Based on interview and record review, the facility failed to ensure physician orders were in place related to code status for 2 of 3 residents reviewed. ( Resident 62 and 166) Findings include: 1. Resident 62's record review on 10/18/24 at 9:41 AM, indicated diagnoses included encephalopathy and generalized anxiety. A review of physician orders indicated there were no orders for Resident 62's code status - Do not resuscitate(DNR). A review of state of Indiana out of hospital DNR declaration and order was signed by physician on 10/3/24. 2. Resident 166's record review on 10/18/24 at 10:30 AM indicated diagnoses included chronic obstructive pulmonary disease. A review of physician orders indicated there were no physician orders for Resident 166's code status- Do nor resuscitate (DNR). A review of treatment option declaration (advance directives) indicated the resident wished no Resuscitation. The document was signed on 10/8/24. In an interview, on 10/18/24 at 9:48 AM, Registered Nurse 5, indicated code status should be on the face sheet, physician orders, and resident room doors. In an interview, on 10/21/24 at 9:55 AM, the Director of Nursing (DON) indicated there should have been a physician order for the DNR code status. A current facility policy, titled Medical Treatment Declaration Policy, dated 9/15, was provided by the DON on 10/21/24 at 10:30 AM. The policy indicated . to establish guidelines to ensure each resident is given the appropriate and required information in order to make informed choices in their medical treatment 3.1-4

Based on interview and record review the facility failed to ensure intervention were implented to prevent elopement for 1 of 4 residents reviewed (Resident B). Findings include: During an interview on 8/5/24 at 9:57 AM, the Administrator indicated on 5/18/24 Resident B was in the courtyard with Activity Aide 2. Activity Aide 2 told Resident B she needed to use the restroom and indicated for Resident B to stay in the courtyard. Activity Aide 2 returned from the restroom and Resident B was no longer in the courtyard. The Administrator indicated Resident B had exited the courtyard through the gate, walked around the building to door 8 and rang the door bell. The Administrator indicated Resident B was let in by staff and Resident B's nurse was notified. The Administrator indicated the gate exiting the courtyard was not locked. During an interview on 8/5/24 at 10:30 AM, the Director of Nursing (DON) indicated on 5/18/24, Activity Aide 2 entered the courtyard with Resident B. The DON indicated Resident B had a wanderguard/code alert attached to her walker. The DON indicated the door to the courtyard alarmed due to Resident B's wanderguard/code alert. Activity Aide 2 disarmed upon entering the courtyard. The gate did not have a code alert alarm. A statement, undated, was provided by Human Resources on 8/5/24 at 10:03 AM. The statement indicated the Activity Aide 2 did not realize Resident B shouldn't be unattended outside. The typical standard was to not leave residents outside alone. Resident B was able to walk herself, communicate her needs/wants and was alert. The statement indicated activity staff were given education regarding residents not to be outside alone when the following applied: the resident was a fall risk, unable to communicate needs/wants, confusion, dementia, and/or the resident is unable to move/transfer themselves. During an interview on 8/15/24 at 11:30 AM, Registered Nurse (RN) 3 indicated cognitively intact residents were allowed to be on the patio/courtyard area unattended. Residents who were unable to be alone, staff stayed with the residents while in the courtyard. RN 3 indicated Resident B had a wanderguard/code alert on her walker due to exit seeking. A record review was completed on 8/5/24 at 10:56 AM. Diagnosis include dementia and anxiety disorder. A progress note, dated 5/18/24, indicated around 3:20 PM, Resident B was outside, on patio with Activity Aide 2. Activity Aide 2 went inside to use the restroom and left Resident B outside, unattended on the patio. While unattended Resident B opened the gate, walked around the building to door 8 and rang the doorbell. A nurse let Resident B inside and called Resident B's nurse to assist resident back to the hall she resided on. The progress note also indicated Resident B's mental state was normally confused. A policy, revised 3/22, titled Elopement of a Resident, was provided by Human Resources on 8/5/24 at 10:03 AM. The policy indicated elopement is defined as an unplanned exit of a resident outside of the building educate all staff to at risk status and interventions developed to reduce or prevent elopement. This Federal citation relates to Complaint IN00434869. 3.1-45(a)