Health inspection·January 4, 2024

F 0695 Provide safe and appropriate respiratory care for a resident when needed. 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 facility policy review, the facility failed to ensure oxygen tubing and sterile water containers were dated. This affected three residents (#7, #69, and #166) of three residents reviewed for oxygen. The facility census was 14. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #7 revealed an admission date of 12/22/23 with diagnosis including left hip revision, sleep apnea, and obesity. Review of the Social Work Admit (SWA) assessment dated [DATE], revealed Resident #7 had a Brief Interview for Mental Status (BIMS) score of 15 that indicated she was alert and oriented to person, place, and time. Review of the physician orders dated 01/01/24 revealed an order for oxygen therapy per protocol routinely. Observation and interview on 01/03/24 at 1:53 P.M. with Resident #7 revealed she was sitting in her room with her nasal canula, and oxygen tubing connected to a bottle of sterile water affixed to the wall. Resident #7's oxygen tubing and bottle of sterile water were undated. Resident #7 revealed she only wore her oxygen at night. 2. Review of the medical record for Resident #69 revealed an admission date of 12/24/23 with diagnoses including dehydration, hypertensive heart disease with heart failure, pulmonary hypertension, and dysphagia. Review of the SWA assessment dated [DATE], revealed Resident #69 had a BIMS score of 15 that indicated she was alert and oriented to person, place, and time. Review of the physician orders dated 12/26/23 revealed an order for oxygen therapy per protocol routinely. Observation on 01/03/24 at 1:50 P.M. revealed Resident #69 sitting in a recliner with her nasal canula in place with the oxygen tubing connected to a bottle of sterile water affixed to the wall. Resident #69's oxygen tubing and bottle of sterile water were undated. 3. Review of the medical record for Resident #166 revealed an admission date of 12/21/23 with diagnoses including pneumonia, hypertension, and acute respiratory failure with hypoxia. Page 1 of 3 366405 366405 01/04/2024 Wooster Community Hospital Snf 1761 Beall Avenue Wooster, OH 44691

F 0695 Review of the SWA assessment dated [DATE], revealed Resident #166 had a BIMS score of 13 that indicated she was alert and oriented to person, place, and time. Level of Harm - Minimal harm or potential for actual harm Review of the plan of care dated 12/21/23 revealed Resident #166 was on two liters of oxygen. Residents Affected - Few Review of the physician orders dated 12/24/23 revealed an order for oxygen therapy per protocol routinely. Review of the medical record, reflecting occupational therapy (OT), revealed Resident #166 was on two liters of oxygen but was increased to three liters during OT activity for safety and comfort. Resident #166 complained of being weak and winded. Observation and interview on 01/02/24 at 9:50 A.M. with Resident #166 revealed she had been in the facility for three weeks for therapy due to being out of breath. Observation revealed Resident #166 was sitting in a recliner with a nasal canula in place with the oxygen tubing connected to a bottle of sterile water affixed to the wall. Observation revealed the oxygen tubing and sterile water were undated. Resident #166 revealed she was unsure of when the oxygen tubing and sterile water was last changed. Interview with Registered Nurse (RN) #804 on 01/02/24 at 11:04 A.M. verified and confirmed Residents #7, #69, and #166 oxygen tubing and sterile water were undated. RN #804 revealed she was not sure when the tubing was changed out, but staff waited until the containers were empty. RN #804 revealed she could not indicate when the last time the oxygen tubing and sterile water were changed due to no documentation and no tracking system in place. Interview on 01/03/24 at 1:55 P.M. with State Tested Nurse Assistants (STNAs) #811 and #819 revealed Residents #7, #69, and #166 all wore oxygen during their stay in the hospital. STNAs #811 and #819 revealed Resident #7 wore her oxygen only at night. STNAs #811 and #819 were unaware when the oxygen tubing and sterile water were changed. Interview on 01/03/24 at 2:10 P.M. with the Administrator verified the above findings. Interview with the Administrator revealed oxygen tubing and sterile water were changed every Sunday, but staff did not document the changes, there were no physician orders to change the sterile water or oxygen tubing, and it was not in their policy to do so. Interview with the Administrator revealed there was a form to document and track the changing of oxygen tubing on Sundays, but staff did not utilize it and she was unable to provide any history of utilization. Interview with the Administrator revealed there was no way to verify the time and date oxygen and tubing was changed. Review of the facility document titled PCA task List revealed the facility had a form to document and track new oxygen tubing on Sundays. The form was blank. Review of the facility document titled Oxygen Administration, Long-Term Care, revised 12/11/23, revealed the facility had a policy in place for implementation of oxygen. Review of the policy revealed staff would verify the physician order, complete the administering protocol, and document the procedure. Review of the facility document revealed the facility did not implement the policy. 366405 Page 2 of 3 366405 01/04/2024 Wooster Community Hospital Snf 1761 Beall Avenue Wooster, OH 44691

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to provide an appropriate diagnosis for the use of an antipsychotic medication. This affected one resident (#67) out of five residents reviewed for unnecessary medications. The facility census was 14. Findings include: Review of Resident #67's medical record revealed the resident was admitted on [DATE] with diagnoses including encephalopathy, left hemiparesis, hemorrhagic stroke, and debility. Review of Resident #67's Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident exhibited severe cognitive impairment, no behaviors were noted, and the resident was dependent for activities of daily living (ADL). Review of Resident #67's physician orders revealed an order dated 01/01/24 for quetiapine fumarate (antipsychotic medication) 25 milligrams (mg) give one tablet by mouth once a day. Review of the current resident diagnoses revealed this resident does not have an active diagnosis of psychosis in the medical chart. Interview on 01/02/23 at 3:50 P.M. with Administrator revealed that quetiapine fumarate was ordered for Resident #67 related to anxiety, and that quetiapine fumarate is not an antianxiety medication. The Administrator also verified that there was no documented evidence from the nursing staff that Resident #67 had signs or symptoms of anxiety or restlessness. 366405 Page 3 of 3