Health inspection·March 13, 2024

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview the facility failed to ensure the appropriate state agency (The Ohio Department of Mental Health and Addiction Services) was notified of a significant change in a resident's Pre-admission Screen and Resident Review (PASRR). This affected one (Resident #88) of one resident reviewed for PASRR status. The facility census was 117. Findings include: Clinical record review revealed Resident #88 was admitted to the facility on [DATE] with diagnoses that included but were not limited to metabolic encephalopathy, unspecified dementia, type II diabetes mellitus, schizoid personality disorder and major depressive disorder. Review of the most recent quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #88 had severe cognitive impairment and required extensive assistance for completion of activities of daily living. Review of the PASRR form dated 08/01/23 for Resident #88 revealed no indications of serious mental illness and/or developmental disability. Review of section E; Indications of Serious Mental Illness revealed mood disorder and personality disorder were indicated. Review of nursing progress note dated 11/07/23 timed at 11:49 P.M. revealed Resident #88 was sent out and admitted to the hospital for diagnosis of jaundice and abnormal lab values. Review of nursing progress note dated 11/14/23 timed at 9:00 P.M. revealed Resident #88 was readmitted to the facility. Review of medical diagnoses for Resident #88 dated 11/14/23 revealed new diagnoses of schizoaffective disorder and bipolar disorder. Review of current PASRR records on 03/11/24 for Resident #88 revealed no evidence the state PASRR authority (The Ohio Department of Mental Health and Addiction Services) was made aware of Resident #88's new mental health diagnoses following her readmission on [DATE] via the completion of a new PASRR as required. Interview on 03/11/24 at 2:40 P.M. with the Administrator confirmed a PASRR was not completed following Resident #88's readmission on [DATE]. Interview on 03/11/23 at 3:55 P.M. with Social Worker #203 confirmed no new PASRR was submitted to the state PASRR authority to address Resident #88's new mental health diagnoses of schizoaffective Page 1 of 4 365264 365264 03/13/2024 O'Neill Healthcare Bay Village 605 Bradley Rd Bay Village, OH 44140

F 0644 disorder and bipolar disorder following her readmission on [DATE]. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 365264 Page 2 of 4 365264 03/13/2024 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, staff interview and facility policy review, the facility failed to ensure food was served in a sanitary manner and food was stored and dated properly. This had the potential to affect 114 residents receiving meals from the facility. The facility identified three residents (#14, #113, and #168) who received nothing by mouth. The facility census was 117. Findings include: A tour of the kitchen was conducted on 03/10/24 from 9:05 A.M. to 9:55 A.M. with Dietary Manager #200. The following concerns were observed during the kitchen tour. In the dry storage area, five packages of eight count Italian split sub buns were found with a use by date of 03/05/24, one package of 12 count hamburger buns with a use by date of 03/05/24. In the walk in refrigerator, a Ziploc bag with ham slices was found with a date of 02/28/24, a plastic container of egg salad dated 03/05/24, a plastic container of sliced peaches dated 03/05/24, a plastic container of sliced cucumbers dated 03/05/24 which appeared to be slimy, an unlabeled, undated Ziploc bag of cooked bacon slices, a Ziploc bag of four hot dogs with a date of 03/05/24, an undated container of egg salad, two open packages of sliced American cheese that were undated, and one undated open package of mozzarella wrapped in plastic wrap. An observation of the convection oven revealed it was heavily soiled on the bottom of the oven and the two ovens were also heavily soiled on the bottom. Review of the facility document titled, Weekly cleaning assignments hanging of the kitchen wall revealed incomplete daily cleaning assignments for all shifts dated 02/25/24 through 03/02/24. Interview at the time of the observations with Dietary Manager #200 confirmed the above findings. Dietary Manager #200 stated foods were to be labeled and dated when stored, leftovers were to be discarded after three days and kitchen cleaning tasks were to be completed per the posted cleaning schedule. Observation on 03/10/24 at 9:50 A.M. in the kitchen revealed Dietary Supervisor #201 with an uncovered beard. Interview at the time of the observation with Dietary Supervisor #201 confirmed he was not wearing a beard cover, he stated they were out of beard covers. Observation on 03/11/24 at 11:43 A.M. during tray line observation revealed [NAME] #202 was wearing a mask below his chin exposing his beard while preparing sandwiches. Dietary Manager #200 confirmed the observation and stated facial hair was to be covered. Review of the undated facility policy called Food Storage revealed leftover food was to be stored in covered containers or wrapped carefully and securely. Each item was to be clearly labeled and dated before being refrigerated. Leftover food was to be used within three days. Review of the undated facility policy called General Sanitation of Kitchen revealed the staff would maintain the sanitation of the kitchen through compliance with a comprehensive cleaning schedule. Tasks would be assigned to the responsibility of specific positions. Cleaning schedule would be 365264 Page 3 of 4 365264 03/13/2024 O'Neill Healthcare Bay Village 605 Bradley Rd Bay Village, OH 44140

F 0812 posted, and employees were to initial and date tasks when completed. Level of Harm - Minimal harm or potential for actual harm Review of the undated facility policy called Employee Sanitary Practices revealed all employees were to wear hair restraints. Residents Affected - Many The facility identified three residents (#14, #113, and #168) who received nothing by mouth. 365264 Page 4 of 4