Kingston Health Center of Perrysburg

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, staff interview, medical record review, review of maintenance documents, and review of the facility's policies, the facility failed to ensure staff wore appropriate Personal Protective Equipment (PPE) when providing care for residents who were infected with COVID-19. This affected one (Resident #114) of one resident observed for droplet precautions. Additionally, the facility failed to complete weekly water flushes of equipment at risk for developing Legionella pneumophila (the cause of Legionnaire's Disease). This had the potential to affect all 55 residents in the facility. Findings include: 1. Review of the medical record for Resident #114 revealed an admission date of 08/26/24 with a diagnosis of COVID-19 on 09/12/24. Review of modified 5-day Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #114 had intact cognition. Review of a physician order dated 08/27/24 revealed Resident #114 received occupational therapy (OT) five times weekly for 60 days. Review of a physician…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, record review, resident and staff interview, and review of the facility policy, the facility failed to ensure residents were provided a bed long enough to accommodate their height. This affected one (#107) of one resident reviewed for bed length. The facility census was 55. Findings include: Review of the medical record for Resident #107 revealed an admission date of 09/03/24 with diagnoses of osteoarthritis, anxiety, and gout. Review of the admission Evaluation/Observation dated 09/03/24 revealed Resident #107 was alert and oriented to person, place, time, and event. Review of the Resident #107's height, documented 09/03/24, revealed he was 78 inches tall (six feet, six inches tall). Review of a nurses progress note dated 09/03/24 revealed a tall bed was ordered for Resident #107. Observation and interview on 09/16/24 at 9:33 A.M. revealed Resident #107 in bed with the head of the bed elevated to allow him to sit up in bed. Resident #107's head was at the same height as the top of the mattress and he had pillows under each knee keeping his knees bent. A flat…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, resident interview, staff interview, and review of policy, the facility failed to ensure care conferences were offered quarterly. This affected two (#13 and #41) of three residents reviewed for care plan conferences. The facility census was 55. Findings include: 1. Review of the medical record revealed Resident #13 was admitted on [DATE]. Diagnoses included hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side, hypertensive heart disease without heart failure, major depressive disorder recurrent, and mixed hyperlipidemia. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed the resident was not assessed for cognition. The previous MDS assessment, dated 04/04/24, revealed Resident #13 was cognitively impaired. Review of the social service progress note dated 11/02/23 revealed a care conference was held. Further review of the medical record revealed no additional care conferences were completed. Interview on 09/19/24 at 10:54 A.M.…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, resident interview, staff interview, and policy review, the facility failed to assist dependent male residents with shaving. This affected two (Residents #22 and #157) of two reviewed for activities of daily living. The facility census was 55. Findings include: 1. Review of Resident #22's medical record revealed an admission date of 07/24/24. Diagnoses included hemiplegia, hemiparesis, and diabetes mellitus. Review of Resident #22's admission Minimum Data Set (MDS) assessment dated [DATE] revealed the resident was cognitively intact and required substantial assistance for showering and bathing. Review of Resident #22's most recent care plan revealed the resident required assistance with activities of daily living related to weakness. He required assistance with dressing and grooming. Observation of Resident #22 on 09/16/22 revealed he had a full beard which was uneven and approximately 1.5 inches long. Interview with Resident #22 on 09/16/24 at 1:23 P.M. revealed he wanted his beard shaved…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, observation, resident interview, staff interview, and review of policy, the facility failed to ensure pressure ulcer reducing interventions were implemented as ordered. This affected one (#41) of one residents reviewed for pressure ulcers. The facility census was 55. Findings include: Review of the medical record revealed Resident #41 was admitted on [DATE]. Diagnoses included other incomplete lesion at C1, C2, C3, and C4 level of cervical spinal cord, acute and chronic respiratory failure with hypoxia, type two diabetes mellitus with hyperglycemia, pressure ulcer of sacral region stage four, and pressure ulcer of other site stage four. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed the resident was cognitively intact and had range of motion impairment on the upper and lower extremities. Resident #41 required substantial/maximal assistance with toileting, bathing and was dependent for transfers. Review of physician orders dated 03/25/24 revealed Resident #41…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation and staff interview, the facility failed to ensure the gap between mattresses and bed rails were safe and appropriate. This affected one (#32) of two residents reviewed for bed rails. The facility census was 55. Findings include: Review of the medical record for Resident #32 revealed an admission date of 08/13/24 with diagnoses of acute and chronic respiratory failure and quadriplegia. Review of the 5-day Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #32 was rarely/never understood and was dependent on staff for all Activities of Daily Living (ADLs). Review of the Bed Rail Safety assessment dated [DATE] revealed Resident #32 was appropriate for bed rails to assist in alerting staff when unsafe transfers were attempted. Review of the current care plan for Resident #32 revealed bed rails were in place to provide a feeling of comfort/security, increase mobility, and act as a bed perimeter reminder. Interview on 09/16/24 at 9:25 A.M. with Licensed Practical Nurse (LPN) #362…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation and staff interview, the facility failed to ensure residents had access to a call light. This affected one (#32) of one resident reviewed for call light accessibility. The facility census was 55. Findings include: Review of the medical record for Resident #32 revealed an admission date of 08/13/24 with diagnoses of acute and chronic respiratory failure and quadriplegia. Review of the 5-day Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #32 was rarely/never understood and was dependent on staff for all Activities of Daily Living (ADLs). Review of the current care plan for Resident #32 revealed he had a communication problem, Resident #32 was unable to communicate and had been working with speech language pathology (SLP) therapy, outpatient, to use eye gaze device. Interventions included keeping Resident #32's call light in reach. Interview on 09/16/24 at 9:25 A.M. with Licensed Practical Nurse (LPN) #362 revealed Resident #32 was quadriplegic and had no function of his arms…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, observation, staff interview, and policy review, the facility failed to ensure medications were not left at bedside and were administered appropriately. This affected one (Resident #30) out of 24 residents on the third floor. The facility census was 52. Findings include: Review of Resident #30's medical record revealed an admission date of 04/26/22 with diagnoses including macular degeneration, multiple fractures due to a preadmission fall, diabetes mellitus, and depression. Review of Resident #30's 5-day admission Minimum Data Set assessment dated [DATE] revealed Resident #30 had a high cognitive function. Review of Resident #30's most recent care plan revealed the resident had impaired swallowing related to dysphagia and wearing a cervical collar. Interventions included to observe the resident for signs and symptoms of swallowing issues. Observation on 06/06/22 at 9:51 A.M. revealed Resident #30 was laying in bed with a plastic cup on her bedside table. The cup contained four…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, resident and staff interview, medical record review, and review of a facility policy, the facility failed to ensure medications were stored in a safe and secure manner. This affected two (Resident #34 and #152) out of 28 resident bedrooms observed on the second floor of the facility. The census was 52. Findings include: 1. Review of Resident #34's medical record revealed an admission date of 05/03/22. Diagnoses included orthopedic aftercare following surgical amputation, chronic respiratory failure with hypoxia, end stage renal disease, diabetes mellitus type two, and peripheral vascular disease. Review of an admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #34 was assessed with moderately impaired cognition. Review of physician orders dated between 05/03/22 and 06/07/22 revealed Resident #34 had no physician order for artificial tears. Review of medication administration records (MARs) from May 2022 and June 2022 revealed no documentation of Resident #34 ever…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on review of the Water Management Protocol and staff interview, the facility failed to ensure Legionella control measures were implemented per the facility protocol. This had the potential to affect 53 of 53 residents who reside in the facility. Findings include: Review of the undated facility protocol titled, Water Management Protocol, revealed the purpose was to provide appropriate monitoring, proactive intervention, corrective action and continuous process improvement relative to the facility potable systems. Water management protocols included: regular water samples will be collected from control point area; chlorine concentration levels will be taken and recorded from multiple areas (no established time frames documented); all fixtures will be exercised and allowed to flush with a moderate or better water flow (both hot and cold water) for 30 seconds weekly; staff members will complete this task in all resident rooms (including lavatory sinks, eye wash station, all point of use devices; the Maintenance Director or designee is responsible for flushing point of use devices…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.