Health inspection·January 31, 2019

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to accurately code the Minimum Data Set (MDS) assessment for two (# 93 and # 43) of 44 residents reviewed during the annual survey. The total facility census was 139. Residents Affected - Few Findings include: 1. Review of Resident #93's medical record revealed the resident was admitted to the facility on [DATE]. Diagnoses included atrial fibrillation, encephalopaty, altered mental status, pain, chronic kidney disease, gout, and partial traumatic transphalangeal amputation of left middle finger. Review of the admission assessment, dated 12/28/18, revealed the resident had left middle finger amputation, left index finger dark area tip of finger and right index finger red and non blanchable. Review of hospital transfer orders, dated 12/28/18, revealed Resident #93 had no pressure ulcers and the resident had wounds to the finger tips. Review of the plastic surgeon note dated 12/28/18, revealed the resident had a an amputation of the distal phalanx of his left, long finger after thromboembolic ischemia to the tip of the finger on 11/19/18. The area had delayed healing and the site currently was covered in eschar. The resident also has wounds to left ring finger tip consistent with previous thromboembolic ischemia. Review of admission MDS assessment, dated 01/04/19, revealed the resident was coded as having cognitive impairment. The resident was coded as having two deep tissue pressure ulcers that were present on admission. The resident had a pressure reducing device to the bed and chair and pressure injury care with application of non-surgical dressings with or without topical medications other than to the feet coded. Additionally application of ointment other than to the feet coded as well. Review of the five day MDS assessment dated [DATE] and the 14 day MDS assessment, dated 01/22/19, revealed the resident the resident was coded as having pressure ulcers that were two unstageable deep tissue pressure injuries that were present on admission. Review of plastic surgery note from 01/15/19 revealed the resident has small scattered finger tip eschars, other fingers markedly improved. The resident left long finger post amputation with overlying dark eschar. On 01/14/19 dehiscence of incision but no obvious exposed bone, fingertip still tender. The note documented the resident was two months post-op for left, long finger tip amputation for embolic disease with dry gangrene. Wound dehisced, finger remains ischemic. Page 1 of 3 366388 366388 01/31/2019 Stonespring of Vandalia 4000 Singing Hills Bvld Dayton, OH 45414

F 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 01/30/19 at 3:10 P.M., Registered Nurse (RN) #300 revealed the resident wounds on the left middle finger were due to thrombosis and the resident had an amputation. Interview on 01/30/19 at 4:00 P.M., the Director of Nursing (DON), the Administrator, and RN #179 confirmed the facility was classifying Resident # 93's finger wounds as pressure wounds which were deep tissue areas. RN #179 stated the resident had eschar on his fingers and the facility did not have vascular studies to support the wounds as being vascular wounds. Interview on 01/30/19 at 4:20 P.M., Certified Nurse Practitioner #250 revealed Resident #93's finger wounds were from a thrombosis and are not pressure ulcers. 2. Review of medical record for Resident # 43 revealed an admission date of 06/05/18. Diagnosis included hemiplegia and hemiparesis following cerebral infarction affecting right dominant side, dementia with behavioral disturbance, hallucinations, major depressive disorder, and anxiety disorder. Review of psychiatrist progress note dated 10/02/18 documented Resident #43 has having a diagnosis of Alzheimer's disease. Review of quarterly MDS assessment, dated 12/15/18, did not indicate a diagnosis of Alzheimer's disease. Interview on 01/31/19 at 11:15 A.M., the DON verified Resident #43's diagnosis of Alzheimer's disease was not coded accurately on the MDS assessment dated [DATE]. 366388 Page 2 of 3 366388 01/31/2019 Stonespring of Vandalia 4000 Singing Hills Bvld Dayton, OH 45414

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 Based on observations, record review, resident interview, and staff interview, the facility failed to ensure residents were provided appropriate grooming assistance for one one (#109) of seven residents observed during phase two of the survey. The facility census was 139. Residents Affected - Few Findings include: Review of Resident #109's medical records revealed an admission date of 11/06/10. Diagnoses included hypertension, hyperlipidemia, chronic obstructive pulmonary disease, idiopathic peripheral autonomic neuropathy, muscle weakness, osteoarthritis, type two diabetes mellitus, bipolar disorder, and hypothyroidism. Review of the quarterly Minimum Data Set (MDS) assessment, dated 01/10/19, revealed Resident #109 was cognitively intact, required extensive assistance with activities of daily living (ADL), and was occasionally incontinent of bladder and frequently incontinent of bowels. Observation of Resident #109 on 01/28/19 at 10:09 A.M., on 01/29/19 at 9:23 A.M., and 01/29/19 at 2:43 P.M., revealed Resident #109 had one and a half inch growth of hair underneath her chin. Resident's #109 hands were shaking uncontrollably. Interview on 01/29/19 at 3:37 P.M., State Tested Nursing (STNA) #149 verified one and half inch-long strands of hair hanging from the chin of Resident #109. Interview on 01/30/19 at 11:14 A.M., Resident #109 stated she normally does everything for herself but she was unable to due to the pain in her left arm. Resident #109 reported she kept forgetting to remind the STNA to shave her during her shower days. Interview on 01/30/19 at 11:45 A.M., the Directed of Nursing (DON) reported the STNAs should ask residents if they would like their hair to be removed from the chin during shower days. 366388 Page 3 of 3