Health inspection·July 11, 2019

F 0582 Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. Level of Harm - Minimal harm or potential for actual harm Based on record review and staff interview, the facility failed to notify a resident of possible financial liability when Medicare services were discontinued. This affected one (#43) resident of three reviewed for Medicare Part A services and had the potential to affect any residents with Medicare Part A coverage. The facility identified three residents currently on Part A services. Residents Affected - Few Findings include: Review of Resident #43's medical record revealed an admit date of 01/31/19 with diagnoses included diabetes mellitus and muscle weakness. Review of the admission Minimum Data Set (MDS) assessment, dated 02/07/19, revealed the resident's cognition was severely impaired. Review of social worker progress note, dated 02/15/19, revealed a Medicare Notice of Non-coverage was signed 02/15/19 with a last covered day of 02/18/19. Review of the medical record failed to reveal any documentation of a Skilled Nursing Facility Advance Beneficiary Notice (SNFABN) was provided to the resident's representative. Interview with Social Worker (SW) #12 on 07/08/19 at 3:44 P.M. stated a SNFABN was not provided to Resident #43 since he remained in the facility and was treated with part B services. Page 1 of 4 366421 366421 07/11/2019 Florentine Gardens 409 Wards Corner Road Loveland, OH 45140

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 interview the facility failed to accurately develop and implement care plans for resident use of diuretics and hearing aids. This affected two (#15 and #20) of 18 residents reviewed for care planning. The facility census was 75. Findings include: 1. Record review for Resident #20 revealed the resident was admitted to the facility on [DATE]. Diagnoses included atrial fibrillation and heart failure. Review of the quarterly Minimum Data Set (MDS) assessment, dated 04/09/19, revealed Resident #20 had severe cognitive deficits. Review of the physician order, dated 07/26/17, revealed the resident was to receive Furosemide (diuretic) 20 milligrams (mg.) once daily. Review of the care plans revealed the electronic health record (EHR) was silent for care plan for the use of a diuretic. Interview on 07/11/19 at 10:48 A.M. with the Director of Nursing (DON) verified that there was no care plan for the use of diuretics for Resident #20. 2. Record review of Resident #15's chart revealed the resident was admitted to the facility on [DATE]. Diagnoses included dementia. Review of the resident's quarterly Minimum Data Set (MDS) assessment, dated 04/05/19, revealed the resident was cognitively intact and was reported to have the adequate ability to hear with no hearing aid or other hearing appliance used. Review of Resident #15's care plan revealed the resident to have impaired communication due to her having her hearing deficit. Resident #15 was also reported to have hearing aids listed on the care plan. Interview with the Director of Nursing (DON) on 7/10/19 at 5:00 P.M. revealed the resident did not have hearing aids. Subsequent interview with the DON on 07/11/19 at 10:37 A.M. verified Resident #15's care plan for hearing did not accurately reflect that the resident did not have hearing aids. 366421 Page 2 of 4 366421 07/11/2019 Florentine Gardens 409 Wards Corner Road Loveland, OH 45140

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. Based on observation, record review and staff interview, the facility failed to update a fall care plan to include physician ordered alarms. This affected one (#13) of three residents reviewed for accidents. The facility census was 75. Findings include: Review of Resident #13's medical record revealed an admission date of 05/04/15. Diagnoses included schizoaffective disorder and osteoporosis. Review of the annual Minimum Data Set (MDS) assessment, dated 04/4/19, revealed the resident had moderate cognitive impairment and indicated alarms were used daily. Review of the physician orders for July 2019 revealed an order to place an alarm to the resident's bed, check placement and function every shift and place an alarm to the resident's wheelchair, check placement and function every shift. Review of the fall care plan, dated 11/23/18, revealed the resident had a potential risk for falls related to debilitation, weakness, medications, pain, unsteady gait, and disease process. Interventions were locked bed, items (including call light) within reach, clear pathways, education, therapy evaluation, and monitoring for medication side effects. The care plan was silent to use of alarms. Observation of Resident #13 on 07/10/19 at 11:51 A.M. revealed her sitting in a wheelchair with a tab alarm attached to her and the wheelchair. Interview on 07/11/19 at 9:38 A.M. with the Director of Nursing (DON) reported alarms for bed and chair were ordered for Resident #13 after a fall on 03/17/19 to remind her to request for assistance. The DON verified Resident #13's care plan was silent for use of alarms. The DON said the alarms used for residents should be care planned. 366421 Page 3 of 4 366421 07/11/2019 Florentine Gardens 409 Wards Corner Road Loveland, OH 45140

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review, and staff interview, the facility failed to maintain infection control procedures when a medication was administered. This affected one (#34) of six residents observed receiving medications and had the potential to affect all 75 residents residing in the facility identified as receiving medications from facility nurses. Residents Affected - Few Findings include: Review of Resident #34's medical record revealed an admit date of 06/18/18. Diagnoses included dementia, congestive heart failure, anxiety, depressive disorder, diabetes, hypertension, and asthma. Review of a quarterly Minimum Data Set (MDS) assessment, dated 05/28/19, indicated the resident had intact cognition. Review of Resident #34's physician orders for July 2019 failed to reveal any mention of a Stiolto inhaler (a medication to relax pulmonary muscles). Observation of Resident #34 receiving medications at 4:32 P.M. on 07/10/19 from Registered Nurse (RN) #3 revealed a Stiolto inhaler provided to Resident #34 who took two puffs through her mouth. Interview on 07/11/19 at 9:30 A.M. with Director of Nursing (DON) reported that RN #3 had administered Resident #70's inhaler to Resident #34. The DON verified it would be an infection control issue since the inhaler was placed in the mouth when administering the medication. 366421 Page 4 of 4