Health inspection·May 30, 2019

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on record review, observation, resident interview, staff interview, and review of job description, the facility failed to ensure clothing other than hospital gowns were obtained for daily wear for one (#140) out of one resident reviewed for choices. The facility census was 49. Findings include: Review of the medical record of Resident #140 revealed an admission date of 05/09/19. Diagnoses included systolic and diastolic heart failure, altered mental status, hypertension, and benign lipomatous neoplasm of skin and subcutaneous tissue of unspecified limb. Review of the admission Minimum Data Set assessment, dated 05/16/19, revealed Resident #140 had severe cognition impairment and it was very important to the resident to choose what clothes to wear. Random observations on 05/28/19, 05/29/19, and 05/30/19 revealed Resident #140 to be dressed in a hospital type gown and seated in a wheelchair or in his bed. Interview on 05/30/19 at 9:26 A.M., Resident #140 revealed he would like to have clothes to wear but has none. He denies anyone talking with him regarding clothes. He admits he would leave his room if he had clothes to wear. Interview on 05/30/19 at 9:38 A.M., the Social Service Director (SSD) #220 revealed she only received the telephone numbers yesterday to contact family members to obtain clothing. She added when residents arrive without clothing the facility will look at the extra clothing at the facility for a fit. If none, the facility will reach out to family for clothing and then ask the owners for assistance to purchase clothing. SSD #220 revealed she had not assisted Resident #140 to obtain any clothing while at this facility. Review of the facility document titled Social Worker Job Description, dated 01/23/18, revealed it is the responsibility of the Social Worker to maximize the well-being and quality of life of residents. Page 1 of 6 365279 365279 05/30/2019 Merit House LLC 4645 Lewis Ave Toledo, OH 43612

F 0558 Reasonably accommodate the needs and preferences of each resident. 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, observation, resident interview, staff interview, and facility policy review, the facility failed to ensure the call light was within reach for two (#34 and #4) of 42 residents identified by the facility to utilize call lights. The facility census was 49. Residents Affected - Few Findings include: 1. Resident #34 was admitted to the facility on [DATE] with diagnoses including congestive heart failure, psychosis, anxiety disorder, hypertension, and morbid obesity. Review of the significant change in status Minimum Data Set (MDS) assessment, dated 05/06/19, revealed the resident had no cognitive deficits and was dependent on one staff member for bed mobility, transfers, and toileting. Review of the plan of care dated 05/01/19 noted the resident was incontinent of bowel and bladder. The interventions included to ask and encourage the resident to utilize the call light system to report the need to use the bathroom. Observation and interview on 05/28/19 at 11:01 A.M., Resident #34 asked the surveyor to get staff to put her on the bed pan. The resident's call light was draped over the center of the oxygen concentrator on the floor by her bed out of her reach. The resident verified she was unable to reach her call light Interview on 05/28/19 at 11:05 A.M., State Tested Nursing Assistant (STNA) #200 verified Resident #34's call light was draped over the oxygen concentrator and the resident was unable to reach it. 2. Review of the medical record for Resident #4 revealed she was admitted to the facility on [DATE]. Diagnoses included fracture of the left tibia, fracture of the right tibia, atrial fibrillation, heart failure and hypertension. Review of the quarterly MDS assessment, dated 02/27/19, revealed Resident #4 was cognitively intact. Resident #4 was dependent on two staff for bed mobility, transfers, locomotion, dressing, toileting, personal hygiene and bathing. Resident #4 had no impairment of her upper extremities. Review of the current plan of care revealed Resident #4 required extensive to total care assistance with Activities of Daily Living. Interventions included to remind and instruct resident to utilize call light and keep call light within reach while in her room. Observation and interview on 05/28/19 at 10:55 A.M. revealed upon entering Resident #4's room, she was sitting in her wheelchair. Resident #4 stated her leg was hurting and she wanted some help but she was not able to reach her call light to call for assistance. She stated the staff had not given it to her after they got her up into the wheelchair. Observation revealed her call light was clipped to the sheet at the head of the bed behind Resident #4 and not in with in her reach. Interview on 05/28/19 at 11:00 A.M., Registered Nurse (RN) #230 verified the call light was not in reach for Resident #4. 365279 Page 2 of 6 365279 05/30/2019 Merit House LLC 4645 Lewis Ave Toledo, OH 43612

F 0558 Review of the undated facility policy titled Call Light Response revealed call lights must be within reach of the resident at all times. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 365279 Page 3 of 6 365279 05/30/2019 Merit House LLC 4645 Lewis Ave Toledo, OH 43612

F 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to provide residents and their representative(s) with written notice of the reason for the discharge to three (#37, #39 and #28) of three residents reviewed for hospitalization. The facility census was 49. Finding include: 1. Review of the medical record revealed Resident #37 was admitted to the facility on [DATE]. Diagnoses included multiple sclerosis, peripheral vascular disease, neurogenic bladder, flexion contracture of left lower leg, and amputation right lower leg. Review of the medical record revealed the resident was admitted to the hospital on [DATE] for an infection. She returned to the facility on [DATE]. There was no evidence in the resident's medical record indicating the resident and her representative were provided a written reason for the transfer to the hospital. Interview with Social Service Director (SSD) #220 on 05/28/19 at 2:00 P.M. she verified she did not give Resident #37 or her representative a written statement for reason for discharge to the hospital on [DATE]. 2. Review of the medical record for Resident #39 revealed an admission to the facility on [DATE]. Diagnoses included chronic obstructive pulmonary disease, chronic respiratory failure, osteoporosis, atrial fibrillation, hypertension, diabetes type II, and obstructive sleep apnea. Review of the medical record revealed the resident was admitted to the hospital on [DATE] for a respiratory infection. There was no evidence in the medical record indicating the resident and resident's representative was provided the reason for transfer to the hospital in writing. Interview on 05/30/19 at 12:15 P.M., SSD #20 verified she did not give Resident #39 or her representative the reason for transfer to the hospital in writing. 3. Review of the medical record for Resident #28 revealed she was admitted to the facility on [DATE]. Diagnoses included anxiety, insomnia, bladder disorder, hypothyroidism and dementia. Review of the nurse progress notes revealed Resident #28 was discharged to the hospital after a fall on 04/1/2019 at 11:33 A.M. Resident #28 returned from the hospital to the facility on [DATE] at 7:15 P.M. There was no evidence in the resident's medical record indicating the resident and her representative were provided a written reason for the transfer to the hospital. Interview on 05/29/19 at 2:03 P.M., SSD #20 stated she was not aware she was required to provide written notice of discharge to residents and their representatives. Interview on 05/30/19 at 8:44 A.M., SSD #20 verified no written notice of discharge was given to Resident #28 or her family/representative. 365279 Page 4 of 6 365279 05/30/2019 Merit House LLC 4645 Lewis Ave Toledo, OH 43612

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. Based on record review, resident interview, staff interview and review of the care conference documentation, the facility failed to hold care conferences with resident input for one (#2) out of three residents reviewed for care plan participation. The facility census was 49. Findings include: Review of the medical record of Resident #2 revealed an admission date of 08/13/18. Diagnoses included chronic obstructive pulmonary disease, iron deficiency anemia, diabetes mellitus, major depression and chronic pulmonary edema. Review of the quarterly Minimum Data Set assessment, dated 02/20/19, revealed Resident #2 to have no cognitive deficit. Interview on 05/28/19 at 11:10 A.M., Resident #2 revealed she has not been invited nor has she attended a care plan conference since admission here. Review of the Care Plan Conference form for Resident #2, dated 03/28/19, revealed it to be blank except for the signatures on the last page. This was verified by the Director of Nursing at the time of review on 05/29/17 at 12:18 P.M. Interview on 05/29/19 at 2:35 P.M., Social Service Director (SSD) #220 revealed Resident #2 had been given a form to attend the care conference scheduled for 05/28/19 and had not responded. The care conference was held with the interdisciplinary team on 05/27/19. SSD #220 could not identify the exact date the scheduled meeting was given to Resident #2. 365279 Page 5 of 6 365279 05/30/2019 Merit House LLC 4645 Lewis Ave Toledo, OH 43612

F 0880 Provide and implement an infection prevention and control program. 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, observation, resident interview, staff interview, and facility policy review, the facility failed to address the use of signage to inform the public of a communicable disease requiring isolation and failed to provide signage for isolation for one resident (#19) of one resident reviewed for isolation. The facility identified one resident in the facility in isolation. The facility census was 49. Residents Affected - Few Findings include: Review of the medical record revealed Resident #19 was admitted to the facility on [DATE]. Diagnoses included intellectual disabilities, depression, schizoaffective disorder, neuromuscular dysfunction of the bladder, a history of Methicillin Resistant Staphylococcus Aureus (MRSA) infection, hypertension and anxiety. Review of the physician order dated 05/16/19 revealed an order for a urinalysis with a culture and sensitivity (UA C&S) due to blood tinged sediment noted in his urine. On 05/16/19 the antibiotic Macrobid 100 milligrams (mg) twice daily for ten days was ordered with contact isolation due to isolate was Methicillin susceptible. Review of the UA C&S report dated 5/20/19 revealed the urine was positive for infection with an Methicillin susceptible isolate. Observations on 05/28/19 at 9:48 A.M. revealed there was an isolation cart outside Resident #19's door. There was no signage on the door for any information indicating to check with the nurse prior to entering the resident's room or of the resident's isolation status. Addition observations from 05/28/19 at 9:48 A.M. to 05/29/19 at 11:09 A.M. revealed Resident #19 continued to have the isolation cart beside his door and there was no signage on his door related to his isolation status. Interview on 05/28/19 at 9:48 A.M., Resident #19 verified he had a urinary tract infection (UTI) and he was in isolation. Interview with Licensed Practical Nurse (LPN) #210 on 05/29/19 at 11:10 A.M. she verified Resident #19 was in isolation for a UTI with contact precautions. LPN #210 verified there was no signage on Resident #19's door to indicate he was in isolation or provide direction to visitors. Interview with Director of Nursing (DON) on 05/28/19 at 4:37 P.M. she also verified Resident #19 was in contact isolation for UTI. He was on an antibiotic for UTI since 05/22/19. DON verified his UA C&S was completed and positive for Methicillin Sensitive Staphylococcus Aureus (MSSA). DON stated Resident #19 will stay in isolation until his antibiotic was complete. Review of the undated facility policy titled Infection Control and Prevention Plan revealed a discription of when Contact Precautions are applicable and steps to implement for contact precautions. The policy was silent to posting any signage providing information regarding the need to see staff or to identify steps to protect against transmission of disease when isolation was required. 365279 Page 6 of 6