities. For the activity log, dated 10/2021, revealed Resident #38 had only participated in news television, talking and conversation and smoking. There was no indication of refusal of activities. Interview with Resident #38 on 10/04/21 at 1:47 P.M. revealed the facility only played Bingo and Thirsty Thursday as activities to participate in. She stated she wished there was more of a variety of activities to participate in. Interview with the Director of Nursing on 10/07/21 at 9:15 A.M. verified the activity calendar did 366313 Page 5 of 20 366313 10/15/2021 Scioto Pointe 740 Canonby Place Columbus, OH 43223

F 0679 not tailor to Resident #38 preferences and further verified news television and smoking was not an activity. He further stated the activity form did not reveal if the resident was offered and refused to participate. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 366313 Page 6 of 20 366313 10/15/2021 Scioto Pointe 740 Canonby Place Columbus, OH 43223

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 record review, resident and staff interview, observation, and review of the facility's policy, the facility failed to ensure treatment orders were completed per physician orders. This affected one (#45) of one resident reviewed for non-pressure related skin issues. The facility identified one resident with treatment orders for skin tears. The facility census was 81. Residents Affected - Few Findings include: Review of medical record for Resident #45 revealed an admission date of 02/15/17. Diagnoses included Diabetes Mellitus (DM) Type II, dementia without behavioral disturbances, schizoaffective disorder, bipolar disorder, and anxiety disorder. Review of the quarterly Minimum Data Set (MDS) assessment, dated 08/17/21, revealed the resident had impaired cognition. Review of the care plan, dated 02/16/17, revealed Resident #45 was at risk for actual/potential alteration in skin integrity related to DM, fragile skin, dry itchy scalp, and right elbow skin tear. Interventions included to provide treatments per physician order, weekly skin assessment for skin irritation, redness, bruises, scratches, open areas, and provide treatment per physician order. Review of the physician orders, dated 09/16/21, revealed an order to cleanse the skin tear to the right elbow with non-sterile saline, pat dry, and apply with bordered gauze and clean daily. Review of the Medication Administration Records (MAR) and Treatment Administration Records (TAR) dated 09/16/21 through 10/03/21 revealed the physician order was not transcribed to the MAR and TARs and there were no records of the treatment being administered. Review of the skin assessments, dated 09/15/21, 09/22/21, 09/29/21, and 10/05/21, revealed the resident's skin tear was not documented on the assessment. Interview and observation on 10/04/21 at 11:31 A.M. with Resident #45 revealed he had an abrasion on his right elbow the size of a quarter and two small pencil eraser size red spots above the abrasion. The abrasion and spots were red and scabbed over. The resident was unsure where they came from. Resident did not have any bandages in place. Interview on 10/07/21 at 9:15 A.M. with the Director of Nursing (DON) verified Resident #45 had physician orders to cleanse the skin tear, dated 09/16/21. The DON verified there was no documentation on the MAR and/or TAR verifying the treatment was being completed as physician ordered. Observation on 10/07/21 at 10:30 A.M. with the DON verified the resident did have an abrasion on his right elbow and the two spots above the abrasion. Review of the facility's policy titled Charting and Documentation revealed services provided to the resident, progress towards the care plan goals, or any changes in the resident's medical physical functional or psychosocial condition, shall be documented in the resident's medical record. The medical record should facilitate communication between the interdisciplinary team regarding the resident's condition and response to care. 366313 Page 7 of 20 366313 10/15/2021 Scioto Pointe 740 Canonby Place Columbus, OH 43223

F 0687 Provide appropriate foot care. Level of Harm - Minimal harm or potential for actual harm Based on record review, resident and staff interview, and observation, the facility failed to ensure the resident received proper treatment to maintain good foot health. This affected one (#1) of one resident reviewed for foot care. The facility census was 81. Residents Affected - Few Findings include: Review of the medical record for Resident #1 revealed an admission date of 05/29/13. Diagnoses included Diabetes Mellitus (DM) Type Two. Review of the care plan, dated 05/30/21, revealed Resident #1 had potential for alteration in skin integrity related to DM, history of tinea unguium (superficial fungal infection), resistant to care/skin interventions, incontinence of urine, and resident was non-complaint with showers and personal hygiene at times. Interventions included to assess the condition of the resident's feet weekly and report abnormal findings to the physician. Keep nails trimmed short and filed smooth. Refer to podiatry for routine and as needed foot care. Review of the quarterly Minimum Data Set (MDS) assessment, dated 06/16/21, revealed the resident had impaired cognition. She required supervision for dressing, personal hygiene, and bathing. Review of the standing physician orders revealed the resident to see podiatry. Review of the podiatry notes revealed the resident was last seen by podiatry on 01/23/21. Nails were yellow to white thick and crumbling. Nails were incurvated. Nails without care would result in complications, abscesses, pain, paronychia (soft issue infection around a toenail), and marked limited ambulation. Observation and interview on 10/04/21 at 10:35 A.M. with Resident #1 revealed the podiatrist was just there, and he didn't see her. She was unsure why she was not seen. Resident #1's feet did not have socks on them and her toenails were visible during the interview. Her toenails were approximately one inch long, thick, yellow in color and curling. Interview with the Director of Nursing (DON) on 10/07/21 at 9:15 A.M. verified the podiatrist was in the building on 04/26/21, 05/03/21, 07/02/21, 07/28/21, and 09/29/21 and was unsure why she was not seen. When the podiatrist comes, she will see two hallways one time and then the next time she will see the other two hallways. She would also see any resident who needed seen. Resident #1's documentation to assess her feet weekly would be located on the skin assessment, however the resident refuses skin assessments and showers consistently. He further stated the resident refused to be seen by podiatry on 05/03/21 and was not seen on 09/29/21. Observation on 10/07/21 at 10:30 A.M. with the DON revealed Resident #1's feet did not have socks on them and her toenails were visible and the DON verified Resident #1 did have long toenails. 366313 Page 8 of 20 366313 10/15/2021 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, staff interview, and review of the faciliy's policy, the facility failed to ensure a resident's fall was investigated in a timely manner to determine the root cause and to identify any patterns of repeated falls and to evaluate, revise and/or add individualized interventions to the resident's care plan. This affected one (#73) of three residents reviewed for falls. The facility census was 81. Findings include: Review of the medical record for Resident #73 revealed an admission date of 04/08/15. Diagnoses included secondary Parkinsonism, mood disorder, depressive disorder, dementia without behavioral disturbance, schizophrenia, psychosis, and creutzfeldt-[NAME] disease. Review of the resident's undated care plan revealed the resident was at risk for falls as evidence by history of falls with injury, multiple risk factors related to use of psychotropic medications, pain in bilateral knees, weakness, lack of coordination, tremors, dorsalgia, and secondary Parkinsonism. The goal was for no falls with injuries with a target date of 11/04/21. The last intervention added to the resident's care plan was for a broda chair due to poor trunk control dated 09/15/21. Review of the comprehensive Minimum Data Set (MDS) assessment, dated 09/03/21, revealed the resident had severely impaired cognition. The resident required extensive assistance of one staff for bed mobility, transfers, and toileting. Review of a progress note, dated 10/01/21 (Friday) at 3:55 P.M., revealed the resident was trying to walk and fell and hit his head. No injuries were noted. Interview on 10/06/21 at 3:45 P.M. with the Assistant Director of Nursing (ADON) #366 stated a fall investigation had not been completed for Resident #73's fall which occurred on 10/01/21. Interview on 10/06/21 at 4:47 P.M. with the Director of Nursing (DON) stated fall investigations should be completed within 24 hours on a week day or the nurse should implement an intervention and the fall investigation should be completed at the beginning of the following week. Review of the facility's undated document titled, Guidelines for Fall Documentation revealed when a resident falls, the charge nurse must immediately complete incident and fall investigation reports. Review of the facility's undated policy titled Falls-Clinical Protocol revealed when an individual falls, staff should attempt to define possible causes within 24 hours of the fall. 366313 Page 9 of 20 366313 10/15/2021 Scioto Pointe 740 Canonby Place Columbus, OH 43223

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. Based on record review, resident and staff interview, and review of the facility's policy, the facility failed to ensure bowel movements and toileting program were monitored per physician orders and the resident's plan of care. This affected one (#21) of one resident reviewed for bowel incontinence. The facility identified 29 residents who required assistance from staff or dependent on staff for toileting. The facility census was 81. Findings include: Review of medical record for Resident #21 revealed a re-admission date of 12/01/19. Diagnoses included sequelae of cerebral infarction, schizoaffective disorder, constipation, bipolar disorder, and dementia without behavioral disturbances. Review of the care plan, dated 02/22/13, revealed Resident #21 was at risk for alteration in bowel elimination related to medications and potential for occasional bowel incontinence. Interventions included to record bowel movements daily and note the size and consistency and report any abnormalities to the charge nurse. Review of the quarterly Minimum Data Set (MDS) assessment, dated 04/14/21, revealed the resident had intact cognition. She required extensive assistance with toileting. Review of the physician orders revealed an order, dated 04/16/19, for Loperamide (treats diarrhea) two milligrams (mg) by mouth as needed for diarrhea and docusate (treats constipation) 100 mg two times a day. There was also an order, dated 02/16/21, for a scheduled toileting program per the plan of care and as needed, chart bowel movements, and if no bowel movement in three days follow protocol. Review of the Medication Administration Record (MAR) and Treatment Administration Record (TAR), dated 08/2021, 09/2021, and 10/2021, revealed there was no charting on bowel movements. Review of the State Tested Nursing Aide (STNA) documentation during this time revealed there was no documentation regarding the resident's daily bowel movements and the size and consistency of the bowel movements. Interview on 10/04/21 at 10:52 A.M. with Resident #21 revealed had been constipated or had diarrhea that lasted longer than three days and had to ask for medication from the nurse. Interview on 10/07/21 at 9:15 A.M. with the Director of Nursing (DON) verified Resident #21 had physician orders for a toileting program and to document bowel movements. The DON verified there was no documentation regarding the residents bowel movements and toileting program on the MAR, TAR, and/or STNA documents for 08/2021, 09/2021, and 10/2021. Review of the facility's undated policy titled Charting and Documentation revealed services provided to the resident, progress towards the care plan goals, or any changes in the resident's medical physical functional or psychosocial condition, shall be documented in the resident's medical record. The medical record should facilitate communication between the interdisciplinary team regarding the resident's condition and response to care. 366313 Page 10 of 20 366313 10/15/2021 Scioto Pointe 740 Canonby Place Columbus, OH 43223

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, facility record review, staff interview, and policy review, the facility failed to ensure Resident #22's weights were performed as recommended and per facility policy and failed to monitor and intervene appropriately for a resident who was at a nutritional risk for weight loss. This affected one (#22) of three residents reviewed for weight loss. The facility identified two current residents with significant weight loss. The facility census was 81. Residents Affected - Few Findings include: Review of the medical record of Resident #22 revealed an admission date of 02/02/18. The resident was hospitalized from [DATE] to 06/24/21 and 07/02/21 to 07/07/21. Diagnoses included diffuse traumatic brain injury with loss of consciousness, dementia with behavioral disturbance, Type II diabetes mellitus (DM), history of COVID-19, cerebral infarction, chronic pain syndrome, abnormal weight loss, major depressive disorder, schizoaffective disorder, oropharyngeal dysphagia, anxiety disorder, epilepsy, and gastro-esophageal reflux disease (GERD). Review of the quarterly Minimum Data Set (MDS), dated [DATE], revealed the resident had a severe cognitive impairment. The resident exhibited delusions and verbal behavioral symptoms directed toward others one to three days during the assessment period. The resident was dependent on two staff for transfers and required extensive assistance of one staff for eating. Review of the physician orders revealed on 11/25/20, Boost Breeze (a high calorie nutritional supplement) was ordered due to weight loss and on 01/15/21, Remeron 7.5 milligrams (mg) was ordered for appetite stimulation. On 04/19/21, an order for Health Shakes (a high calorie nutritional supplement) two times per day. Review of the resident's weights revealed, on 04/06/21, the resident weighed 142.2 pounds. On 04/08/21, the resident weighed 143.6 pounds. There were no weights obtained from 04/09/21 through 07/20/21 and there was no documentation in the medical record why the weights were not obtained. This included no re-admission weights on 06/24/21 and 07/07/21 when the resident returned from hospital stays. On 07/21/21, the resident weighed 124.8 pounds. This reflected an 18.8-pound weight loss and a 13% severe weight loss in three months. On 07/28/21, the resident weighed 126.2 pounds. There was no weight recorded for the month of August 2021. On 09/13/21, the resident weighed 123.4 pounds. Review of the nutrition assessment, dated 04/12/21, revealed the resident was at a moderate nutritional risk secondary to weight loss over the previous 90 days, limited assist at meals, adaptive equipment, fair-to-good meal intakes, confusion at times, and a history of constipation. The resident was receiving a health shake (a high calorie nutritional supplement) daily at lunch and Boost Breeze (a high calorie nutritional supplement) twice per day with the medication pass. Recommendations were made to add a health shake to dinner. Review of the progress notes, dated 04/15/21 through 07/08/21, revealed the resident was a Hoyer lift for all transfers. On 05/13/21, the resident aspirated during lunch time. On 06/16/21, the resident choked on his food. On 06/18/21, speech therapy evaluated the resident due to swallowing difficulties and began treatment. On 06/22/21, the resident was noted as not tolerating food and was spitting, coughing, and restless. The resident failed swallowing evaluation and was sent to the hospital for further evaluation. On 07/02/21, the resident was spitting, and projectile vomiting and the 366313 Page 11 of 20 366313 10/15/2021 Scioto Pointe 740 Canonby Place Columbus, OH 43223

F 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few resident was sent to the hospital for further evaluation. On 07/08/21, the resident was eating his dinner and began throwing up and choking. Review of the plan of care, dated 06/28/21, revealed the resident had altered nutritional status as evidenced by a history of dysphagia, GERD, DM, requires assistance at meals as needed, recent weight loss, and a history of weight loss and weight fluctuations. Interventions included to monitor weight per facility protocol and provide snacks/supplements as indicated. Review of the nutrition assessment, dated 07/12/21, revealed no weight was available and the resident remained at a moderate nutritional risk. There were no new nutritional recommendations. There was no mention of the resident's difficulty swallowing and choking on meals. There was no explanation why the resident was not weighed and no recommendation to obtain a weight at this time. Review of the physician progress note, dated 07/16/21, revealed the resident presented with recurrent vomiting after eating. There was a concern for dysphagia, reflux, hiatal hernia, or esophageal stricture. Additionally, a concern for a significant inability to keep food and fluid down and for nutritional imbalance was reviewed. Reglan was ordered with a plan to consider intravenous therapy if unable to keep fluid down and monitoring weight loss. Review of the nutrition assessment, dated 07/19/21, revealed no weight was available. The resident remained at a moderate nutritional risk secondary to limited assist at meals, adaptive equipment, fair meal intakes, confusion at times, and a history of constipation. The resident was noted to have emesis with vomiting often and difficulty keeping food down. The resident had modified barium swallow evaluations completed on 06/23/21 and 07/02/21 and an esophageal dilation (EGD) on 07/22/21. The resident continued to receive health shakes twice per day and Boost Breeze twice per day. There were no new recommendations. Again, there was no explanation why the resident was not weighed and no recommendation to obtain a weight at this time. Review of the weight change note, dated 07/29/21, revealed the resident triggered for a 19.6% weight loss. The resident had seen the gastrointerologist doctor twice during the current month, started on Reglan, and vomiting was noted to be improved. The resident remained on Boost Breeze twice per day and health shakes twice per day. There were no new recommendations. Review of the physician progress note, dated 08/10/21, identified recent significant weight loss with decreased ability to keep food down. The plan was to monitor and for the dietitian to monitor for supplements and weight loss. There were no weights obtained from 07/22/21 to 09/12/21 after the Physician wrote for the dietitian to monitor for supplements and weight loss. Review of the weight change note, dated 09/20/21, revealed the resident continued to trigger for a 13.2% weight loss. The weight loss was described by Registered Dietitian (RD) #330 as gradual loss over the last 180 days. The resident was noted as having EGDs every two weeks with the last visit on 09/17/21. There were no new recommendations. Interview on 10/07/21 at 3:58 P.M. with RD #330 stated the residents were to be weighed at least monthly and upon readmitting from the hospital. RD #330 verified the resident was not weighed between 04/09/21 and 07/20/21, including when the resident readmitted to the facility from the hospital on [DATE] and 07/07/21, and again between 07/28/21 and 09/13/21. RD #330 stated the resident should have been weighed more often than monthly while he was experiencing vomiting and choking. RD #330 stated she had been having difficulty making sure residents were weighed and had talked to the Director of 366313 Page 12 of 20 366313 10/15/2021 Scioto Pointe 740 Canonby Place Columbus, OH 43223

F 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Nursing (DON) and Administrator about the issue. RD #330 stated she only worked in the building three days a week and she lets staff know when weights were needed and if weights were not obtained, by the time she comes back in the building again, she asks for them again. RD #330 stated the facility scale was not working correctly in May 2021. Subsequent interview on 10/07/21 at 5:42 P.M. with RD #330 stated she did not implement any new interventions following the identification of the weight loss because the resident had improved tolerance of his diet. Interview on 10/07/21 at 4:57 P.M. with the Administrator stated the missing weights was an oversight and related to challenges with staffing. Interview on 10/07/21 at 5:00 P.M. with the DON verified Resident #22 had required a Hoyer lift for all transfers since admitting to the facility. The DON further confirmed one of the two Hoyer lifts in the facility had a scale, but RD #330 preferred to have all residents weighed on the same scale. Review of a timeline of scale repairs provided by the facility revealed, on 05/05/21, the scale was identified as not working properly and the maintenance director contacted the repair company. On 05/19/21, quotes were received from the repair company and parts were ordered. On 06/03/21, the scale repairs were completed. Review of the facility's undated policy titled Weight Assessment and Intervention revealed residents should be weighed upon admission and monthly thereafter unless otherwise ordered by the physician, and the weight should be recorded in the resident's medical record. 366313 Page 13 of 20 366313 10/15/2021 Scioto Pointe 740 Canonby Place Columbus, OH 43223

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. Based on medical record review, observations, staff interview, and review of the facility's Medication Regimen Review policy, the facility failed to ensure residents receiving psychotropic medication were monitored accurately for adverse reactions. This affected one (Resident #40) of five residents reviewed for unnecessary medications. The facility census was 81. Findings include: Review of the medical record for Resident #40 revealed an admission date of 12/29/16. Diagnoses included schizoaffective disorder, anxiety disorder, obsessive-compulsive behavior, and bipolar disorder. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 08/03/21, revealed the resident had a moderately impaired cognition for daily decision making ability. Resident #40 was noted to display verbal behaviors director towards others. Review of the physician orders for Resident #40 revealed the follow orders related to mood and/or behaviors: on 03/10/21, Buspirone (antianxiety) 10 mg tablet, give two tablets, three times a day for anxiety. On 08/17/21, Invega Sustenna (antipsychotic) suspension pre-filled syringe, 234 milligrams (mg) /1.5 milliliters (ml), inject one dose intramuscularly (IM) once a day every 28 days related to schizoaffective disorder. On 09/25/21, Lamictal (a mood-stabilizing anticonvulsant) 25 mg tablet, give one tablet daily for mood disorder Review of the undated plan of care revealed Resident #40 exhibited behavioral symptoms that were not easily altered and potentially harmful to resident or others. Resident #40 has been socially inappropriate/disruptive, history or wanting to attempt to get out of the facility front door, can be non-compliant with care and treatment regimen. Interventions included to encourage resident to take medication as ordered, and monitor mood affect and behaviors. The resident was at risk for post-traumatic syndrome related to past experiences. Interventions included to assess the resident for fears or concerns, document behaviors, and encourage to express self. Review of Resident #40's Medication Administration Record (MAR) dated from 10/01/21 through 10/07/21 revealed the resident was free from any adverse reactions or side effects related to the use of psychotropic medications. Review of Resident #40's nursing progress notes from 10/01/21 through 10/07/21 revealed no documentation related to the resident experiencing any adverse reactions from current medication regimen. Observation of Resident #40 from 10/04/21 at 10:27 A.M. reveled the resident was sitting on the side of her bed using the bedside table to lean on to sleep. When the resident was verbally addressed, the resident, without raising her head or opening her eyes, slurred , Yes, and continued resting quietly with her head placed on the bedside tablet and her eyes closed. Subsequent observations on 10/05/21 at 1:43 P.M. revealed Resident #40 was laying on her left side in bed. When verbally addressed, the resident once again slurred a answer that could not be understood and then continued resting quietly with her eyes closed. Observation on 10/06/21 at 3:47 P.M. 366313 Page 14 of 20 366313 10/15/2021 Scioto Pointe 740 Canonby Place Columbus, OH 43223

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few revealed the resident was sitting in a chair in the facility's main lobby area. Resident #40 was noted to be sitting with her head down allowing her chain to rest on her chest, resting quietly with her eyes closed. Resident #40 did not open her eyes when addressed. Continued observation at 5:00 P.M. revealed the resident was sitting in the same chair in the facility's lobby area, resting quietly with her eyes opened. When verbally addressed, Resident #40 nodded her head and then closed her eyes again. Observation on 10/07/21 at 2:00 P.M. revealed the resident was sitting on the edge of her bed, resting with her head placed on the bedside table, resting quietly with here eyes closed. Interview on 10/06/21 6:15 P.M. with the Director of Nursing (DON) revealed Resident #40 was just started on the medication Lamictal for mood disorder on 09/25/21 due to noted behaviors such as screaming out and ambulating out into the lobby area and urinating on the floor. The DON verified Resident #40 have been very lethargic the last few days and claimed it could be related to the new mood medication she was started on. The DON also confirmed Resident #40's medical record lacked the documentation related to the increase drowsiness or increased sleeping. Review of the facility's undated policy titled Medication Administration revealed the facility is to monitor the resident for any adverse reaction to the medication or side effects. 366313 Page 15 of 20 366313 10/15/2021 Scioto Pointe 740 Canonby Place Columbus, OH 43223

F 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. Based on record review, observation, and staff interview, the facility failed to ensure residents were provided food which met the resident's preference such as not being served pork. This affected one (Resident #54) of four residents reviewed for food preferences. The facility census was 81. Findings include: Review of the medical record for Resident #54 revealed a admission date of 03/02/20. Diagnoses included post-traumatic stress disorder, and dementia with behavioral disturbances. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 08/20/21, revealed the resident had a moderately impaired cognition for daily decision making ability, and was noted to express verbal behaviors directed towards others. Review of the meal slip, dated 10/05/21 and 10/06/21, stated the resident did not like pork. Review of the facility's monthly menu for October 2021 revealed for lunch on 10/05/21, the facility was serving tacos made with pork meat. On 10/06/21 for dinner, the facility was serving baked pork. Observation on 10/05/21 at 1:20 P.M. of Resident #54's lunch tray revealed the resident had been served tacos made with pork meat. Observation on 10/06/21 at 5:00 P.M. revealed Resident #54 was served baked pork for dinner. Interview on 10/06/21 at 5:10 P.M. with Licensed Practical Nurse (LPN) #365 confirmed Resident #54 was noted to dislike pork which was noted on his dietary slip. LPN #365 also confirmed Resident #54 was served a pork food item on 10/05/21 for lunch and on 10/06/21 for dinner. 366313 Page 16 of 20 366313 10/15/2021 Scioto Pointe 740 Canonby Place Columbus, OH 43223

F 0810 Provide special eating equipment and utensils for residents who need them and appropriate assistance. Level of Harm - Minimal harm or potential for actual harm Based on medical record review, observation, and staff interview, the facility failed to provide residents with physician ordered adaptive equipment during meal time. This affected four (Resident #10, #19, #21, and #22) of four residents reviewed for adaptive equipment. The facility identified 13 residents who utilize adaptive equipment. The facility census was 81. Residents Affected - Some Findings include: 1.) Review of the medical record for Resident #19 revealed an admission date of 10/15/18. Diagnoses included squeal cardiovascular disease, altered mental status, and muscle spasms. Review of the annual Minimum Data Set (MDS) 3.0 assessment, dated 10/01/21, revealed the resident with a moderately impaired cognition for daily decision making ability. Resident #19 was noted to require extensive assistance from one staff member for eating. Resident #19 was noted to have impairment to one of her upper and one of the her lower extremities. Review of Resident #19's physician orders for October 2021 revealed for the resident to have a dycem (a non-slip material) to be placed under the resident plate and to have a plate guard with meals. Observation on 10/06/21 at 5:00 P.M. revealed Resident #19 was served a dinner tray with no dycem noted under the plate and no plate guard noted. Interview on 10/06/21 at 5:02 P.M. with Licensed Practical Nurse (LPN) #365 confirmed Resident #19 had a order for dycem to be placed under her plate and a plate guard put in place. LPN #365 confirmed Resident #19 was not provided any of the ordered adaptive equipment with her dinner. 2.) Review of the medical record for Resident #22 revealed an admission date of 02/02/18. Diagnoses included dementia with behavioral disturbance, Type II diabetes mellitus, abnormal weight loss, major depressive disorder, schizoaffective disorder, oropharyngeal dysphagia, and gastro-esophageal reflux disease (GERD). Review of the quarterly Minimum Data Set (MDS) assessment, dated 07/14/21, revealed the resident had a severe cognitive impairment and required extensive assistance of one staff for eating. Review of the plan of care, dated 06/25/21, revealed the resident was encouraged to be monitored in eating related to dysphagia related to poor safety awareness. Interventions included a dycem on the meal tray and small utensils at all meals. Review of the physician's orders for October 2021 revealed an order for a dycem on tray. Review of the meal ticket for Resident #22, dated 10/07/21, revealed the resident was to have a non-skid placemat/dycem and small utensils. Observation on 10/06/21 at 5:00 P.M. revealed Resident #22 was served a dinner tray with no dycem noted under the plate or small utensils. Interview on 10/06/21 at 5:02 P.M. with Licensed Practical Nurse (LPN) #365 confirmed Resident #22 had a order for dycem to be placed under his plate and for small utensils. LPN #365 confirmed 366313 Page 17 of 20 366313 10/15/2021 Scioto Pointe 740 Canonby Place Columbus, OH 43223

F 0810 Resident #22 was not provided any of the ordered adaptive equipment with his dinner. Level of Harm - Minimal harm or potential for actual harm 3). Review of medical record for Resident #21 revealed a readmission date of 12/01/19. Diagnoses included sequelae of cerebral infarction, anemia, hemiplegia, and dementia without behavioral disturbances. Review of the quarterly Minimum Data Set (MDS) assessment, dated 04/14/21, revealed the resident had intact cognition. She required supervision during eating. Residents Affected - Some Review of the care plan, dated 02/22/13, revealed Resident #21 was at risk for self-care deficit in eating related to CVA hemiparesis, potential for chewing problems, chokes easily, choking episodes, inability to use utensils, lack of fine motor skills, poor oral intake, risk of aspiration, spills food/liquid during self-feeding, weakness. Interventions included to provide plate guard to patient to maximize independence with self-feeding, small utensils at all meals to decrease bite size, and ensure resident had all adaptive equipment. Review of the physician orders, dated 10/2021, revealed an order for a plate guard at meal to maximize independence and small utensils at meals. Review of the meal ticket, dated 10/06/21, revealed all three meals resident was to receive pureed diet, small utensils, and a plate guard. Observation and interview on 10/06/21 at 11:45 A.M. with State Tested Nursing Aide (STNA) #322 verified Resident #21's meal was served in a Styrofoam container with no plate guard and had regular silverware to use. 4). Review of the medical record for Resident #10 revealed an admission date of 03/16/18. Diagnoses included Type II Diabetes Mellitus, oropharyngeal dysphagia, and chronic fatigue. Review of the quarterly MDS assessment, dated 07/01/21, revealed the resident had intact cognition. The resident required supervision and setup assistance for eating. Review of the care plan, dated 08/06/18, revealed Resident #10 had a self-care deficit in eating related to cognitive deficits, risk for aspiration, and swallowing problems. Interventions included to provide small utensils at meals to decrease bite size and ensure resident had all adaptive equipment. Review of a physician's order, dated 03/30/21, revealed the resident was to receive small utensils at meals to decrease bite size. Review of the meal ticket, dated 10/06/21, revealed the resident was to receive small utensils. Observation on 10/06/21 at 5:00 P.M. revealed Resident #10 was seated in her wheelchair at the bedside table in her room. The resident was eating the dinner tray on the bedside table in front of her. The resident was not observed to have small utensils and, instead, had plastic utensils. Interview on 10/06/21 at 5:05 P.M. with Culinary Aide (CA) #374 stated she had not provided any residents with small utensils during the dinner meal. CA #374 obtained the small utensils and showed the surveyor. The small utensils were observed to be metal and significantly smaller than the plastic silverware provided to Resident #10. Interview on 10/06/21 at 5:10 P.M. with STNA #347 verified Resident #10 did not have small utensils 366313 Page 18 of 20 366313 10/15/2021 Scioto Pointe 740 Canonby Place Columbus, OH 43223

F 0810 on her meal tray. Level of Harm - Minimal harm or potential for actual harm Interview on 10/07/21 at 9:15 A.M. with the Director of Nursing revealed adaptive equipment needs of the resident would be on the meal tickets and would be in place when the meal leaves the kitchen. Residents Affected - Some Review of the facility's policy titled Assistance with Meals revealed adaptive devices (special eating equipment and utensils) will be provided for residents who need or request them. These include devices such as silverware with enlarged/padded handles, plate guards and/or specialized cups. 366313 Page 19 of 20 366313 10/15/2021 Scioto Pointe 740 Canonby Place Columbus, OH 43223

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on record review, staff interview, and policy review, the facility failed to ensure falls were documented in the medical record. This affected one (#73) of three residents reviewed for falls. The facility census was 81. Findings include: Review of Resident #73's medical record revealed an admission date of 04/08/15. Diagnoses included secondary parkinsonism, mood disorder, depressive disorder, dementia without behavioral disturbance, schizophrenia, and psychosis. Review of the comprehensive Minimum Data Set (MDS) assessment, dated 09/03/21, revealed the resident had severely impaired cognition. The resident required extensive assistance of one staff for bed mobility, transfers, and toileting. Review of the facility's incident logs from 04/01/21 through 09/30/21 revealed the resident had falls on 04/30/21, 05/02/21, 05/19/21, 07/09/21, 09/02/21, and 09/27/21. Review of the progress notes, dated 04/29/21 through 09/30/21, revealed there was documentation of falls which occurred on 05/19/21, 09/02/21, and 09/28/21. There was no documentation of the resident's falls occurring on 04/30/21, 05/02/21, and 07/09/21. Interview on 10/06/21 at 3:45 P.M. with the Assistant Director of Nursing (ADON) #366 stated all falls should be documented in the electronic medical record and verified Resident #73's chart lacked documentation of falls which occurred on 04/30/21 and 05/02/21. Interview on 10/06/21 at 4:47 P.M. with the Director of Nursing (DON) verified Resident #73's chart lacked documentation of the fall which occurred on 07/09/21. Review of the facility's undated policy titled Falls-Clinical Protocol revealed staff will document falls that occur while the individual is in the facility. 366313 Page 20 of 20