Health inspection·April 4, 2019

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, observation and record review, the facility failed to ensure the care plans were updated timely for residents with catheters. This affected two residents (Resident #44 and Resident #88) out of two residents reviewed for catheters. The facility census was 148. Findings Include 1. Resident #44 was admitted to the facility on [DATE]. Her admitting diagnoses included urinary tract infection, severe sepsis with septic shock, neuromuscular dysfunction of the bladder, chronic kidney failure and encephalopathy. According to Resident #44's Minimum Data Set 3.0 (MDS) assessment, dated 01/24/19, this resident had moderate cognitive impairment. She needed extensive assistance of staff for bed mobility, transfers, dressing, toilet use and personal hygiene. Review of the bowel and bladder assessment of this MDS showed that the resident did have an indwelling urinary catheter. Review of Resident #44's physician orders revealed on 02/05/19 the physician wrote an order for the resident to have a foley (Urinary drainage tube that is inserted into the bladder) due to a neurogenic bladder. The foley is to be a size 16 FR with a 10 cc balloon to gravity drainage. The foley catheter is to be secured with the foley leg strap. Review of this resident's plan of care dated 01/21/19 revealed the resident was at risk for infection and/or trauma related to use of a foley catheter for a neurogenic bladder. Review of the interventions for this plan of care showed to: Check foley catheter for patency, and/or kinks in tubing every shift; foley catheter care every shift, assess resident for pain/discomfort every shift and to monitor for signs/symptoms of urinary tract infection. There was no intervention listed to secure the foley with a foley leg strap. Interview with the Director of Nursing (DON) on 04/03/19 at 12:35 P.M. revealed that the resident did not have the intervention to secure the resident's catheter with foley leg strap. 2. Resident #88 was admitted to this facility on 01/09/18. His admitting diagnoses included acute kidney failure, chronic kidney disease, Alzheimer's disease, dementia and neuromuscular dysfunction of the bladder. Resident #88's Minimum Data Set 3.0 (MDS) assessment dated [DATE] revealed this resident was cognitively intact. Resident #88 needed extensive assistance of staff for bed mobility, transfers, toilet Page 1 of 3 365084 365084 04/04/2019 Pleasantview Care Center 7377 Ridge Rd Parma, OH 44129

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few use and personal hygiene. The bowel and bladder assessment of this MDS stated the resident did have a foley catheter (a urinary catheter inserted into the bladder) to drain his urine. Review of the physician's order for this resident showed that on 01/31/19 the physician wrote an order for foley catheter insertion related to obstructive uropathy. A 16 FR foley catheter was to be inserted with a 10 cc balloon to gravity drainage. Secure the foley catheter with a leg strap. Review of the care plan dated 03/01/19 revealed the resident was at risk for infection related to the use of a foley catheter. Interventions for this care plan included Checking the foley catheter for patency, kinks in tubing every shift; and to provide foley catheter care every shift. It did not include that the foley catheter was to be secured with a foley catheter leg strap. Observation of catheter care being provided to this resident by State Tested Nurse Aide (STNA) #500 on 04/03/19 at 11:00 A.M. revealed that the resident did not have his foley catheter secured with a leg strap per the physician's order. STNA #500 verified that the resident did not have a leg strap in place on 04/03/19 at 11:25 A.M. Interview with the DON on 04/04/19 at 12:35 P.M. verified that the resident did not have an intervention in his care plan instructing staff to secure the foley catheter with a leg bag. . 365084 Page 2 of 3 365084 04/04/2019 Pleasantview Care Center 7377 Ridge Rd Parma, OH 44129

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on record review, observation, and interview, the facility failed to ensure staff did not falsely record the removal of lidocaine patches for Resident #105. This affected one of seven residents reviewed for medication administration (Resident #105, #447, #62, #64, #98, #67, and #110). the facility census was 150. Findings include: Observation of a medication administration pass for Resident #105 on 04/02/19 at 8:25 A.M. by Licensed Practical Nurse #201 revealed the resident to have two Lidocaine 4% patches dated 04/01/19 already on their knees. The nurse removed the old patches then applied new patches on each knee. Record review of Resident #105 revealed orders for their lidocaine patches to be applied at 9:00 A.M. each morning and removed at 5:00 P.M. each evening. Review of their medication administration record revealed a staff member documented that the patches were removed on 04/01/19 at 5:00 P.M. No evidence could be found indicating a different set was applied in between that time and Licensed Practical Nurse #201's removal of the old patches on 04/02/19. This finding was confirmed with the Director of Nursing on 04/02/19 at 4:12 P.M. 365084 Page 3 of 3