Health inspection·August 10, 2023

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on record review, observation and interview, the facility did not ensure Resident #19's room was free from safety hazards that could potentiate fall risk. This affected one resident (#19) of four residents reviewed for accident hazards. The facility census was 27. Findings include: Medical record review was conducted for Resident #19 revealing a diagnosis of pain, malnutrition, and debility. Resident #19 had altered visual depth perception and was a fall risk. Observation of Resident #19's room on 08/07/23 at 3:32 P.M., 08/08/23 at 8:30 A.M. and 08/09/23 at 9:43 A.M. revealed both wooden doors to her clothing closet full of her clothing were off track at the bottom and leaning against her clothing. The top of the wooden closet doors were attached to the closet door frame, but the bottom of the doors swung loosely back and forth upon opening and there was no bottom track placement to safety secure the doors. Interview was conducted on 08/08/23 at 9:47 A.M. with STNA #301 who stated Resident #19 made her own choices and was able to go into her own closet to pick out her own clothes. Interview was conducted on 08/08/23 at 9:57 A.M. with Maintenance Director #332 who verified Resident #19's closet doors were not safely secured at the bottom so there was nothing to prevent the doors from falling out. Interview was conducted on 08/09/23 at 9:43 A.M. with Physical Therapy Assistant #335 who verified the loose closet doors and added this was not safe for Resident #19 because she was at risk for falls. Page 1 of 3 365051 365051 08/10/2023 Ohio Living Rockynol 1150 W Market St Akron, OH 44313

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 observations, interview and policy review, the facility failed to ensure safe food handling to prevent cross contamination. This had the potential to affect all 27 residents receiving meals from the kitchen. The facility did not identify any residents who did not eat by mouth. Findings include: Observation was conducted on 08/08/23 at 11:30 A.M. of the lunch tray line. The cook serving on tray line was observed grabbing plates on the tray line then using the same gloved hand to grab sandwich buns out of a plastic bag. After throwing away the plastic bag in the trash can, the cook proceeded to touch another sandwich bun out of a new plastic bag with the same gloved hands. The cook then changed into new gloves without performing hand washing before applying the new gloves and proceeded to use her gloved hands to grab more buns, fresh lettuce and fresh tomato slices for sandwiches for the residents. Observation was conducted on 08/09/23 at 11:45 A.M. of the luch tray line, and it was noted the tray line cook used a gloved hand to grab a hamburger bun out of a plastic bag then touched loose potato chips , a serving scoop handle and another hamburger bun. After discarding a plastic bag in the trash can, the cook proceeded to touch loose open chips for serving to residents with the same gloved hand. The cook made no attempt to wash her hands or change into clean gloves when moving between touching the food items and touching the scoop handles and plastic bags. Interview was conducted on 08/09/23 at 12:00 P.M. with Culinary Director (CD) #338 whoverified the tray line cook did not practice proper glove usage or proper hand hygiene. CD #338 revealed the cook should have used tongs to grab the buns and other food items instead of directly touching the food with her gloved hands that had also touched utensils and plates. Review of the Ohio Living Rockynol Cross Contamination Dietary policy, undated, revealed all employees must wash hands when changing jobs. 365051 Page 2 of 3 365051 08/10/2023 Ohio Living Rockynol 1150 W Market St Akron, OH 44313

F 0921 Level of Harm - Potential for minimal harm Residents Affected - Many Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on observation, staff interview, and review of the resident council minutes, the facility failed to ensure the carpeting in the resident hallways and resident rooms was maintained in a clean manner and in good condition. This had the potential to affect all 27 residents residing in the facility. Findings include: An environmental tour was conducted on 08/09/23 between 8:00 A.M. and 3:30 P.M. The tour revealed carpeting in the hallways throughout the facility, resident common areas and the carpet leading into resident rooms contained multiple and significantly large stains of brown and other various colors, and multiple areas with a buildup of dust and debris. The carpeting was also noted in numerous areas to be pulling away from the floor in the center of the hallways leading to resident rooms indicating a lack of proper adhesion of the carpet to the floor. Interview was conducted on 08/09/23 at 3:22 P.M. with Corporate Registered Nurse (RN) #334 who verified the condition of the carpeting. Interview was conducted on 08/09/23 at 3:26 P.M. with Resident #19 who stated the carpet by the nurses stations needed to be removed and the facility needed new carpeting. An interview with Housekeeper # 333 on 08/09/23 at 3:28 P.M. stated they told told management a long time ago about the carpet stains. Interview with The Administrator on 08/09/23 at 3:53 P.M. revealed the carpet had not been replaced due to planned move of all residents off the first floor to the second floor. Interview was conducted on 08/09/23 at 4:48 P.M. with Resident #2 who voiced complaints that the carpet in her room was dirty and her room smelled bad from the dirty carpet. Observation and interview on 08/10/23 at 11:00 A.M. with the Administrator of the second floor of the facility revealed no evidence of remodeling in progress for the move of residents to the second floor. The Administrator stated there was no start date set for the remodeling. Record review of Resident Council minutes revealed January 2023 environmental concerns were reported about dirty carpets. 365051 Page 3 of 3