Health inspection·May 13, 2022

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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, resident interview, staff interview, and medical record review the facility failed to identify and monitor a resident's skin with regards to bruising and a discolored area. This affected one (Resident #04) of four sampled residents reviewed for skin conditions non-pressure. The facility census was 32. Residents Affected - Few Findings include: Review of Resident #04's medical record revealed she was admitted on [DATE] with diagnoses that included: Parkinson's disease, type II diabetes with polyneuropathy, hypertension, hyperlipidemia, bipolar disease, anxiety, psychosis, restless legs, and overactive bladder. Review of Resident #04's quarterly Minimum Data Set (MDS) dated [DATE] revealed the following. Resident #04 had minimal difficulty hearing, had a hearing aid, her speech was clear, she made herself understood, understands others, and her cognition was intact. Resident #04 had minimal depression, had no indicators of psychosis, had no behaviors, and did not reject care. Resident #04 required extensive assistance of two staff for bed mobility, to transfer, and to walk. Resident #04 had no skin conditions. Review of Resident #04's physician orders revealed she received two blood thinning medications (Aspirin 81 milligrams (mg) daily and Xarelto 10 mg daily). Review of Resident #04's skin assessment dated [DATE] revealed a new skin tear on Resident #04's right leg that measured 0.7 centimeter (cm) by 0.7 cm. Review of Resident #04's progress notes from 05/01/22 to 05/12/22 revealed no bruises or other skin abnormalities. Observation of Resident #04 on 05/09/22 at 10:14 A.M. revealed a scabbed area on her right leg, a dark circular area on her left leg, and a bruise on her left forearm. The areas were observed on 05/10/22 at 1:54 P.M., 05/11/22 at 8:49 A.M., and 05/12/22 at 10:11 A.M. Interview of Resident #04 on 05/09/22 at 10:14 A.M. revealed the bruise on her left arm happened a few days earlier when she was hugged by staff. The bruise was an accident. Interview of Resident #04 on 05/12/22 at 2:26 P.M. revealed she had a scabbed area on inner left calf, outer right calf, and a bruise on left forearm. Interview of Registered Nurse (RN) #141 on 05/13/22 at 7:46 A.M. confirmed she was not aware of the bruise or the area on Resident #04's left leg. RN #141 stated she was not sure what the area was on Page 1 of 3 366338 366338 05/13/2022 National Church Residences Chillicothe 142 University Drive Chillicothe, OH 45601

F 0684 Resident #04's left leg, but the doctor would be in today and would look at it. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 366338 Page 2 of 3 366338 05/13/2022 National Church Residences Chillicothe 142 University Drive Chillicothe, OH 45601

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 resident interview, staff interview, and medical record review the facility failed to provide treatment and services to a resident who had a decline in both urinary and bowel continence. This affected one resident (Resident #14) of two sampled residents reviewed for bowel and bladder incontinence. The facility census was 32. Findings include: Review of Resident #14's medical record revealed she was admitted on [DATE] with diagnoses that included: emphysema, atherosclerotic heart disease, type II diabetes with polyneuropathy, morbid obesity, hyperlipidemia, chronic respiratory failure, gastro-esophageal reflux, age related osteoporosis, and diverticulosis. Review of Resident #14's annual Minimum Data Set (MDS) dated [DATE] revealed the following. Resident # 14's speech was clear, she had herself understood, understands others, and her cognition was intact. Resident #14 had minimum depression, had no indicators of psychosis, had no behaviors, and did not reject care. Resident #14 required extensive assistance of two staff for bed mobility, to transfer, and did not walk. Resident #14 had no toileting program, was frequently incontinent of urine and was always continent of bowel. Review of Resident #14's quarterly MDS dated [DATE] revealed the following changes Resident #14 had mild depression, was dependent on two staff to transfer, was always incontinent of urine and frequently incontinent of bowel. There was no comprehensive assessment conducted when Resident #14's bladder incontinence worsened, and her bowel continence declined. Resident 14's monthly bladder and bowel assessment did not identify the decline in her continence or the potential cause of the decline. Resident #14's medical record contained no evidence of measures to restore, to the extent possible, her bowel and bladder continence. Interview of State Tested Nursing Assistant (STNA) #100 on 05/11/22 at 1:39 P.M. revealed Resident #14 was continent of bowel and sometimes she was incontinent of bladder. Resident #100 used to ask for bed pan, then she just stopped and use her adult incontinence product. STNA #100 stated there was no reason she was aware of why Resident #14 stopped asking for it. STNA #100 stated the only in Resident #14's life was her mother passed but nothing else. Interview of Registered Nurse (RN) #118 on 05/11/22 at 2:12 P.M. confirmed no comprehensive assessment of Resident #14's bowel and bladder continence decline was conducted and no treatment and services were provided to restore as much normal function as possible were provided for Resident #14. Interview of Resident #14 on 05/12/22 at 8:28 A.M. revealed she no longer use the bed pan; she just used the incontinence brief and tells the staff when she was wet. She did not provide and answer as to why she did not ask for the bed pan for a bowel movement. 366338 Page 3 of 3