Health inspection·December 6, 2023

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observations, resident and staff interviews, and policy review, the facility failed to provide residents with assistance with activities of daily living (ADL) including oral care and/or bathing services. This affected two (#30 and #35) out of six residents reviewed for ADL/personal hygiene. Facility census was 42. Residents Affected - Few Findings include: 1. Review of Resident #30's medical record revealed the resident was admitted to the facility on [DATE]. Diagnoses include displaced fracture of base of neck of right femur, cerebral ischemia, celiac disease, anxiety disorder, aphasia, and unspecified nausea with vomiting. Review of the admission minimum data set (MDS) dated [DATE] revealed the resident was cognitively intact, had no behaviors, and required assistance from staff for ADL's. Interview with Resident #30 on 12/05/23 at 11:40 A.M. revealed the resident stated she was supposed to have a shower the day before but it did not happen and she could not remember why. Resident #30 stated she had not had any assistance to clean her teeth since her admission on [DATE]. Observation of Resident #30's room and interview with state tested nursing assistant (STNA) #355 on 12/05/23 at 11:50 A.M. confirmed there were no supplies (toothbrush, toothpaste mouth wash, or emesis basin) in the room or bathroom to brush the Resident #30's teeth. STNA #355 verified Resident #30 was on her assignment and she had not provided oral care to the resident on this day. STNA #355 verified there were no supplies in Resident #30's room for providing oral care to the resident. While in the room with STNA #355, Resident #30 asked why she did not get her shower on the day before and STNA #355 stated you did not feel well and did not want the shower and we washed you up in bed instead, the resident replied oh that's right. STNA #355 verified Resident #30's teeth had not been brushed on the prior day. Interview with STNA #315 on 12/06/23 at 11:10 A.M. confirmed oral care should be provided every morning to the residents, and showers are provided twice weekly or as desired by the resident. 2. Review of Resident #35's medical record revealed 35 the resident was admitted [DATE]. Diagnoses include traumatic subarachnoid hemorrhage without loss of consciousness, diffuse traumatic brain injury, protein calorie malnutrition, obesity, dementia, and type two diabetes. Review of the admission MDS dated [DATE] revealed the resident was cognitively impaired, had no behaviors required assist from staff for ADL's. Page 1 of 4 366492 366492 12/06/2023 Norwich Springs Health Campus 4680 Library Way Hilliard, OH 43026

F 0677 Level of Harm - Minimal harm or potential for actual harm Review of Resident #35's bathing documentation revealed the resident had no shower/bathing service documented at the facility from 11/03/23 through 11/10/23. Interview with STNA #315 on 12/06/23 at 11:10 A.M. confirmed showers are provided twice weekly or as desired by the resident. Residents Affected - Few Interview with the Director of Nursing (DON) on 12/06/23 at approximately 4:30 P.M. confirmed Resident #35 had no documented shower or bathing services from 11/03/23 through 11/10/23 verifying that seven days without being washed up was too long. Review of a facility policy titled Guidelines for Bathing Preference, dated 05/11/16 last revised 12/31/22 revealed the purpose is to establish a personal preference bathing routine. The resident will be advised of Trilogy's guidelines for residents to self-determine their plan of care and schedule during their stay in the campus. Bathing shall occur at least twice a week unless resident preference states otherwise. This deficiency represents non-compliance investigated under Complaint Number OH00147793. 366492 Page 2 of 4 366492 12/06/2023 Norwich Springs Health Campus 4680 Library Way Hilliard, OH 43026

F 0760 Ensure that residents are free from significant medication errors. 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, observations and staff interviews, the facility failed to provide a resident with medication as ordered by the physician which resulted in a significant medication error when the resident was provided a medication he was not ordered and the medication was listed as a mediation the resident was allergic to. This affected one (#45) out of two residents observed for medication administration. Facility census was 42. Residents Affected - Few Findings include: Review of Resident #45's medical record revealed the resident was admitted to the facility on [DATE]. Diagnosis include fractured femur, chronic respiratory failure, type two diabetes, cardiomyopathy, peripheral vascular disease, asthma and hypertension. Resident #45 had allergies listed as Atorvastatin (statin) with reaction of severe weakness stating statin's other than Rosuvastatin (statin) cause problems, Liraglutide (incretin mimetics) reaction nausea and vomiting, Nortriptyline (antidepressant) dizziness. Review of Resident #45's orders revealed the resident had orders for Rosuvastatin 10 mg daily for hyperlipidemia, daily 7:00 P.M.-10:00 P. M. dated 11/23/23. Further record review revealed there was no order in Resident #45's medical record for Atorvastatin 40 mg. Resident #45 had an order that indicated may use generic equivalents unless otherwise stated dated 11/22/23. Review of Resident #45's physician progress note dated 11/24/23 at 10:36 P.M. revealed the resident had a hospital stay related to a left femoral fracture, pain, muscle weakness, nausea, and diabetes. The fracture occurred as result of a fall and he was medically stabilized and transferred to the nursing facility for ongoing care and therapy. Observation of medication pass on 12/06/23 revealed Resident #45 was provided Atorvastatin (statin) 40 mg at 8:29 A.M. by Licensed Practical Nurse (LPN) #400. During the medication pass LPN #400 removed one medication Lasix (diuretic) 20 mg as the resident was leaving for an appointment and the family requested the medication to be administered when the resident returned from the appointment. LPN #400 verified no other medications were removed from the morning medication pack. Interview on 12/06/23 at 9:45 A.M. with Clinical Nurse Consultant (CNC) #375 confirmed Atorvastatin 40 mg was not ordered for Resident #45. Observation of the 12/06/23 morning medication pack for Resident #45, CNC #375 confirmed the pack had Atorvastatin 40 mg listed as included in the pack which was administered to the resident on 12/06/23. Observation of the medication cart with CNC #375 on 12/06/23 at 10:00 A.M. confirmed the medication packs supplied from pharmacy for Resident #45 had Atorvastatin 40 mg in the morning medication packs, and the evening medication packs did not contain Rosuvastatin 10 mg. Observation of Resident #45's medication administration record (MAR) with CNC #375 on 12/06/23 at 10:05 A.M. confirmed the staff were documenting Resident #45 was receiving Rosuvastatin 10 mg every night however the medication was not in the medication packs that were available in the medication cart to administer to the resident, and there was no record of an order for Atorvastatin for Resident #45 which was the medication 366492 Page 3 of 4 366492 12/06/2023 Norwich Springs Health Campus 4680 Library Way Hilliard, OH 43026

F 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few included in his morning medication packs and was observed to be administered to the resident on 12/06/23 at 8:29 A.M. Interview with CNC #375 on 12/06/23 at 10:45 A.M. revealed the pharmacy had a therapeutic interchange for Rosuvastatin to be changed to Atorvastatin for residents in the facility. It was asked if the pharmacy routinely interchanged medication when the resident was documented as allergic to the medication. CNC #375 stated she would not think so but the Atorvastatin was documented to cause weakness in Resident #45. CNC #375 verified there was no documentation in the medical record indicating Resident #45's practitioner was asked if Resident #45 could have Atorvastatin administered instead of Rosuvastatin. CNC #375 confirmed Resident #45 was at the facility to receive therapy services after a fall at home. Interview on 12/06/23 at 1:26 P.M. with Certified Nurse Practitioner (CNP) #350 revealed she would expect pharmacy to not complete a therapeutic interchange and provide a resident medications they were allergic to. CNP #350 verified she had not been asked if she wanted or if it was ok to change the Rosuvastatin to Atorvastatin for Resident #45. CNP #350 verified Resident #45's hospital paperwork revealed all statin's except Rosuvastatin caused issues for Resident #45. CNP #350 verified Resident #45's facility medical chart including his pharmacy orders listed Atorvastatin as an active allergy for the resident. CNP #350 verified Resident #45 was at the facility to gain strength after a fall with a fracture occurred at his home. This deficiency represents non-compliance investigated under Complaint Number OH00147793. 366492 Page 4 of 4