Health inspection·October 18, 2022

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to develop a comprehensive care plan to reflect the resident's risk for Urinary Tract Infections (UTIs). This affected one (Resident #18) of three residents reviewed for comprehensive care plans. The facility census was 57. Findings include: Review of the medical record for Resident #18 revealed she was admitted to the facility on [DATE]. Diagnoses included heart failure, type II diabetes, morbid obesity, paroxysmal atrial fibrillation, acute respiratory failure, specified disorders of kidney and ureter, depression, anxiety, and rheumatoid arthritis. Review of the Minimal Data Set (MDS) assessment dated [DATE] revealed Resident #18 was cognitively intact. Resident #18 required extensive two person assist for all activities of daily living. The MDS also revealed Resident #18 was frequently incontinent of urine and bowel. Review of the hospital discharge documents dated 07/19/22 revealed Resident #18 was admitted to the hospital for sepsis due to a UTI, with acute sepsis-related organ dysfunction, acute hypoxic, and respiratory failure. Review of Resident #18's care plan dated 07/22/22 revealed the facility failed to address the resident's risk for UTIs. There were no goals or interventions in place to potentially prevent UTIs. Interview on 10/12/22 at 1:00 P.M. with the Director of Nursing (DON) verified the facility failed to address the Resident #18's history of urinary tract infections or urosepsis in the resident's care plan. Page 1 of 3 366368 366368 10/18/2022 Otterbein Springboro 9320 Avalon Circle Centerville, OH 45458

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, staff interview, and review of facility policy, the facility failed to ensure foods were stored properly to potentially prevent spoilage. This had the potential to affect 24 (Residents #19, #5, #46, #32, #11, #16, #48, #30, #54, #50, #25, #38, #40, #23, #37, #6, #49, #33, #12, #47, #21, #9, #35, and #155) who resided in House #49 and House #35. The facility's census was 57. Findings include: Observation on 10/11/22 at 10:32 A.M. in House #49's kitchen revealed following sanitation violations: 1. Open container of juice was unlabeled 2. Pitcher of dark liquid was unlabeled and undated 3. Opened package of cream cheese with no date 4. Container of bacon and turkey with no open date Interview on 10/11/22 at 10:32 A.M. with State Tested Nurse Aide (STNA) #14 working in House #49, verified food should be labeled and dated. Observation on 10/11/22 at 10:45 A.M. in House #35's kitchen revealed following sanitation violations: 1. Opened bologna package undated 2. Container applesauce undated 3. Opened juice bottle not dated Interview on 10/1122 at 10:45 A.M. with State Tested Nurse Aide, (STNA) #85 working in House #35, verified foods should be labeled and dated. 366368 Page 2 of 3 366368 10/18/2022 Otterbein Springboro 9320 Avalon Circle Centerville, OH 45458

F 0812 Level of Harm - Minimal harm or potential for actual harm Review of facility policies, Food Labeling and Dating, dated 06/01/08 and Food Storage Best Practice, dated August 2022 revealed once food is removed, the bulk foods may be stored in approved container, identified by name and dated. Once opened, foods should be marked open and dated. Residents Affected - Many 366368 Page 3 of 3