Health inspection·September 13, 2018

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** 2. Resident #352 was admitted to the facility on [DATE] with diagnosis including cerebral vascular disease, depression, anemia, cognitive communication deficit, chronic kidney disease, anxiety, coronary artery disease, dementia. Review of the most current MDS assessment dated [DATE] identified the resident with moderately impaired cognition, dependent on staff for the completion of ADL and rejection of care. Review of a nursing plan of care dated 11/13/17 revealed the residents need for assistance with ADL's. Interventions included to allow the resident time to complete task as able, monitor the need for clothing or personal care items and assist with purchasing, two staff assist with all care. Additionally on 11/21/17 a plan of care was developed due to the resident's behavior of resistance to care. Interventions included explain procedures prior to beginning, use two care givers with care, when episodes of refusing care are noted approach with calm manner, explain all care, attempt to address any concerns related to care, notify social worker or Registered Nurse for follow up. Surveyor observations on 09/10/18 at 11:10 A.M., 1:00 P.M., 2:20 P.M. and on 09/11/18 at 11:08 A.M., 1:09 P.M. and 2:55 P.M. noted the resident was in bed wearing a hospital house gown. The resident had a wardrobe closet with approximately five shirts and one pair of pants. On 09/11/18 at 2:58 P.M., interview with State Tested Nurse Aide (STNA) #101 revealed no attempts were made to get the resident dressed due to behavioral concerns and resistance to care. STNA #101 also noted the resident lacked adequate clothing. On 09/11/18 at 3:01 P.M., interview with Licensed Practical Nurse (LPN) #200 confirmed the resident was resistive to care and was not dressed or out of bed on 09/10/18 or 09/11/18. Review of the medical record for 09/10/18 and 09/11/18 revealed no documentation indicating the resident was resistive to care on those dates. Based on medial record review, observation, and review of facility policy the facility failed to ensure residents with indwelling catheters had their catheters managed in a dignified manner. This affected one Resident (#147) of four reviewed for activity of daily living (ADL) care. The facility identified 41 residents as having indwelling catheters. In addition, the facility failed to ensure dependent residents were dressed on a daily basis. This affected one Resident (#352) of four reviewed for ADL care. The facility identified 24 residents as being dependent for dressing. The facility census was 392. Findings Include: (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 5 Event ID: 366325 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 366325 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ohio Veterans Home 3416 Columbus Ave Sandusky, OH 44870 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)