Bickford of Bexley

Based on closed record review, interview and policy review the facility failed to ensure residents were provided assistance with personal care needs. This affected one resident (Resident #52) of three residents reviewed for activities of daily living.

Findings include:

Review of Resident #52's closed medical record revealed an admission date of 12/04/23 with diagnoses including Alzheimer's disease, hyperlipidemia, prediabetes, and dementia.

Review of her resident assessment, dated 07/02/24, revealed the resident required minimal assistance with bathing and she used a shower chair. Further review revealed the resident had minimal needs for cognitive status, forgetfulness and difficulty concentrating.

Review of the resident's service plan, dated 07/04/24 revealed the resident required set up and/or cueing with bathing. Staff were to assist with turning on the water to a temperature of her liking and would remain with the resident to offer stand by assistance.

Interview with the resident's family revealed the resident often looked filthy and would have an odor as though the resident had not been bathed regularly. The resident's family was concerned about the resident's hygiene.

Interview with Health and Wellness Director #108, Executive Director #150, and Regional Director #151 on 03/12/25 at 2:35 P.M. and 3:00 P.M. confirmed they do not keep shower/bathing documentation for more than seven days. They stated because they have hard copy records for resident baths/showers, they do not have the storage space to keep records for all residents more than that time. The staff confirmed there was no evidence the resident received her showers/regular bathing.

Review of facility Personnel policy, dated July 2024, revealed during each shift, the facility staff shall document pertinent resident information, from their shift, in the electronic medical records. Information documented will be by exception only. Completed care needs, including notes, will be submitted to the Health and Wellness Director at the end of each shift. The Executive Director or Health and Wellness Director will review completed care needs daily, and follow up with concerns. Care needs are to be kept for seven days and then discarded if not needed for documentation.

This violation was an incidental finding related to complaint number OH00161725.

Based on record review and staff interview the facility failed to ensure all staff were examined by a physician or other health care professional acting within their applicable scope of practice within thirty days before commencing work or on the first day of work as required. This had the potential to affect all 51 residents residing in the facility. The facility census was 51.

Findings include:

1. Review of the facility's Criminal Background Check Log revealed Licensed Practical Nurse (LPN) #100 had a date started working listed as 07/20/24.

Review of Licensed Practical Nurse job description dated 11/2019 revealed physical demand required is to use hands to finger, handle, or feel; reach with hands and arms; stoop, kneel, crouch or crawl; and talk, hear and smell. The caregiver is occasionally required to climb or balance. The caregiver must frequently lift, move, push and/or pull up to 50 pounds and occasionally lift, move, push and/or pull up to 75 pounds.

Review of LPN #100's employee record revealed a physical was completed on 11/14/24.

Interview on 11/21/24 at 5:07 P.M. with the Administrator confirmed LPN #100's physical was not completed 30 days before hire or on the start date. The Administrator was unaware of the time required regarding physicals. The Administrator confirmed the physical was completed approximately four months after the LPN #100's start date.

2. Review of facility's Criminal Background Check Log revealed Certified Nursing Assistant (CNA) #101 had a date started working of 08/27/24.

Review of Certified Caregiver job description dated 12/2022 revealed their primary responsibility is for resident care and services outlined in residents service plans including: personal care needs, laundry, activities, meals, and pet care. Physical demands state while performing the duties of this job, the caregiver is required to use hands to finger, handle, or feel; reach with hands and arms; stoop, kneel, crouch or crawl; and talk, hear and smell. The caregiver is occasionally required to climb or balance. The caregiver must frequently lift, move, push and/or pull up to 50 pounds and occasionally lift, move, push and/or pull up to 75 pounds.

Review of CNA #101's employee record revealed a physical was completed on 10/03/24.

Interview on 11/21/24 at 5:07 P.M. with the Administrator confirmed CNA #101's physical was not completed 30 days before hire or on the start date. The Administrator was unaware of the time required regarding physicals. The Administrator confirmed the physical was completed approximately three months after the CNA #101's start date.

Based on observation, staff interview, and record review, the facility failed to provide clean and sanitary food storage, preparation, and distribution practices as evidenced by improper storage of dry goods, failing to appropriately discard soiled foods, and failing to perform hand hygiene routinely. This had the potential to affect all residents in the facility. The facility census was 51.

Findings include:

1. Observation on 11/21/24 at 9:13 A.M. of the kitchenette on the first floor revealed the serving station had food splattered along the front of the station, the white cabinets had caked-on debris along the crevices of the wood joints, the cabinets had dried drips of an unknown liquid along the front, and the floor was sticky.

Observation on 11/21/24 at 10:32 A.M. of the kitchenette revealed the cabinet fronts were still soiled, the floor remained sticky, and the serving station still had food splattered along the front.

Observation on 11/21/24 from 12:10 P.M. to 12:29 P.M. revealed the floors remained extremely sticky, and near the fridge and the cabinets and preparation station remained soiled as well.

Interview on 11/21/24 at 12:32 P.M. with Director of Dietary (DD) #188 and Dietary #189 confirmed the kitchenette cabinets were soiled with an unknown dripping substance, the serving station had splatters of old food along the front, and the kitchen floors were sticky throughout breakfast and lunch service. DD #188 said the kitchenette surfaces should be cleaned after each meal service.

Interview on 11/21/24 at 12:55 P.M. with the Director of Nursing (DON) stated that the facility had a schedule to clean the kitchenette, and wiping down surfaces and mopping the floor should be conducted after each meal service. However, the DON could not provide evidence that the kitchen area had been cleaned on 11/21/24.

2. Observation on 11/21/24 at 9:13 A.M. of the kitchenette fridge revealed a large container of cottage cheese with an expiration date of 10/08/24 and no open date, three large containers of tomato soup with no open date, and English muffins left open to air in the dark cabinets without an open date.

Interview on 11/21/24 at 9:13 A.M. with Certified Caregiver #193 confirmed the cottage cheese was expired, the tomato soup did not have an open date, and the English muffins were left open to air without an open date.

3. Observation on 11/21/24 at 9:27 A.M. of the stand-up freezer revealed an open bag of peas without an open date, mixed berries with no open date, and a large plastic container of baked beans with no open date or expiration.

Interview on 11/21/24 at 9:28 A.M. with Dietary #189 confirmed the berries and peas were opened without an open date, and the large plastic container of beans did not have a prepared date or expiration date.

4. Observation on 11/21/24 at 9:32 A.M. of the walk-in refrigerator revealed 7 cartons of strawberries covered in a significant amount of mold.

Interview on 11/21/24 at 9:34 A.M. with DD #188 confirmed seven cartons of strawberries were covered in mold, he stated these were a new batch of strawberries they received on 11/19/24 and staff must have not checked them thoroughly for mold.

5. Observation on 11/21/24 from 12:10 P.M. to 12:28 P.M. of lunch meal service plating revealed Dietary #189 was plating food, which included orange-glazed ham steak, scalloped potatoes, and spinach or succotash. Throughout meal service, Dietary #189 touched many contaminated surfaces such as meal tickets, countertops, cabinet handles, serving utensils, and sanitizer cloth during plating. Occasionally, Dietary #189 would change gloves; however, once removed, a new pair would be placed without conducting hand hygiene. Upon removal of the gloves, the surveyor observed Dietary #189's hands glistening due to accumulated moisture in the gloves. Throughout the observation, Dietary #189 changed his gloves three times and did not conduct hand hygiene after doffing soiled gloves and donning clean gloves.

Interview on 11/21/24 at 12:30 P.M. with Dietary #189 denied needing to wash his hands because he would put on new gloves.

Interview on 11/21/24 at 12:32 P.M. with DD #188 confirmed that hand hygiene should be conducted after removing soiled gloves or when hands are visibly soiled.

Interview on 11/21/24 at 12:55 P.M. with the DON confirmed that hand hygiene should be conducted after removing soiled gloves and prior to donning clean gloves.

Review of the policy Food Storage and Labeling and Dating dated 10/2024 revealed dietary staff are required to wrap, cover, label, and date, and store all foods in a safe, appropriate manner. The policy states staff should only use approved labeling stickers which include the contents of the item, the preparation/opening date, use by and other pertinent information related to the food item and initial of the employee who prepared or stored the item. The policy states to regularly check labeled items for expiration dates and freshness, and to discard items that are past their use-by date.

Review of the policy Dining Services dated 03/2017 revealed Bickford staff should wash their hands between handling different types of food, after handling trash or other contaminated objects, after handling chemicals, and after touching anything else that may contaminate hands, such as dirty equipment, work surfaces, or cloths.

Based on interview and record review the facility failed to maintain bi-annual inspections of the heating system to prevent malfunction and confirm proper functioning. This had the potential to affect all residents at the facility. The facility census was 51.

Findings include:

Review of the most recent heating and cooling inspection report, dated 03/27/22, revealed that the facility had performed a preventative maintenance (PM) check. This inspection included work on: roof-top units (RTUs), fans, cooler/freezer units, boilers/hot water tanks, fire dampers (function check), and the cooling tower.

Interview on 11/21/24 at 10:22 A.M. with Director of Maintenance #152 confirmed that the facility is not up to date on the required bi-annual inspection of the heating system. The Director of Maintenance confirmed that the most recent inspection occurred on 03/27/22 and explained that the corporate office had not provided the necessary funds to complete this routine maintenance. The Director stressed the importance of routinely checking the heating system due to the building's age and the compliance requirements outlined in Ohio Revised Code 3701-16-15.

Review of Ohio revised code rule 3701-16-15 titled building maintenance, equipment and supplies dated 07/12/24 revealed each residential care facility is obligated to maintain heating, electrical, and other building service equipment in good working and safe condition and have its central heating system check every two years by a heating contractor.

Based on observation and interview the facility failed to securely store sharp objects in the memory care unit. This had the potential to affect eight residents (Residents #33, #37, #41, #42, #44, #45, #47 and #48) that the facility identified were independently ambulatory and cognitively impaired whom resided on the memory care unit. The facility census was 51.

Findings include:

Review of the Medical record for Resident #45 revealed an admission date of 10/29/21 to the memory care unit. Diagnoses including anxiety, dementia, diabetes, hypertension and cerebral vascular accident.

Review of physician visit dated 08/08/24 for Resident #45 revealed a diagnosis of dementia with memory loss described as difficulty learning new information, long term memory loss, short term memory impairment. Resident #45's confusion was described as difficulty completing tasks, difficulty focusing attention, and associated symptoms included unsteady gait, insomnia, behavioral changes and memory loss.

Review of Resident Assessment dated 03/09/24 revealed Resident #45 was independent with transfers, and listed the resident walked freely around the unit, gait was unsteady, and shuffling was noted. Resident #45 required maximum assistance due to cognitive function, noting the resident was disoriented to person/place/time, had a memory impairment, repeated information, had poor safety awareness and judgement, and was a poor historian. Resident #45 was identified as a moderate elopement risk who could occasionally be redirected if wandering or approaching exits. The assessment noted Resident #45 ambulated around the unit freely.

Review of progress note dated 06/27/24 for Resident #45 revealed during lunch I was trying to get resident to sit down so I could give her lunch plate to her, while I was doing this she was grabbing food off of other residents plates. I said please don't do that its not yours, I have your plate right here. Resident told me to leave her alone and then spit on the left side of my face.

Review of progress notes dated 07/04/24 and 04/05/24 revealed Resident #45 exhibited aggressive behaviors in the dining room.

Observation on 11/21/24 at 9:59 A.M. revealed that metal forks, knives, and a corkscrew bottle opener were located in an unlocked cabinet in the memory care kitchenette. Additionally, two residents were sitting at tables unattended in the memory care dining room.

Interview on 11/21/24 at 10:00 with Certified Caregiver (CC) #184 confirmed that the sharp items were not securely locked or out of residents' reach. CC #184 acknowledged that the items should have been locked up for safety.

Interview on 11/21/24 at 3:55 P.M. with CC #155 confirmed that Resident #45 randomly exhibited combative or physical behaviors towards staff and other residents. CC #155 further confirmed that the resident attempts to punch, kick, and throw items at staff members.

Interview on 11/21/24 at 5:07 P.M. with the Administrator confirmed that the corkscrew should be locked up and kept out of residents' reach. However, the Administrator denied the presence of any combative residents or those exhibiting behaviors towards staff or other residents, on the memory care unit.