Health inspection·February 13, 2020

F 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm Based on medical record review, staff interview, review of Self Reported Incident (SRI) and facility policy, the facility failed to perform a thorough investigation regarding an allegation of sexual abuse. This affected one (#6) out of one SRI's reviewed. The facility identified one SRI in the last six months. Facility census was 48. Residents Affected - Few Findings include: Review of the medical record for Resident #6 revealed an admission date of 08/28/18. Diagnoses included chronic kidney disease, unsteady on feet, difficulty in walking, abnormalities of gait an mobility. Review of the Minimum Data Set for Resident #6 dated 10/29/19 revealed she was assessed as being cognitively intact. Her activity of daily living was assessed as needing supervision of one person physical assistance for locomotion on the unit and uses a wheelchair for mobility. Review of the nurses notes for Resident #6 dated 10/31/19 at 4:49 revealed at 11:00 A.M. the resident reported incident involving a male resident that lives in Assisted Living (AL) to State Tested Nurse Assistant (STNA). STNA reported incident to nurse and then reported to management. Resident is alert and oriented SRI opened for related allegations. Review of the SRI dated 10/31/19 revealed the incident information of category of allegation or suspicion was for sexual abuse. The alleged or suspected perpetrator was family or visitor with initial source of allegation or suspicion was staff. The SRI involved Resident #6 and a resident who resides in the AL. The summary of the incident revealed the resident of the AL facility, attached to the nursing home, asked to take Resident #6 back to her room from dining room. Resident #6 told him it was okay for him to take her back to her room. Resident #6 alleged, when the two were approaching her room, he stepped in front of her wheelchair and touched her breast. She asked him to stop, he stopped and walked away. After interviewing Resident #6, she verified she feels safe and was not harmed in anyway. She does not have any physical or mental anguish from the incident. The facility asked the resident from AL to only visit the nursing home under supervision. Nursing home staff are aware to redirect him back to the AL. The allegation was unsubstantiated. The investigation included interviews with Resident #6, the resident from AL, Director of Nursing (DON) and STNA whom the Resident #6 had talked to her. The investigation did not include interviews with other female residents who reside in the facility or any staff who may have been working in the facility at the time of the incident. Interview with the Administrator on 02/11/20 at 2:09 P.M. verified he did not interview any Page 1 of 3 366444 366444 02/13/2020 Vancrest of Ada 600 West North Avenue Ada, OH 45810

F 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few residents or staff regarding Resident #6's allegation of sexual abuse. The Administrator stated he only put a message on the message board for the resident from the AL who is to be redirected back to the AL side. There was no interviews of any of the other female residents. Interview on 02/11/20 at 2:36 P.M. with STNA #300 and STNA# 301 revealed they were not aware there was a resident from the AL who had to be supervised when in the nursing home side of the building. Review of the facility's policy Abuse, Neglect, Exploitation, and Misappropriation of Resident Property undated revealed it is the facility's policy to investigate all alleged violations involving Abuse, Neglect, Exploitation, Mistreatment of a resident, or Misappropriation of Resident Property, including injuries of Unknown Source, in accordance with this policy. Under the section of investigation revealed the investigation protocol is for the person investigating the incident should generally take the following actions included to interview the resident, the accused, and all witnesses. Witness generally include anyone who: witnessed or heard the incident; came in close contact with the resident the day of the incident (including other residents and or family members) and employees who worked closely with the alleged victim the day of the incident. If there are no direct witnesses, then the interviews may be expanded, to cover all employees on the unit or as appropriate the shift. 366444 Page 2 of 3 366444 02/13/2020 Vancrest of Ada 600 West North Avenue Ada, OH 45810

F 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. 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, staff interview and policy review, the facility failed to ensure a resident was free from unnecessary medications when staff failed to administer blood pressure medications in accordance with the blood pressure parameters ordered by the physician. This affected one (#25) of five residents reviewed for unnecessary medications. The census was 48. Residents Affected - Few Findings include: Review of the medical record for Resident #25 revealed the resident was admitted to the facility on [DATE]. Diagnoses include vascular dementia with behavioral disturbance, acute and chronic respiratory failure with hypoxia, acute and chronic respiratory failure with hypercapnia, Parkinson's disease, anxiety disorder, acute rheumatic heart disease, atrial fibrillation, hypertension, gastroesophageal reflux disease, dysphagia, muscle weakness, difficulty walking, repeated falls, malignant neoplasm of the breast, arthropathy and urinary urgency. Review of the medication administration records (MARs) dated 11/2019, 12/2019 and 01/2020 revealed Resident #25 was to be administered Valsartan 160 milligrams (mg) one tablet by mouth twice daily related to hypertension. The instructions included to hold the medication if the systolic blood pressure (SBP) was less than 110 milligrams of mercury (mmHg). Continued review of the MARs revealed on 11/24/19 (evening) the resident was administered the medication when the resident's blood pressure was 108/56 mmHg. Review of the 12/2019 MARs revealed on 12/15/19 (evening) the resident was administered the medication when the resident's blood pressure was 105/80 mmHg; administered on 12/18/19 (evening) when the resident's blood pressure was 103/51 mmHg and administered on 12/21/19 (evening) when the resident's blood pressure was 108/60 mmHg. Further review of the MAR for 01/2020 revealed on 01/13/20 (evening) the medication was administered when the resident's blood pressure was 101/74 mmHg and administered on 01/22/20 (evening) when the resident's blood pressure was 108/73 mmHg. Interview on 02/11/20 at 10:36 A.M. with Registered Nurse (RN) #101 verified Resident #25 was documented as receiving the medication on the above listed dates when it should not have been held according to the parameters specified by the physician. Review of a facility provided undated policy titled, Administering Medications revealed that medications must be administered in accordance with the orders. 366444 Page 3 of 3