Health inspection·June 29, 2023

F 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff and resident interview, review of the activity calendar, and policy review, the facility failed to ensure evening activities were provided. This affected three resident (#03, #16, and #47) out of 10 residents and three families interviewed for activities. The facility census was 73. Residents Affected - Few Findings Include: Review of the medical record for Resident #16 revealed an admission date of 08/18/22. Diagnoses included schizoaffective disorder, bipolar, anxiety, epilepsy, and alcohol induced dementia. Review of the quarterly Minimum Set (MDS) 3.0 dated 06/13/23, revealed she had intact cognition and was independent with transfers, ambulation, and hygiene. Review of the plan of care dated 06/12/23 revealed the resident is a sociable person and likes to participate in various activities. Intervention included to participate in group activities at least twice a week. Keeping busy with self-directed activities throughout the week. Interview on 06/26/23 at 11:59 A.M., during the initial screening process Resident #16 revealed there was nothing to do in the evening. Resident #16 stated she bought a [NAME] hoop for entertainment. Interview on 06/27/23 at 2:16 P.M., with Registered Nurse #390 stated activities are scheduled in the morning, after breakfast and in the afternoon between 2:00 P.M. and 3:00 P.M. There were no scheduled activities after dinner. Interviews on 06/28/23 with State Tested Nursing Assistant (STNA) #344 at 10:22 A.M. and STNA #322 at 3:10 P.M. each revealed no activities were provided during evening hours. Interviews on 06/28/23 at 3:55 P.M., during the resident council meeting Resident #47 said the place was an absolute ghost town after 4:00 P.M. and barely anything goes on besides reading the chronicle/newspaper thing on the weekends. Resident #03 said a friend of mine here has a saying when nothing is going on. Time to go back to our prison cells. Interview on 06/29/23 at 8:04 A.M., with Activity Personnel (AP) #348 stated all facility activities are provided from 8:00 A.M. to 4:00 P.M. seven days a week. AP #348 stated they have been without an Activity Director since April 2023. Interview on 06/29/23 at 8:59 A.M., with Human Resources (HR) Director #402 stated the former Page 1 of 3 365155 365155 06/29/2023 Avon Place Healthcare Center 32900 Detroit Rd Avon, OH 44011

F 0679 Level of Harm - Minimal harm or potential for actual harm Activity Director was terminated in April 2023. HR #402 stated a new Activity Director will onboard on 07/11/23. She stated it was difficult to find a Certified Activity Director. Review of the Activity Calender for April 2023, May 2023 and June 2023, revealed no activities were scheduled past 3:30 P.M. Residents Affected - Few Review of the policy titled Program Planning/Scheduling, dated 10/18/2001 revealed the activity department is responsible for planning and scheduling an Activity Program consisting of stimulating and therapeutic activities, diverse in focus, and consistent with resident's wishes and needs. The activity calendar will include some evening and weekend activities. The calendar will be implemented as written. 365155 Page 2 of 3 365155 06/29/2023 Avon Place Healthcare Center 32900 Detroit Rd Avon, OH 44011

F 0744 Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, staff interview and review of material safety and data sheets (MSDS), the facility failed to ensure a safe environment for residents residing on the secured memory care unit, when Resident #54 was able to have direct access to chemicals (spray can air freshener). This affected one resident (#54) of one resident reviewed for accident hazards. This had the potential to affect the 31 Residents (Residents #02, #04, #05, #06, #08, #13, #15, #16, #18, #23, #28, #30, #31, #33, #34, #36, #39, #40, #42, #44, #48, #49, #51, #56, #57, #64, #66, #67 #68, #71 and #125) who resided on the facilitys' secured dementia care unit. The facility census was 73. Residents Affected - Few Findings Include: Review of the medical record revealed Resident #54 was admitted to the facility on [DATE]. Diagnoses included chronic kidney disease, dementia and psychosis. Review of the most recent Minimum Data Set 3.0 assessment dated [DATE] revealed Resident #54 was cognitively impaired, does not speak English (Romanian was primary language), has active hallucinations and delusions and required hands on assistance for completing her activities of daily living (ADLs). Review of the care plan dated 06/28/22 revealed Resident #54 experienced alteration in mood and/or behavior as evidence by spraying herself and others with air freshener. No interventions related to inappropriate air freshener use or related chemicals were noted in the care plan. Observation of Resident #54 on 06/26/23 at 9:15 A.M. revealed Resident #54 was in her room, laying in bed watching television. Upon entrance in Resident #54's room Resident #54 immediately grabbed a bottle of febreeze air freshener from the bed side table behind her bed and began spraying the surveyor and shouting very loudly in her native language for approximately fifteen to twenty seconds until the surveyor left the room. Interview on 06/26/23 at 9:16 A.M., with the Housekeeper #399 who was cleaning the hallway in front of Resident #54's room while the above observation took place verified Resident #54 had the bottle of febreeze air freshener and probably should not have access to such items. The Housekeeper #399 said that was just who Resident #54 was. Interview with the Director of Nursing and the Administrator on 06/27/23 at 2:30 P.M., revealed they were aware of Resident #54 having access to items such as air fresheners and it was constant battle to educate Resident #54's family and loved ones regarding the safety of the use of such items as they are noted to frequently purchase similar items for Resident #54. Review of the MSDS sheet for the febreeze air freshener used by and located in Resident #54's room dated March 2011 revealed misuse by concentrating and inhaling the contents (the air freshener) can be harmful or fatal. 365155 Page 3 of 3