Health inspection·April 21, 2022

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, interview, record review, and policy review the facility failed to change oxygen tubing weekly for Resident's #11 and #121. This affected two residents (Resident's #11 and #121) of seven residents reviewed for oxygen use. Facility census was 20. Residents Affected - Few Findings include: 1. Review of the medical record revealed Resident #121 was admitted on [DATE] with diagnoses including chronic respiratory failure with hypoxia, chronic obstructive pulmonary disease, and dependence on supplemental oxygen. Review of physician orders dated 04/03/22 revealed Resident #121 was ordered two-to-four liters via nasal cannula as needed for oxygen saturation below 90-percent. Review of the admission Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #121 had severe cognitive impairment and shortness of breath with exertion. Review of the plan of care dated 04/14/22 revealed Resident #121 had oxygen therapy. Interventions included oxygen via nasal cannula. Observation on 04/19/22 at 10:15 A.M. revealed Resident #121's oxygen tubing was dated 04/10/22. Resident #121 had oxygen in place via nasal cannula. Interview on 04/20/22 at 4:36 P.M. Licensed Practical Nurse (LPN) #314 verified Resident #121's oxygen tubing was dated 04/10/22. LPN #314 verified the oxygen tubing was to be changed every week. 2. Review of the medical record for Resident #11 revealed an admission date of 05/16/16. Diagnoses included insomnia, heart disease, depression, cerebrovascular disease, hyponatremia, and hypertension. Review of the quarterly MDS 3.0 assessment dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of 03 indicating Resident #11 was cognitively impaired. Review of the plan of care dated 02/16/22 revealed Resident #11 had altered cardiovascular status related to hypertension, atherosclerotic heart disease, and cerebrovascular disease. Interventions included encourage the resident to report chest pain and/or difficulty breathing. Administer medication/oxygen as ordered/needed per physician's orders. Page 1 of 2 366412 366412 04/21/2022 Als Mount Vernon Inc 1135 Gambier Road Mount Vernon, OH 43050

F 0695 Level of Harm - Minimal harm or potential for actual harm Review of the physician orders dated April 2022 revealed to change oxygen tubing and humidifier every week, to change every night shift on Sunday with date. Review of the Treatment Administration Record (TAR) revealed no treatment in place to change Resident #11's oxygen tubing on Sunday night every week. Residents Affected - Few Observations on 04/19/22 of Resident #11's oxygen tubing from 9:24 A.M. to 3:39 P.M. and on 04/20/22 at 8:16 A.M. revealed the tubing was dated 04/04/22. Interview on 04/20/22 at 4:36 P.M. with LPN #314 revealed tubing was to be changed weekly on the night shift. LPN #314 verified that oxygen tubing was not changed and was dated 04/04/22. Review of the facility policy titled Oxygen Administration revealed that staff shall change oxygen tubing and mask/cannula weekly and as needed if it becomes soiled or contaminated. 366412 Page 2 of 2