Health inspection·June 21, 2018

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. 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 facility staff interview, the facility failed to follow physician recommendations for one (#31) of five residents reviewed for unnecessary medications. The facility census was 93. Residents Affected - Few Findings included: Record review revealed Resident #31 was admitted to the facility on [DATE] with the following diagnoses; Alzheimer's disease, cancer of the ovary, depressive disorder, dementia with behavioral disturbance,and anxiety disorder. Further review of the record revealed the resident was moderately cognitively impaired. Review of Resident #31's history and physical dated 03/27/18, revealed the resident was currently prescribed Celexa (anti-depressant) and Seroquel (Anti- psychotic). A recommendation was made to consult with psychiatry. There was no evidence in the resident's record an appointment had ever been made, or that the resident had ever been seen by psychiatry. Interview with Unit Manager #35 on 06/20/18 at 2:55 P.M., confirmed Resident #31 had not been seen by psychiatry, or was she on the current list to be seen. The Unit Manager further revealed the physician probably just missed seeing the resident, as he had been at the facility in April. Page 1 of 5 366437 366437 06/21/2018 Arlington Pointe 4900 Hendrickson Road Middletown, OH 45044

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, resident and facility policy review, staff interviews, the facility failed to provide safe storage of self administered medications for one (#80) of one residents reviewed for self administration of medications. This had the potential to affect two (#343 and #77) residents on the 400 hall who the facility identified as being independently mobile and cognitively impaired. Findings included: Review of resident #80 medical record revealed the resident was admitted to the facility on [DATE] with diagnoses of chronic right heart failure, type 2 diabetes mellitus, and typical atrial flutter. Review of the comprehensive assessment dated [DATE] revealed the resident was cognitively intact. Review of Resident #80's medication orders dated 06/03/18 revealed the resident had an order for a Proventil inhaler. On 06/19/18 Resident #80 was assessed as being able to self-administer medications, and order was written for the resident to keep his inhaler at the bedside. Interview and observation with Resident #80 on 06/20/18 at 11:50 A.M., confirmed the resident's inhaler was on the bedside table, and the resident confirmed his inhaler was always kept on his bedside table. During an interview on 06/21/18 at 9:45 A.M., with Registered Nurse (RN) #25 confirmed Resident #80 kept his inhaler on his bedside table, or sometimes in the bed side drawer. RN #25 confirmed the resident did not have access to a secured locking drawer to keep the inhaler in. Review of the Self-Administration of Medications Policy, (undated) revealed, self-administered medications must be stored in a safe manner. If safe storage is not possible in the resident's room, the medication will be stored with the nursing staff in a medication cart or medication room, and nursing will transfer the unopened medication to the resident when the resident requests them. 366437 Page 2 of 5 366437 06/21/2018 Arlington Pointe 4900 Hendrickson Road Middletown, OH 45044

F 0791 Provide or obtain dental services for each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and staff interview, the facility failed to provide dental services for one (#3) of two residents reviewed for dental services. The facility census was 93. Residents Affected - Few Findings included: Medical record review revealed Resident #3 was admitted to the facility on [DATE] with diagnoses including dementia with behavioral disturbances, and chronic obstructive pulmonary disease. Review of the Minimum Data Set (MDS) assessment completed on 06/18/18 revealed Resident #3 was cognitively impaired. Observation and interview on 06/18/18 at 9:14 A.M., revealed Resident #3 did not have any teeth visible. Resident #3 revealed she did not have teeth. She stated she used to have dentures, however they did not fit her anymore. She further revealed she had never seen a dentist since being admitted to the facility and would like to have dentures. Interview on 06/21/18 at 10:09 A.M., with Registered Nurse Case Manager (RNCM) #16 revealed residents were supposed to be set up on admission with a dental visit. RNCM #16 verified Resident #3 had not seen a dentist since admission to the facility. 366437 Page 3 of 5 366437 06/21/2018 Arlington Pointe 4900 Hendrickson Road Middletown, OH 45044

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, staff interview and policy review, the facility failed to ensure foods in the coolers and freezer were dated, were not expired, and stored in closed containers. This had the potential to affect all 93 residents of the facility who were identified as receiving meals from the kitchen. Findings included: Observations of the kitchen on 06/18/18 at 6:31 P.M., revealed the following areas of concern: 1. The walk in cooler contained undated side salads, and bowls of cottage cheese. 2. The walk in cooler had a bag of tortillas with a use by date of 09/18/17, and a plastic container of shredded carrots with a use by date of 06/14/18. 3. The walk in freezer had unsealed bags left open to air, of hamburger patties, chicken breasts, and breaded steaks. 4. The dry storage room had two racks of rolls with use by dates of 06/11/18, two racks of rolls with use by dates of 06/14/18, a box of individual servings of thickened orange juice, with a use by date of 05/22/18, and two boxes of individual cartons of thickened dairy beverage, with a use by date of 05/11/18. All the areas of concern were verified with Dietary [NAME] #27 on 06/18/18 at 7:00 P.M. Review of policy titled Food Storage dated 01/20/18, revealed all foods stored in the refrigerator should be dated, all foods stored in the freezer should be covered, and the date of preparation for food may not exceed the use by date. 366437 Page 4 of 5 366437 06/21/2018 Arlington Pointe 4900 Hendrickson Road Middletown, OH 45044

F 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, resident and staff interview, the facility failed to maintain one resident's wheelchairs in a safe working condition. This affected one (#57) of four residents reviewed for environmental concerns. The facility census was 93. Residents Affected - Few Findings included: Medical record review revealed Resident #57 was admitted to the facility on [DATE] with diagnoses of sepsis and atherosclerotic heart disease. Observation of Resident #57 on 06/19/18 at 10:20 A.M., revealed the armrest of resident's wheelchair was ripped, exposing a portion of foam insulation, approximately eight inches in length. Interview with State Tested Nurse Aide (STNA) #10 on 06/19/18 at 10:25 A.M., confirmed the armrest of Resident #57's wheelchair was ripped, exposing the foam insulation underneath, and it needed repaired. Interview with Maintenance Director #52 confirmed the maintenance department had received no requests regarding repairs to Resident #57's wheelchair. 366437 Page 5 of 5