Health inspection·January 8, 2024

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, resident interview, staff interview and review of facility training, the facility failed to ensure passive range of motion (PROM) was completed as ordered. This affected one (#1) of three residents reviewed for range of motion. The facility census was 83. Findings include: Review of Resident #1's medical record revealed an admission date of 09/25/19. Diagnoses included acute respiratory failure, quadriplegia, emphysema, heart disease with heart failure, dysphagia, post-traumatic stress disorder, anxiety disorder, personality disorder, and delirium. Review of Resident #1's Minimum Data Set (MDS) assessment dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of 15 indicating Resident #1 was cognitively intact. Resident #1 had impaired upper and lower extremities. Resident #1 required extensive assistance with bed mobility, transfer, and toilet use. Resident #1 displayed rejection of care behaviors one to three days during the review period. Review of Resident #1's care plan revised 11/09/23 revealed supports and interventions for risk for decline of range of motion. Resident #1's goal was for Resident #1 to tolerate passive range of motion to all extremities without signs and symptoms of pain. Interventions included observe for any presence of pain during ROM twice a day between 6:00 A.M. to 2:00 P.M. and 6:00 P.M. and 10:00 P.M., provide passive ROM to upper and lower extremities twice a day between 6:00 A.M. to 2:00 P.M. and 6:00 P.M. and 10:00 P.M., and provide rest periods as needed. Review of Resident #1's physician orders revealed an order dated 11/29/23 for Passive Range of Motion (PROM) to bilateral upper and lower extremities twice a day. Review of Resident #1's Physical Therapy (PT) Discharge paperwork dated 11/21/23 revealed discharge recommendations of Range of Motion twice a day. Review of Resident #1's Occupational Therapy (OT) Discharge paperwork dated 11/30/23 revealed State Tested Nursing Assistants (STNA) #208, #205, #212 and #207 were trained on Resident #1's bilateral upper extremity passive range of motion exercises. Resident #1 was discharged from OT due to exhausting his benefits and declined treatment. Review of Resident #1's Passive Range of Motion (PROM) documentation from 12/01/23 through 12/31/23 revealed Resident #1 was not provided PROM on first shift 19 out of the 31 days. ROM was not Page 1 of 2 366423 366423 01/08/2024 Meadows of Ottawa The 147 Putnam Parkway Ottawa, OH 45875

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few performed on first shift on 12/01/23, 12/04/23, 12/05/23, 12/06/23, 12/08/23, 12/11/23, 12/12/23, 12/13/23, 12/14/23, 12/15/23, 12/16/23, 12/17/23, 12/18/23, 12/19/23, 12/21/23, 12/22/23, 12/23/23, 12/24/23, and 12/25/23. No information was provided as to why the PROM was not completed. Resident #1 was documented as refused one time on 12/29/23. Of the 19 instances State Tested Nursing Assistant (STNA) #205 was the staff who documented PROM was not performed. Further medical record review found no documented refusals. Interview on 01/08/24 at 10:08 A.M., with Resident #1 found him to be alert and aware. Resident #1 reported he was not getting his range of motion as ordered. Resident #1 stated the issue was primarily on first shift and was with STNA #205 who did not provide the range of motion. Resident #1 stated he did not refuse his ROM and he actually wanted more than he was getting. Resident #1 reported STNA #205 would say there wasn't time and it would not be done. Interview on 01/08/24 at 12:42 P.M., with STNA #205 verified Resident #1's range of motion was not completed. STNA #205 reported Resident #1 was very particular and wanted all of his care completed at one time. If there was not enough time she would ask if they could do the ROM later. Review of the undated facility training titled, Restorative Nursing Training- Range of Motion (ROM), Walking, Dressing/Grooming revealed ROM should be completed with daily activities of daily living care. The staff were to follow the ROM program as assigned in the electronic system, the care plan, and the resident's profile. This deficiency represents non-compliance investigated under Complaint Number OH00148946. 366423 Page 2 of 2