Health inspection·May 19, 2022

F 0567 Honor the resident's right to manage his or her financial affairs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, review of the resident account information and interviews the facility purchased additional insurance for Resident #61 and Resident #138 without consent from the resident or their legal representative. This affected two residents of five residents reviewed for resident funds. Residents Affected - Few Findings Included: 1. Review of the medical record revealed Resident #61 was admitted to the facility on [DATE]. Diagnoses included chronic obstructive pulmonary disease, convulsions, diabetes, multiple sclerosis, hypertension, crushing injury of the skull, hemiplegia and tremors. Resident #61's sister was listed as his legal representative. Review of the Living Care Facility Resident Application for Insurance form dated 09/05/19 revealed Resident #61 was to pay $127.00 per month for dental coverage, $35.00 a month for vision coverage, $62.00 a month for audiology coverage and $66.00 a month for podiatry coverage, totaling $290.00 a month. The form was signed electronically by Business Office Manager (BOM) #197 with the facility as the legal representative. Review of the quarterly bank statements from 01/08/21 through 03/31/22 revealed Resident #61 had a monthly withdraw of $290.00 for the insurance premium. Review of the annual Minimum Data Set 3.0 assessment dated [DATE] revealed Resident #61 had intact cognition. Interview on 05/17/22 at 8:45 A.M. with Resident #61 indicated the facility was taking an extra $290.00 a month out of his monthly liability for an additional insurance he did not need. Resident #61 indicated he never agreed to have this premium paid from his account. Interview on 05/19/22 at 9:11 A.M. with BOM #197 indicated Resident #61's sister consented to the insurance premium. BOM #197 stated the Citizens Security Life Insurance was a 360 insurance offered by the state and the facility's corporate ownership had agreed to have it for some residents. She indicated it would reduce the amount of the resident's liability by $290.00 a month to pay for the insurance. BOM #197 verified Resident #61 had spoken to her a couple times indicating he did not want this extra insurance coverage and she said Resident #61 had never used any of their services. Review of an email dated 05/19/22 at 2:55 P.M. revealed the Administrator indicated she would investigate issues with the 360 insurance and why staff names were on the consents because the facility does not have anything to do with the consent. The Administrator stated 360 insurance was applying Page 1 of 5 366333 366333 05/19/2022 Scenic Pointe Nursing and Rehab Ctr 8067 Township Road 334 Millersburg, OH 44654

F 0567 the staff names to the consents without talking to the residents and she would address this problem. Level of Harm - Minimal harm or potential for actual harm 2. Record review Resident #138 was admitted to the facility on [DATE]. Diagnoses included chronic obstructive pulmonary disease, diabetes, hypertension, anxiety disorder, major depressive disorder, bipolar disorder, affective mood disorder, paranoid schizophrenia, extrapyramidal and movement disorder, and dementia with behavioral disturbance. Further review of the medical record revealed Resident #138 had a guardian of person. Residents Affected - Few Review of the Living Care Facility Resident Application for Insurance form dated 06/17/19 revealed Resident #138 was to pay $127.00 per month for dental coverage, $35.00 a month for vision coverage, $62.00 a month for audiology coverage and $66.00 a month for podiatry coverage, totaling $290.00 per month. The form as signed by the facility Administrator with the facility as the legal representative. Review of the quarterly statements from 01/08/21 through 03/31/22 revealed Resident #138 had a monthly withdraw of $290.00 for payment of the insurance premium. Review of the quarterly Minimum Data Set 3.0 assessment dated [DATE] revealed Resident #138 was severely cognitively impaired and exhibited disorganized thinking and inattention. Interview on 05/19/22 at 9:11 A.M. with BOM #197 stated the Citizens Security Life Insurance was a 360 insurance offered by the state and the facility's corporate ownership had agreed to have it for some residents. She indicated it would reduce the amount of the resident's liability by $290.00 a month to pay for the insurance. Review of an email dated 05/19/22 at 2:55 P.M. from the Administrator indicated she was going to look into the concern with the 360 insurance and how staff names were on the consents. The Administrator indicated she was not sure how it happened because the facility does not have anything to do with the consents and the 360 insurance was applying the names to the consents without talking to the residents. The Administrator verified it was a problem and it would be addressed. 366333 Page 2 of 5 366333 05/19/2022 Scenic Pointe Nursing and Rehab Ctr 8067 Township Road 334 Millersburg, OH 44654

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review the facility failed to ensure pressure relieving interventions were in place for Resident #143. This affected one of one residents reviewed for pressure ulcers. The facility census was 153. Residents Affected - Few Findings include: Review of Resident #143's medical record revealed and admission date of 06/04/19. Diagnoses included multiple sclerosis, chronic obstructive pulmonary disease, hypertension, osteoarthritis, and a pressure ulcer stage four to his coccyx. Stage four pressure ulcers involve a full-thickness skin and tissue loss with exposed fascia, muscle, tendon, ligaments, cartilage or bone and may have slough or eschar (dead or devitalized) tissue in the wound. Review of May 2022 physician order's for Resident #143 revealed orders for staff to use padded heel suspended boots to both of his feet while in bed and while in his wheelchair, and an order for a chair cushion in place on every shift. Review of Resident #143's care plan 05/02/22 revealed to maintain skin integrity, the facility staff would apply padded heel suspended boots to both feet/calves, and apply a pressure reducing chair cushion as tolerated/needed. Observations on 05/18/22 at 9:07 A.M. and 11:10 A.M. revealed Resident #143 sitting in his Broda chair, a specialized type of wheelchair. Resident #143 was not wearing the padded heel suspended boots. Observation on 05/18/22 at 1:36 P.M. revealed Resident #143 lying in his bed and he was not wearing his padded heel suspended boots. Interview and observation at the time of this observation with Registered Nurse #196 confirmed she was working as a State Tested Nursing Assistant that day and forgot to apply Resident #143's padded heel suspended boots. Observations on 05/19/22 at 8:17 A.M. and 9:32 A.M. of Resident #143 revealed he was sitting in his Broda chair and he was not wearing his padded heel suspended boots, his feet were not elevated, and he did not have a pressure relieving cushion on his chair. Interview and observation of Resident #143 on 05/19/22 at 9:32 A.M. with the Director of Nursing confirmed Resident #143 did not have his padded heel suspended boots in place and he was not sitting on a pressure relieving cushion in his Broda chair. Interview on 05/19/22 at 11:37 A.M. with Registered Nurse #251, the hospice nurse, confirmed Resident #143 should have the additional pressure reducing cushion in his Broda chair and not just the standard cushion on the chair. 366333 Page 3 of 5 366333 05/19/2022 Scenic Pointe Nursing and Rehab Ctr 8067 Township Road 334 Millersburg, OH 44654

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, U.S. Department of Agriculture/U.S. Food and Drug Administration guidelines, and maintenance records the facility failed to ensure kitchen equipment was properly functioning and the facility did not properly store food. This had the potential to affect all 153 residents residing in the facility and consuming food/meals from the kitchen. Findings include: 1. Observation on 05/16/22 at 8:35 A.M. of the facility's kitchen revealed a pan covered with aluminum foil with writing on top of the foil identifying it as pork roast. The writing indicated the pork roast was made 05/11/22 and the use by date was 05/18/22. There was a pan covered with aluminum foil and labeled as country fried steak (poultry) with the date made as 05/11/22 and the use by date as 05/18/22. Interview on 05/16/22 at 8:35 A.M. with Dietary Aide #128 revealed all leftovers, including meats, are kept for seven days before they are discarded. Interview on 05/16/22 at 2:22 P.M. with Dietary Manager #218 revealed all leftovers are kept for seven days except for produce, which is kept for three days before discarding. She confirmed the leftovers can be served to the residents residing in the facility up to the discard date. Review of the U.S. Department of Agriculture/U.S. Food and Drug Administration Cold Storage Chart, dated July 2020, revealed that cooked meat leftovers should be kept for three to four days before discarding. 2. Review of the maintenance log dated 02/01/22 revealed State Tested Nursing Assistant #159 reported the bars needed welded on the food cart in the kitchen and indicated she had cut her arms several times. Observation on 05/16/22 at 8:35 A.M. of the facility's kitchen revealed a bucket collecting water underneath the drain of the three compartment sink, a leaky faucet sprayer, layers of tape holding a temperature knob in place on the warming oven, three other knobs missing from the warming oven, seven handles missing on the kitchen cabinets, and a metal food cart with a missing metal bar. Interview on 05/16/22 at 2:22 P.M. with Dietary Manager #218 confirmed the above finding and stated maintenance and the Administrator have been made aware of the conditions of the warming oven for awhile. She verified it is still in use at this time. Dietary Manager #218 reported maintenance was aware of the other issues as well but has yet to fix them. 366333 Page 4 of 5 366333 05/19/2022 Scenic Pointe Nursing and Rehab Ctr 8067 Township Road 334 Millersburg, OH 44654

F 0921 Level of Harm - Minimal harm or potential for actual harm Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on observations and interview, the facility failed to maintain a sanitary laundry room. This had the potential to affect all 153 residents residing in the facility at the time of survey. Residents Affected - Many Findings included: Observation on 05/17/22 at 10:15 A.M. of the laundry room revealed four fans located on the clean side of the laundry room. The fans were visibly dirty with a heavy build-up of dirt and dust particles. Laundry staff were present in the laundry area folding residents' clothes and facility bed linens for all residents. Interview immediately after this observation with Laundry Staff #16 and Laundry Staff #101 verified the four fans on in the clean area of the laundry were covered in dirt/dust and needed cleaned. 366333 Page 5 of 5