**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, medical record review, and policy review, the facility failed to ensure a no smoking/oxygen in use sign was posted for a resident receiving oxygen therapy. This affected one (#46) of one residents reviewed for respiratory care. The facility identified 14 residents receiving oxygen therapy. The resident census was 55. Findings include: Medical record revealed Resident #46 was admitted to the facility on [DATE]. Diagnoses included anemia, non-Alzheimer's dementia, anxiety and depression. Review of the quarterly Minimum Data Set Assessment revealed she had a cognition impairment and required the assistance of staff with her activities of daily living. Review of physician orders dated 09/02/19 revealed oxygen was to be titrated to keep her oxygen saturations above 90% PRN (as needed). Observation on 09/10/18 at 10:45 A.M. revealed Resident #46 was receiving two liters per minute of oxygen therapy via nasal cannula. There was no smoking/oxygen in use sign was not on the door. On 09/11/18 at 3:10 P.M. the resident was sitting in her room chair with the oxygen concentrator beside her. The resident said she last used oxygen at lunch time today and she usually used oxygen at night. On 09/11/18 at 3:30 P.M. Licensed Practical Nurse (LPN) #325 said the resident used oxygen PRN (as needed). The nurse checked the residents' oxygen saturation levels PRN. LPN #325 verified the resident did not have a smoking/oxygen in use sign on her door. LPN #325 said the physician had recently ordered the oxygen therapy. On 09/11/18 at 3:42 P.M. State Tested Nurse Aide (STNA) #330 stated the resident used the oxygen at night and sometimes during the day. A review of the Oxygen Administration policy (undated) was conducted. This policy instructed No Smoking/Oxygen in Use signs were to be used.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to implement timely interventions for a resident with a significant weight loss. This affected one (#17) out of two residents reviewed for nutrition. The facility census was 55. Findings include: Review of Resident #17's medical record revealed an admission date of 11/05/16 with diagnoses including dementia with behavioral disturbances, Alzheimer's disease, anxiety disorder, delusional disorders, Parkinson's disease. Resident #17's Comprehensive Minimum Data Set Assessment (MDS) dated [DATE] indicated the resident has severe cognitive impairment and requires extensive assist with all activities of daily living including dressing, toilet use, personal hygiene and eating. Review of the resident's weight log revealed the resident's weight on 08/06/18 was 167.4 pounds and on 09/03/18 the residents weight was 157.6 pounds indicating a weight loss of 5.85% in twenty-eight days. Further review of Resident #17's medical record revealed no documentation related to the significant weight loss, from 09/03/18 to 09/12/18. On 09/12/18 at 9:04 A.M., during an interview Licensed Practical Nurse (LPN) #301 revealed the Licensed Dietician Registered Dietician (LDRD) #200 was in the facility on 9/11/18 and requested the resident be re-weighed, no new orders for dietary interventions were given for Resident #17 at that time. LPN #301 stated the resident was re-weighed on 09/12/18 and weighed 157.8 pounds, LDRD #200 was notified and new orders were given for two nutritional supplements for Resident #17: Ensure Plus 120 milliliters (mls) twice daily, and Magic Cup with lunch and dinner. Review of the Clinical Notes dated 09/12/18 at 10:18 A.M., LDRD #200 documented Resident reviewed, resident re-weight obtained today at 157.8 pounds which verifies weight of 157.6 pounds obtained on 09/03/18 and indicates a significant weight loss of 5.7% in one month. Current body Mass Index (BMI) of 30.9 indicating obesity. On 09/13/18 at 10:54 A.M. during an interview LDRD #200 confirmed nutritional interventions for Resident #17 were not implemented on 09/03/18 when the significant weight loss was discovered.

**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 one residents's (#34) glucometer was cleansed and disinfected appropriately. This occurred when the glucometer was cleansed with an alcohol pad after use. This affected one resident (#34) of one sampled residents for glucometer cleansing. This had the potential to affect three (#34, #3 and #45) residents who had glucometer monitoring on the Memory Support Unit and shared the device. The facility census was 55. Findings include: Review of Resident #34's medical record revealed she was admitted to the facility on [DATE]. Diagnoses include hypertension, diabetes mellitus, arthritis, non-Alzheimer's dementia, unspecified osteoarthritis, history of falling, muscle weakness and Vitamin D deficiency, unspecified. On 09/12/18 at 4:20 P.M. Licensed Practical Nurse (LPN) #301 removed a bag from the medication cart that contained alcohol pads and the residents' glucometer. The nurse said she cleansed the glucometer after use with an alcohol pad. LPN #301 conducted a fingerstick blood glucose sample from Resident #34 finger. At 4:33 P.M. when she went to clean the glucometer prior to putting it back into the medication cart, the nurse wiped it down with an alcohol pad. On 09/12/18 at 4:35 P.M. an interview with the Director of Nursing (DON) revealed the glucometer should have been cleaned after use with the disposable germicidal cleansing wipes. He affirmed the facility policy for Glucometer Cleaning attested to this instruction. The facility confirmed this had the potential to affect the three (#34, #3 and #45) residents who share the glucometer. A review of the Glucometer Cleaning Policy dated 10/15/17 was conducted. The policy instructed the glucometers used for testing (active) residents' blood sugars will be cleansed after each use with the disposable germicidal cleansing wipes. The procedure instructed to wipe the exposed surfaces of the glucometer using the disposable germicidal surface wipes for four minutes. Allow the meter to dry on a clean surface.