Health inspection·April 3, 2023

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 medical record review, observation, staff and resident interview, and policy review, the facility failed to ensure residents received timely incontinence care. This affected two residents (#38 and #73) of four residents reviewed for incontinence care. The facility census was 105. Findings include: 1. Review of the medical record for Resident #38 revealed an admission date of 03/27/23. Diagnoses included type II diabetes, morbid obesity, diastolic heart failure, and hemiparesis/hemiplegia following cerebral infarction affecting left non-dominant side. Review of the Minimum Data Set (MDS) assessment initiated 04/02/23 revealed the resident had moderately impaired cognition. Resident #38's ADL assessment was incomplete. The resident required two-person staff assistance with care but had not been assessed for the extent of care needed. Review of the care plan dated 03/28/23 revealed Resident #38 had bladder incontinence related to impaired mobility, physical limitations, and hemiparesis/hemiplegia. Interventions included disposable briefs, peri-care with each incontinence episode, laboratory studies as ordered, monitor/report signs of urinary tract infection (UTI), and provide protective barrier after incontinent episodes. Review of the task documentation dated 04/02/23 revealed Resident #38 received total one-staff assistance with toilet use and bowel and bladder elimination twice for the entire day, once at 12:30 A.M. and once at 10:13 A.M. There was no documentation for evening or night shift assistance with toilet use or bowel/bladder elimination on 04/02/23. 2. Review of the medical record for Resident #73 revealed an admission date of 02/21/20. Diagnoses included stage II chronic kidney disease, anxiety disorder, flaccid neuropathic bladder, and chronic pain syndrome. Review of the Minimum Data Set (MDS) annual assessment dated [DATE] revealed the resident had moderately impaired cognition, had no behaviors, did not reject care, and did not wander. Resident #73 required one to two person physical assistance, extensive assistance for bed mobility, transfers, dressing, and toilet use, limited assistance with personal hygiene, supervision with eating, and locomotion had not occurred. Resident #73 had an indwelling catheter, was occasionally incontinent of bowel, and was not on a toileting program. Review of the care plan revealed Resident #73 had bowel incontinence related to immobility and Page 1 of 3 366320 366320 04/03/2023 Shawneespring Health Care Center 10111 Simonson Road Harrison, OH 45030

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few impaired cognition. Interventions included evaluate for complaints of abdominal distention/discomfort, assist to bathroom/with bedpan as needed, keep call light within reach, monitor bowel elimination offer privacy with toilet use, and offer peri care after each incontinent episode. Additionally, Resident #73 had a behavior problem related to anxiety and refused to be changed/refused peri care. Interventions included administer medications as ordered, anticipate resident needs, provide opportunities for positive interactions, elicit family input for successful interventions, and encourage participation in self-care. Review of the task documentation dated 04/02/23 revealed Resident #73 received total one staff assistance with toilet use and bowel and bladder elimination twice for the entire day, once at 12:40 A.M. and once at 10:08 A.M. There was no documentation for evening or night shift assistance with toilet use or bowel/bladder elimination on 04/02/23. During an observation and interview on 04/03/23 at 9:44 A.M. Nurse Aide Trainee (NAT) #136 entered Resident #38's room and answered the call light. At 9:46 A.M. after NAT #136 left the room, Resident #38 stated he had just told NAT #136 that he needed to be changed, and she said she would let his aide know. Observation from 9:46 A.M. to 10:35 A.M. revealed no staff returned to Resident #38's room. At 10:35 A.M. State Tested Nurse Aide (STNA) #200 entered Resident #38's room and asked if the resident wanted to get up. Resident #38 told STNA #200 that he had not been changed all night and he just wanted to be changed and left in bed. STNA #200 provided incontinence care with no concerns noted. During an interview on 04/02/23 at 10:35 A.M. and 10:48 A.M. STNA #200 stated she arrived late to work around 8:00 A.M. and verified 9:46 A.M. was the first time she had seen or offered care to Resident #38 that day. STNA #200 verified incontinence rounds were to be completed every two hours at minimum. Observation and interview on 04/03/23 from 10:54 A.M. to 11:15 A.M. STNA #200 entered Resident #73's room and told her she would get her up for therapy and STNA #200 left the room. Resident #73 was laying in bed wearing a shirt, had a blanket covering her lower extremities, and had bowel movement (BM) smeared on her fitted sheet by her right hip. There was an odor of BM in the room. At 10:58 A.M. STNA #200 entered the room with a stack of linens and began incontinence care. STNA #200 washed hands and changed gloves multiple times and pressed the call light and asked staff to bring additional washcloths to clean the BM that, once the blanket was removed from the resident's legs, was observed leaking out of the sides of the resident's brief. NAT #111 and STNA #103 stayed to assist STNA #200 to clean the resident and changed the sheets on the bed. STNA #200 verified 10:58 A.M. was the first round she had completed for Resident #73 since she had arrived at work. During interviews on 04/03/23 from 1:05 P.M. to 1:41 P.M., Licensed Practical Nurse (LPN) #190, and NAT's #136 and #155 each stated they had not performed incontinence care on any resident on the hall where Resident #38 and #73 lived. STNA #129 stated she was able to dress Resident #31 before breakfast on 04/03/23 but had not checked or changed any other resident on the hall. Staff stated incontinence care rounds should be completed every two hours at minimum and as needed. Review of the policy titled Peri Care revised 06/2021 revealed peri care was performed after each occurrence for bowel and/or bladder incontinence to prevent urinary tract infections and staff reported unusual findings to the nurse. 366320 Page 2 of 3 366320 04/03/2023 Shawneespring Health Care Center 10111 Simonson Road Harrison, OH 45030

F 0690 This deficiency represents non-compliance investigated under Complaint Number OH00141095. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 366320 Page 3 of 3