Health inspection·July 18, 2023

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review, and review of the facility policy, the facility failed to provide timely incontinence care, turning and repositioning, and positioning to prevent increased edema for one resident, Resident #30 of three residents reviewed for assistance provident with activities of daily living. The facility census was 32. Residents Affected - Few Findings include: Record review for Resident # 30 revealed an admission date of 07/14/23. Diagnosis included urinary tract infection, hypertension, asthma and shortness of breath. Record review of the admission assessment dated [DATE] at 8:46 P.M. completed by Licensed Practical Nurse (LPN) #108 revealed Resident #30 was alert with occasional confusion and required one person assistants with positioning, transfers, ambulation, and total dependence for dressing and grooming. Resident #30 was incontinent of bowel and bladder. Resident #30's skin was within normal limits, there were no abnormal findings. Interventions to maintain skin integrity included a pressure reducing cushion to the chair and turn and reposition every two hours and as needed. Record review of the physician orders revealed Resident #30 received Aix 20 milligrams (mg) one time a day for edema. Review of the admission assessment revealed Resident #30 had no edema present. Record review of the Care assessment dated [DATE] revealed Resident #30 required partial moderate assistants with eating, toileting, perineal hygiene, toileting, and substantial/maximum assist with bathing, upper and lower body dressing. Record review of the progress note dated 02/17/23 at 2:56 P.M. completed by LPN #102 revealed Resident #30 had two plus pitting edema noted. Observation on 07/17/23 at 10:41 A.M. revealed Resident #30 was sitting up in a chair near his bed. Saturated blankets and sheets were lying near Resident #30 on the floor. The odor in Resident #30's room was a strong urine odor. State Tested Nurse Aide (STNA) #107 confirmed the strong urine odor and verified Resident #30's blankets and sheets lying next to him on the floor were saturated in urine. Resident #30 revealed he slept in the chair overnight because he does not sleep in a bed and had not for several years. Resident #30 had edema to his bilateral lower extremities. STNA #107 verified when she came at 7:00 A.M., Resident #30 was in the chair. The chair was similar to a kitchen chair, it did not recline. Resident #30 revealed he slept in a recliner chair at home and while in the hospital. Resident #30's pants were covered with food crumbs and saturated with urine covering the front of the pants. STNA #107 verified the pants Resident #30 was wearing was saturated with urine. STNA #107 stood Resident #30 up with the assistants of his walker. Resident #30's back of his pants were saturated with urine, the seat of the chair was saturated, and a puddle of urine was on the floor Page 1 of 2 365006 365006 07/18/2023 Hillside Plaza 18220 Euclid Ave Cleveland, OH 44112

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few next to his chair. STNA #107 confirmed the areas was urine and revealed she did not check Resident #30 for incontinence because she thought Resident #30 was continent and used a urinal. STNA #107 confirmed Resident #30 did not have a pressure reduced cushion in his chair and she did not turn or reposition him this shift. Observation revealed an unused urinal was sitting across the room on a shelf out of Resident #30's reach. Observation during peri care revealed Resident #30 had dried pieces of stool hanging from several hairs near his scrotum. Resident #30 did not have a bowel movement prior to or during observation of incontinence care. Resident #30's buttocks and upper thighs were discolored (darker skin tone) with lines of the chair where he had been sitting. STNA #107 verified the dried stool particles and discolored skin and revealed she did not know Resident #30 required assistants with incontinence care, transfers, and ambulation. STNA #107 confirmed she was Resident #30's assigned caregiver and revealed she did not know him because he was new, he arrived three days ago. STNA #107 revealed there was no documentation available to her revealing the individual needs of the residents, she just knew how to care for them because she had done it for so long. Interview on 07/17/23 at 11:14 A.M. with Certified Nurse Practitioner (CNP) #105 revealed if a resident did not want to lay in bed and the resident had edema, she would expect the facility to provide a recliner chair to keep the residents legs elevated. Interview on 07/17/23 at 11:20 A.M. with LPN #102 revealed she received in report Resident #30 preferred to sleep in a chair. Resident #30 was incontinent and required assistants with care. Licensed Practical Nurse (LPN) #102 revealed the State Tested Nursing Assistant (STNA) received report from nurses regarding resident care but not usually until after 11:00 A.M. LPN #102 confirmed Resident #30 did not have a pressure reducing cushion to his chair and Resident #30 had pitting edema to the bilateral lower extremities. LPN #102 confirmed Resident #30's legs were not elevated and Resident #30 was not offered additional options to elevate his legs. Interview on 07/17/23 at 1:49 P.M. with the Director of Nursing (DON) revealed residents who required assistant with incontinence care should be checked every two hours and assisted with care as needed. DON revealed STNA's had electronic access to residents medical records and used a [NAME] (located in the electronical medical records) to determine the residents individual needs. DON confirmed Resident #30's information regarding his personal needs have not been placed in the [NAME] (electronic section of the medical records) for the STNA's use. DON revealed if a resident did not sleep in the bed, the facility would either provide a recliner or a wheelchair with elevated leg rests especially if they had edema. DON revealed the nurses did not notify him Resident #30 never slept in his bed. Review of the facility policy titled, Incontinence Care dated 10/20/22, revealed the purpose was to keep skin clean, dry, free of irritation and odor and to identify skin problems as soon as possible so treatment can be started and to prevent skin breakdown. This deficiency represents non-compliance investigated under Complaint Number OH00144168. 365006 Page 2 of 2