Health inspection·July 7, 2023

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, resident interview, and staff interview, the facility failed to ensure residents were provided assistance with showers or bathing as scheduled. This affected two (#7 and #25) of three residents reviewed for bathing assistance. The facility census was 54. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #7 revealed an admission date of 05/29/20. Diagnoses included hypertension, heart disease, dementia, lymphedema and polyneuropathy. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #7 was cognitively impaired and required the physical assistance of one for bathing/showering. Review of the care plan dated 06/01/23 for Resident #7 revealed an activities of daily living self-care deficit with interventions that included assistance as needed and one assist for bathing/showering. Review of Resident #7's activity of daily living documentation noted the resident to be scheduled for shows each Monday and Thursday on first shift. According to the shower documentation from 06/08/23 to 07/06/23 Resident #7 was assisted with a shower on 06/08/23 and 06/26/23. There was no evidence of any other showers/bathing being provided. 2. Review of the medical record for Resident #25 revealed an admission date of 06/22/23. Diagnoses included type 2 diabetes mellitus, major depressive disorder, hypertension, hemiplegia, and hemiparesis status post cerebral infarction. Review of the comprehensive MDS assessment dated [DATE] revealed Resident #25 was cognitively intact and required the physical assistance of two staff for bed mobility, transfers, toilet use and personal hygiene, including two-person physical assist in part of bathing. Review of the bathing schedule for Resident #25, showers per the resident preference were scheduled each Tuesday and Saturday in the evening. Review of the activities of daily living for bathing from 06/22/23 to 07/07/23 the activity itself had not occurred. There was no evidence of the showers/bathing being documented during this time. Interview on 07/07/23 at 2:47 P.M., with Resident #25 verified showers are not occurring and the resident had requested a shower none had been provided. Page 1 of 4 366361 366361 07/07/2023 Otterbein Monclova 5069 Otterbein Way Monclova, OH 43542

F 0677 Level of Harm - Minimal harm or potential for actual harm Interview on 07/07/23 at 4:39 P.M., with the Administrator confirmed no additional documentation was available indicating Resident #7 and Resident #25 received showers/bathing twice weekly as scheduled. This deficiency represents the continued non-compliance from the survey dated 06/01/23 and under Complaint Number OH00143812. Residents Affected - Few 366361 Page 2 of 4 366361 07/07/2023 Otterbein Monclova 5069 Otterbein Way Monclova, OH 43542

F 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm Based on observation, staff interview and review of policy, the facility failed to ensure residents were free from significant medication errors. This affected two (#28 and #7) of two residents observed for medication administration. The facility census was 54. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #28 revealed an admission date of 01/28/22. Diagnoses included congestive heart failure, atrial fibrillation, hypothyroidism, protein calorie malnutrition, kidney disease, and chronic obstructive pulmonary disease. Review of the physician orders for Resident #28 revealed orders written on 12/19/22 for Aspirin 81 milligrams (mg), one tablet by mouth in the morning every Monday, Wednesday and Friday, Levothyroxine Sodium 150 micrograms (mcg), one tablet once daily, Digoxin 125 mcg, one tablet daily by mouth in the morning, Ferrous Sulfate 325 mg, one tablet daily in the morning, Claritin 10 mg, one tablet by mouth in the morning, Toprol extended release 100 mg, one tablet by mouth each morning, multiple vitamin with minerals, one tablet by mouth daily in the morning. Observation on 07/07/23 at 8:05 A.M., of medication administration for Resident #28, completed by Licensed Practical Nurse (LPN) #110 revealed the following medications: Synthroid 150 micrograms (mcg), one tablet, Aspirin 81 milligrams (mg), one tablet, Digoxin 0.125 mg, one tablet, Feosol 325 mg,one tablet, Claritin 10 mg, one tablet, Toprol, extended release 100 mg, one tablet, and Multivitamin, one tablet, were removed the pharmacy pill pack. The medications were removed from the individually sealed package and placed into a medicine cup. A Perservision Ared2 capsule was removed from the packaging and placed in a second and separate medicine cup, LPN #110 stated the capsule cannot be crushed. LPN #110 proceed to pour the medications from the first medicine cup into a plastic sleeve, placed the sleeve into the pill crusher and crushed the pills all together, poured the medications back into the medication cup and added a spoonful of applesauce, stirred the medications in the applesauce, secured a glass of water and the second medication cup and proceeded to the Resident #28's room. LPN #110 knocked on the door, entered, placed the two medication cups and the water on the overbed table, positioned the resident and proceeded to assist feeding the applesauce with the medications to the resident in three separate bites, provided water and then the Perservision capsule. Interview on 07/07/23 at 8:11 A.M., with LPN #110 verified all medications except for the Perservision were crushed together and placed in applesauce and administered to Resident #28 and further verified the pill pack identified the Feosol and Toprol extended release were label do not crush. 2. Review of the medical record for Resident #7 revealed an admission date of 05/29/20. Diagnoses included hypertension, heart disease, dementia, lymphedema, and polyneuropathy. Review of the current physician orders revealed an order written on 08/15/22 for natural balance tears solution 0.1 - 0.3%, instill one drop in both eyes four times a day for dry eyes. Observation on 07/07/23 at 8:24 A.M., of medication administration for Resident #7, completed by LPN #100 revealed one drop of lubricating eye drops 0.3% were placed in each eye of Resident #7, the bottle of lubricating eye drops was labeled for Resident #10. 366361 Page 3 of 4 366361 07/07/2023 Otterbein Monclova 5069 Otterbein Way Monclova, OH 43542

F 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 07/07/23 at 8:26 A.M., with LPN #100 verified the eye drops administered to Resident #7 belonged to another resident. Review of the policy titled, Medication Administration, dated 11/09/21, stated if safe to do so, medications tablets may be crushed. Tablets which can be appropriately crushed may be ground coarsely and mixed with appropriate vehicle so that the resident receives the entire dose ordered. Crushed medications should not be combined and given all at once. Medications are administered on accordance with the written order of the physician. Prior to administration, the medication and the dosage schedule on the medication administration record is compared with the medication label and residents are identified before medication is administered. This deficiency represents the continued non-compliance from the survey dated 06/01/23 and under Complaint Number OH00143812. 366361 Page 4 of 4