Artis Senior Living of Bridgetown

Based on record review, staff interview, and review of facility policy, the facility failed to adequately assess a resident who tested positive for Coronavirus (COVID-19). This affected one resident (#16) of three residents reviewed for change in condition. The facility census was 63 residents.

Findings include:

Review of the medical record for Resident #16 revealed an admission date of 04/24/23 with diagnoses including COVID-19, dementia, diabetes mellitus (DM), and depression.

Review of the admission health assessment for Resident #16 dated 04/24/23, revealed the resident was cognitively impaired and required supervision with activities of daily living (ADLs.)

Review of a fax communication sheet to the physician for Resident #16 dated 05/23/23, revealed the resident had tested positive for COVID-19 and the physician had responded with orders for Paxlovid (antiviral medication) based on the renal dosing and to hold Flomax (medication for enlarged prostate) and Primidone (anticonvulsant) for five days while taking Paxlovid and to hold Atorvastatin (statin medication to lower cholesterol) for eight days while taking Paxlovid.

Review of the nurse's progress note for Resident #16 dated 05/23/23, revealed the resident tested positive for COVID-19 and the physician was notified. Review of the nurse progress notes dated 05/23/23 to 05/31/23 revealed no documented evidence Resident #16 had a physical assessment, respiratory assessment and/or vital signs following the resident's COVID-19 diagnosis.

Review of the May 2023 Medication Administration Record (MAR) for Resident #16, revealed Flomax, Primidone, and Atorvastatin were marked as held per the physician's order. Paxlovid two tablets daily for five days was marked as administered per physician's order from 05/24/23 to 05/30/23 for a total of ten doses.

Review of the May 2023 vital signs record for Resident #16, revealed the resident had vital signs taken on 05/15/23 and a daily temperature taken from 05/01/23 to 05/31/23.

Interview on 08/28/23 at 1:21 P.M. with the Director of Nursing (DON), confirmed Resident #16 tested positive for COVID-19 on 05/23/23 and was treated with Paxlovid. The DON confirmed Resident #16's record did not include any assessments and vital signs following the resident's COVID-19 diagnosis. The DON confirmed Resident #16's record should include an assessment of resident's symptoms and respiratory status following a COVID-19 diagnosis.

Review of the facility policy titled Change of Condition dated January 2020, revealed staff will monitor residents for change in condition, nurses will provide assessment and intervention and prompt notification to the resident's physician and responsible party. Nurse will document assessment of the change in condition in the resident's medical record.

Review of the facility policy titled COVID-19 Protocols dated 05/11/23, revealed COVID-19 positive residents will have increased monitoring and if they do not have respiratory distress the resident may remain in the community and be managed in-house. Residents testing positive will be isolated in a single room with dedicated staff for at least five days after they first tested positive.

This violation represents non-compliance investigated under Complaint Number OH00144531

Based on record review, staff interview, review of the resident agreement, and review of the facility admission packet, the facility failed to ensure residents discharged from the facility were provided with a written notice of discharge which included information regarding the resident's right to appeal the decision. This affected one resident (#64) of three residents reviewed for discharge. The facility census was 63.

Findings include:

Review of the medical record for Resident #64 revealed an admission date of 12/21/22 with diagnoses including arthropathy, major depressive disorder, osteoarthritis, cataracts, and dementia and a discharge date of 05/17/23.

Review of care conference note for Resident #64 dated 05/10/23 revealed facility Director of Artis Way Experience (DAWE) #365 and Executive Director (ED) met with resident's representative and informed her if resident had another episode of unprovoked combativeness towards other residents the representative would need to find alternate placement. DAWE #365 suggested the name of another facility.

Review of the nurse progress note for Resident #64 dated 05/17/23, revealed the resident was involved in an altercation with another resident (Resident #14), and Resident #64 was sent to the hospital for psychiatric evaluation.

Interview on 06/26/23 at 9:05 A.M. with the ED and DAWE #365 confirmed Resident #64 had a history of aggressive behaviors towards other residents and the staff. ED confirmed Resident #64's behaviors had never resulted in any significant injury to others, but facility felt the resident was a risk to others due to his behaviors. ED confirmed he and DAWE #365 met with Resident #64's representative on 05/10/23 and informed her she would need to find alternate placement for resident if he had another episode of unprovoked aggression towards another resident. ED confirmed Resident #64 was physically aggressive towards Resident #14 and the facility obtained an order to send resident to the hospital via 911 for a psychiatric evaluation. ED confirmed the resident went to the hospital but was not admitted and the emergency personnel brought resident back to the facility. ED confirmed the facility staff told the emergency personnel they would not accept the resident back due to his aggressive behaviors, and the emergency personnel took Resident #64 back to the hospital. ED confirmed he spoke with hospital staff and told him the facility would not accept resident back due his aggressive behaviors. ED confirmed the hospital found alternate placement for the resident at another assisted living facility, and the Director of that facility called for an update on Resident #64's behaviors. ED confirmed the other facility accepted Resident #64 for admission and resident never returned to the facility. DAWE #365 confirmed all the information provided by the ED, and also that she was present when the facility met with Resident #64's representative on 05/10/23. ED and DAWE #365 confirmed Resident #64 and his representative were not provided with a written notice of discharge and were not advised of their rights to appeal the decision to discharge the resident.

Interview on 06/26/23 at 2:00 P.M. with the Director of Nursing (DON) / Director of Health and Wellness (DHW) confirmed Resident #64 was involved in an altercation with Resident #14 on 05/17/23, and the facility sent Resident #64 to the hospital for a psychiatric evaluation.

Review of the facility's Residency Agreement dated 01/01/20 revealed if a resident's condition changes so that the assessed level of assistance is no longer appropriate, the facility will reassess resident and determine appropriate level of need and will notify the resident and responsible party of the same. The facility may terminate the agreement at any time with or without cause by giving 30 days written notice to the responsible party or less than 30 days' notice if facility determines the resident is engaging in a behavior that is a threat to his/her mental and/or physical health and safety or the health and safety of others. The facility will assist the resident and responsible party with discharge planning and referrals.

Review of the undated facility's Admission Packet revealed the facility followed the Ohio Revised Code (ORC) which indicated the resident has the right not to be transferred or discharged from the home unless the transfer is necessary because safety of individuals in the home is endangered. The Administrator of the home should notify the resident and the resident's sponsor in writing of any proposed transfer or discharge from the home at least thirty days in advance. If an emergency arises and a thirty-day notice cannot be given, notice should be made as soon as possible. The written notice should be sent the state department of health and should be sent via certified mail with return receipt requested and should include the following: the reasons for the proposed transfer or discharge, the proposed date the resident is to be transferred or discharged, a proposed location to which the resident may relocate and a notice that the resident and resident's sponsor may choose another location to which the resident will relocate,

notice of the right of the resident and the resident's sponsor to an impartial hearing at the home on the proposed transfer or discharge, the manner in which and the time within which the resident or sponsor may request a hearing, the address of the legal services office of the department of health, the name, address and telephone number of the state long term care ombudsman, the proposed location to which a resident may relocate.

This violation represents non-compliance investigated under Complaint Number OH00143404.