**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interviews, and policy review, the facility failed to treat a resident with dignity and respect by violating their privacy. This affected one (#249) out of four residents reviewed for resident rights. The facility census was 248. Findings include: Review of the closed medical record for Resident #249 revealed an admission date of 07/25/19 and a discharge date of 02/02/25. Diagnoses included viral pneumonia, depression, psoriasis, hypertension, atrial fibrillation, vitamin d deficiency, localized edema, anxiety disorder, and hyperlipidemia. Review of the significant change Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #249 had moderately impaired cognition. Resident #249 was assessed to require setup assistance for eating, and oral hygiene, substantial/maximal assistance for bathing, dressing, personal hygiene, and bed mobility, and was dependent on staff for toileting. Review of the facility's counseling/education forms for State Tested Nursing Assistants (STNA) #12 and #14 dated 01/20/25 revealed they were educated for taking pictures of a resident that was soiled and showing the pictures to other staff at the facility. The form indicated they were advised not to take pictures of residents with their personal phones or share pictures of residents with other staff. Interviews on 03/02/25 from 1:19 P.M. to 1:49 P.M. via telephone with Registered Nurse (RN) Unit Manager (UM) #100 revealed there was an incident where a picture was taken of a resident, and the staff involved were STNAs #12 and #14. RN UM #100 stated the picture did not show the resident's face and only showed their hands and abdominal area that were soiled. RN UM #100 reported she completed a counseling form with both employees involved. Interview on 03/02/25 at 1:45 P.M. with the Director of Nursing (DON) revealed the picture was alleged to be of Resident #249 and showed feces on their hands and abdominal area. Interview on 03/02/25 at 1:52 P.M. via telephone with STNA #14 revealed she delivered a breakfast tray to Resident #249 and discovered her hands were dirty. STNA #14 stated she informed Resident #249's aide, STNA #12, and both staff pulled back the blankets on Resident #249 where it was revealed the resident was soiled with feces. STNA #14 verified she took a picture of Resident #249's legs that had feces on them and sent the picture to STNA #12 who then shared the picture with RN UM #100. Interview on 03/02/25 at 2:12 P.M. via telephone with STNA #16 revealed STNA #12 showed her the picture and said it was of Resident #249. STNA #16 stated she reported the incident to RN UM #100. Review of the policy titled, Residents' Rights, reviewed 10/22/19, revealed residents had the right to be treated with respect and dignity. This deficiency represents non-compliance investigated under Master Complaint Number OH00161794.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, and review of facility policy, the facility failed ensure a resident was free from unnecessary psychotropic medications by ensuring staff documented justification for an increase in a resident's antipsychotic medication. This affected one (#117) of five reviewed for unnecessary medications. The census was 239. Findings include: Review of Resident #117's medical record revealed an admission date of 03/06/20. Diagnoses listed included cerebral atherosclerosis, heart failure, restlessness and agitation, depression, and dementia with agitation. Review of an annual Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #117's brief interview for mental status (BIMS) score was 12, indicating the resident had moderate cognitive impairment. Resident #117 was assessed as not having any psychotic disorders. Review of physician orders revealed an order to increase the antipsychotic medication Seroquel from 25 milligrams (mg) twice a day to 50 mg twice a day (BID) by mouth (PO) dated 04/15/22 for unspecified dementia with behavioral disturbance. Resident #117 remained on Seroquel 50 mg PO BID with an order dated 09/10/22. Review of social services progress notes dated 03/14/22 revealed Licensed Social Worker (LSW) met with Resident #117's daughter via telephone. Resident #117 was adjusting favorably to new living environment with no changes in mood or behavior. Review of physician assistant (PA) progress notes dated 04/15/22 revealed Resident #117 had cerebral atherosclerosis with behaviors and was evaluated for delusions. Resident #117's daughter stated her mother had increased delusions, distressed, and tearful. Resident #117's daughter said many things her mother is saying are not based on reality, such as her spouse is cheating, etc. Resident #117 is currently on Seroquel 25 mg PO BID. Review of an facility internal email dated 04/14/22 from Licensed Social Worker (LSW) #9 to members of the Interdisciplinary Team (IDT) members revealed LSW #9 spoke with Resident #117's daughter who expressed concerns regarding her mother's demeanor, citing that Resident #117 had become increasingly delusional, distressed, and tearful. Resident #117's daughter reported Resident #117 says many things that are not based in reality (such as spouse is cheating on her) and wanted the physician to be consulted regarding whether or not an increase in Seroquel was warranted. Nursing staff was to make the physician aware of Resident #117's daughter's request and provide supporting documentation in the clinical record of Resident #117's mood for physician reference. Further review of Resident #117's medical record from admission from 03/09/22 (date of admission to dementia care unit) through 04/15/22 revealed no documentation of any increase in behaviors such as delusions, distress, or tearfulness. Interview with the Director of Nursing (DON) on 10/27/22 at 1:40 P.M. confirmed there was not documentation in the medical record of any increase of Resident #117's behaviors that would justify an increase in the antipsychotic Seroquel on 04/15/22. The DON confirmed nursing staff should monitor and document any increase in behaviors in a resident's medical record. Review of the facility's policy titled Use pf Psychotropic Drugs dated effective 04/16/91 and last revised 05/13/22 revealed the IDT will monitor to verify that residents who receive psychotropic drugs either are currently exhibiting identified symptoms, behaviors or have a history of said behaviors. Behaviors include but are not limited to the following: a. Sundowning; b. Severe anger; c. Aggression; d. Agitation related to sundowning; e. Agitation due to pain (i.e. osteoarthritis); and f. Anxiety. The IDT is responsible for the following: a. Reviewing the resident's behaviors as indicated; b. Monitoring to ensure behaviors are tracked; c. Providing direction to unit nurse regarding consulting with and discussing with the physician any recommended psychotropic drug changes; and d. The MDS nurse will verify that the AIMS (abnormal involuntary movement score) test is done initially and every six months thereafter for antipsychotic drugs.