Health inspection·October 19, 2023

F 0582 Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. Level of Harm - Minimal harm or potential for actual harm Based on record review and staff interview, the facility failed to ensure all required notices of potential financial obligation were provided to residents prior to the discontinuation of skilled services while using their Medicare Part A benefit. This affected three residents (#38, #69, and #98) of three residents reviewed for appropriate beneficiary notices. Residents Affected - Few Findings include: Review of the beneficiary notice worksheet provided by the facility during the annual survey revealed the following: 1. Resident #38 was discharged from skilled therapy services while using their Medicare Part A benefit on 05/18/23. Resident #38 remained in the facility after discharge. 2. Resident #69 was discharged from skilled therapy services while using their Medicare Part A benefit on 05/31/23. Resident #69 remained in the facility after discharge. 3. Resident #98 was discharged from skilled therapy services while using their Medicare Part A benefit on 05/05/23. Resident #98 remained in the facility after discharge. Review of the notices provided to Resident's #38, #68, and #98 upon discontinuation of skilled services revealed no Skilled Nursing Facility Advanced Beneficiary Notice of Non-Coverage (SNFABN) was given to Residents #36, #68 and #98 as required. Interview with Social Worker #845 on 10/17/23 at 1:20 P.M. verified the SNFABN was not given to Resident's #36, #68, and #98 as required. Page 1 of 7 365048 365048 10/19/2023 Life Care Center of Westlake 26520 Center Ridge Rd Westlake, OH 44145

F 0645 PASARR screening for Mental disorders or Intellectual Disabilities Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview the facility failed to ensure a valid level one pre-admission screen and resident review (PASRR) was completed prior to Resident #26's admission to the facility from a community setting. This affected one resident (#26) of three residents reviewed for PASRR. The facility census was 96. Residents Affected - Few Findings include: Resident #26 was admitted to the facility on [DATE] from home with diagnoses including major depressive disorder, anxiety disorder, dementia, and post-traumatic stress disorder. Review of Resident #26's PASRR records revealed a PASRR was completed on 04/07/22 by Residents #26's community case management agency. The form noted she was admitting the resident to the facility from a community setting. Licensed Social Worker (LSW) #845 verified that Resident #26's PASRR was not completed prior to admission as required during an interview on 10/19/23 at 10:30 A.M. 365048 Page 2 of 7 365048 10/19/2023 Life Care Center of Westlake 26520 Center Ridge Rd Westlake, OH 44145

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to provide care and services to diagnose and treat a suspected urinary tract infection (UTI) in a timely manner for Resident #43. This affected one resident (#43) of one resident reviewed for UTIs. The facility census was 96. Findings include: Review of the medical record for Resident #43 revealed an admission date of 09/09/21 with diagnoses including need for assistance with personal care, overactive bladder, anxiety disorder, and chronic diastolic congestive heart failure. Review of the Urinary Incontinence Tool assessment dated [DATE] revealed Resident #43 had urge incontinence and would try to use restroom. Resident #43 was reported to have a history of UTIs with historical symptoms including confusion and lethargy. Review of the Minimum Data Set (MDS) quarterly assessment dated [DATE] revealed Resident #43 had Brief Interview for Mental Status (BIMS) score of 12, indicating the resident had moderately impaired cognition. Resident #43 required extensive one staff assistance for bed mobility, transfers, toileting, and personal hygiene. Resident #43 was frequently incontinent of bowel and bladder. Review of the plan of care dated 10/05/23 revealed Resident #43 had recurrent UTIs. Interventions included to report signs and symptoms of UTI to the physician as needed, encourage adequate fluid intake, lab work as ordered, supplements as ordered for urinary health, and educate on good hygiene practices. Review of the Lab Result dated 10/10/23 revealed urine specimen collected on 10/06/23 for urinalysis with culture and sensitivity (UA C&S). Mixed pathogen growth of greater than 100,000 colony-forming unit per milliliter (CFU/mL) was found, and contamination was suspected. Review of the Health Status Note dated 10/11/23 at 3:16 A.M. revealed urine for culture and sensitivity was obtained via straight catheter. Urine was noted to be very thick, purulent with foul odor. Resident #43 was noted to be confused during the shift. Resident #43 denied dysuria (painful or difficult urination). Review of the Health Status Note dated 10/11/23 at 5:25 A.M. revealed Resident #43 was noted to have confusion and called the police. Resident #43 was noted to have had specimen collected and taken to lab. Resident #43 was reoriented to surroundings and left with the call light within reach. Review of the Cognitive Patterns/BIMS note dated 10/11/23 at 5:50 P.M. revealed Resident #43 had shown drastic decline in BIMS score from 12 on 10/02/23 to 7 on 10/11/23. Resident #43 stated she noticed the decline in cognition and reported having no energy. Resident #43 was noted to have a UTI and could cause fogginess. Review of Lab Result dated 10/12/23 revealed urine specimen for UA C&S was collected on 10/11/23. Mixed urogenital flora growth of less than 10,000 CFU/mL was found. 365048 Page 3 of 7 365048 10/19/2023 Life Care Center of Westlake 26520 Center Ridge Rd Westlake, OH 44145

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the Health Status Note dated 10/13/23 at 2:32 P.M. revealed UA C&S results had returned, and no new orders were obtained. Interview on 10/16/23 at 10:18 A.M. with Resident #43 revealed she believed she had a UTI. Resident #43 noted she was having periods of confusion and had gotten lost when trying to find her room yesterday. Resident #43 indicated she was unable to remember where her room was, and staff had to show her where it was. Resident #43 was unable to report what the facility was doing to treat a UTI. Review of the Health Status Note dated 10/17/23 at 12:34 A.M. revealed Resident #43 had been increasingly confused. Resident #43 continued to complain of burning during urination and lethargy. Resident #43 refused daytime medications. The on-call Nurse Practitioner was notified, and a new order for lab work in the morning was received. Review of the Health Status Note dated 10/17/23 at 1:54 P.M. revealed the Nurse Practitioner was notified regarding recent increase in confusion and a new order for UA C&S via straight catheter was obtained. Review of the Order-Administration Note dated 10/18/23 at 4:16 A.M. revealed staff were unable to obtain urine via straight catheter as ordered for Resident #43. Interview on 10/18/23 at 1:50 P.M. with Infection Control Nurse #821 revealed staff had reported a change in mental status for Resident #43. Infection Control Nurse #821 noted there had been two urinalysis labs come back as inconclusive. Infection Control Nurse #821 noted Resident #43 had not been acting like her normal self by refusing to get out of bed, not wanting to eat, confusion, and increase in incontinence episodes. Interview on 10/18/21 at 3:49 P.M. with State Tested Nursing Assistant (STNA) #938 and STNA #940 revealed Resident #43 had a change in mental status. STNA #938 noted Resident #43 was looking for her family in the hallway and not recognizing normal staff. STNAs #938 and #940 noted Resident #43 has had more episodes of incontinence lately. Review of the Order Note dated 10/19/23 at 1:28 A.M. revealed the on-call Nurse Practitioner was notified of increased confusion and abnormal lab work. The on-call Nurse Practitioner ordered 500 milligrams (mg) Ciprofloxacin HCl (antibiotic) every 12 hours for five days. Interview on 10/19/23 at 9:41 A.M. with Infection Control Nurse #821 confirmed urine specimen had not been collected on 10/17/23 or 10/18/23 as ordered. Infection Control Nurse #821 reported the pharmacy recommended doing another UA C&S via straight catheter to get a clear sample on 10/12/23 when the second result came back inconclusive. Infection Control Nurse #821 confirmed it was unusual to have a delay in treatment for a UTI. Infection Control Nurse #821 indicated she had reached out to the physician to discuss the situation. The physician was notified of Resident #43's UTI symptoms had not improved and an antibiotic was ordered on 10/19/23. Review of the Health Status Note dated 10/19/23 at 11:34 A.M. revealed a urine specimen was obtained via straight catheter for Resident #43. 365048 Page 4 of 7 365048 10/19/2023 Life Care Center of Westlake 26520 Center Ridge Rd Westlake, OH 44145

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, review of the facility insulin storage parameters, and interview, the facility failed to ensure insulin containers were labeled with opening dates to ensure they were not used beyond their recommended expiration. This affected four of four residents with insulin stored on the 200-hall medication cart (Resident's #34, #97, #9, and #30). The facility census was 96. Findings include: Observation of the unrefrigerated 200-hall medication cart on 10/16/23 at 4:50 P.M. revealed insulin injection pens had no date of opening recorded either on the pens or the plastic bags they were stored in. This affected two of two insulin pens for Resident #34, two of three pens for Resident #97, one of one pen for Resident #9, and one of one pen for Resident #30. Interview with Registered Nurse (RN) #891 on 10/16/23 at 4:50 P.M. confirmed the above findings, and that she could not identify what date the pens were opened. Record review of the facility's undated insulin storage parameters revealed insulin could only be stored at room temperature for a certain number of days before they should be discarded, ranging from ten to 56 days depending on the type of insulin. 365048 Page 5 of 7 365048 10/19/2023 Life Care Center of Westlake 26520 Center Ridge Rd Westlake, OH 44145

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation and staff interview the facility failed to ensure food was labeled and dated properly and was stored in a clean and sanitary manner to prevent contamination and food borne illness. This had the potential to affect 95 of 96 residents who received meals from the kitchen. The facility identified one resident (#8) who received nothing by mouth (NPO). Findings include: During the initial kitchen tour conducted on 10/16/23 from 9:03 A.M. through 9:28 A.M. revealed the following: • Two full packages of hot dog buns were dated use by 10/09/23. • In the deli cooler there was a package of undated shaved turkey and a container of shredded lettuce that was brown/slimy at the bottom. • In the freezer there was a plastic bag with ten pieces of breaded fish not labeled or dated. • The microwave had food spilled inside. These findings were verified by Dietary Manager #883 at the time of the observations. 365048 Page 6 of 7 365048 10/19/2023 Life Care Center of Westlake 26520 Center Ridge Rd Westlake, OH 44145

F 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation and staff interview, the facility failed to maintain its garbage disposal area in a clean and sanitary condition. This had the potential to affect 95 of 96 residents who received meals from the kitchen. The facility identified one resident (#8) who received nothing by mouth (NPO). Residents Affected - Many Findings include: Observation of the facilities garbage disposal area with Dietary Manager #883 on 10/16/23 at 9:20 A.M. revealed side doors to two dumpsters were open and garbage bags were protruding out the sides. There was some trash around the dumpster such as plastic cups, plastic gloves, dirt, and leaves. These observations were verified by Dietary Manager #883 at the time of the observation. An additional observation on 10/18/23 at 1:11 PM. bags of trash hanging out of the dumpster was verified by the Administrator at 1:26 PM. 365048 Page 7 of 7