Based on interview and record review, the facility failed to ensure the accuracy of the Minimum Data Set (MDS) assessment for 1 of 1 residents reviewed for Resident Assessment. (Resident 40) Finding includes: During an interview on 9/26/24 at 10:51 a.m., Resident 40 indicated she had limitation of her upper and lower extremities and staff assisted her with range of motion (ROM) exercise. On 9/30/24 at 3:15 p.m., Resident 40's clinical record was reviewed. The diagnoses included, but were not limited to, cerebral infarction (stroke), right side hemiparesis (partial paralysis on one side of the body), and contracture (shortening of muscles that causes joints to stiffen). The Annual MDS assessment, dated 9/6/24, indicated Resident 40 was cognitively intact, had impairment on one side of her upper and lower extremity, had no days that PROM was preformed for at least 15 minutes a day, and had no days that AAROM was performed for at least 15 minutes a day. The Passive Range of Motion (PROM) Report, dated 9/1/24-10/1/24, indicated the following: - On 9/3/24 at 2:59 p.m., Resident 40 had 15 minutes of PROM. - On 9/4/24 at 2:59 p.m., Resident 40 had 15 minutes of PROM. -On 9/5/24 at 2:59 p.m., Resident 40 had 15 minutes of PROM. The Active Assisted Range of Motion (AAROM) Report, dated 9/1/24-10/1/24, indicated the following: - On 9/3/24 at 2:59 p.m., Resident 40 had 15 minutes of AAROM. -On 9/4/24 at 2:59 p.m., Resident 40 had 15 minutes of AAROM. -On 9/5/24 at 2:59 p.m., Resident 40 had 15 minutes of AAROM. The Restorative Nursing Progress Notes, dated 9/6/24, indicated Resident 40 received AAROM and PROM restorative program three times a week. During an interview on 10/1/24 at 9:35 a.m., the MDS Coordinator indicated the MDS assessment should of been coded for the three days Resident 40 received PROM and AAROM. On 10/1/24 at 3:42 p.m., the Assistant Director of Nursing (ADON) indicated they did not have a MDS assessment coding policy. They followed the Resident Assessment Instrument (RAI) manual for coding the MDS assessment. 3.1-31(d)

Based on observation, record review, and interview, the facility failed to provide respiratory care for 1 of 3 residents reviewed for oxygen therapy. Oxygen tubing and humidification water bottles were not labeled with a date. (Resident 26) Finding includes: On 9/26/24 at 10:15 a.m., Resident 26 was observed lying in bed with oxygen (O2) being administered via nasal cannula (NC) at 4 liters (L). There was no date observed on the NC tubing or humidification water bottle. On 9/26/24 at 1:52 p.m., Resident 26 was observed lying in bed with O2 being administered via NC at 4 L. There was no date observed on the NC tubing or humidification water bottle. On 9/27/24 at 10:30 a.m., Resident 26 was observed standing at bedside with oxygen being administered at 4 L via NC, no date observed on the NC tubing or humidification water bottle. On 9/30/24 at 9:15 a.m., Resident 26 was observed lying in bed with oxygen in use. There was no date observed on the NC or humidification water bottle. On 10/1/24 at 9:49 a.m., Resident 26 was observed lying in bed with oxygen in place at 4 L via NC. There was no date observed on the NC or humidification water bottle. On 9/27/24 12:51 p.m., Resident 26's clinical record was reviewed. The diagnoses included, but not limited to, Chronic Obstructive Pulmonary Disease (COPD), Type 2 diabetes mellitus, and dementia. The quarterly Minimum Data Set (MDS) assessment, dated 7/5/24, indicated Resident 26 received oxygen therapy. The care plan, revised on 10/30/23, indicated Resident 26 had oxygen therapy related to respiratory illness. The care plan indicated to change O2 nebulizer, tubing, and humidifier weekly. A physician's order, dated 4/15/24, indicated titrate oxygen to keep saturations greater than 92% on 2-5L per NC every shift. A physician's order, dated 9/6/24, indicated O2 tubing and humidified water change every week, night shift every Friday for oxygen usage. During an interview on 10/1/24 at 10:20 a.m., the Director of Nursing (DON) indicated Resident 26 had current order for oxygen therapy. The DON indicated that they changed the tubing and humidification bottle each week. The DON indicated the date should be written on the tubing and bottle. The DON indicated there was no date noted on nasal cannula tubing and humidification water bottle. On 10/1/24 at 2:30 p.m., the Assistant Director of Nursing (ADON) provided the facility policy, Oxygen Administration, dated 1/8/24, she indicated it was a policy currently being used. A review of the policy indicated, .5. Staff shall perform hand hygiene and don gloves when administering oxygen .Other infection control measures include: .b. change oxygen tubing and mask/cannula weekly .c. change humidification bottle every 72 hours or per facility policy, or as recommended by manufacturer . 3.1-47(a)(6)

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure sit to stand lift foot platforms were clean for 4 of 4 sit to stand lifts observed. Findings include: 1. On the following dates and times, a non-mechanized sit to stand lift was observed in the hallway outside of room [ROOM NUMBER] with the foot platform containing food crumbs and debris: - On 9/27/24 at 10:10 a.m. - On 9/30/24 at 1:20 p.m. - On 10/1/24 at 11:45 a.m. 2. On the following dates and times, a non-mechanized sit to stand lift was observed in the hallway outside of room [ROOM NUMBER] with the foot platform containing food crumbs and debris: - On 9/27/24 at 10:20 a.m. - On 9/30/24 at 1:30 p.m. - On 10/1/24 at 11:55 a.m. 3. On the following dates and times, a mechanized sit to stand lift was observed in the hallway outside of room [ROOM NUMBER] with the foot platform containing food crumbs and debris: - On 9/27/24 at 10:25 a.m. - On 9/30/24 at 1:35 p.m. - On 10/1/24 at 11:58 a.m. 4. On the following dates and times, a non-mechanized sit to stand lift was observed in the hallway next to the Unit 500 soiled utility room with the foot platform containing food crumbs and debris: - On 9/27/24 at 10:30 a.m. - On 9/30/24 at 1:40 p.m. - On 10/1/24 at 12:02 .p.m During an interview on 10/1/24 at 3:00 p.m., the Administrator indicated the foot platforms of the sit to stand lifts were in need of cleaning before resident use. On 10/1/24 at 3:40 p.m., the Assistant Director of Nursing provided the Resident Rights, revised date 3/5/24, and indicated this was the Resident Rights policy used by the facility. A review of the policy indicated, .the resident has the right to a safe, clean, comfortable and homelike environment . 3.1-19(f)

2. On 10/30/23 at 11:35 a.m., Resident 89's clinical record was reviewed. The diagnoses included, but were not limited to, diabetes mellitus and depression. Resident 89's progress note, dated 10/3/23 at 8:26 a.m., indicated she was transferred to another facility. The clinical record lacked documentation of the resident or the resident's representative being notified in writing the reason of the transfer. During an interview on 10/30/23 at 1:10 p.m., the Administrator indicated the Notice of Transfer or Discharge forms were not sent to the representative in writing. The representative would be notified verbally by phone when a resident was transferred to the hospital. The forms would be sent when the resident goes to the hospital but there was no documentation the resident received it in writing. On 10/30/23 at 1:30 p.m., the Administrator provided the facility policy, Bed Hold and Return to Facility Policy and Procedure, undated and indicated this was the policy currently being used by the facility. A review of the policy indicated .The nurse will obtain the Bed Hold Policy and Return to Facility notice and provide the notice to the resident and their representative at the time of transfer or leave of absence .The nurse will inform the resident representative, on the telephone if necessary, about the bed hold and return to the facility policy and ask how best to provide a copy of notice to the representative . 3.1-12(a)(6)(A)(i) 3.1-12(a)(6)(A)(ii) Based on interview and record review, the facility failed to ensure the written notification required for a transfer and discharge was given to the resident and the resident representative for 2 of 3 residents reviewed. (Resident 43, Resident 89) Findings include: 1. On 10/30/23 at 11:42 a.m., Resident 43's clinical record was reviewed. The diagnosis included, but was not limited to Alzheimer's disease with late onset. Resident 43's progress notes indicated the resident was sent to the hospital on 6/29/23. The Notice of Transfer or Discharge forms dated 6/29/23, lacked documentation the resident and the resident's representative had been notified of the transfer in writing and provided the appeal rights information in writing including the contact information of the Office of the State LTC (Long Term Care) Ombudsman, after the resident was sent out to the hospital.

Based on interview and record review, the facility failed to ensure the notification of the bed-hold policy required for residents who transferred to the hospital was provided in writing to the resident or the residents representative for 1 of 2 residents reviewed for hospitalization. (Resident 43) Findings include: On 10/30/23 at 11:42 a.m., Resident 43's clinical record was reviewed. The diagnosis included, but was not limited to, Alzheimer's disease with late onset. Resident 43's progress notes indicated the resident was sent to the hospital on 6/29/23. There was no documentation that a written notice that specified the facility's bed-hold policy forms were provided to the resident or the resident's representative. During an interview on 10/30/23 at 1:10 p.m., the Administrator indicated the bed-hold policy forms were not sent to the representative in writing. The representative would be notified verbally by phone when a resident was transferred to the hospital. The forms would be sent when the resident goes to the hospital but there was no documentation the resident received it in writing. On 10/30/23 at 1:30 p.m., the Administrator provided the facility policy, Bed Hold and Return to Facility Policy and Procedure, undated and indicated this was the policy currently being used by the facility. A review of the policy indicated, . The nurse will obtain the Bed Hold Policy and Return to Facility notice and provide the notice to the resident and their representative at the time of transfer or leave of absence .The nurse will inform the resident representative, on the telephone if necessary, about the bed hold and return to the facility policy and ask how best to provide a copy of notice to the representative . 3.1-12(a)(25) 3.1-12(a)(26)

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to identify and respond to an assessed weight loss and failed to implement interventions for 1 of 2 residents reviewed for nutrition. (Resident 61) Findings include: Resident 61's clinical record was reviewed on 10/26/23 at 10:00 a.m. The diagnoses included, but were not limited to, dementia and anxiety disorder. The Quarterly Minimum Data Set (MDS) assessment dated [DATE], assessed Resident 61 as being extensive assistance of 1 with eating. Resident 61's weights indicated the following: - On 8/1/23, the resident weighed 121.8 pounds. - On 9/1/23, the resident weighed 122.6 pounds. - On 10/4/23, the resident weighed 122 pounds. - On 10/16/23, the resident weighed 114.8 pounds. - On 10/17/23, the resident weighed 114.8 pounds. This was an assessed 5.90 percent weight loss in 12 days. The clinical record for Resident 61 lacked documentation of an assessment or implementation of a nutritional intervention after the resident was noted to have a weight loss on 10/16/2023. During an observation on 10/26/23 at 12:07 p.m., Resident 61 was observed to be sitting at a table in the dining room. The meal contained a tenderloin sandwich, ice cream, french fries, peach crisp and a coke. Resident 61 was feeding herself but only ate a small amount of ice cream before trying to stand up and roll away from the table in her wheelchair. Certified Nursing Aide (CNA) 1 attempted to have the resident sit back down and finish her meal but was unsuccessful. CNA 1 did not attempt to assist the resident with eating. The resident eventually rolled away in her wheelchair down the hall. During an observation on 10/26/23 at 12:14 p.m., CNA 2 was observed to bring Resident 61 back to the table to finish her meal. CNA 2 was observed to tell Resident 61, I have a cup of coffee for you and that would taste good with the peach crisp wouldn't it? The resident replied, yes. CNA 2 fed a bite of the peach crisp to Resident 61 and then walked off saying, enjoy. Resident 61 was observed to immediately roll away from the table and down the hall. During an observation on 10/27/23 at 12:12 p.m., Resident 61 was observed to be sitting at a table in the dining room. The meal contained beef stew, pie, a roll, ice cream, coffee and coke. Resident 61 was feeding herself and ate 100% of the pie, 1/2 carton of ice cream and 1 bite of the roll before trying to stand up and roll away from the table. Staff were not observed trying to assist resident with feeding or attempting to get her to keep eating. During an interview on 10/27/23 at 10:30 a.m., the Director of Nursing (DON) indicated the computer system would trigger a weight loss and would generate a report for them to discuss in morning meeting. The dietician would also run a report on all the residents in the facility. During an interview on 10/30/23 at 10:23 a.m., the DON indicated they weighed Resident 61 on 10/16/23 and noticed she had a weight loss. She ordered a reweigh for 10/17/23. She was unable to find any notes in the computer for recommendations and contact with the dietician. During an interview on 10/30/23 at 10:58 a.m., the Dietician indicated she was just looking at Resident 61 that morning for weight loss because she was a monthly weight and had been consistent with her weight for a long time. She did not have any recent progress except for the Quarterly evaluation on 10/3/23 when she had not lost the weight yet. She planned to put interventions in for her weight loss today. On 10/30/23 at 11:30 a.m., Resident 61's clinical record was revewed. A progress note dated 10/30/23 at 10:49 a.m., indicated, . Resident discussed in NAR [Nutrition at Risk] on 10/17/23 r/t [related to]wt [weight] loss of 7.8# in 30 days. Reweight obtained and is congruent with previous wt. Intake is sporadic with meal consumption averaging 26-50%. RD [Registered Dietician] spoke to nursing about resident preferences. House supps [supplements] ordered TID [three times a day] with meals as resident likes to walk around during meals. Will add he [sic] to NAR for closer monitoring . During an interview on 10/30/23 at 1:07 p.m., Registered Nurse 1 indicated she reweighed Resident 61 today and her weighed was 112.6 both standing and in the wheelchair. On 10/30/23 at 11:00 a.m., the Administrator provided the facility's policy, Weight Monitoring dated, 11/29/22, and indicated it was the policy currently being used by the facility. A review of the policy indicated, . 4. Interventions will be identified, implemented, monitored and modified [as appropriate] consistent with the resident's assessed needs . to maintain acceptable parameters of nutritional status . 3.1-46(a)(1)

Based on observation, interview, and record review, the facility failed to ensure food was stored in a sanitary manner for 3 of 3 kitchen observations. Expired food was not discarded, juice in damaged cans were not separated for return, and food was stored beneath a leaking condenser. Findings include: During tours of the facility kitchen on 10/24/23 at 1:55 P.M., 10/26/23 at 10:45 A.M., and 10/27/23 at 12:30 P.M., the following was observed: 1. On a shelf in the walk-in refrigerator were two 5 pound containers of cottage cheese with the best by date of 10/23/23. 2. In the walk-in freezer, beneath a condenser upon which water had leaked and formed ice was an open 29.7 pound box of biscuit dough upon and within which ice had fallen. 3. In the kitchen dry stock room, on the shelving unit upon which multiple canned goods were stored for consumption were three 46 ounce cans of pineapple juice. The double seal edges of the cans were deeply dented. During an interview on 10/27/23 at 2:20 P.M., the facility administrator indicated the expired cottage cheese should have been discarded, food should not have been stored beneath a leaking condenser, and the dented cans of pineapple juice should have been removed from the canned goods shelving unit. On 10/31/23 at 10:22 A.M., the facility administrator provided the Food and Supply Storage policy, revised date of January 2022 and indicated this was the policy used by the facility. A review of the policy indicated, .foods past the .best by date should be discarded .maintain designated area for items that are damaged (such as dented cans) . On 10/31/23 at 1:05 P.M., a review of the Indiana State Department of Health Retail Food Establishment Sanitation Requirements manual, effective date November 13, 2004 indicated, .410 IAC 7-24-178 Food storage; prohibited areas Sec. 178. (a) Food may not be stored as follows: .(2) Under the following: .under lines on which water has condensed .410 IAC 7-24-202 .products that are held by the owner or operator in a retail food establishment for credit, redemption, or return to the distributor, such as damaged .products, shall be segregated and held in designated areas that are separated from (1) food . 3.1-21(i)(2) 3.1-21(i)(3)

Based on interview and record review, the facility failed to protect the residents right to be free from misappropriation of resident property for 1 of 3 residents reviewed. (Resident B, RN 1) Finding include: During an interview on 5/25/23 at 2:00 P.M., the DON indicated she was approached by a nurse at the end of March 2023 who was concerned with a residents muscle relaxer. Resident B was running out of the muscle relaxer too soon. The DON indicated she waited until the next delivery and took a picture of the medication. At that time, the DON noticed the medication was missing but documented as administered on the MAR (Medication Administration Record). The DON indicated RN 1 was the nurse removing the medication from the EDK (Emergency Drug Kit). The DON indicated the following morning picture of the medication indicated 7 pills were missing and Resident B was only prescribed to take one pill three times a day. She also indicated RN 1 was the only person to have the keys to the medication cart. RN 1 denied taking any medication, didn't return to the facility, and stopped responding to their phone calls. The DON indicated during the facility investigation, the DON and Administrator checked RN 1's office and found 2 empty pill packets for the muscle relaxer, dating back to December 2022 in her file cabinet. The pill packet had contained tizanidine HCl Tablet 4 mg (milligrams). On 5/25/23 at 2:15 P.M., Resident B's clinical record was reviewed. The diagnoses included, but were not limited to, dementia, anxiety, and diabetes. The Annual Minimum Data Set (MDS) assessment, dated 3/4/22, indicated Resident B was cognitively intact. The Physician's Orders included, but were not limited to: Tizanidine HCl (muscle relaxer) 4 mg, three times a day, initiated on 6/15/22. On 5/25/23 at 2:45 P.M., RN 1 was unable to be contacted for interview. On 5/25/23 at 2:06 P.M., the Administrator provided the current Medication Management Policy, undated, and indicated it was the current policy in use by the facility. It indicated the policy was to promote a safe and accurate medication management system for each individual resident. This Federal tag is related to Complaint IN00406868. 3.1-28(a)