Health inspection·March 3, 2022

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure weights were taken as ordered and meal intakes were recorded consistently for Residents #440 and Resident #445. This affected two residents (Resident #440 and Resident #445) of three residents reviewed for nutrition. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #445 revealed the resident was admitted on [DATE] with diagnoses including multiple fractures of ribs, right side, chronic obstructive pulmonary disorder (COPD), emphysema, heart failure, dementia, and pneumonia. Review of Resident #445's physician orders dated 02/03/22 and 02/24/22 revealed orders for weekly weights. Review of the care plan dated 02/04/22, revealed a care area for risk of altered nutrition/hydration with interventions dated 02/07/22 to monitor weight per protocol and monitor oral (P.O.) intake. Review of progress notes revealed Resident #445 was hospitalized from [DATE] until 02/24/22. Review of the Minimum Data Summary (MDS) 3.0 assessment dated [DATE], revealed Resident #445 was severely cognitively impaired and required maximum for oral hygiene, and upper body dressing. The resident was totally dependent for toileting, showers, lower body dressing, and bed mobility. Review of weights for Resident #445 revealed an admission weight on 02/03/22 of 88 pounds (lbs.) and a weight on 02/18/22 of 84 lbs. and a Body Mass Index (BMI) of 16.2, indicating the resident was underweight. There were no weights taken when the resident was readmitted to the facility on [DATE]. Review of the 02/28/22 Nutritional Assessment (NA) for Resident #445 revealed intakes were poor. Orders for a pureed diet and liquid supplements were continued pending a re-entry weight. Review of the P.O. intake log for Resident #445 from 02/25/22 to 02/28/22 revealed nothing was recorded for dinner during these dates. Interview on 03/01/22 at 4:55 P.M. with Registered Nurse (RN) #504 revealed the aides recorded meal intake on the log after each meal. The RN verified there was no dinner intake recorded for Resident #445 from 02/25/22 through 02/28/22. Interview on 03/02/22 11:53 A.M. with Registered Dietician (RDLD) #519 verified a re-entry weight Page 1 of 3 365264 365264 03/03/2022 O'Neill Healthcare Bay Village 605 Bradley Rd Bay Village, OH 44140

F 0692 should have been taken for Resident #445 when she returned to the facility on [DATE]. Level of Harm - Minimal harm or potential for actual harm Review of the June 2012 facility policy titled, Obtaining and Documenting Weights, revealed weights would be obtained upon admission, weekly for 3 more weeks, then weekly for 3 more weeks, then monthly unless directed otherwise by the physician orders/RDLA/dietetic professional's recommendation. Residents Affected - Few 2. Review of the medical record for Resident #440 revealed the resident was admitted on [DATE] with diagnoses including displaced fracture of femur, COPD, heart failure (CHF), chronic kidney disease stage III, hypertension and hyperlipidemia. Resident #440's physician orders dated 02/22/22, revealed an order for daily weights with no end date, due to CHF protocol one time a day for CHF monitoring, and an order for weekly weights for four weeks. Review of admission MDS 3.0 assessment dated [DATE], revealed the resident was cognitively intact and had a significant weight loss not on a prescribed program. Review of the care plan dated 02/24/22, revealed a care area for a risk for altered nutrition/hydration with interventions to monitor weights per protocol and monitor intake. Review of the nutritional assessment dated [DATE] for Resident #440, revealed a weight loss of 10% or more last six months. Review of the intake log from 02/22/22 to 03/01/22 for Resident #440 revealed the only meal with intake recorded was dinner on 02/22/22, 02/23/22, and breakfast on 02/26/22. Review of the weights for Resident #440 revealed the resident refused being weighed on 02/22/22 and was weighed on 02/23/22, 02/27/22 and 03/02/22. Interview on 03/01/22 at 4:55 P.M. with Registered Nurse (RN) #504 revealed the aides recorded meal intake on the log after each meal. The RN verified incomplete intake log for Resident #440 from 02/23/22 to 03/01/22. Interview on 03/03/22 at 11:22 A.M. with Licensed Practical Nurse (LPN) #966 verified there were no weights for Resident #440 for 02/24/22 through 02/26/22, 02/28/22 and 03/01/22 despite the order for daily weights. Review of the June 2012 facility policy titled, Obtaining and Documenting Weights, revealed weights would be obtained upon admission, weekly for 3 more weeks, then weekly for 3 more weeks, then monthly unless directed otherwise by the physician orders/RDLA/dietetic professional's recommendation. 365264 Page 2 of 3 365264 03/03/2022 O'Neill Healthcare Bay Village 605 Bradley Rd Bay Village, OH 44140

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, interview, and record review, the facility failed to ensure the high temperature dishwasher was maintained at appropriate temperatures to effectively wash and rinse dishes to help prevent food borne illnesses. This had the potential to affect 90 residents who receive meals daily from the kitchen, one resident, Resident #67 was ordered nothing by mouth. The facility census was 91. Findings include: Initial tour kitchen observation on 02/28/22 at 7:20 A.M. revealed the high temperature dishwasher wash temperature was 121 degrees Fahrenheit (F) and rinse temperature 176 degrees (F). The dishwasher was ran twice and temperatures were the same. Interview on 02/28/22 at 7:20 A.M. with Dietary Manager #900 confirmed the above temperatures and revealed the dishwasher was not getting up to the appropriate temperatures. Dietary Manager #900 reported the maintenance department was notified of the malfunction on 01/23/22. Review of facility maintenance repair request revealed a note on 01/23/22 reporting dishwasher rinse not hitting temp; on 02/08/22 dishwasher temperatures continue problems hitting temperature; on 02/13/22 continue dishwasher temperatures; and on 02/27/22 continue dishwasher temperatures. Review of facility policy titled, clean dishes dish machine, dated 2005, revealed dishes and cookware would be washed and sanitized after each meal. The policy also stated mechanical dish machine using hot water to sanitize must be 165 degrees (F) to wash and 194 degrees (F) to rinse to achieve sanitation. 365264 Page 3 of 3