Health inspection·January 21, 2025

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 interview, record review, and policy review, the facility failed to ensure residents received appropriate and timely care after a fall resulting in a fracture. This affected one resident (Resident #19) of three residents reviewed for care. The facility census was 65. Residents Affected - Few Findings Include: Medical record review revealed Resident #19 was admitted to the facility on [DATE] with diagnoses including dementia without behavioral disturbance, repeated falls, urinary retention, bradycardia, arthritis, and high blood pressure. Review of Resident #19's physician's orders revealed an order dated 05/08/23 for hydrocodone acetaminophen 5-325 milligrams (mg) (an opioid pain medication) three times daily. Review of the Medicare quarterly Minimum Data Set 3.0 assessment, dated 11/21/24, revealed Resident #19 was severely cognitively impaired, needed moderate assistance from staff for toileting and maximum assistance for showering. Review of the nurses' notes revealed on 12/25/24 at 8:01 P.M. Registered Nurse (RN) #219 found Resident #19 on the floor. RN #219 assessed Resident #19 and the resident complained of pain to her right hip with movement and was unable to move her right leg from front to back or up and down. Resident #19 was able to move all her other extremities. RN #219 assisted Resident #19 to her recliner and then notified Nurse Practitioner (NP) #400 who ordered a right hip x-ray. Further review of the nurses' notes revealed on 12/26/24 at 7:50 A.M. RN #224 administered Resident #19's scheduled pain medication. RN #224 along with two other aides transferred Resident #19 to her bed. At 12:00 P.M. radiology arrived to take the x-ray. At 12:16 P.M. RN #224 notified NP #400 Resident #19 had a fractured femur and NP #400 gave an order to transfer Resident #19 to the hospital. At 12:53 P.M. Resident #19 left for the hospital and were she was admitted to the hospital for hip surgery. Review of the fall investigation dated 12/25/24 revealed on 12/25/24 at 7:20 P.M. Registered Nurse #219 was administering evening medications when she entered Resident #19's room and found the resident on the floor. RN #219 asked Resident #19 what happened, and the resident said she was trying to get to her bed. Resident #19 was lying on the floor between her recliner and wheelchair. Resident #19 complained of pain to her right hip area. RN #219 notified NP #400 regarding the fall. NP #400 ordered a right hip x-ray. Radiology was notified at 8:09 P.M. Page 1 of 2 366479 366479 01/21/2025 Timberland Ridge Nursing & Rehabilitation 3558 Ridgewood Road Fairlawn, OH 44333

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Telephone interview with NP #400 on 01/21/25 at 9:45 A.M. revealed the nurse (RN #219) had called her to notify her of Resident #19's fall and that she was having hip pain. NP #400 said she ordered a STAT (immediate) hip x-ray. NP #400 was not aware that the x-ray had not been taken until 12/26/24 at 12:00 P.M., approximately 17 hours after the injury was noted. Telephone interview with RN #224 on 01/21/25 at 3:04 P.M. revealed on 12/26/24 after receiving morning shift report she went straight to Resident #19's room. RN #224 noticed Resident #19 was in more pain than she usually was. Resident #19 was also very soiled due to being incontinent. RN #224 and two aides transferred Resident #19 to bed utilizing a tarp. Once Resident #19 was in bed they provided incontinence care and put her in clean and dry clothing. Resident #19 was due for her scheduled pain medication which RN #224 administered. RN #224 was surprised Resident #19 had not been transferred to the hospital prior to this time because RN #224 observed the right leg was externally rotated and she had a fractured hip. Once the x-ray results were faxed to the facility Resident #19 was transferred to the hospital around 1:00 P.M. Interview with the Regional Nurse on 01/21/25 at 5:45 P.M. confirmed Resident #19 fell on [DATE] at 7:20 P.M. and did not receive the STAT hip x-ray until 12/26/24 between 11:00 A.M. and 12:00 P.M. Review of the facility's Change of Condition policy, revised April 2013, revealed a change of condition was defined as a deterioration in the health, mental, or psychosocial status of a resident related to a life-threatening condition, a significant alteration in treatment, or a significant change in the resident's clinical condition or status. Life threatening conditions include broken bones. This deficiency represents noncompliance investigated under Complaint Number OH00160893. 366479 Page 2 of 2