Health inspection·October 6, 2022

F 0730 Observe each nurse aide's job performance and give regular training. Level of Harm - Minimal harm or potential for actual harm Based on facility personnel record review and staff interview the facility failed to ensure annual performance reviews were completed. This affected three of four State Tested Nursing Assistants (STNAs) reviewed (STNAs #324, #325 and #397). The facility census was 94. Residents Affected - Few Findings included: Review of STNA #324's personnel file revealed a date of hire on 08/23/21. Further review of the STNA's personnel file revealed no evidence of an annual performance review. Review of STNA #325's personnel file revealed a date of hire on 09/03/19. Further review of the STNA's personnel file revealed no evidence of an annual performance review. Review of STNA #397's personnel file revealed a date of hire on 10/04/21. Further review of the STNA's personnel file revealed no evidence of an annual performance review. Interview on 10/05/22 at 5:02 P.M. with Human Resources Director (HR) #396 revealed she was not able to provide evidence an annual performance review was completed on STNAs (#324, #325 or #397). Interview on 10/06/22 at 8:17 A.M. with the Director of Nursing (DON) confirmed no annual performance reviews were completed on STNAs (#324, #325 or #397). Page 1 of 2 366469 366469 10/06/2022 Siena Gardens Rehabilitation & Transitional Care 1055 State Route 125 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, staff interview and review of facility policy, the facility failed to ensure physician ordered laboratory (lab) tests were completed as ordered. This affected one Resident (#75) of five residents reviewed for unnecessary medications. The facility census was 94. Residents Affected - Few Findings include: Review of the medical record of Resident #75 revealed an admission date of 02/18/20. Diagnoses included, but not limited to, unspecified dementia, type two diabetes mellitus, congestive heart failure, vitamin-D deficiency, and hypothyroidism. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #75 had intact cognition. Review of the plan of care dated 03/01/22 revealed Resident #75 was at risk for hypoglycemia (low blood sugar) and/or hyperglycemia (elevated blood sugar) episodes related to insulin dependent diabetes mellitus (IDDM). Interventions included to complete labs as ordered and report results. Review of the pharmacist recommendations dated 05/06/22 addressed to the Attending Physician/Prescriber revealed the pharmacist recommended for Resident #75 to have a Hemoglobin A1C (three-month measurement of blood sugar) checked on the next lab day and every six months thereafter due to being on antidiabetic medications. The form was signed by the physician on 06/01/22 and the physician was in agreement with the recommendation and to write the order. Review of physician's orders for Resident #75 revealed an order dated 05/24/22 for resident to have laboratory work which included Hemoglobin A1C, complete blood count (CBC), complete metabolic panel (CMP), thyroid stimulating hormone (TSH), vitamin D level completed every six months. Review of lab results for Resident #75 revealed no Hemoglobin A1C labs obtained per physician orders on 05/24/22. Interview on 10/04/22 at 4:45 P.M., the Director of Nursing (DON) verified the Hemoglobin A1C lab for Resident #75 was not completed as ordered. Review of the facility policy titled, Diagnostic Testing, dated 10/21/21, revealed the facility will obtain diagnostic tests (laboratory and radiology) in accordance with the orders from the physician, in accordance with regulatory requirements. 366469 Page 2 of 2