Based on record review, review of the facility self-reported incidents, staff interview, and review of the facility policy on abuse, the facility failed to ensure an allegation of physical abuse was reported to the state agency as required. This affected one (#55) of 19 residents screened for abuse. The facility census was 81. Findings include: Review of the medical record for Resident #55 revealed an admission date of 09/26/18. Medical diagnoses included cerebral infarction (stroke), vascular dementia, and depression. Resident #55 resided on the secured memory care unit. Review of the Minimum Data Set (MDS) quarterly assessment, dated 09/06/23, revealed Resident #55 had a Brief Interview for Mental Status (BIMS) score of 04 which indicated severely impaired cognition. Resident #55 had no hallucinations, delusions, or behaviors. Resident #55 was coded to have adequate hearing with no hearing aid or other appliance used. The assessment further identified Resident #55 to need extensive assistance from one to two staff members for transferring, dressing, and personal hygiene. Review of the progress note dated 09/26/23 and timed 9:20 P.M. revealed an incident between Resident #55 and Agency State Tested Nursing Assistant (STNA) #495. Resident #55 called out help me, and a staff STNA responded to take over care of Resident #55. The note described Resident #55 as fearful after Agency STNA #495 had began to start evening care without making Resident #55 aware of the plan. The progress note was authored by Licensed Practical Nurse #418 and was created on 09/27/23 at 10:33 A.M., thirteen hours after the event occurred. Interviews conducted on 10/25/23 between 6:20 A.M. and 7:24 A.M. with Licensed Practical Nurse (LPN) #418 revealed she was the night shift nurse for the memory care unit on 09/26/23. Agency STNA #495 worked in the memory care unit for a twelve hour shift with one other staff STNA. LPN #418 did not directly witness the event, but based her charting on the STNA's account of the event. LPN #418 stated she initially wrote a progress note that described the interaction between Resident #55 and Agency STNA #495 as an attack, but was called back in to the facility the next morning to meet with the Activities Director (AD) #479 and the Director of Nursing (DON), after which meeting she changed her documentation. LPN #418 stated she inactivated her original documentation and re-phrased her progress note. LPN #418 stated she did not directly notify a supervisor about the event that night, but may have mentioned it to the DON during a phone call about another situation. LPN #418 stated both she and the staff STNA she worked with that night provided a written statement. Review of Ohio Department of Health's Certification and Licensure System on 10/26/23 at 10:00 A.M. revealed no self-reported incident had been filed by the facility related to the allegation of physical abuse by Resident #55 on 09/26/23. Review of the daily staffing schedule, dated 09/26/23, revealed STNA #460 was mandated to work from 7:00 P.M. to 11:00 P.M. in the memory care unit with Agency STNA #495. An interview on 10/25/23 at 3:24 P.M. with STNA #460 revealed she works day shift from 7:00 A.M. to 7:00 P.M., but on 09/26/23 was mandated to work an additional four hours. STNA #460 stated 09/26/23 was the first time she had worked with Agency STNA #495. Agency STNA #495 entered Resident #55's room to provide care. STNA #460 walked down the hall when she heard Resident #55 yell help me. STNA #460 stated she knocked quickly but immediately entered the room and found Resident #55 with a hold on Agency STNA's arms. STNA #460 stated Resident #55 recognized her and asked you saw him attack me, right?. STNA #460 sent Agency STNA #495 out of the room and provided care to Resident #55. Resident #55 was upset, fearful, and continued to ask STNA #460 you saw him attack me, right. After care was completed for Resident #55, STNA #460 reported the event to LPN #418. STNA #460 stated she was called back in to the facility the next morning to discuss the incident and provide a written statement. Interview on 10/26/23 at 10:08 A.M. with the Administrator revealed she had no knowledge the incident with Resident #55 on 09/26/23. The Administrator verified she had not reported any self-reported incidents in September 2023, and confirmed the Administrator should be made aware of any and all abuse allegations and investigations of abuse. Interview on 10/26/23 at 10:15 A.M. with the DON and the Administrator revealed the DON was familiar with the incident. The DON stated she was aware of the situation, the facility had investigated the incident, and it was not an abuse situation. Interview on 10/26/23 at 10:35 A.M. with AD #479 revealed she also functioned as the Memory Support Manager and oversaw care of the residents who lived in the memory care unit. On 09/27/23, she saw LPN #418's progress note describing the event, and was concerned. AD#479 and the DON reached out to LPN #418 and STNA #460 and asked them to come in to discuss the situation. Both LPN #418 and STNA #460 provided a written statement. AD #479 stated there was no statement from Agency STNA #495, and the DON had the investigation in her office. AD #479 verified that Resident #55 had severely impaired cognition and a BIMS score of 04 seemed accurate for him. Interview on 10/26/23 at 11:02 A.M. with the DON revealed she discussed the incident with LPN #418 and STNA #460. The DON stated she asked LPN #418 to modify her statement, but figured she would add an addendum, not strike out and completely re-write the narrative. The DON provided a copy of the investigation which included two witness statements and two pages of printed-off progress notes from Resident #55's electronic medical record. The DON verified the four pages were the full investigation the facility completed. Review of witness statement authored by LPN #418, dated 09/27/23, referenced event that occurred 09/26/23 around 9:20 P.M. Agency STNA #495 went into Resident #495's room and did not ask for Resident #55's permission to perform care. Resident #55 yelled help, and STNA#460 entered the room. STNA #460 reported to LPN #418 that Agency STNA #495 attacked me. LPN #418 asked Resident #55 about the incident, and he reported he felt attacked and unsafe. LPN #418 asked Resident #55 why he felt that way, to which he stated Agency STNA #495 entered his room and just started touching and grabbing at him, and that the nurse needed to do something about him, referring to Agency STNA #495. The statement further indicated that LPN #418 asked Agency STNA #495 to not enter Resident #55's room the rest of the night and to communicate with residents before care was attempted. Review of witness statement authored by STNA #460, dated 09/27/23, revealed she entered Resident #55's room after she heard him call for help. Resident #55 was in bed, had a hold on Agency STNA #495's arm. Resident #55 recognized STNA #460 and stated she was his friend. STNA #460 took over the care of Resident #55 and asked him what had happened. Resident #55 asked if STNA #460 had seen Agency STNA #495 attack him. STNA #460 stated she had not witnessed anything firsthand. Resident #55 said nothing further other than he was glad STNA #460 was there. STNA #460 then reported the incident to the nurse. Interview on 10/26/23 at 12:28 with the Administrator and DON revealed the provided witness statements from LPN #418 and STNA #460 and the progress notes documented in Resident #55's medical record were the only components of the facility's investigative file for the incident. The Administrator and DON verified there had been no interviews or assessments attempted of like residents, no recent abuse education or in-servicing for staff, and Agency STNA #495 completed his twelve hour shift, and was not immediately removed from the patient care area. The Administrator indicated she had not read the two staff witness statements until 10/26/23 and verified both statements used the term attacked. Review of the policy Resident Rights, revised August 2022, revealed The resident has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility. Employees shall treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of lift, recognizing each resident's individuality. The facility will protect and promote the rights of the resident. Review of the policy titled Abuse, Mistreatment, Neglect, Exploitation and Misappropriation of Resident Property, dated 2017, revealed residents have the right to be free from abuse, neglect, exploitation, and misappropriation of resident property. It is the facility's policy to investigate all alleged violations involving abuse. Facility staff should immediately report all such allegations to the Administrator and to the Ohio Department of Health (ODH). If a staff member is accused or suspected of Abuse, they should immediately remove that staff member from the facility and the schedule pending the outcome of the investigation. The policy additionally notes that nursing home staff includes employees, consultants, contractors, volunteers, and any other caregivers who provide care and services to residents on behalf of the facility. Documentation in the nurses' notes should include the result of the resident's assessment, notification of the physician and the Resident Representative, and any treatment provided.

Based on record review, review of the facility self-reported incidents, staff interview, and review of the facility policy on abuse, the facility failed to conduct a thorogh investigation of alleged physical abuse. This affected one (#55) of 19 residents screened for abuse. The facility census was 81. Findings include: Review of the medical record for Resident #55 revealed an admission date of 09/26/18. Medical diagnoses included cerebral infarction (stroke), vascular dementia, and depression. Resident #55 resided on the secured memory care unit. Review of the Minimum Data Set (MDS) quarterly assessment, dated 09/06/23, revealed Resident #55 had a Brief Interview for Mental Status (BIMS) score of 04 which indicated severely impaired cognition. Resident #55 had no hallucinations, delusions, or behaviors. Resident #55 was coded to have adequate hearing with no hearing aid or other appliance used. The assessment further identified Resident #55 to need extensive assistance from one to two staff members for transferring, dressing, and personal hygiene. Review of the progress note dated 09/26/23 and timed 9:20 P.M. revealed an incident between Resident #55 and Agency State Tested Nursing Assistant (STNA) #495. Resident #55 called out help me, and a staff STNA responded to take over care of Resident #55. The note described Resident #55 as fearful after Agency STNA #495 had began to start evening care without making Resident #55 aware of the plan. The progress note was authored by Licensed Practical Nurse #418 and was created on 09/27/23 at 10:33 A.M., thirteen hours after the event occurred. Interviews conducted on 10/25/23 between 6:20 A.M. and 7:24 A.M. with Licensed Practical Nurse (LPN) #418 revealed she was the night shift nurse for the memory care unit on 09/26/23. Agency STNA #495 worked in the memory care unit for a twelve hour shift with one other staff STNA. LPN #418 did not directly witness the event, but based her charting on the STNA's account of the event. LPN #418 stated she initially wrote a progress note that described the interaction between Resident #55 and Agency STNA #495 as an attack, but was called back in to the facility the next morning to meet with the Activities Director (AD) #479 and the Director of Nursing (DON), after which meeting she changed her documentation. LPN #418 stated she inactivated her original documentation and re-phrased her progress note. LPN #418 stated she did not directly notify a supervisor about the event that night, but may have mentioned it to the DON during a phone call about another situation. LPN #418 stated both she and the staff STNA she worked with that night provided a written statement. Review of Ohio Department of Health's Certification and Licensure System on 10/26/23 at 10:00 A.M. revealed no self-reported incident had been filed by the facility related to the allegation of physical abuse by Resident #55 on 09/26/23. Review of the daily staffing schedule, dated 09/26/23, revealed STNA #460 was mandated to work from 7:00 P.M. to 11:00 P.M. in the memory care unit with Agency STNA #495. An interview on 10/25/23 at 3:24 P.M. with STNA #460 revealed she works day shift from 7:00 A.M. to 7:00 P.M., but on 09/26/23 was mandated to work an additional four hours. STNA #460 stated 09/26/23 was the first time she had worked with Agency STNA #495. Agency STNA #495 entered Resident #55's room to provide care. STNA #460 walked down the hall when she heard Resident #55 yell help me. STNA #460 stated she knocked quickly but immediately entered the room and found Resident #55 with a hold on Agency STNA's arms. STNA #460 stated Resident #55 recognized her and asked you saw him attack me, right?. STNA #460 sent Agency STNA #495 out of the room and provided care to Resident #55. Resident #55 was upset, fearful, and continued to ask STNA #460 you saw him attack me, right. After care was completed for Resident #55, STNA #460 reported the event to LPN #418. STNA #460 stated she was called back in to the facility the next morning to discuss the incident and provide a written statement. An interview on 10/26/23 at 10:08 A.M. with the Administrator revealed she had no knowledge the incident with Resident #55 on 09/26/23. The administrator verified she had not reported any self-reported incidents in September 2023, but the Administrator should be made aware of any and all abuse allegations and investigations of abuse. An interview on 10/26/23 at 10:15 A.M. with the DON and the Administrator revealed the DON was familiar with the incident. The DON stated she was aware of the situation, the facility had investigated the incident, and it was not an abuse situation. An interview on 10/26/23 at 10:35 with AD #479 revealed she also functions as the Memory Support Manager and oversaw care of the residents who lived in the memory care unit. On 09/27/23, she saw LPN #418's progress note describing the event, and was concerned. AD#479 and the DON reached out to LPN #418 and STNA #460 and asked them to come in to discuss the situation. Both LPN #418 and STNA #460 provided a written statement. AD #479 stated there was no statement from Agency STNA #495, and the DON had the investigation in her office. AD #479 verified that Resident #55 had severely impaired cognition and a BIMS score of 04 seemed accurate for him. An interview on 10/26/23 at 11:02 A.M. with the DON revealed she discussed the incident with LPN #418 and STNA #460. The DON stated she asked LPN #418 to modify her statement, but figured she would add an addendum, not strike out and completely re-write the narrative. The DON provided a copy of the investigation which included two witness statements and two pages of printed-off progress notes from Resident #55's electronic medical record. The DON verified the four pages were the full investigation the facility completed. Review of witness statement authored by LPN #418, dated 09/27/23, referenced event that occurred 09/26/23 around 9:20 P.M. Agency STNA #495 went into Resident #495's room and did not ask for Resident #55's permission to perform care. Resident #55 yelled help, and STNA#460 entered the room. STNA #460 reported to LPN #418 that Agency STNA #495 attacked me. LPN #418 asked Resident #55 about the incident, and he reported he felt attacked and unsafe. LPN #418 asked Resident #55 why he felt that way, to which he stated Agency STNA #495 entered his room and just started touching and grabbing at him, and that the nurse needed to do something about him, referring to Agency STNA #495. The statement further indicated that LPN #418 asked Agency STNA #495 to not enter Resident #55's room the rest of the night and to communicate with residents before care was attempted. Review of witness statement authored by STNA #460, dated 09/27/23, revealed she entered Resident #55's room after she heard him call for help. Resident #55 was in bed, had a hold on Agency STNA #495's arm. Resident #55 recognized STNA #460 and stated she was his friend. STNA #460 took over the care of Resident #55 and asked him what had happened. Resident #55 asked if STNA #460 had seen Agency STNA #495 attack him. STNA #460 stated she had not witnessed anything firsthand. Resident #55 said nothing further other than he was glad STNA #460 was there. STNA #460 then reported the incident to the nurse. An interview on 10/26/23 at 12:28 with the Administrator and DON revealed the provided witness statements from LPN #418 and STNA #460 and the progress notes documented in Resident #55's medical record were the only components of the facility's investigative file for the incident. The Administrator and DON verified there had been no interviews or assessments attempted of like residents, no recent abuse education or in-servicing for staff, and Agency STNA #495 completed his twelve hour shift, and was not immediately removed from the patient care area. The Administrator indicated she had not read the two staff witness statements until 10/26/23 and verified both statements used the term attacked. Review of the policy Resident Rights, revised August 2022, revealed The resident has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility. Employees shall treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of lift, recognizing each resident's individuality. The facility will protect and promote the rights of the resident. Review of the policy titled Abuse, Mistreatment, Neglect, Exploitation and Misappropriation of Resident Property, dated 2017, revealed residents have the right to be free from abuse, neglect, exploitation, and misappropriation of resident property. It is the facility's policy to investigate all alleged violations involving abuse. Facility staff should immediately report all such allegations to the Administrator and to the Ohio Department of Health (ODH). If a staff member is accused or suspected of Abuse, they should immediately remove that staff member from the facility and the schedule pending the outcome of the investigation. The policy additionally notes that nursing home staff includes employees, consultants, contractors, volunteers, and any other caregivers who provide care and services to residents on behalf of the facility. Documentation in the nurses' notes should include the result of the resident's assessment, notification of the physician and the Resident Representative, and any treatment provided.

**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 to implement appropriate fall interventions for Resident #69. This affected one (#69) of two residents reviewed for falls. The facility census was 81. Findings include: Review of the medical record for Resident #69 revealed an admission date of 09/23/21. Medical diagnoses included dementia, anxiety, osteoarthritis, and closed left hip fracture with surgical repair. Resident #69 resided on the secured memory care unit. Review of the Minimum Data Set (MDS) quarterly assessment, dated 09/01/23 revealed Resident #69 had a Brief Interview for Mental Status (BIMS) score of 03, which indicated severely impaired cognition. Resident #69 required extensive assistance of one to two staff members with activities of daily living (ADLs). Review of the plan of care, initiated 09/24/21, revealed Resident #69 to be at high risk for falls and injury due to arthritis, dementia, cardiac disease, confusion, incontinence, poor balance and safety awareness and an unsteady gait. The care plan was updated on 07/14/23 and indicated Resident #69 sustained a left hip fracture and was sent to the hospital on [DATE]. Review of Resident #69's Fall Risk Assessment, dated 07/13/23, revealed a score of a 13. Review of the Fall Risk Assessment, dated 09/23/23, revealed a score of 16. Each assessment score indicated Resident #69 was at high risk for falls. Review of interdisciplinary progress notes revealed Resident #69 had falls at the facility on 07/13/23, 08/03/23, 09/21/23 and 09/23/23. The documentation did not identify interventions placed to prevent fall reoccurrence. Further review revealed no documented falls in the year prior to the fall on 07/13/23. Review of the Nurse Root Cause Analysis form, dated 07/13/23 and timed 6:40 A.M., completed by Licensed Practical Nurse (LPN) #418, revealed Resident #69 was found on the floor lying on her left side in front of her wheelchair. Resident #69 was in pain and was transferred to the local hospital for evaluation. There was no intervention listed on the root cause analysis form with a statement of there has been no implementations, I suggest a fall mat and a pendant. Review of Resident #69's hospital records dated 07/13/23 and 07/14/23 revealed Resident #69 sustained a closed left hip fracture as a result of a fall that occurred at the facility on 07/13/23. Resident #69 had her hip surgically repaired at the hospital on [DATE] and returned to the facility on [DATE]. Review of the Nurse Root Cause Analysis form, dated 08/03/23 and timed 3:15 P.M., completed by LPN #415, revealed Resident #69 sustained a fall in her bathroom after an attempted self-transfer. Resident #69 was not injured. The listed intervention was to encourage Resident #69 to use her call light. Review of the Nurse Root Cause Analysis form, dated 09/21/23 and timed 6:50 P.M., completed by Registered Nurse (RN) #405, revealed Resident #69 was observed on the floor in the lounge area seated on her buttocks. Resident #69 was not injured. There was no listed intervention implemented to prevent future fall occurrences. Review of the Nurse Root Cause Analysis form, dated 09/23/23 and timed 9:45 A.M., completed by LPN #412, revealed Resident #69 sustained a fall when she was attempting to transfer from wheelchair to bed, but the wheelchair brakes were not locked. Resident #69 was observed on the ground near her bed and wheelchair. Resident #69 was not injured. The listed intervention was to reinforce the need for Resident #69 to use her call light for assistance. Interview on 10/24/23 at 4:44 P.M. with LPN #411 revealed Resident #69 was independently mobile in her wheelchair, confused, and extremely forgetful. Interview on 10/26/23 at 10:35 A.M. with Activities Director (AD) #479 revealed she also functioned as the Memory Support Manager and oversaw care of the residents who lived in the memory care unit. AD #479 stated the nurse on duty should have assessed Resident #69 after each fall, completed the notifications to the provider and responsible party, completed the incident report and implemented a fall intervention. AD #479 stated she then gave completed fall reports to the Director of Nursing (DON). Falls were routinely discussed in morning meeting where the root cause was identified. AD #479 stated all falls should have an intervention placed to prevent fall recurrence. AD #479 verified Resident #69 had severely impaired cognition and education on the use of a call light would not be appropriate or effective. AD #479 verified the fall reports dated 07/13/23 and 09/21/23 listed no intervention and that fall reports dated 08/03/23 and 09/23/23 listed an inappropriate and ineffective intervention. Interview on 10/26/23 at 11:11 A.M. with the Director of Nursing (DON) verified Resident #69 had impaired cognition. The DON verified no interventions were placed for Resident #69 following falls sustained on 07/13/23 and 09/21/23. The DON stated the fall interventions placed following falls on 08/03/23 and 09/23/23 of reminders or education for Resident #69 to utilize her call light to call for assistance were not appropriate for her cognition. Review of the policy Fall Risk Assessment Policy and Incident and Accident Reporting, revised 10/01/14, revealed a Fall Risk Assessment with a score of 10 or greater indicates the resident is at high risk for falls and appropriate interventions should be put into place. Additionally, an immediate intervention to prevent reoccurrence must be instituted for all falls.

Based on staff interview, medical record review, and review of facility policy, the facility failed to ensure the pharmacy recommendations were completed on a monthly basis and were timely addressed by the physician. This affected one (Resident #34) of five reviewed for unnecessary medications. The facility census was 81. Findings include: Review of the medical record for Resident #34 revealed an admission date of 01/31/23. Medical diagnoses included cerebral infarction (stroke) affecting left non-dominant side, vascular dementia, and insomnia. Resident #34 resided in the secured memory care unit. Review of the Minimum Data Set (MDS) quarterly assessment, dated 08/10/23, revealed a Brief Interview for Mental Status (BIMS) of 00, indicating severely impaired cognition. The resident was noted to have verbal behaviors directed towards others and other behavioral symptoms not directed towards others on one to three days during the seven-day lookback period. Resident #34 required extensive assistance of one to two staff members for activities of daily living (ADLs). Resident #34 was identified to have received antipsychotic medications on a routine basis during the seven-day lookback period. Review of consultant pharmacist recommendations revealed no evidence that a medication regimen review was completed by the consultant pharmacist in April 2023. Additionally, the facility was unable to locate the recommendation completed by the consultant pharmacist dated 05/23/23. An interview on 10/25/23 at 3:43 P.M. with the Director of Nursing (DON) verified she was unable to locate the physician-signed pharmacy recommendation sheet from 05/23/23 for Resident #34. Follow-up interview on 10/26/23 at 11:02 A.M. with the DON verified there was no evidence of a medication regimen review completed in April 2023. The DON verified there was no evidence of a medication regimen review conducted between 03/01/23 and 05/23/23. Additionally, the DON stated she was still unable to locate the physician-signed pharmacy recommendation sheet from 05/23/23 and it was unknown what recommendation was made. The DON stated the facility had three different pharmacies over the past year and believed that was where the breakdown occurred. Review of the policy titled Medication Regimen Reviews, revised May 2019, revealed the consultant pharmacist performs a medication regimen review for every resident in the facility receiving medication. Medication regimen reviews are done upon admission and at least monthly thereafter, or more frequently if indicated. The consultant pharmacist provides the director of nursing services and medical director with a written, signed and dated copy of all medication regimen reports. Copies of medication regimen reports, including physician responses, are maintained as part of the permanent medical record.

Based on staff interview, medical record review, and review of facility policy, the facility failed to ensure an as needed medication order for a psychotropic medication was limited to a 14 day duration and instructions for use were followed. This affected one (Resident #61) of five reviewed for unnecessary medications. The facility census was 81. Findings include: Review of the medical record for Resident #61 revealed an admission date of 08/02/23. Medical diagnoses included Alzheimer's disease, depression, cognitive communication deficit, and anxiety. Resident #61 resided on the secured memory care unit. Review of Resident #61's Minimum Data Set (MDS) admission assessment, dated 08/09/23, revealed a Brief Interview for Mental Status (BIMS) score of 00, indicating severely impaired cognition. Resident #61 required extensive assistance of one to two staff members for activities of daily living (ADLs). Review of Resident#61's physician's order, dated 09/19/23 revealed a medication order for Lorazepam (Ativan, an anti-anxiety medication) 0.25 milligrams (mg) by mouth twice daily routinely for anxiety. Review of Resident #61's physician's order, dated 09/19/23, revealed an as needed medication order, for Ativan 0.25 mg by mouth as needed for anxiety at 2 P.M. The order was open-ended with no end date listed. Review of Resident #61's Medication Administration Record (MAR) for September 2023 revealed Resident #61 received an as needed dose of Ativan on 09/22/23 at 5:00 A.M. An interview on 10/26/23 at 12:40 P.M. with the Director of Nursing (DON) verified Resident #61's open-ended as needed Ativan order and stated the order should be limited to 14 days duration. The DON verified the dose administered to Resident #61 on 09/22/23 at 5:00 A.M. was not given within the order parameters and should not have been administered. Review of the policy Tapering Medications and Gradual Dose Reductions, Revised July 2022, revealed the staff and practitioner shall seek an appropriate dose and duration for each medication that also minimizes the risk of adverse consequences.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on resident funds account review and staff interview, the facility failed to ensure resident fund accounts were dispersed within 30 days of discharge from the facility. This affected one (#133) of one resident reviewed for conveyance of funds upon discharge. The facility census was 81. Findings Included: Review of Resident #133's medical record revealed an admission date of [DATE]. The resident expired in the facility on [DATE]. Review of Resident #133's personal funds account revealed a copy of a check dated [DATE] made out to the resident's funeral home for $603.70. An additional check to the Treasurer of the State of Ohio was dated [DATE] in the amount of $654.29. Interview with Business Office Manager #476 on [DATE] at 1:28 P.M. verified Resident #133's remaining funds failed to be distributed timely. Interview with the Administrator on [DATE] at 2:15 P.M. verified the facility did not have a policy specific to resident funds but followed State regulations.

Based on record review, staff interview, and review of facility policy, the facility failed to ensure implementation of their abuse policy and obtain an employee background check was completed for State Tested Nurse Aide (STNA) #432 prior to working with residents. This had the potential to affect 30 (#2, #4, #13, #14, #16, #18, #19, #20, #21, #24, #25, #27, #30, #31, #32, #35, #36, #38, #40, #42, #46, #47, #49, #54, #62, #63, #71, #74, #131, and #132) residents identified as residing on the 2 North Hallway in the facility and received care from STNA #432. The facility census was 81. Findings include: Review of State Tested Nurse Aide (STNA) #432's personnel file revealed a hire date of 09/26/23. Further review revealed no evidence of the completion, or attempt to complete, a background check prior to employment. Review of the staffing schedules from 09/26/23 through 10/24/23 revealed STNA #432 was assigned to provide care to 30 (#2, #4, #13, #14, #16, #18, #19, #20, #21, #24, #25, #27, #30, #31, #32, #35, #36, #38, #40, #42, #46, #47, #49, #54, #62, #63, #71, #74, #131, and #132) residents on the 2 North Hallway during the night shift on 10/2/23, 10/4/23, 10/5/23, 10/9/23, 10/10/23, 10/13/23, 10/15/23, 10/18/23, 10/19/23, 10/23/23, and 10/24/23. Interview on 10/26/23 at 2:14 P.M. with Business Manager (BM) #476 confirmed the facility did not have STNA #432's background check. Follow-up interview on 10/26/23 at 3:40 P.M. with BM #476 revealed BM #476 called the sheriff's department and verified STNA #432 had not been in for a background check. Interview on 10/26/23 at 3:54 P.M. with the Administrator revealed she thought they had 30 days to get the background check completed and back to the facility. Review of facility policy titled Vancrest: Abuse: Abuse, Mistreatment, Neglect, Exploitation and Misappropriation of Resident Property, undated, revealed it was the policy to undertake background checks of all employees and to retain on file applicable records of current employees regarding such checks. Additionally, the policy stated prior to hiring a new employee, the facility would conduct a criminal background check in accordance with Ohio law and Vancrest's policy;.

THE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NON-COMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Based on the review of the facility's Payroll-Based Journal (PBJ) Staffing Data Report, staffing schedule, posted daily staffing sheets, staff time sheets, and staff interview, the facility failed to submit accurate information in the PBJ in the third quarter of 2022. This had the potential to affect all residents. The facility census was 81. Findings Include: Review of the Payroll-Based Journal (PBJ) Staffing Data Report revealed the facility triggered for excessively low weekend staffing and not having licensed nursing coverage 24 hours a day in the third quarter of 2022. The specific days identified were Saturday 04/02/22, Sunday 04/03/22, Saturday 04/30/22, Saturday 05/14/22, Sunday 05/15/22, Saturday 06/11/22, and Saturday 06/25/22. Review of the Staffing Schedule and Posted Daily Staffing sheets for Saturday 04/02/22, Sunday 04/03/22, Saturday 04/30/22, Saturday 05/14/22, Sunday 05/15/22, Saturday 06/11/22, and Saturday 06/25/22 revealed the nursing staff worked 12 hour shifts, 7:00 A.M. to 7:30 P.M. and 7:00 P.M. to 7:30 A.M. On Saturday 04/02/22 there were four nurses working 7:00 A.M. to 7:30 P.M. and four nurses working in the facility from 7:00 P.M. to 7:30 A.M. On Sunday 04/03/22 there were four nurses working 7:00 A.M. to 7:30 P.M. and four nurses working in the facility from 7:00 P.M. to 7:30 A.M. On Saturday 04/30/22 there were four nurses working 7:00 A.M. to 7:30 P.M. and four nurses working in the facility from 7:00 P.M. to 7:30 A.M. On Saturday 05/14/22 there were four nurses working 7:00 A.M. to 7:30 P.M. and four nurses working in the facility from 7:00 P.M. to 7:30 A.M. On Sunday 05/15/22 there were four nurses working 7:00 A.M. to 7:30 P.M. and four nurses working in the facility from 7:00 P.M. to 7:30 A.M. On Saturday 06/11/22 there were four nurses working 7:00 A.M. to 7:30 P.M. and four nurses working in the facility from 7:00 P.M. to 7:30 A.M. On Saturday 06/25/22 there were four nurses working 7:00 A.M. to 7:30 P.M. and four nurses working in the facility from 7:00 P.M. to 7:30 A.M. The Staffing Schedules did not match the information entered into the PBJ as there was sufficient nurse staffing for 24 hours on each of the days identified as deficient in the PBJ. Reconciliation of the staff time sheets for Saturday 04/02/22, Sunday 04/03/22, Saturday 04/30/22, Saturday 05/14/22, Sunday 05/15/22, Saturday 06/11/22, and Saturday 06/25/22 verified the data on the Staffing Schedule and Posted Daily Staffing sheets were accurate. Interview on 10/25/23 at 10:53 A.M. with the Administrator verified the data entered into the PBJ for the third quarter of 2022 was not entered accurately. The Administrator reviewed the staffing schedule for each day indicated as not having sufficient 24 hour nursing staff and verified there were four nurses in the facility 24 hours a day on those days. The Administrator reported some of the shifts were split between two nurses but there were no gaps. The deficient practice was corrected on 06/01/23 when the facility implemented the following corrective action: • On 06/01/23, new ownership assumed responsibility of the facility and implemented a new PBJ data reporting procedure. • On 06/01/23, corporate support began staff data collection, review of facility staffing, and submission of data for the PBJ. • Since the implementation of the new procedure, no additional concerns had been identified related to PBJ data reporting.

Based on observation, interview, record review and policy review, the facility failed to ensure residents were served the correct altered texture diet. This affected two (Residents #9 and #102) of two residents reviewed for altered diets. The facility census was 113. Findings include: 1. Review of the Minimum Data Set (MDS) assessment for Resident #9, dated 03/31/21 revealed the resident required total dependence for eating with one person physical assistance, was cognitively impaired and rarely understood. The resident's diet order was a regular diet, pureed texture, nectar consistency. 2. Review of the MDS assessment for Resident #102, dated 05/31/21, revealed the resident required extensive assistance of one person for eating, was cognitively impaired and rarely understood. The resident's diet order was a regular diet, blended texture, thin consistency. 3. During observation on 06/28/21 between 12:24 P.M. and 12:32 P.M. Resident #102 was served Resident #9's meal tray and Resident #9 was served Resident #102's meal tray. Resident #102 had a tray with pureed roast beef, mashed potatoes, carrots, pudding, chocolate magic cup and thickened cranberry juice. The meal ticket had Resident #9's name printed on the top. Resident #9 had a tray with pureed roast beef, mashed potatoes, carrots, pudding, magic cup (thickened nutritional supplement ice cream) and ensure plus (nutritional supplement drink) and thinned juice. The meal ticket had Resident #102's name printed at the top. Both residents were ordered a pureed texture diet, however Resident #9 was supposed to have nectar thickened liquids and Resident #102 was supposed to have thin liquids. Resident #102 received Resident #9's thickened liquids and Resident #9 received Resident #102's thin liquids. State Tested Nursing Assistant (STNA) #616 was observed feeding Resident #9's meal to Resident #102, including Resident #9's thickened liquids. Registered Nurse (RN) #614 was assisting Resident #9 with eating Resident #102's meal. RN #614 offered thinned juice to Resident #9. Resident #9 proceeded to drink the thinned juice. During interview on 06/28/21 at 12:32 P.M., STNA #616 reported it was her second day and she was unaware of which resident she was assisting. She identified Resident #102 by reviewing the resident's sock label. STNA #616 verified Resident #102 was served and being fed Resident #9's meal, but it was okay because both residents had the same diet. STNA #616 did not attempt to stop feeding Resident #102, even after realizing she was feeding Resident #102 the wrong meal tray. RN #614 verified Resident #102 and Resident #9 were served each other's meal trays. RN #614 further verified Resident #102 received and consumed Resident #9's thickened juice and Resident #9 received and consumed Resident #102's thinned juice. Review of facility policy titled Therapeutic Diets, revised 12/11/19 revealed the facility had a policy in place for assuring a resident receives and consumes foods in the appropriate form and/or the appropriate nutritive content as prescribed by a physician, and/or assessed by the interdisciplinary team to support the resident's treatment, plan of care, in accordance with his/her goals and preferences.

Based only record review, observation, interview, review and review of Centers for Disease Control and Prevention (CDC) guidance, the facility failed to resume communal dining as per CMS and CDC guidelines. This had the potential to affect all residents of the facility with the exception of one (Resident #5) who received no food by mouth and three (Residents #25, #108, #420) who are on transmission-based precautions and isolated to their rooms. The facility census was 113. Findings include: Review of the CDC COVID-19 county positivity rate dated 06/28/21 revealed Wyandot county had a positivity rate of 2.2 percent. During observation on 06/28/21 at 11:38 A.M., the main dining room on the first floor had ten residents, seated one resident per table. No residents were observed seated together. During observation on 06/28/21 from 11:53 A.M. to 12:32 P.M., the second floor dining room had eight residents, seated one resident per table. No residents were observed seated together. During observation on 06/29/21 at 12:00 P.M., Resident #4 was eating lunch in her room. During interview on 06/29/21 at 2:36 P.M., State Tested Nursing Assistant (STNA) #602 stated Resident #4 has been eating in her room. The resident used to eat in the dining room with other residents, but since the facility is only allowing one resident per table, she now prefers to eat in her room. STNA stated the resident enjoyed sitting with other residents. STNA stated she believed all but one resident on the floor is vaccinated. During observation on 06/30/21 at 11:37 A.M., the first floor dining room revealed residents eating at separate individual tables for social distancing. During interview on 06/30/21 at 12:16 P.M., STNA #604 stated residents eat at separate individual tables for social distancing. During interview on 07/01/21 at 10:32 A.M., Residents #114, #36, #99, #71, #2, #66, and #88 stated they were not allowed to sit together in the dining room during meals. Residents #114 and #71 reported they had tried to sit together for meals on multiple occasions and staff tell them they need to separate. Review of the CDC website titled Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 vaccination dated 04/27/21 revealed, fully vaccinated residents can participate in communal dining without use of source control or physical distancing. Unvaccinated residents in communal area should use source control when not eating and unvaccinated residents should continue to remain at least six feet from others.

Based on medical record review, staff interview, and policy review, the facility failed to follow their policy to report to the state agency and to investigate an alleged allegation of sexual abuse involving one (#59) of two residents reviewed for abuse. The facility census was 133. Findings include: Review of Resident #59's medical record revealed an admission date of 09/28/18. Diagnoses included anxiety disorder, intellectual disabilities, and specified disorders of the brain. Review of the quarterly Minimum Data Set (MDS) assessment, dated 01/17/19, identified the resident as having moderate cognitive impairment. Review of Resident #59's nurses notes dated 02/23/19 at 6:44 P.M. revealed the resident reported to the nurse that male resident across the hall from her had come into her room and rubbed his hand across her upper chest. The note revealed several staff members and Licensed Practical Nurse (LPN) #207 have seen her repeatedly try to go into this male's room and he shoos her out. When LPN #207 relayed this information to Resident #59, she then said it was because he tells her to come over there. She then changed her story and said the incident happened when she went to his room. Resident #59 has a known history of being manipulative and making untruthful statements to get what she wants. When the nurse approached the male resident across the hall from her he denied he has ever went to Resident #59's room and that she keeps coming to his room and he shoos her out. LPN #207 informed Resident #59 and the male resident that they are not to go into each other's room. Staff then noted Resident #59 was using a flashlight and shining it in that male resident's room. The nurse again went to her room and she denied this happening. A staff member then told LPN #207 that Resident #59 had been in another gentleman's room lying on his bed and they had told her that wasn't the proper thing to do and she should not to go into his room. LPN #207 contacted Resident #59's father and informed him what was occurring. Resident #59 then told the State Tested Nurse Aide (STNA) another female resident had told her to try these two gentlemen to see if they would be her boyfriend. Staff nurse on duty was aware of the situation. Resident #59 had her door closed at this time. The Administrator and Director of Nursing (DON) were aware of this situation. Resident #59 was placed on 30 minute checks throughout the weekend. Review of the facility Self-Reported Incidents (SRI's) failed to indicate this allegation of sexual abuse was reported to the state agency. There was no investigation to review in regards to the allegation of sexual abuse. Interview with the Director of Nursing (DON) and Administrator on 03/21/19 at 9:34 A.M. revealed the DON voiced they have 24 hours to reports an allegation and they concluded that nothing happened and the male resident didn't go in Resident #59's room, so there was nothing to report. The DON stated the reason this allegation was not reported was because it wasn't substantiated. If this would have been substantiated then it would have been reported. The Administrator voiced Resident #59 makes things up all the time. The Administrator voiced they called Resident #59's father and he voiced she was making it up because she does that. The Administrator voiced other residents were not interviewed, only the male resident who's bed Resident #59 had laid down on. Review of the facility policy titled Abuse, Mistreatment, Neglect, Exploitation, Injuries of Unknown Source and Misappropriation of Resident Property, dated 12/05/17, revealed residents have the right to be free from abuse, neglect, exploitation and misappropriation of resident property. The Administrator or his/her designee will notify the State Department of Health of all alleged violations involving mistreatment, neglect, abuse exploitation, misappropriation of resident property and injuries of unknown source as soon as possible, but in no event later than 24 hours from the time the incident/allegation was made known to the staff member. It indicated it is the policy to investigate all alleged violations involving abuse. It revealed once the Administrator and State Department of Health are notified, an investigation of the allegation violation will be conducted. The investigation must be completed within five working days. It revealed the person investigating the incident should generally take the following actions: interview the resident, the accused and all witnesses. Witnesses generally include anyone who witnessed or heard the incident; came in close contact with the resident the day of the incident (including other residents and family members); and employees's who worked closely with the accused employee and/or alleged victim the day of the event. It revealed to obtain a statement from the resident, if possible, the accused, and each witness; and evidence of the investigation should be documented.

Based on medical record review, staff interview, and policy review, the facility failed to report to the state agency an alleged allegation of sexual abuse involving one (#59) of two residents reviewed for abuse. The facility census was 133. Findings include: Review of Resident #59's medical record revealed an admission date of 09/28/18. Diagnoses included anxiety disorder, intellectual disabilities, and specified disorders of the brain. Review of the quarterly Minimum Data Set (MDS) assessment, dated 01/17/19, identified the resident as having moderate cognitive impairment. Review of Resident #59's nurses notes dated 02/23/19 at 6:44 P.M. revealed the resident reported to the nurse that male resident across the hall from her had come into her room and rubbed his hand across her upper chest. The note revealed several staff members and Licensed Practical Nurse (LPN) #207 have seen her repeatedly try to go into this male's room and he shoos her out. When LPN #207 relayed this information to Resident #59, she then said it was because he tells her to come over there. She then changed her story and said the incident happened when she went to his room. Resident #59 has a known history of being manipulative and making untruthful statements to get what she wants. When the nurse approached the male resident across the hall from her he denied he has ever went to Resident #59's room and that she keeps coming to his room and he shoos her out. LPN #207 informed Resident #59 and the male resident that they are not to go into each other's room. Staff then noted Resident #59 was using a flashlight and shining it in that male resident's room. The nurse again went to her room and she denied this happening. A staff member then told LPN #207 that Resident #59 had been in another gentleman's room lying on his bed and they had told her that wasn't the proper thing to do and she should not to go into his room. LPN #207 contacted Resident #59's father and informed him what was occurring. Resident #59 then told the State Tested Nurse Aide (STNA) another female resident had told her to try these two gentlemen to see if they would be her boyfriend. Staff nurse on duty was aware of the situation. Resident #59 had her door closed at this time. The Administrator and Director of Nursing (DON) were aware of this situation. Resident #59 was placed on 30 minute checks throughout the weekend. Review of the facility Self-Reported Incidents (SRI's) revealed this allegation of sexual abuse was reported to the state agency. Interview with the Director of Nursing (DON) and Administrator on 03/21/19 at 9:34 A.M. revealed the DON voiced they have 24 hours to reports an allegation and they concluded that nothing happened and the male resident didn't go in Resident #59's room, so there was nothing to report. The DON stated the reason this allegation was not reported was because it wasn't substantiated. If this would have been substantiated then it would have been reported. The Administrator voiced Resident #59 makes things up all the time. The Administrator voiced they called Resident #59's father and he voiced she was making it up because she does that. Review of the facility policy titled Abuse, Mistreatment, Neglect, Exploitation, Injuries of Unknown Source and Misappropriation of Resident Property, dated 12/05/17, revealed residents have the right to be free from abuse, neglect, exploitation and misappropriation of resident property. The Administrator or his/her designee will notify the State Department of Health of all alleged violations involving mistreatment, neglect, abuse exploitation, misappropriation of resident property and injuries of unknown source as soon as possible, but in no event later than 24 hours from the time the incident/allegation was made known to the staff member.

Based on medical record review, staff interview, and policy review, the facility failed to investigate an alleged allegation of sexual abuse for one (#59) of two residents reviewed for abuse. The facility census was 133. Findings include: Review of Resident #59's medical record revealed an admission date of 09/28/18. Diagnoses included anxiety disorder, intellectual disabilities, and specified disorders of the brain. Review of the quarterly Minimum Data Set (MDS) assessment, dated 01/17/19, identified the resident as having moderate cognitive impairment. Review of Resident #59's nurses notes dated 02/23/19 at 6:44 P.M. revealed the resident reported to the nurse that male resident across the hall from her had come into her room and rubbed his hand across her upper chest. The note revealed several staff members and Licensed Practical Nurse (LPN) #207 have seen her repeatedly try to go into this male's room and he shoos her out. When LPN #207 relayed this information to Resident #59, she then said it was because he tells her to come over there. She then changed her story and said the incident happened when she went to his room. Resident #59 has a known history of being manipulative and making untruthful statements to get what she wants. When the nurse approached the male resident across the hall from her he denied he has ever went to Resident #59's room and that she keeps coming to his room and he shoos her out. LPN #207 informed Resident #59 and the male resident that they are not to go into each other's room. Staff then noted Resident #59 was using a flashlight and shining it in that male resident's room. The nurse again went to her room and she denied this happening. A staff member then told LPN #207 that Resident #59 had been in another gentleman's room lying on his bed and they had told her that wasn't the proper thing to do and she should not to go into his room. LPN #207 contacted Resident #59's father and informed him what was occurring. Resident #59 then told the State Tested Nurse Aide (STNA) another female resident had told her to try these two gentlemen to see if they would be her boyfriend. Staff nurse on duty was aware of the situation. Resident #59 had her door closed at this time. The Administrator and Director of Nursing (DON) were aware of this situation. Resident #59 was placed on 30 minute checks throughout the weekend. There was no investigation to review in regards to the allegation of sexual abuse. Interview with the Director of Nursing (DON) and Administrator on 03/21/19 at 9:34 A.M. revealed the DON voiced they concluded that nothing happened and the male resident didn't go in Resident #59's room, so there was nothing to report. The Administrator voiced Resident #59 makes things up all the time. The Administrator voiced they called Resident #59's father and he voiced she was making it up because she does that. The Administrator voiced other residents were not interviewed, only the male resident who's bed Resident #59 had laid down on. Review of the facility policy titled Abuse, Mistreatment, Neglect, Exploitation, Injuries of Unknown Source and Misappropriation of Resident Property, dated 12/05/17, revealed residents have the right to be free from abuse, neglect, exploitation and misappropriation of resident property. It indicated it is the policy to investigate all alleged violations involving abuse. It revealed once the Administrator and State Department of Health are notified, an investigation of the allegation violation will be conducted. The investigation must be completed within five working days. It revealed the person investigating the incident should generally take the following actions: interview the resident, the accused and all witnesses. Witnesses generally include anyone who witnessed or heard the incident; came in close contact with the resident the day of the incident (including other residents and family members); and employees's who worked closely with the accused employee and/or alleged victim the day of the event. It revealed to obtain a statement from the resident, if possible, the accused, and each witness; and evidence of the investigation should be documented.

Based on medical record review, staff interview, and review of facility policy, the facility failed to monitor a resident's dialysis access port and fistula. This affected one resident (#126) of two residents who received dialysis treatment. The facility census was 133. Findings include: Review of Resident #126's medical record revealed an admission date of 08/30/18. Diagnoses included chronic kidney disease, end stage renal disease, heart failure, diabetes, atrial fibrillation, anemia, diverticulosis, methicillin-resistant staphylococcus aureus, and hypertension. Review of Resident #126's Minimum Data Set (MDS) assessment, dated 02/19/19, revealed the resident to have no cognitive impairment and received dialysis. Review of Resident #126's current care plan revealed the resident received dialysis services due to chronic kidney disease. Interventions included daily skilled charting and assessment of dialysis fistula left arm and dialysis port right upper chest. Review of Resident #126's monthly physician orders dated March 2019 revealed an order for dialysis Monday, Wednesday and Fridays. Review of Resident #126's Treatment Administration Record (TAR) dated March 2019 revealed no documentation of the resident's dialysis fistula or access port being monitored. Interview on 03/21/19 at 9:34 A.M., Licensed Practical Nurse (LPN) #207 verified Resident #126's dialysis port and fistula had not been documented as being monitored. LPN #207 stated the monitoring must have been left off the TAR when the resident returned from the hospital. Review of facility policy titled Hemodialysis Policy, undated, revealed daily assessment of dialysis resident will include to assess and feel for thrill or use the stethoscope to listen for bruit and monitor for signs and symptoms of infection at the site.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, staff interview, review of pest control inspection report, and review of facility policy, the facility failed to ensure timely treatment of bed bugs. This affected one resident (#44) of two residents reviewed for bed bugs. The facility census was 133. Findings Include: Review of Resident #44's medical record revealed an admission date of 12/18/17. Diagnoses included diabetes, venous insufficiency, hypertension, heart failure, sleep apnea, acute and chronic respiratory failure, morbid obesity, and muscle weakness. Review of Resident #44's Minimum Data Set (MDS) assessment, dated 01/18/19, revealed the resident had no cognitive impairment and no skin issues. Review of Resident #44's care plan dated 02/03/19 revealed the resident had a skin rash. Interventions included to apply Aquaphor ointment for 14 days or until resolved. Review of Resident #44's nurse's note dated 11/12/18 revealed the resident had complained of being bit two times on his right leg. There were two areas noted on the resident's right thigh. The resident had reported itching and the physician was notified. Review of Resident #44's nurse's note dated 03/07/19 revealed a large and small bed bug had been found crawling on the sheet on top of the resident. The resident had requested that his room be sprayed or something because he is tired of being bitten. Maintenance had been notified of the request. Review of Certified Nurse Practitioner (CNP) note, dated 03/20/19, revealed Resident #44 stated a rash scattered throughout the body for the past two weeks and complains of itching. The rash is consistent and scattered throughout the patient's body and is consistent with what could be bed bugs that were identified in patient's chair per nursing staff's report. Medications were ordered. Review of Resident #44's physician orders revealed the following orders; on 01/15/19 Triamcinolone cream three times a day for raised rash. On 01/23/19 an order for Aquaphor ointment apply daily for 14 days. On 03/20/19 an order for Desonide foam to rash for 14 days and Benadryl 25 milligrams (mg) every eight hours as needed for itching. Observation on 03/19/19 at 9:10 A.M. of Resident #44 revealed the resident sitting in a cloth covered reclining chair. The resident stated bugs have been biting him for about two to four weeks and then the resident revealed a rash on his arms and stomach. An isolation cart was outside the resident's room. Interview on 03/19/19 at 3:09 P.M., Director of Environmental Services stated the staff gave a bed bug to her on Saturday 03/16/19. The staff had reported they saw a bed bug about a month ago and Resident #44's reclining chair had been taken out of the room, checked and cleaned, and they did not see any bed bugs. Director of Environmental Services stated the exterminating service came today and did a bed bug treatment to the resident's room. The resident's chair will be removed from the room. The resident's room mate had no concerns regarding bed bugs. Interview on 03/19/19 at 3:15 P.M., Registered Nurse (RN) #111 stated Resident #44 had a skin assessment completed on 01/25/19 due to a possible bed bug that had been found with no bug bites noted. RN #111 stated within the last week or two the resident's rash has gotten worse and the physician had ordered creams for dry skin. Interview on 03/20/19 at 9:36 A.M., Licensed Practical Nurse (LPN) #132 stated he had never seen a live bed bug. He had heard that some were found in Resident #44's room about three weeks ago. LPN #132 stated the resident's chair had been cleaned once and the resident had creams ordered for a rash. Interview on 03/20/19 at 10:20 A.M., LPN #118 stated the staff started to find bed bugs sometime in January 2019. Resident #44's chair had been cleaned and no bed bugs were found on the roommate's side of the room. The residents in the room were put on isolation on 03/17/19 when the bed bugs were found. Interview on 03/20/19 at 10:44 A.M., CNP #500 stated he assessed Resident #44 and stated the skin rash could be consistent with bed bug bites. Review of Service Inspection Report dated 03/19/19 revealed the treatment for bed bugs was completed in room [ROOM NUMBER] with treatment to all areas of the room. A heavy infestation of live bed bugs were found on the recliner of Bed A. No bed bugs were found on Bed B. If possible dispose of recliner due to tears in upholstery. Monitors were placed and will follow up. Review of facility policy titled Bed Bugs Management, dated November 2018, revealed if bed bugs are suspected/found on a resident the resident should be placed in contact isolation, the door to the room should be kept closed and a blanket placed at threshold.