Health inspection·October 10, 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview the facility failed to provide dignified care for Resident #22 who had an indwelling urinary catheter. This affected one of one resident reviewed for dignity. The facility census was 61. Findings include: Resident #22 was admitted to the facility on [DATE]. Admitting diagnoses included healing femur (thigh bone)fractures, chronic kidney disease and dementia. According to the minimum data set (MDS) admission assessment dated [DATE], Resident #22 was cognitively impaired, required extensive assistance for bed mobility and personal hygiene, and was totally dependent on staff for dressing, toileting and bathing, and needed staff supervision with eating. Resident #22 had an indwelling urinary catheter and was frequently incontinent of bowel. On 10/07/19 at 10:07 A.M. Resident #22 was observed in a reclining chair in her room. Her urinary catheter drainage bag was visible from the hallway and was not covered with a privacy cover. Interview with State Tested Nursing Assistant (STNA) #112 at the time of the observation verified Resident #22's urinary catheter drainage bag was not covered as required. On 10/08/19 at 11:08 A.M. Resident #22 was observed sitting in the dining room with an unknown visitor. There was no privacy cover over the urinary catheter drainage bag. On 10/08/19 at 1:29 P.M. Resident #22 was observed in the common area watching television with no privacy cover over the urinary catheter drainage bag. Interview with Licensed Practical Nurse (LPN) #500 at the time of observation verified Resident #22's urinary catheter drainage bag was not covered for dignity as required. On 10/09/19 at 8:01 A.M. Resident #22 was observed in the dining room during the breakfast meal. Resident #22 was in a reclining chair positioned upright, leaning forward with her head resting onto the table in front of her partially eaten breakfast plate. Resident #22 was observed wearing a hospital gown, secured only at the neck, exposing her incontinence brief and there was no privacy cover over the urinary catheter drainage bag. Resident #22's back was fully exposed with the top portion of the incontinence brief visible. Resident #22 was observed at a table with four other residents and two staff members who were assisting those residents with eating the breakfast meal. Interview with STNA #125 at the time of the observation verified Resident #22's back and incontinence brief were exposed and the urinary catheter drainage bag was not covered for dignity as required. Page 1 of 5 365287 365287 10/10/2019 Altercare of Cuyahoga Falls Ctr for Rehab & Nursin 2728 Bailey Rd Cuyahoga Falls, OH 44221

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 10/09/19 at 9:06 A.M. with Activity Director #126 verified Resident #22's back and incontinence brief was visible while sitting with other residents during the breakfast meal in the dining room and Resident #22 was not covered for dignity as required. On 10/09/19 at 9:48 A.M. Resident #22 was observed in the common area with two other residents. There was no privacy cover on her urinary catheter drainage bag. Interview with STNA #104 at the time of the observation verified the urinary catheter bag was not covered for dignity as required. Interview on 10/10/19 at 12:02 P.M. with Director of Nursing confirmed a cover should be placed over urinary catheter drainage bags for dignity and Resident #22's back and incontinence brief should have been covered while in the dining room during the breakfast meal. Review of the undated facility policy entitled, Resident Rights, revealed the facility would make every effort to assist each resident in exercising rights to assure treatment of kindness and respect. 365287 Page 2 of 5 365287 10/10/2019 Altercare of Cuyahoga Falls Ctr for Rehab & Nursin 2728 Bailey Rd Cuyahoga Falls, OH 44221

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interviews and review of the facility policy and procedure for medication administration, the facility did not ensure medications were properly secured on the D hall during medication preparation for Resident #26. This had the potential to affect the seven residents in the dining room, Resident #22, #29, #33, #37, #41, #43 and #46. The census was 61 residents. Findings include: Record review for Resident #26 revealed the latest return to the facility was on 02/20/19. Diagnoses included a cerebral infarction or stroke, dysphagia or difficulty swallowing, which required a feeding tube placed in the stomach for nutritional feeding and medication administration. Observation of medication preparation and medication administration was completed on 10/08/19 at 8:51 A.M. with Licensed Practical Nurse (LPN) #500. During the observation, LPN #500 dispensed the following medications into a 30 milliliter (ml) plastic disposable cup for Resident #26 who had a feeding tube. The medications required crushing and mixing with water for administration through the feeding tube located in the stomach. This process required the use of a 60 ml syringe. 1. 81 milligrams (mg) of aspirin 2. Cilostazol 100 mg 3. Clopidogrel 75 mg 4. Furosemide 40 mg 5. Carvedilol 6.25 mg 6. Isosorbide mononitrate 30 mg 7. Lisinopril 20 mg 365287 Page 3 of 5 365287 10/10/2019 Altercare of Cuyahoga Falls Ctr for Rehab & Nursin 2728 Bailey Rd Cuyahoga Falls, OH 44221

F 0761 8. Level of Harm - Minimal harm or potential for actual harm Metformin 500 mg 9. Residents Affected - Some Senna docusate sodium 8.6 mg/50 mg, two tablets The 30 ml plastic cup containing Resident #26's medications was placed on the top of the medication cart located at the central hub of the D unit. The dining area was located to the right side of the medication cart. LPN #500 stated she needed to obtain a syringe from the medication room and walked approximately 20 feet to the left of the medication cart to the medication room, opened the secured door, turned around and asked the surveyor if he wanted to accompany the nurse into the medication room. The surveyor responded no and remained at the medication cart, along with another surveyor. The medications were observed left out on top of the medication cart and were unsecured. LPN #500 entered the medication room and exited approximately 30 seconds later. Upon returning to the medication cart, LPN #500 verified she had left these medications unsecured and out of her visual sight. At the time of observation, seven residents, Resident #22, #29, #33, #37, #41, #43 and #46 were identified in the dining area and had access to the medication cart. Review of the document titled #181, General Guidelines for Medication Administration, effective date 06/02/15, revealed under bullet point #20, During administration of medications, the medications cart is kept closed and locked when out of sight of the medication nurse or aide and no medications are kept on the top of the cart. An interview on 10/09/19 at 11:00 A.M. was completed with the Administrator and the Director of Nursing and these findings were reported. It was stated the medications should never have been left out in the open and unobserved by the nurse. 365287 Page 4 of 5 365287 10/10/2019 Altercare of Cuyahoga Falls Ctr for Rehab & Nursin 2728 Bailey Rd Cuyahoga Falls, OH 44221

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 resident foods were stored in a safe and sanitary manner. These practices had the potential to affect the 58 residents receiving food from the kitchen. The facility identified Resident #1, Resident #8 and Resident #26 as receiving nothing by mouth. The facility census was 61 residents. Findings include: Tour of the kitchen and food storage areas starting on 10/07/19 at 8:25 A.M. with Dietary Manager (DM) #100 revealed a pan of pork gravy not labeled or dated in the reach-in cooler in the kitchen. Tour of the resident units and nourishment refrigerators revealed: on Pod D, a sticky substance on the base of the refrigerator; on Pod A, five Chinese takeout containers, a plastic bag with two slices of pizza, cottage cheese, fruit and a dairy beverage not labeled or dated; and on Pod C, a container of soup not labeled or dated. Interview with DM #100 verified the above findings at the time of observation. DM #100 confirmed resident food was to be labeled and dated and nursing staff was responsible for cleaning out the nourishment refrigerators. DM #100 stated resident food items were safe for consumption for five days before the items would need to be discarded. Interview on 10/07/19 at 8:39 A.M. with Registered Nurse (RN) #101 revealed nurses were supposed to clean the nourishment refrigerators. Interview on 10/07/19 at 9:59 A.M. with Corporate Food Service Director #103 verified the above concerns with resident nourishment refrigerators and stated ultimately the dietary department should be checking resident food items. Review of an undated facility policy on food brought to residents by family and visitors revealed residents and families were given a copy of the policy and offered a handout on safe food handling practices. Food item(s) were to be labeled with the resident's name, the date it was prepared, if known and an expiration date. Review of an undated facility policy on dating and labeling foods revealed all food in production or leftover food must be dated with a made on date and an expiration date not to exceed five days. 365287 Page 5 of 5