Health inspection·November 15, 2019

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and resident and staff interviews, the facility failed to provide a bed that accommodated the height for one (#43) of 19 residents and failed to accommodate fried egg preferences for four (#43,#37, #35 and #20) of 19 residents reviewed for accommodation of needs. The total facility census was 67. Residents Affected - Some Findings include: 1. Review of Resident #43's medical record revealed the resident was admitted to the facility on [DATE], transferred to a local hospital on [DATE], and returned to the facility on [DATE], in a room closer to the nurse's station as a fall precaution. Diagnoses included repeated falls, morbid obesity, congestive heart failure, and myocardial infarction. Resident #43's Minimum Data Set (MDS) assessment dated [DATE], revealed Resident #43 was cognitively intact and required extensive assistance from staff for activities of daily living. Interview and observation on 10/29/19 at 11:18 A.M. with Resident #43, revealed his mid calves and feet were hanging off the bed. Resident #43 stated he had talked to staff a few days after he had returned to the facility from the hospital about getting an extender for his bed, but no one had followed up. Resident #43 stated he was six foot, three and a half inches. During an interview on 10/29/19 at 11:22 A.M., Interim Social Service Designee (ISSD) #1 revealed prior to Resident #43's hospital transfer, he had been in a different room with a longer bed. She stated she was not sure why Resident #43 did not have the same sized bed as when he was here prior. ISSD #1 stated the facility would provide him the bed extender by the end of 10/29/19. 2. Observations during the kitchen tour on 10/28/19 starting at 8:20 A.M., revealed the facility had no shell pasteurized eggs available if any resident requested a fried egg. Interview on 10/28/19 at 8:25 A.M. with Dietary Coordinator (DC) #379, verified there were no shell pasteurized eggs available at any time for any resident if they requested a fried egg. DC #379 stated the residents were told they had to stick to the available menu egg alternatives such as an omelet or hard boiled egg. Interview on 10/28/19 at 8:55 A.M. with [NAME] #358, revealed if a resident requested a fried egg we apologized and explained that fried eggs were not available and offered an omelet or hard boiled egg instead. Interview with Resident #43 on 10/28/19 at 9:42 A.M., revealed she preferred fried eggs over the omelet or scrambled eggs but indicated the staff would not serve fried eggs as an option. Page 1 of 11 366374 366374 11/15/2019 Trueman Pointe Care Center 4660 Trueman Blvd Hilliard, OH 43026

F 0558 Level of Harm - Minimal harm or potential for actual harm Interview with Resident #37 on 10/28/19 at 12:00 P.M., revealed the staff do not offer fried eggs as an option. The resident preferred fried eggs which were not offered. Interview with Resident #35 on 10/28/19 at 12:49 P.M., revealed she would like a fried egg over easy at times but it was not a choice. Residents Affected - Some Interview with Resident #20 on 10/28/19 at 01:08 P.M., revealed she would love a fried egg over easy sandwich but the staff stated no, that was not a choice. 366374 Page 2 of 11 366374 11/15/2019 Trueman Pointe Care Center 4660 Trueman Blvd Hilliard, OH 43026

F 0645 PASARR screening for Mental disorders or Intellectual Disabilities Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, and review of facility policy, the facility failed to complete a pre-admission screening resident review (PASRR) for one resident who had a diagnosis of mild cognitive impairment. This affected one (#45) of four residents reviewed for PAS/RR's. The facility identified three residents as having diagnoses of mental retardation. The total facility census was 67. Residents Affected - Few Findings include: Review of Resident #45's record revealed she was admitted to the facility on [DATE]. Diagnoses included mild cognitive impairment, epilepsy, adjustment disorder with mixed anxiety and depressed mood. Resident #45's 7000 Form (a hospital exemption form allowing the resident to admit to the facility for 30 days before a full PASRR was required), was dated [DATE], and expired [DATE]. After surveyor intervention, the facility provided a PASRR dated [DATE], with the appropriate diagnoses listed. Resident #45 did not require level two PASRR services. Interview on [DATE] with Corporate Registered Nurse #411, confirmed Resident #45's PASRR had not been completed within 30 days from the hospital exemption. She confirmed the PASRR was completed by the facility on [DATE], 11 days after the exemption expired and Resident #45's diagnoses could have triggered for a level two screening. Review of a facility policy titled, Pre-admission Screening and Resident Review (PASRR)-Ohio, revised [DATE], revealed the facility would ensure the PAS/RR process was maintained for all residents to ensure individuals were evaluated for a serious mental disorder and/or intellectual disability and that those identified individuals were offered the most appropriate setting. The policy further revealed prior to resident admission, the admission coordinator would ensure either the hospital exemption form or PASRR was completed. The policy revealed the facility would complete the PASRR if a resident admitted with a hospital exemption form and had not been discharged by day 29 of the stay. The PASRR would be completed by day 29 of the resident's stay. 366374 Page 3 of 11 366374 11/15/2019 Trueman Pointe Care Center 4660 Trueman Blvd Hilliard, OH 43026

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 record review and staff interviews, the facility failed to implement a restorative care/range of motion (ROM) care plan for one resident. This affected one (#26) of one resident reviewed for position and mobility. The total facility census was 67. Findings include: Review of the record for Resident #26 revealed an admission date of 06/06/19. Diagnoses included malignant neoplasm of the esophagus, adult failure to thrive, spinal stenosis, osteoarthritis, anxiety disorder, idiopathic neuropathy and chronic pain. Review of Resident #26's quarterly Minimum Data Set (MDS) assessment dated [DATE], revealed the resident had no cognitive impairment, required supervision for walking and transfers and had not participated in any restorative programs. Review of the form titled, Observation Detail List Report under Restorative Nursing - Functional Limitation of Range of Motion for Resident #26, dated 08/12/19, revealed limited ROM to both arms including the shoulder or elbow with partial voluntary movement loss; and limited ROM to the left leg including the hip or knee with partial loss of voluntary movement. The ROM summary documented the limitations would have potential safety risks and to see the resident's care plan. Review of the Restorative Nursing - Restorative program initial observation dated 09/23/19, revealed Assistant Director of Nursing (ADON) Registered Nurse (RN) #394, documented a decline in ROM to Resident #26's upper and lower extremities and referred the resident for a Restorative program. Review of the plan of care dated 09/23/19 for Resident #26, revealed the resident was care planned for a restorative active ROM program due to weakness and a decline in ROM. Interventions included a start date of 09/23/19, and indicated the duration of restorative ROM program was to be 15 minutes per day, with 15 repetitions occurring four to seven days per week. Interview on 10/30/19 at 8:54 A.M. with State Tested Nurse's Assistant (STNA) #412, confirmed she had Resident #26 in her assignment. The STNA also stated the resident did not receive any restorative care. Interview on 10/30/19 at 8:58 A.M. with Regional RN #411, confirmed the facility did not have dedicated STNA's for the restorative program, but each STNA could perform restorative ROM for the residents. Interview on 10/30/19 at 9:01 A.M. with STNA #412, confirmed she had not performed ROM for Resident #26. Interview on 10/30/19 at 9:17 A.M. with ADON #394 and the Director of Nursing (DON), confirmed restorative care would be in the resident's profile, which was accessible to the STNA's to guide care. ADON #394 stated restorative care was a nursing order and when ordered, goes onto the resident's care plan and was initiated. 366374 Page 4 of 11 366374 11/15/2019 Trueman Pointe Care Center 4660 Trueman Blvd Hilliard, OH 43026

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 10/30/19 at 9:30 A.M. with ADON #394, confirmed ROM was care planned but had never been ordered and initiated. Interview with Licensed Practical Nurse (LPN) #314 on 10/30/19 at 2:22 P.M., confirmed if a resident was on the restorative program it would appear in the STNA tasks and they would perform that task and check it off. Review of Resident #26's STNA task for restorative care with LPN #314, revealed the resident had the ROM task listed in her profile and it had been signed off as being administered. Interview on 10/30/19 at 2:48 P.M. with Regional RN #411, confirmed orders for Resident #26's restorative care/ROM had just been put into the residents STNA tasks on 10/30/19. 366374 Page 5 of 11 366374 11/15/2019 Trueman Pointe Care Center 4660 Trueman Blvd Hilliard, OH 43026

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff and family interviews, the facility failed to provide quarterly care conferences for one resident. This affected one (#18) of five residents reviewed for care conferences. The total facility census was 67. Findings include: Review of the record for Resident #18 revealed an admission date of 05/16/19. Diagnoses included dementia, Alzheimer's disease, cognitive communication deficit, chronic atrial fibrillation, Type 2 diabetes mellitus, major depressive disorder, Barrett's esophagus, diaphragmatic hernia, obesity and history of malignant neoplasm. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE], revealed Resident #18 had severe cognitive impairment due to Alzheimer's disease. Review of the nursing progress notes dated 05/16/19 through 10/29/19, revealed a progress note dated 05/21/19, for the initial care conference. No further documentation was noted related to care conferences. Review of the social service progress notes from 05/16/19 through 10/29/19, revealed no documentation of a care conference after the initial care conference was held on 05/21/19. Phone interview with Resident #18's Power of Attorney #900 on 10/28/19 at 4:58 P.M., revealed she had attended an initial care conference for her mother but had no further care conferences since the initial conference. Interview with Social Service Designee (SSD) #408, confirmed no care conferences had been held for Resident #18, other than the admission care conference held on 05/21/19. 366374 Page 6 of 11 366374 11/15/2019 Trueman Pointe Care Center 4660 Trueman Blvd Hilliard, OH 43026

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 observations and resident, family, and staff interviews, the facility failed to provide timely incontinence care to one dependent resident. This affected one (#215) of 19 residents reviewed for activities of daily living (ADL;s) care. The facility identified 33 residents who required assistance from staff with incontinence care. The total facility census was 67. Residents Affected - Few Findings include: Review of the record for Resident #215 revealed the resident was admitted to the facility on [DATE]. Diagnoses included intracranial injury, traumatic subdural hemorrhage, and flaccid hemiplegia. Resident #215's baseline care plan stated staff were to check on him at least every two hours for needs and safety. Review of a physician order dated 10/23/19, revealed Resident #212 was only oriented to himself and experienced short and long-term memory loss. A physician order dated 10/25/19, revealed Resident #215 was totally dependent on staff for toileting and was incontinent of bowel and bladder. An interview on 10/28/19 at 10:47 A.M. with Resident #215's Power-of-Attorney (POA), revealed on 09/27/19, she had arrived to Resident #215's room around 6:45 A.M. and he had been lying in his feces. POA #215 stated it appeared he had been in that condition for an extended period. Observation on 10/29/19 at 9:15 A.M., revealed Resident #215 in bed with a soiled incontinence product and a putrid odor in the room. The feces were not contained in the incontinence product and had been smeared on Resident #215's inner right thigh. Observation on 10/29/19 at 9:23 A.M. and 9:47 A.M., revealed Resident #215 was in the same condition and the odor continued. Interview on 10/29/19 with State Tested Nursing Assistant (STNA) #343, revealed she had last observed Resident #215 when she arrived on shift at 6:45 A.M. She stated she had checked his vitals and he had not had any signs of incontinence. Interview on 10/29/19 with STNA #415, revealed the last time she had observed Resident #215 had been 7:30 A.M. and he had not had any signs of incontinence. She confirmed Resident #215 required assistance from staff for incontinence care and he was care planned to be checked at least every two hours. During subsequent observation following the interview, STNA #415 confirmed Resident #215 had been incontinent and that fecal matter was not contained in his incontinence product and was smeared on his right inner thigh. 366374 Page 7 of 11 366374 11/15/2019 Trueman Pointe Care Center 4660 Trueman Blvd Hilliard, OH 43026

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 medical record review and staff interview, the facility failed to complete daily weights and notify the physician a weight gain for two residents (#43 and #49) of two reveiwed for weight gain. The facility census was 67. Residents Affected - Few Findings include: 1. Review of Resident #43's medical record revealed he originally admitted to the facility on [DATE], and returned to the facility on [DATE]. Diagnoses included morbid obesity, congestive heart failure (CHF), and myocardial infarction (heart attack). Review of Resident #43's physician orders dated 10/24/19, revealed the resident should be weighed daily and to notify the physician of a weight gain of two pounds in one day, or five pounds in a week. Review of Resident #43's weights revealed the following: on 10/24/19 he weighed 320 pounds (lb), on 10/25/19 and 10/26/19 he weighed 375.2 lb. There were no weights in the medical record for 10/27/19 or 10/28/19. Interview on 10/29/19 at 3:24 P.M. with Licensed Practical Nurse (LPN) #317 confirmed Resident #43 had not been weighed since 10/26/19 and that the physician had not been notified of his significant weight gain on 10/26/19. 2. Review of the medical record for Resident #49 revealed an admission date of 10/02/19. Diagnoses included CHF and emphysema. Review of the physician order dated 10/15/19 revealed Resident #49 was ordered for daily weights, and if the resident gained more than two pounds in one week to call the heart failure center. Review of the treatment administration record (TAR) for Resident #49 revealed no evidence the resident was weighed on 10/17/19, 10/19/19 and 10/24/19. Review of the weight variance report for Resident #49 revealed on 10/16/19 the resident weighed 206 lb and on 10/18/19 the resident weighed 212.6 lb (6.6 lb gain). On 10/21/19 the resident weighed 201 lb and on 10/23/19 the resident weighed 240.2 lb (39.2 lb gain). There was no evidence the weight gain was reported to the heart failure center. On 10/29/19 at 4:35 P.M. interview with the ADON #395 confirmed Resident #49 had gained more than two pounds on 10/18/19 and 10/23/19, and no notification had been given to either the physician or the heart failure center. 366374 Page 8 of 11 366374 11/15/2019 Trueman Pointe Care Center 4660 Trueman Blvd Hilliard, OH 43026

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interviews, the facility failed to provide restorative care/range of motion (ROM) for one Resident (#26) of one reviewed for position and mobility. The facility census was 67. Findings include: Review of the medical record for Resident #26 revealed an admission date of 06/06/19 with diagnoses including malignant neoplasm (cancer) of the esophagus, and spinal stenosis. Review of the Observation Detail List Report under Restorative Nursing - Functional Limitation of Range of Motion for Resident #26, dated 08/12/19, revealed limited ROM to both arms including the shoulder or elbow with partial voluntary movement loss and limited ROM to the left leg including the hip or knee with partial loss of voluntary movement. The ROM summary documented the limitations would have potential safety risks and to see the resident's care plan. Review of Resident #26's quarterly Minimum Data Set (MDS) assessment dated [DATE], revealed the resident had no cognitive impairment, and had not participated in any restorative programs. Review of the Restorative Nursing - Restorative program initial observation, dated 09/23/19, revealed Assistant Director of Nursing (ADON) Registered Nurse (RN) #394, documented a decline in ROM to Resident #26's upper and lower extremities and referred the resident for the Restorative program. Review of the plan of care dated 09/23/19, for Resident #26 revealed the resident was care planned for a restorative active ROM program due to weakness and decline in ROM. Interventions included approach start date 09/23/19, duration of restorative ROM program to be 15 minutes per day, with 15 repetitions occurring four to seven days per week. Interview on 10/30/19 at 8:54 A.M. with State Tested Nurse's Assistant (STNA) #412 confirmed she had Resident #26 on her assignment. The STNA also confirmed the resident did not receive any restorative care. Interview on 10/30/19 at 8:58 A.M. with the Regional RN #411, confirmed the facility did not have dedicated STNAs for the restorative program, however each STNA could perform restorative ROM for the residents. Interview on 10/30/19 at 9:17 A.M. with ADON #394 and the Director of Nursing (DON) confirmed restorative care would be in the resident's profile, which is accessible to the STNA's to guide care. The ADON #394 confirmed she had not ordered restorative ROM for Resident #26. She confirmed the ROM was care planned, however had never been ordered to start. 366374 Page 9 of 11 366374 11/15/2019 Trueman Pointe Care Center 4660 Trueman Blvd Hilliard, OH 43026

F 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on medical record review, observations, staff interview, and review of facility policy, the facility failed to ensure medications were administered with a medication error rate of less than five percent. This affected one Resident (#27) out of six residents observed during medication administration in which four errors were observed out of 25 opportunities for a 16 percent (%) error rate. The facility census was 67. Residents Affected - Few Findings include: Review of the medical record for Resident #27 revealed an admission date of 03/23/19 with diagnoses including dysphagia, convulsions, Type 2 Diabetes Mellitus, and gastrostomy status (G tube). Review of the physician orders for 10/2019 revealed Resident #27 was ordered levetiracetam 500 milligrams (mg) to be administered twice per day via G tube, Pepcid 20 mg, twice per day via G tube, folic acid 1 mg, once per day via G tube and Prosource no carb liquid, 15-60 gram-kcal/30 milliliters (ml), administer 30 ml via G tube once per day. An order was also identified that medication may be crushed and cocktailed (mixed together) in food or liquid to be administered, unless contraindicated by the pharmacy. Observation on 10/29/19 at 10:20 A.M. revealed Resident #27 was administered folic acid one milligram (mg), Levetiracetam 500 mg (anticonvulsant), Pepcid 20 mg and Prosource, no carbohydrate (amino acid/protein supplement) 30 ml. The folic acid, Levetiracetam and Pepcid were crushed and cocktailed (mixed) with the Prosource and approximately 60 ml of water and administered via the resident's G Tube by Registered Nurse (RN) #305. RN #305 was observed to lay Resident #27's unclamped G tube onto a folded wash cloth. RN #305 then turned away from the resident to add water to the residual medication left in the administration cup. During this time the unclamped G tube was observed to be leaking pink fluid onto the wash cloth, completely soaking the folded wash cloth. Review of the medication administration records (MAR) for 10/2019 revealed Resident #27 was documented as having received folic acid one milligram (mg), Levetiracetam 500 mg (anticonvulsant), Pepcid 20 mg and Prosource, no carbohydrate (amino acid/protein supplement) 30 ml on 10/29/19 for the 7:00 A.M. to 11:00 A.M. medication time. Interview on 10/29/19 at 10:22 A.M. with RN #305 confirmed an unspecified amount of the previously administered medications which consisted of folic acid one milligram (mg), Levetiracetam 500 mg (anticonvulsant), Pepcid 20 mg and Prosource, no carbohydrate (amino acid/protein supplement) 30 ml, had leaked out of Resident #27's G tube. Review of the facility's policy titled Feeding Tube (Flushing) - Maintaining Patency, undated, revealed when flushing a resident's G tube, the G tube should be clamped when not directly administering fluids. This deficiency substantiates Master Complaint Number OH00107795 and is an example of the continuned non-complaince from the survey dated 09/19/19 366374 Page 10 of 11 366374 11/15/2019 Trueman Pointe Care Center 4660 Trueman Blvd Hilliard, OH 43026

F 0880 Provide and implement an infection prevention and control program. 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, observation, staff interview, and review of the facility policy, the facility failed to ensure a State Tested Nursing Assistant (STNA) #412 wore appropriate personal protective equipment (PPE) and performed hand hygiene during personal care for a resident in isolation. This affected one Resident (#164) of one reviewed for isolation. This had the potential to affect eight Residents (#5, #26, #27, #29, #53, #58, #59 and #162) who resided on the hall where STNA #412 was assigned. The facility census was 67. Residents Affected - Some Findings include: Review of the medical record for Resident #164 revealed an admission date of 10/15/19. Diagnoses included sepsis, urinary tract infection, extended spectrum beta lactamase (ESBL) resistance, and Escherichia coli (e coli). Review of the nursing admission assessment dated [DATE], revealed Resident #164 had no cognitive deficits. He was also noted to be on intravenous (V) antibiotics for ESBL in his urine. Resident #164 was listed being in isolation for contact precautions. Observation on 10/30/19 at 8:47 A.M. revealed STNA #412 was assisting Resident #164 out of his bathroom to his chair. STNA #412 did not have PPE on, nor was she wearing gloves during her care for Resident #164. At 8:48 A.M. STNA #412 exited Resident #164's room and did not wash her hands. At 8:50 A.M. STNA #412 confirmed she had not worn and PPE while caring for Resident #164, nor did she wash her hands before exiting the resident's room. STNA #412 also confirmed she did know the policy for contact isolation and stated staff should wear gown and gloves when entering an isolation room. Review of the facility's policy titled Transmission-Based Precautions: Contact Precautions, dated 07/2014, revealed gloves should be worn when entering an isolation room. Hand hygiene should be performed immediately with an Antimicrobial agent before leaving the room. In addition, a gown should be worn when entering the room if the staff anticipated their clothes may encounter the resident or environmental surfaces or items in the resident's room. 366374 Page 11 of 11