Health inspection·August 28, 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to ensure residents were discharged from Medicare Part A skilled services were notified of the potential liability for payment. This affected two (Resident #3 and Resident #7) of three residents reviewed for beneficiary notices. The facility census was 39. Residents Affected - Few Findings include: 1. Review of the record for Resident #3 revealed the resident was admitted to the facility on [DATE]. Diagnoses included heart failure, primary pulmonary hypertension, cardiomyopathy, chronic obstructive pulmonary disease, acute bronchitis, hypertensive heart disease, hypothyroidism, type two diabetes mellitus, chest pain, dyspnea, asthma, and gastro esophageal reflux. Review of Resident #3's chart revealed resident was admitted to Medicare Part A skilled services on 05/31/19 and had a last covered day of skilled services on 06/21/19. Further review of Resident #3's chart revealed the resident signed the Notice of Medicare Non-Coverage (NOMNC) on 06/18/19. Resident #3's chart did not include a Skilled Nursing Facility Advance Beneficiary Notice of Non-coverage (SNF ABN) to inform the resident of the potential liability for payment. Interview with the Administrator on 08/25/19 at 2:29 P.M. verified Resident #3 did not receive an SNF ABN to inform the resident of the potential liability for payment upon Resident #3's discharge from skilled services on 06/21/19. The Administrator verified Resident #3 remained in the facility after discharging from Medicare Part A skilled services. 2. Review of the record for Resident #7 revealed theresident was admitted to the facility on [DATE]. Diagnoses included myocardial infarction, venous insufficiency, lymphedema, obstructive sleep apnea, anemia, type two diabetes mellitus, hypertension, hypothyroidism, and acute kidney failure. Review of Resident #7's chart revealed resident was admitted to Medicare Part A skilled services on 05/22/19 and had a last covered day of skilled services on 07/05/19. Further review of Resident #7's chart revealed the resident signed the Notice of Medicare Non-Coverage (NOMNC) on 06/27/19. Resident #7's chart did not include a SNF ABN to inform the resident of the potential liability for payment. Interview with the Administrator on 08/25/19 at 2:29 P.M. verified Resident #7 or their representative did not receive an SNF ABN to inform the resident of the potential liability for payment upon Resident #7's discharge from skilled services on 07/05/19. The Administrator verified Resident #7 remained in the facility after discharging from Medicare Part A skilled services. Page 1 of 7 366465 366465 08/28/2019 Glen The 4300 Gleneste-Withamsville Road Cincinnati, OH 45245

F 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, review of facility policy, and staff interview, the facility failed to notify the Ombudsman of a discharge from the facility for one (#14) of five residents reviewed for discharge notification. The facility census was 39. Findings include: Review of the medical record revealed Resident #14 was admitted to the facility on [DATE]. Diagnoses included transient ischemic attack and cerebral infarction, cardiac pacemaker, mental and behavioral disorders, overactive bladder, muscle weakness, disorder, hypertension, hypothyroidism, anemia, and chronic pain. Review of the record revealed Resident #14 discharged to the hospital on [DATE] with bloody stools and returned to the facility on [DATE]. Further review of Resident #14's chart revealed no Ombudsman notification for Resident #14's hospitalization on 12/24/18. Interview with Director of Social Services #6 on 08/27/19 at 2:21 P.M. verified Resident #14 discharged to the hospital on [DATE] and the Ombudsman was not notified of her discharged . Review of the facility policy titled Social Service Standard Operating Procedure, dated 11/08/17, revealed the facility must send a copy of the transfer notice to the representative of the Office of the State Long Term Care Ombudsman. 366465 Page 2 of 7 366465 08/28/2019 Glen The 4300 Gleneste-Withamsville Road Cincinnati, OH 45245

F 0625 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, and review of facility policy, the facility failed to ensure residents received bed hold notification for hospital in writing. This affected two (Resident #9 and Resident #14) of five residents reviewed for discharge notification. The facility census was 39. Findings include: 1. Review of the medical record revealed Resident #9 was admitted to the facility on [DATE]. Diagnoses included heart failure, chronic respiratory failure with hypoxia, atherosclerotic heart disease of native coronary artery, dementia, overactive bladder, type two diabetes mellitus with diabetic neuropathy, chest pain and anxiety disorder. Review of Resident #9's record revealed resident discharged to the hospital on [DATE] with chest pains and returned to the facility on [DATE]. Resident #9 also discharged to the hospital on [DATE] with congestive heart failure exacerbation and returned to the facility on [DATE]. Resident #9 discharged to the facility on [DATE] with shortness of breath and readmitted to the facility on [DATE]. Further review of Resident #9's chart revealed no bed hold notification were provided to the resident for her hospitalizations on 04/12/19, 05/14/19 and 06/28/19. Interview with Registered Nurse (RN) #600 on 08/28/19 at 4:24 P.M. verified Resident #9 was not given a bed hold notice upon transfer to the hospital on [DATE], 05/14/19 and 06/28/19. 2. Review of the medical record revealed Resident #14 was admitted to the facility on [DATE]. Diagnoses included transient ischemic attack and cerebral infarction, cardiac pacemaker, mental and behavioral disorders, overactive bladder, muscle weakness, disorder, hypertension, hypothyroidism, anemia, and chronic pain. Review of the record revealed Resident #14 discharged to the hospital on [DATE] with bloody stools and returned to the facility on [DATE]. Further review of Resident #14's chart revealed no bed hold notification for Resident #14's hospitalization on 12/24/18 was provided to the resident. Interview with RN #600 on 08/28/19 at 4:24 P.M. verified Resident #14 was not given a bed hold notice upon transfer to the hospital on [DATE]. Review of the facility policy titled Bed Hold Notification, dated 11/18/16, revealed the nursing designee or other designated staff member should provide written information to the resident or a family member of the bed hold and admission policies before transferring a resident the hospital. The policy also stated in cases of emergency, the bed hold policy should be provided within 24 hours. 366465 Page 3 of 7 366465 08/28/2019 Glen The 4300 Gleneste-Withamsville Road Cincinnati, OH 45245

F 0732 Post nurse staffing information every day. Level of Harm - Potential for minimal harm Based on review of daily posted staffing sheets, review of daily staff assignment sheets, and staff interview, the facility failed to post accurate staffing information on 08/23/19, 08/24/19, and 08/25/19. This had the potential to affect all 39 resident's residing in the facility. Residents Affected - Many Findings include: 1. Review of posted staffing sheet dated 08/23/19 revealed the census to be reported as 37 residents. There were no Registered Nurses (RNs) on evening shift, and two RNs for a total of 16 hours on night shift. Three State Tested Nursing Assistants (STNA) were scheduled a total of 24 hours on day shift. Two STNAs were scheduled a total of 16 hours on evening shift. Review of corresponding daily assignment sheet for 08/23/19 revealed there were two RNs on evening shift, and one RN on night shift. Two STNAs were assigned on day shift, three and one-half STNAs on evening shift. The facility census was 39 on 08/24/19. 2. Review of posted staffing sheet dated 08/24/19 revealed the census was reported to be 37. There was one RN scheduled for day shift and one RN for evening shift. Two STNAs were scheduled day shift and one STNA for night shift. Review of the corresponding daily assignment sheet for 08/24/19 revealed the facility had two RNs on day shift and two RNs on evening shift. Three STNAs were assigned day shift and one-and one half STNAs (one eight-hour and one four-hour shift) were assigned for night shift. The facility census was 39 on 08/24/19. 3. Review of posted staffing sheet dated 08/25/19 revealed the census to be 37. There was one RN scheduled for day shift. There were no Licensed Practical Nurses (LPNs) scheduled for 08/25/19. There were two STNAs scheduled for day shift, three STNAs for evening shift, and one STNA for night shift. The posted staffing sheet provided revealed one and one-half RNs scheduled for day shift. One-half LPN for day shift and one LPN for evening shift. Three STNAs for day shift, four STNAs for evening shift, and two STNAs for night shift. Interview on 08/27/19 at 4:10 P.M. the Assistant Director of Health Services (ADHS) #28 verified the daily posted staffing sheets for 08/23/19, 08/24/19, and 08/25/19 were inaccurate. 366465 Page 4 of 7 366465 08/28/2019 Glen The 4300 Gleneste-Withamsville Road Cincinnati, OH 45245

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to ensure an as needed psychotropic medication was limited to 14 days. This affected one (#3) of five residents reviewed for unnecessary medications. The facility census was 39. Findings include: Review of the medical record for Resident #3 revealed the resident was admitted to the facility on [DATE]. Diagnoses included heart failure, pulmonary hypertension, cardiomyopathy, chronic obstructive pulmonary disease, acute bronchitis, hypertensive heart disease, hypothyroidism, type two diabetes mellitus, chest pain, dyspnea, asthma, and gastro esophageal reflux. Review of Resident #3's quarterly Minimum Data Sets (MDS) assessment, dated 06/23/19, revealed resident to be cognitively intact. Review of Resident #3's physician orders revealed resident was ordered lorazepam 0.5 milligrams (mg) as needed every eight hours for anxiety on 08/06/19. There was no stop date on the as needed lorazepam. Interview with Corporate Registered Nurse (Corporate RN) #500 on 08/27/19 at 3:19 P.M. verified Resident #3's lorazepam as needed ordered on 08/06/19 did not have a stop date. 366465 Page 5 of 7 366465 08/28/2019 Glen The 4300 Gleneste-Withamsville Road Cincinnati, OH 45245

F 0770 Provide timely, quality laboratory services/tests to meet the needs of residents. 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 and staff interview, the facility failed to ensure laboratory tests were obtained per physician's order for one (#15) of three residents reviewed for unnecessary medications. The facility census was 39. Residents Affected - Few Findings include: Review of the medical record for Resident #15 revealed the resident was admitted to the facility on [DATE]. Diagnoses included disorder of thyroid, muscle weakness, heart failure, hyperlipidemia, spinal stenosis, type two diabetes mellitus, hypertension, atherosclerotic heart disease, chronic kidney disease, major depressive disorder, unspecified convulsions, anxiety disorder, and anemia. Review of Resident #15's pharmacy recommendation dated 05/17/19, revealed a recommendation to have a thyroid-stimulating hormone (TSH) checked with the next scheduled labs and then every six months. The physician addressed and accepted the recommendation on 05/23/19. Review of Resident #15's physician's orders revealed a TSH was to be completed every six months on 08/08/19. Review of Resident #15's labs revealed a TSH level was not obtained since the physician order was written on 05/23/19. Interview with Corporate Registered Nurse (Corporate RN) #500 on 08/27/19 at 3:19 P.M. verified Resident #15 did not have a TSH completed. 366465 Page 6 of 7 366465 08/28/2019 Glen The 4300 Gleneste-Withamsville Road Cincinnati, OH 45245

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on review of personnel files and staff interview, the facility failed to follow their tuberculosis control plan to complete two step mantoux testing for one (Director of Plant Services #51) out of the eight employees reviewed with a hire date within the past year. This had the potential to affect all 39 residents residing in the facility. Residents Affected - Many Findings include: Review of the personnel file for the Director of Plant Services #51 revealed the employee was hired on 01/28/19. The personnel file did not contain any information regarding a two step tuberculosis skin test (PPD) or a tuberculosis risk assessment being completed upon hire. Interview with the Administrator on 8/26/19 at 3:17 P.M. verified Director of Plant Services #51 did not have a two step PPD or tuberculosis risk assessment completed upon his hire on 01/28/19. Review of the facility's undated policy titled Staff Guidelines for Tuberculosis Results Summary Documentation revealed each employee will have a two step mantoux PPD test upon hire to ensure they are free form tuberculosis. 366465 Page 7 of 7