Health inspection·March 28, 2024

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of staffing timecards, interviews, and the facility submitted Payroll Based Journal (PBJ) tracking information, the facility failed to ensure there were sufficient staff on the weekends. This had the potential to affect all 131 residents residing in the facility. Findings include: Review of the facility staffing schedule, timecards, and completion of the staffing tool for several weekends on 03/27/24 from 9:00 A.M. through 11:00 A.M. with Administrator and Director of Nursing (DON) revealed that the facility did not meet the required minimum direct care daily average of 2.50 hours on the following dates: • The staffing tool noted 2.25 hours of direct resident care hours on 04/08/23. • The staffing tool noted 1.75 hours of direct resident care hours on 04/09/23. • The staffing tool noted 1.85 hours of direct resident care hours on 05/27/23. • The staffing tool noted 2.28 hours of direct resident care hours on 05/28/23. • The staffing tool noted 2.36 hours of direct resident care hours on 06/17/23. • The staffing tool noted 2.29 hours of direct resident care hours on 06/18/23. • Page 1 of 6 366333 366333 03/28/2024 Scenic Pointe Nursing and Rehab Ctr 8067 Township Road 334 Millersburg, OH 44654

F 0725 The staffing tool noted 2.45 hours of direct resident care hours on 02/17/24. Level of Harm - Minimal harm or potential for actual harm • The staffing tool noted 2.45 hours of direct resident care hours on 03/09/24. Residents Affected - Many • The staffing tool noted 2.40 hours of direct resident care hours on 03/10/24. Interview on 03/27/24 at 1:35 PM with Scheduler #368 revealed that she schedules enough staff, it's the call offs that occur. She stated the facility offers several incentives to maintain staff. Interview on 03/27/24 at 3:00 P.M. with Administrator and DON revealed the incentives that the facility put into place and the quality assurance project to obtain new staff. The administrator stated that due to the cliental, some newly hired staff are not comfortable with psych residents and quit shortly after hire. Scenic Pointe administration was made aware of low staffing measured for weekend for the third quarter of the fiscal year of 2023 per the PBJ staffing data report. In response to receipt of this data, Scenic has implemented additional staff recruitment techniques to assist in improving staff numbers. DON stated that pick up bonuses for weekends, nights, and days. Other incentives included wage increases, flexible scheduling to accommodate both eight- and twelve-hour shifts, as well as paid time off (PTO) accrual after 90 days of employment. For people that want to become state tested nursing assistants (STNA), the course is given at the facility and the potential STNAs are paid during the training and are hired upon graduation. Administrator stated that the new incentives that were introduced since the third quarter PBJ was weekend [NAME] pay, tuition reimbursement and differential for a seven-day schedule, sign on and referral bonuses, and do local job fairs at the local schools about working at the behavioral health facility. The Administrator stated that did experience a COVID outbreak during 02/17/24 through 03/15/24 where we had 26 positive COVID staff members, mostly direct care staff. The Administrator stated that there has been an improvement in staffing since the added incentives were implemented. Review of the PBJ Staffing Data Report form submitted from 04/01/23 to 06/30/23 for the third quarter, revealed the facility submitted weekend staffing data is excessively low. 366333 Page 2 of 6 366333 03/28/2024 Scenic Pointe Nursing and Rehab Ctr 8067 Township Road 334 Millersburg, OH 44654

F 0802 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. Based on observation, interview, and review of staffing schedules the facility failed to ensure they had sufficient dietary staff to maintain a clean dining room and kitchen. This had the potential to affect all residents who consumed food from the kitchen. The facility indicated all residents consumed food from the kitchen. The facility census was 131. Findings include: Observation of the kitchen on 03/25/24 at 8:40 A.M. and on 03/27/24 from 9:40 A.M. to 10:00 A.M. revealed the kitchen floor had an overall muddy appearance, as if wet dirt had been pushed around. This appearance worsened the closer it got to the dish room. Additional observation revealed the floor underneath equipment and tables had a thicker buildup of dirt and food splatter. The corners and edges of the room had a buildup of dirt extending from the baseboard. Additionally, the floor under equipment and tables had several pieces of food, lids, and condiment containers. Interview on 03/27/24 between 9:40 A.M. and 10:00 A.M. with Head [NAME] #389 verified the observation. She reported they deep cleaned the floor and under the equipment once a month; however, they had been short staffed, so it was difficult to keep up with the cleaning. Observation of the kitchen on 03/25/24 at 8:40 A.M. and on 03/27/24 between 9:40 A.M. and 11:35 A.M. revealed the kitchen ceiling was covered in food splatters in almost all areas of the kitchen. In addition to what was suspected to be food splatters there were numerous unidentifiable stains. Interview on 03/27/24 at 11:35 A.M. with Dietary Manager #511 verified the stains on the ceiling. She reported she thought she had put in a maintenance request at some point to get it addressed. Interview on 03/27/24 at 2:59 P.M. with the Administrator revealed she thought it would be maintenance's responsibility to clean the ceiling. Observation on 03/27/24 at 7:20 A.M. of the main dining room revealed the floor was littered with debris including paper tickets, lids to cups, and paper from straws. Interview on 03/27/24 at 7:20 A.M. with Head [NAME] #389 verified the observation. She reported the dietary staff were supposed to clean the dining room after dinner the previous night; however, they had been short staffed and likely did not get the chance to complete it. She reported they only had two dietary aides the previous night which was insufficient to complete their jobs. Observation on 03/27/24 from 9:40 A.M. to 10:00 A.M. revealed a knife organizer attached to the wall. This organizer was clear, observation revealed the organizer was filled with food debris. Observation of the top of the container revealed slots for knives to slide into, at that time the container had one knife and a knife sharpener. The top of the container was covered in dust and food debris. Interview on 03/27/24 from 9:40 A.M. to 10:00 A.M. with Dietary Manager #511 verified the observation and indicated she would ensure it got cleaned. Observation on 03/27/24 at 11:10 A.M. revealed the lids for the six-quart steam table pans were in a large steel container. The container was filled with food crumbs and splatters. 366333 Page 3 of 6 366333 03/28/2024 Scenic Pointe Nursing and Rehab Ctr 8067 Township Road 334 Millersburg, OH 44654

F 0802 Interview on 03/27/24 at 11:35 A.M. with Head [NAME] #389 verified the observation. Level of Harm - Minimal harm or potential for actual harm Interview on 03/27/24 at 12:30 P.M. with Dietitian #349 revealed they were having problems keeping staff in the kitchen. Residents Affected - Many Interview on 03/27/24 at 12:49 P.M. with Dietary Manager #511 verified they had problems keeping staff in the kitchen and it was difficult for them to complete their cleaning tasks with the current staffing levels. Review of the kitchen staffing schedule from 03/17/24 to 03/26/24 revealed there were two second shift dietary aides scheduled on 03/17/24, 03/19/24, 03/20/24, 03/21/24, 03/22/24, 03/23/24, 03/24/24, 03/25/24, and 03/26/24. On 03/18/24 they only had one dietary aide. 366333 Page 4 of 6 366333 03/28/2024 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, and review of cleaning schedules, the facility failed to ensure resident dining areas and the kitchen were maintained in a sanitary manner. Additionally, the facility failed to ensure 26 residents (#6, #10, #13, #14, #17, #33, #35, #41, #42, #45, #47, #51, #52, #71, #84, #88, #93, #95, #97, #102, #105, #120, #122, #123, #125, and #131) in the 300 and 400 hall dining rooms were served food in a sanitary manner. This had the potential to affect all residents who consumed food from the kitchen. The facility indicated all residents consumed food from the kitchen. The facility census was 131. Findings include: 1. Observation of the kitchen on 03/25/24 at 8:40 A.M. and on 03/27/24 from 9:40 A.M. to 10:00 A.M. revealed the kitchen floor had an overall muddy appearance, as if wet dirt had been pushed around. This appearance worsened the closer it got to the dish room. Additional observation revealed the floor underneath equipment and tables had a thicker buildup of dirt and food splatter. The corners and edges of the room had a buildup of dirt extending from the baseboard. Additionally, the floor under equipment and tables had several pieces of food, lids, and condiment containers. Interview on 03/27/24 between 9:40 A.M. and 10:00 A.M. with Head [NAME] #389 verified the observation. She reported they deep cleaned the floor and under the equipment once a month; however, they had been short staffed, so it was difficult to keep up with the cleaning. Observation of the kitchen on 03/25/24 at 8:40 A.M. and on 03/27/24 between 9:40 A.M. and 11:35 A.M. revealed the kitchen ceiling was covered in food splatters in almost all areas of the kitchen. In addition to what was suspected to be food splatters there were numerous unidentifiable stains. Interview on 03/27/24 at 11:35 A.M. with Dietary Manager #511 verified the stains on the ceiling. She reported she thought she had put in a maintenance request at some point to get it addressed. Interview on 03/27/24 at 2:59 P.M. with the Administrator revealed she thought it would be maintenances responsibility to clean the ceiling. Review of the maintenance requests from 01/01/24 to 03/25/24 revealed no requests related to the kitchen ceiling. Observation on 03/27/24 from 9:40 A.M. to 10:00 A.M. revealed a knife organizer attached to the wall. This organizer was clear, observation revealed the organizer was filled with food debris. Observation of the top of the container revealed slots for knives to slide into, at that time the container had one knife and a knife sharpener. The top of the container was covered in dust and food debris. Interview on 03/27/24 from 9:40 A.M. to 10:00 A.M. with Dietary Manager #511 verified the observation and indicated she would ensure it got cleaned. Observation on 03/27/24 at 11:10 A.M. revealed the lids for the six-quart steam table pans were in a large steel container. The container was filled with food crumbs and splatters. Interview on 03/27/24 at 11:35 A.M. with Head [NAME] #389 verified the observation. 366333 Page 5 of 6 366333 03/28/2024 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 2. Observation on 03/25/24 from 11:45 A.M. to 12:05 P.M. of the 300 and 400 hall dining room revealed staff including State Tested Nursing Aide (STNA) #338 and STNA #500, were observed serving residents their lunch trays. Staff were not sanitizing their hands between delivering trays to residents. Interview on 03/25/24 at 11:57 A.M. with STNA #338 and STNA #500 verified this observation, they reported there was no hand sanitizer in the dining room. The facility identified 26 residents in the 300 and 400 hall dining room, these included residents' #6, #10, #13, #14, #17, #33, #35, #41, #42, #45, #47, #51, #52, #71, #84, #88, #93, #95, #97, #102, #105, #120, #122, #123, #125, and #131. 3. Observation on 03/27/24 at 7:20 A.M. of the main dining room revealed the floor was littered with debris including paper tickets, lids to cups, and paper from straws. Interview on 03/27/24 at 7:20 A.M. with Head [NAME] #389 verified the observation. She reported the dietary staff were supposed to clean the dining room after dinner the previous night; however, they had been short staffed and likely did not get the chance to complete it. The facility reported they had no policies related to kitchen sanitation. 366333 Page 6 of 6