Health inspection·July 29, 2024

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, facility self-reported incident (SRI) review, and interview the facility failed to prevent resident-to-resident abuse for residents #41 and #104. This affected two residents (#41 and #104) of three residents reviewed for abuse. The facility census was 103. Findings include: Review of the closed medical record for the Former Resident #104 revealed an admission date of 06/13/24. The resident was discharged to the hospital on [DATE]. Diagnoses included Alzheimer's disease, diabetes, and dementia with agitation. The resident was at the facility for a respite stay. Review of the admission Minimum Data Set (MDS) assessment, dated 06/20/24, revealed Resident #104 had severely impaired cognition. The resident's hearing and vision were adequate without devices. Behaviors included physical behavioral symptoms directed at others, verbal behavioral symptoms directed at others, other behavioral symptoms not directed at others, and rejection of care. Review of physician orders for June 2024 revealed orders for: • Haloperidol Oral Tablet 1 milligram (mg) (antipsychotic) by mouth every three hours as needed for behaviors. The order was dated 06/27/24 at 10:15 A.M. • Alprazolam Oral Tablet (Xanax) 0.5 mg (antianxiety) every four hours as needed for agitation/anxiety. The order was dated 06/25/24. • Alprazolam Oral Tablet (Xanax) 0.5 mg every eight hours as needed for anxiety. The order was dated 06/13/24 to 06/25/2024. • Sertraline HCl Oral Tablet 100 mg (antidepressant) by mouth in the morning for depression. The order was dated 06/14/24. Page 1 of 17 365290 365290 07/29/2024 Kirtland Woods of Journey 9685 Chillicothe Rd Kirtland, OH 44094

F 0600 • Level of Harm - Minimal harm or potential for actual harm Risperidone Oral Tablet 0.25 mg (antipsychotic) by mouth at bedtime for behaviors. The order was dated 06/13/24. Residents Affected - Few • Divalproex Sodium Oral Capsule Delayed Release Sprinkle 125 mg 9anticonvulsant) by mouth two times a day. The order was dated 06/13/24. Review of the plan of care dated 06/17/24 revealed Resident #104 exhibited verbal and physical behaviors related to diagnosis of dementia. He can become combative with hands on care. Interventions included: administering medications as ordered. Monitoring for effectiveness. Intervening as necessary to protect the rights and safety of others. Approaching/speaking in a calm manner. Diverting attention. Removing from the situation and take to an alternate location as needed. Review of the plan of care dated 06/17/24 revealed Resident #104 was an elopement risk/wanderer. Wanders in and out of other's rooms. Interventions included: Gently redirect away from exit doors. Review of the plan of care dated 06/21/24 revealed Resident #104 had potential for delirium or an acute confusional episode related to Alzheimer diagnosis, change in environment, use/side effects of psychotropic medication. Interventions included: engaging the resident in simple, structured activities that avoid overly demanding tasks. Monitor for/address environmental factors recent change in environment, environmental noise and commotion. Provide medications to alleviate agitation as ordered by the physician. Monitor/document side effects and effectiveness. Redirect and provide gentle reality orientation as required. Reorient to person, place, time, situation as required. Review of the nurse's progress note dated 06/22/24 at 6:43 A.M. revealed resident #104 exhibited behaviors of combativeness with care and redirection. The as needed Xanax 0.5 mg was effective. Review of the nurse's progress note dated 06/23/24 at 7:15 P.M. revealed Resident #104 was restless, walking around touching other residents. The as needed Xanax 0.5 MG was effective. Review of the nurse's progress note dated 06/25/24 at 12:15 A.M. revealed Resident #104 was highly agitated, constantly getting out of bed. Review of the nurse's progress note dated 06/25/24 revealed nurse contacted hospice to notify them that resident #104 was highly agitated after dinnertime. The resident was very difficult to redirect even after evening meds and as needed Xanax. Resident #104 was constantly getting up, touching other residents, and going into their rooms. Review of the nurse's progress note dated 06/25/24 revealed the hospice nurse contacted the doctor and increased Resident #104's Xanax 0.5 mg to every four hours as needed for agitation/anxiety. Review of the behavior note dated 06/25/24 at 9:00 P.M. revealed the state tested nurse aide (STNA) stated Resident #104 was constantly getting up out of the wheelchair touching other residents and touching anything in site. Review of the behavior note dated 6/26/24 at 9:30 P.M. revealed Resident #104 had high anxiety and 365290 Page 2 of 17 365290 07/29/2024 Kirtland Woods of Journey 9685 Chillicothe Rd Kirtland, OH 44094

F 0600 was very agitated with care. Level of Harm - Minimal harm or potential for actual harm Review of the nurse's progress note dated 06/26/24 at 10:00 P.M. revealed Resident #104 was constantly moving out of chair, was very agitated, had high anxiety, was touching other residents, and going in their rooms. On 06/27/24 at 1:02 A.M., Xanax was noted as ineffective. Residents Affected - Few Review of the nurse's progress note dated 06/27/24 at 10:06 P.M. revealed Xanax was given to Resident #104 for increased anxiety Review of the nurse's progress note dated 06/27/24 at 10:16 A.M. revealed a new order for Haldol 1 mg was sent to the pharmacy. Review of the nurse's progress note dated 06/27/24 at 11:55 A.M. revealed Xanax 0.5 mg was effective. Review of the incident note on 06/27/24 at 8:30 P.M. revealed an STNA observed Resident #104 being physically aggressive with Resident #41. Resident #104 was observed hitting Resident #41 in her room. When the STNA attempted to remove Resident #104 from the room, he became combative. The STNA notified the nurse. The residents were assessed, and no injuries were noted. The nurse was instructed by the unit manager to send Resident #104 to the hospital for evaluation. Resident #104 was placed on one-to-one observation until he left for the hospital. Review of the medical record for Resident #41 revealed an admission date of 08/28/23. Diagnoses included dementia, anxiety disorder, chronic obstructive pulmonary disease (COPD), and bilateral hearing loss. Review of the quarterly MDS assessment, dated 06/06/24, revealed Resident #41 had impaired cognition and wandering behaviors. Review of the e-INTERACT SBAR Summary for Providers dated 06/27/24 at 8:30 P.M. revealed a change in condition was reported for Resident #41. There was a change in skin color or condition. Review of the comprehensive encounter note 06/28/24 at 1:00 A.M. revealed Resident #41 was seen for a resident associated incident. Resident #41 was alert and oriented to self. Per report, the resident was recently assaulted and hit in the face [by Resident #104]. At the time of assessment, Resident #41 was sitting in the dining room finishing lunch. She ate the entire meal without difficulty. She appeared to be in no distress, smiling during our interaction. Assessment and palpation of the face revealed no signs or symptoms of discomfort. Review of the Incident note 06/28/24 at 1:17 A.M., Late Entry, revealed the nurse was called to Resident #41's room due to an incident with Resident #104. The STNA stated Resident #104 was seen in Resident #41's room hitting her. The STNA separated the residents. Resident #104 was escorted from the room. Resident #41 was assessed for injuries and noted to have a small, reddened area below her left eye. The resident seemed startled and kept stating that a man had hit her on her head. No injuries were noted to her head. Emotional support and comfort were provided. Later, the police officer arrived to interview Resident #41, and she stated that nobody had hit her, no man had hit her in her head. Resident #41 was calm with no behaviors. Resident #41 was resting quietly in bed at this time. Nursing continued to monitor the resident throughout the night for any changes. 365290 Page 3 of 17 365290 07/29/2024 Kirtland Woods of Journey 9685 Chillicothe Rd Kirtland, OH 44094

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the Incident Note dated 06/28/24 at 12:20 P.M. revealed Resident #41 had a small pink area noted under her left eye. The area was not raised. The resident denied pain or discomfort. The resident did not remember anything from last evening and was up ambulating with her walker. Review of the social service progress note dated 06/28/24 at 1:15 P.M. Resident #41 was sitting in the dining room eating lunch and in no distress. The resident spoke and was in good spirits. Resident #41 did not seem to recall any events from the night before. Review of the behavior note dated 06/29/24 at 5:14 A.M. revealed Resident #41 was in bed at onset of this nurse's shift and roused easily without being startled. Resident #41 was pleasant and cooperative with no behaviors observed/reported. Resident #41 slept throughout the night. Review of the nurse's note dated 06/29/24 at 11:25 A.M. revealed an aide reported to the nurse that Resident #41 had bruising to both hands. The nurse reviewed the areas and noticed the scant bruising. The resident did not report any pain at the time. Review of the social service note dated 06/29/24 at 12:32 P.M. revealed Resident #41 was sitting in the dining room with a few of her friends talking and waiting for lunch. The resident was behaving fine and did not realize that there had been an incident. Review of the SRI tracking number 249132 and facility investigation dated 06/27/24 revealed on 06/27/24 at approximately 8:30 P.M. staff responded to a commotion in a resident room. Staff entered the room to find Resident #104 standing over Resident #41, who was in bed. Resident #104 was striking Resident #41 in the head. Staff intervened and attempted to remove Resident #104 from the room. Resident #104 then removed a dry erase board from the wall and repeatedly hit staff with it. Resident #104 maneuvered back to Resident #41 and took the pillow and covered Resident #41's head. Staff were able to remove Resident #104 from the room and remained with him. Resident #41 was evaluated for injuries. A red mark was noted on resident #41's left eye, no other injuries were noted. The physician was notified and gave order for Resident #104 to be sent to the hospital for further evaluation. Resident #104 departed from facility at approximately 8:50 P.M. Resident #104 was placed on one-to-one supervision until departure to the hospital. Resident #104's wife was made aware of the altercations and transfer to the hospital for further evaluation. The police were notified and arrived at the facility to take report of altercation. Follow-up evaluation for injuries revealed bruising to Resident #41's bilateral wrist/forearm, the resident denied pain. Continued emotional support and psychosocial follow-up was provided to Resident #41. Body audits were completed on like residents with no negative findings. Abuse audits were completed on like residents with no negative findings. Psychosocial follow up was completed with no negative findings. On 06/27/24 four STNAs and two Licensed practical Nurse (LPNs) were interviewed and completed witness statements. The statements confirmed the investigation's findings. Reviewed of the closed medical record for aggressive Resident #104 revealed he did not return to the facility. During observations made on 07/17/24, 07/18/24, and 07/22/24 revealed Resident #41 was in good spirits and responded positively to staff and residents. There were no concerns. Interview on 07/24/24 at 3:15 P.M. Unit Manager #428, unit manager for the memory care unit, stated Resident #104 was a fidgeter. He was terminally restless. He would touch everything and everyone 365290 Page 4 of 17 365290 07/29/2024 Kirtland Woods of Journey 9685 Chillicothe Rd Kirtland, OH 44094

F 0600 Level of Harm - Minimal harm or potential for actual harm around him. It was not in an aggressive way. Unit Manager #428 was shocked when she was called regarding the incident. Resident #104 walked into other resident's rooms but had not done anything physical. The resident had not been violent with staff, just resistant to care. There was only one regular aide and three agency aides the night of the incident. The nurse was also an agency nurse the night of the incident. Unit Manager #428 verified the incident had occurred. Residents Affected - Few Interview on 07/24/24 at 5:23 P.M. LPN #455, the usual day shift nurse on the memory care unit, revealed day shift on 06/27/24 received the order for Haldol from hospice. The hospice nurse came in on 06/27/24 at around 9:30 A.M. The night shift nurse had called hospice the previous evening and left a message that Resident #104 had increased behaviors in the evenings, and nursing wanted something in place. However, Resident #104 did not have behaviors that morning or during the day. When LPN #455 left at 7:00 P.M. on 06/27/24, Resident #104 had not exhibited any behaviors of concern and had not needed the new order for Haldol or the previously ordered Xanax. This deficiency represents non-compliance investigated under Master Complaint Number OH00155690 and Complaint Number OH00155684. 365290 Page 5 of 17 365290 07/29/2024 Kirtland Woods of Journey 9685 Chillicothe Rd Kirtland, OH 44094

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Review of the medical record revealed Resident #97 was admitted to the facility on [DATE] with diagnoses including paroxysmal atrial fibrillation, dementia, and anxiety disorder. Review of the admission MDS 3.0 assessment dated [DATE] revealed Resident #97 was cognitively impaired. Review of the immunization status for Resident #97 revealed only the first step of tuberculosis testing was recorded and Pneumococcal 20 had been refused. Interview on 07/23/24 at 11:32 A.M. with UM #447 revealed not all the immunizations had been put into the immunization tab, but they were done. Tuberculosis testing first step was done on 07/03/24. The second step was done on 07/11/24 and read on 07/14/24 but recorded in different places. 3. Review of the medical record revealed Resident #102 was admitted to the facility on [DATE] with diagnoses including fracture of the fifth lumbar vertebra, adult failure to thrive, Parkinson's disease, and chronic pain syndrome. Review of the admission MDS 3.0 assessment dated [DATE] revealed Resident #102 was cognitively intact. Review of the immunization status for Resident #102 revealed the resident had tuberculosis testing upon admission and had received Pneumovax 23 historically, but there was no information on the status of influenza immunization status. Interview on 07/23/24 at 11:32 A.M. with UM #447 revealed the facility looked for information on influenza immunization and were able to find it, but it was not entered in the correct location. This deficiency was an incidental finding identified during the complaint investigation. Based on observation, interview and record review, the facility failed to accurately document fall interventions for Resident #62 and make vaccination documentation readily accessible in the medical record for Residents #97 and #102. This affected three residents (#62, #97 and #102) of 23 medical records reviewed. The facility census was 103. Findings include: 1. Review of the medical record for Resident #62 revealed an admission date of 04/18/23. Diagnoses included muscle weakness and repeated falls. Review of the quarterly Minimum Data Set (MDS) assessment completed 06/19/24 indicated Resident #62 had moderately impaired cognition and received hospice services. Review of the physician's orders revealed an order initiated 12/01/23 and effective July 2024 indicated Resident #62 was to have a floor mat to the left bedside while in bed. 365290 Page 6 of 17 365290 07/29/2024 Kirtland Woods of Journey 9685 Chillicothe Rd Kirtland, OH 44094

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Observation on 07/17/24 at 11:50 A.M. revealed Resident #62 was in bed with no fall mat to the left bedside as ordered. Interview at the time of the observation with State Tested Nursing Assistant (STNA) #470 confirmed there was no mat in place next to the bed, but indicated it was not on the Kardex (a quick reference for resident information). Review of Resident #62's Kardex effective 07/17/24 did not indicate a floor mat was required at the bedside. Review of Resident #62's care plan effective 07/17/24 indicated the fall intervention for a floor mat to the left bedside was discontinued on 06/24/24. Interview on 07/17/24 at 12:21 P.M. with Unit Manager (UM) #447 verified Resident #62 no longer required a left bedside floor mat as a fall intervention, and it was to be discontinued on 06/24/24. UM #447 indicated the active physician's order for the floor mat was an error, and not discontinued on 06/24/24 when required. 365290 Page 7 of 17 365290 07/29/2024 Kirtland Woods of Journey 9685 Chillicothe Rd Kirtland, OH 44094

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and facility policy review the facility failed to appropriately dispose of biohazardous materials and handle clean and soiled linen to prevent the spread of infection. This affected eight residents (#1, #8, #13, #24, #40, #58, #73 and #77) and had the potential to affect all 103 residents residing in the facility. Residents Affected - Many Findings include: Observation on 07/22/24 at 8:53 A.M. the adjoining bathroom shared by Residents #8, #13, #58 and #77 revealed a feces soiled pillowcase crumpled on the bathroom floor next to the toilet. Interview at the time of the observation with State tested Nurse Aide (STNA) #488 confirmed the finding. Observation on 07/22/24 at 11:20 A.M. of the laundry room with Housekeeping District Manager (HDM) #611 revealed a pile of soiled linens placed on the floor in front of the middle washer which was not functioning and filled with washed linen. There were two wall mounted fans on in the clean laundry area, one blowing air toward the dryers and the other blowing air toward the folded and hanging linens/clothes. Both fans were visibly dirty and had lint, dirt, and debris buildup on the back and front fans. Interview at the time of the observation with HDM #611 verified the findings. Observation on 07/23/24 at 9:02 A.M. revealed Laundry Worker (LW) #606 walking through the 300-hallway toward the memory care unit pushing a rolling rack filled with residents' hanging personal clothes and a shelf on the rack bottom just above the wheels with a number of miscellaneous pieces of linen/clothing. Interview at the time of the observation with LW #606 verified the clothing was being delivered to residents. During the interview, LW #606 bent down and picked up a small thin blue sheet from the bottom shelf and swung it over the clothing then adjusted it to try and cover it. The sheet contacted the clothes and covered the width of the rack but only covered the upper half portion of the hanging clothes. The lower shelf also remained uncovered. LW #606 explained the sheet was used daily to cover the clothes, but she had forgotten to put it back over the clothes during delivery. LW #606 confirmed there was no covered linen/clothing cart available to use for delivering clean laundry. Observations on 07/23/24 at 10:43 during an environment tour with Maintenance Director (MD) #474 revealed Resident #24's bathroom had soiled linen on the floor. The adjoining bathroom shared by Residents #1, #40 and #73 had two large biohazardous red bags stored inside. One red bag was not closed and contained a large amount of soiled linen. On top of the other red bag there was a crumpled soiled disposable gown so it could not be determined if the bag was opened or closed or what was inside the red colored bag. Interview at the time of the observation with MD #474 verified the findings. Review of the facility policy, Laundry and Bedding, Soiled, revised September 2022, revealed soiled laundry and bedding was handled, transported and processed according to best practices for infection prevention and control. Clean linen was protected from dust and soiling during transport and storage to ensure cleanliness. This deficiency represents non-compliance investigated under master Complaint Number OH00155690 and Complaint Number OH00155647 and is a recite to the annual and complaint survey completed on 05/02/24. 365290 Page 8 of 17 365290 07/29/2024 Kirtland Woods of Journey 9685 Chillicothe Rd Kirtland, OH 44094

F 0910 Ensure resident rooms meet each resident's needs. Level of Harm - Minimal harm or potential for actual harm Based on observation and interview, the facility failed to provide an adequate bathroom door for privacy for Resident #25. This affected one resident (#25) of 103 residents whose rooms were observed for privacy. The facility census was 103. Residents Affected - Few Findings include: Observations on 07/23/24 at 10:43 A.M. during a facility tour with Maintenance Director (MD) #474 revealed Resident #25's room had a bathroom entrance with a full-length curtain installed to cover the doorway in lieu of a door. The curtain was placed on a rod which extended approximately two to three inches away from the wall/door opening so when the curtain was drawn completely closed, it left a wide gap on both sides leaving ample opening to see inside the bathroom. With Resident #25's bedroom door opened and the bathroom curtain closed, the inside bathroom remained visible through the left bathroom curtain gap from the facility hallway outside of the bedroom. Interview at the time of the observation with MD #474 verified the findings. This deficiency represents non-compliance investigated under Master Complaint Number OH00155690 and Complaint Number OH00155684. 365290 Page 9 of 17 365290 07/29/2024 Kirtland Woods of Journey 9685 Chillicothe Rd Kirtland, OH 44094

F 0917 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Make sure each resident has 1) at least one window to the outside in a room; 2) a room at or above ground level; 3) adequate bedding; 4) furniture that meets the resident's needs; or 5) adequate closet space. Based on observation and interview, the facility failed to provide a private closet space separate from roommates' clothing. This affected 46 residents (#1, #2, #4, #6, #7, #8, #11, #13, #16, #20, #22, #23, #27, #31, #34, #35, #41, #42, #44, #47, #50, #51, #58, #59, #61, #64, #69, #73, #77, #78, #79, #80, #81, #82, #83, #84, #86, #88, #92, #93, #94, #97, #98, #100, #102 and #103) out of 103 resident rooms reviewed for closet space. The facility census was 103. Findings include: Observations on 07/23/24 at 10:43 A.M. during a facility tour with Maintenance Director (MD) #474 revealed the following residents were roommates and had one closet shared by both residents that did not separate the roommates' clothing: • Residents #78 and #80 • Residents #100 and #16 • Residents #77 and #13 • Residents #84 and #44 • Residents #58 and #8 • Residents #31 and #47 • Residents #93 and #35 • Residents #98 and #61 • 365290 Page 10 of 17 365290 07/29/2024 Kirtland Woods of Journey 9685 Chillicothe Rd Kirtland, OH 44094

F 0917 Residents #20 and #64 Level of Harm - Minimal harm or potential for actual harm • Residents #50 and #11 Residents Affected - Some • Residents #4 and #94 • Residents #82 and #59 • Residents #23 and #102 • Residents #73 and #1 • Residents #27 and #79 • Residents #7 and #92 • Residents #81 and #6 • Residents #42 and #88 • Residents #41 and #86 • Residents #22 and #69 • Residents #2 and #103 365290 Page 11 of 17 365290 07/29/2024 Kirtland Woods of Journey 9685 Chillicothe Rd Kirtland, OH 44094

F 0917 • Level of Harm - Minimal harm or potential for actual harm Residents #97 and #34 • Residents Affected - Some Residents #83 and #51 Interview at the time of the observations with MD #474 confirmed the above findings. This deficiency represents non-compliance investigated under Master Complaint Number OH00155690 and Complaint Number OH00155684. 365290 Page 12 of 17 365290 07/29/2024 Kirtland Woods of Journey 9685 Chillicothe Rd Kirtland, OH 44094

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on observation, interview, and facility policy review the facility failed to provide a safe, sanitary, and homelike environment. This affected 48 residents (#3, #6, #7, #8, #13, #15, #16, #17, #19, #21, #23, #24, #27, #31, #32, #34, #35, #37, #38, #39, #42, #44, #46, #47, #49, #51, #55, #58, #59, #74, #75, #76, #77, #78, #79, #80, #81, #82, #83, #84, #88, #89, #92, #93, #95, #97, #100 and #102) and had the potential to affect all 103 residents residing in the facility. Findings include: Observation on 07/17/24 at 10:49 A.M. of the adjoining bathroom shared by Residents #8, #13, #58, and #77 revealed a sticky floor and a toilet paper roll placed on the back of the toilet in lieu of a toilet paper holder, which was not secured tightly to the wall. The toilet water was low inside the commode with a large amount of soiled toilet paper, black/brown in color piled inside, and black/brown soilage dried around the inner commode walls. Residents #13 and #77's shared bedroom closet was missing a handle to functionally open/close the door with only a pointed screw protruding from it, and the floor was sticky in the area from the sink to the bathroom entrance. Resident #24's room had no closet door/cover, and the bathroom had a toilet paper roll placed on the back of the toilet in lieu of a toilet paper holder. Interview on 07/17/24 at 11:00 A.M. with State Tested Nursing Assistant (STNA) #440 verified the findings in the rooms for Residents #8, #13, #24, #58, and #77. Observation on 07/17/24 at 11:26 A.M. of Resident #34 and #97's room revealed no curtain covering the window. Interview at the time of the observation with Licensed Practical Nurse (LPN) #434 confirmed there was no window covering and indicated Resident #97 complained of bright light at night while trying to sleep. Observation on 07/17/24 at 11:35 A.M. of Resident #74's bathroom revealed a toilet paper roll placed on the back of the toilet in lieu of a toilet paper holder. Observation on 07/17/24 at 11:37 A.M. of Resident #21's bathroom revealed a toilet paper roll placed over the attached toilet faucet/sprayer used for cleaning excrement in lieu of a toilet paper holder. Interview on 07/17/24 at 11:38 A.M. with Housekeeper #602 confirmed the observations of Residents #21 and #74's rooms, and indicated there were broken toilet paper holders so toilet paper was placed wherever possible. Observation on 07/17/24 at 11:42 A.M. of the memory care unit revealed a missing baseboard around the walls of the shower room and the area across the hall from the shower room. The hallways throughout the unit had numerous spackled or patched areas. Interview on 07/17/24 at 1:33 P.M. with Administrator verified the memory care unit painting and baseboard repair was planned although it had been that way since May 2024. Observation on 07/22/24 at 8:53 A.M. the adjoining bathroom shared by Residents #8, #13, #58, and #77 revealed dried feces smeared on the bathroom door frame toward Resident #13 and #77's bedroom, a 365290 Page 13 of 17 365290 07/29/2024 Kirtland Woods of Journey 9685 Chillicothe Rd Kirtland, OH 44094

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many feces soiled pillowcase crumpled on the bathroom floor next to the toilet, and visible dried feces on the toilet paper roll and holder which was not fully secured to the wall and hanging down. Dried feces were smeared over a significant portion of the toilet seat. Inside the toilet had a low water level and piles of feces soiled toilet paper piled inside it with dried feces covering most of the inner toilet walls. Interview at the time of the observation with STNA #488 verified the findings. On the floor blocking Resident #13 and #77's bedroom entrance was a large pile of debris including a medication cup with a dried pink substance inside, pieces of paper, food, dust, and dirt. A floor duster handle missing a duster head was left leaning against the wall outside the left entrance door. Interview on 07/22/24 at 8:59 A.M. with Housekeeper #609 verified the pile of swept debris was left in its place blocking Resident #13 and #77's bedroom entrance because a new floor duster head was being retrieved. Observation on 07/22/24 at 11:20 A.M. of the laundry room with Housekeeping District Manager (HDM) #611 revealed a gray colored blanket stuffed between the dryers closest to the door and the next dryer. The blanket was covered with lint, dirt, and debris. HDM #611 indicated it was placed there due to staff being concerned with critters coming through from behind the dryers but confirmed it did not belong there. After blanket removal, there was a large amount of dirt, debris, and lint visible between the dryers. Observations on 07/23/24 at 10:43 A.M. during an environment tour with Maintenance Director (MD) #474 revealed the following findings: • Resident #19's bathroom had a protruding screw point from the wall into the toilet paper holder area where toilet paper was retrieved. The bedroom wall mounted light fixture had no light shade leaving a light bulb fully uncovered. • Resident #95's bathroom had a burned-out light bulb. The bathroom paper towel dispenser was secured to the wall in such a way to block the light switch making it difficult to access for use. • The 300-hall activity and puzzle room had one large and four small water stains on the ceiling tiles. MD #474 indicated a painted covering was used over the large stain, but the replacement tiles had not yet been obtained for replacement. • Resident #78 and #80's bedroom had one shared closet with a folding door which did not function properly being off track, and the closet doorknob was loose and spinning. The lower bathroom wall opposite the toilet had a piece of tile broken off on the floor and a missing tile above the broken tile. • Resident #17's bedroom closet floor contained numerous dead insects in scattered small and larger 365290 Page 14 of 17 365290 07/29/2024 Kirtland Woods of Journey 9685 Chillicothe Rd Kirtland, OH 44094

F 0921 Level of Harm - Minimal harm or potential for actual harm piles. The closet floor carpet had a large unsightly dark stain. The folding door of the closet did not function properly, being off track. MD #474 indicated the bedroom closet area was sprayed for insects and it was not cleaned up afterward. (Review of the pest control treatment and inspection records indicated Resident #17's bedroom was treated for swarmer ants on 06/14/24 and 06/24/24.) Residents Affected - Many • Resident #16 and #100's bedroom had one shared closet with a folding door. The closet doorknob was loose and spinning. • Resident #13 and #77's bedroom had a large wall area to the right of the window with removed paint exposing wallpaper from underneath, a missing floor tile underneath the sink, and an unsecured toilet paper holder in the adjoining bathroom shared with Residents #8 and #58. • Resident #44 and #84's bedroom had one shared closet with a folding door. The closet doorknob was not attached leaving a visible protruding pointed screw. • Resident #8 and #58's bedroom had one shared closet with a folding door not functioning properly being off track. A broken unused wall mounted plastic bracket was protruding from the wall next to Resident #58's bed. • Resident #31 and #47's bedroom had a missing piece of floor tile in the center of the room. • Resident #35 and #93's bedroom had a window with vertical blinds. There were two missing slats from the vertical blinds. The one shared closet had a folding door not functioning properly being off its track. • Resident #3's bathroom had a broken toilet paper holder. • Resident #75's bathroom mirror had multiple areas of dark discoloration making the mirror unusable. • Resident #59 and #82's bathroom had a combined light and fan which made a loud clanging noise when in use. 365290 Page 15 of 17 365290 07/29/2024 Kirtland Woods of Journey 9685 Chillicothe Rd Kirtland, OH 44094

F 0921 • Level of Harm - Minimal harm or potential for actual harm Resident #23, #38, and #102's adjoining bathroom had a toilet paper roll placed over the attached toilet faucet/sprayer used for cleaning excrement in lieu of a toilet paper holder. Residents Affected - Many • Resident #32's bathroom had dried feces smeared on the toilet riser seat, and the left bathroom wall and floor had multiple areas with dried feces. • Resident #39 and #55's inside bedroom door had exposed metal corner bead for drywall over approximately ten inches of the lower door frame. • Resident #15, #39, and #55's adjoining bathroom had dried smeared feces on the toilet riser. The bathroom door handle used to exit from the bathroom into Resident #15's room had a child safety doorknob cover in place which prevented its use. • Resident #27, #79, and #89's adjoining bathroom had a toilet riser with multiple rusted and peeled away coated areas. • Resident #89's bedroom window had vertical blinds with three missing slats. • Resident #37's bathroom had a toilet paper roll placed over the attached toilet faucet/sprayer used for cleaning excrement in lieu of a toilet paper holder. • Resident #6, #7, #81, and #92's adjoining bathroom had a toilet riser with multiple rusted and peeled away coated areas. There was a toilet paper roll placed on the back of toilet in lieu of a toilet paper holder. • Resident #6 and #81's bedroom had one shared closet with a folding door. The closet door had a missing handle leaving a protruding pointed screw. • Resident #7 and #92's bedroom had a non-functioning paper towel dispenser. 365290 Page 16 of 17 365290 07/29/2024 Kirtland Woods of Journey 9685 Chillicothe Rd Kirtland, OH 44094

F 0921 • Level of Harm - Minimal harm or potential for actual harm Resident #49's bedroom window had vertical blinds with one missing slat. The left folding closet door had a broken plastic handle with sharp edges remaining. Residents Affected - Many • Resident #21's bedroom had two folding closet doors with broken plastic handles leaving sharp edges remaining. • Resident #46's bedroom had a folding closet door not properly functioning being off track, and the door was inappropriately sized, not covering the entire closet space. • Residents #42, #76, and #88's adjoining bathroom had dried feces smeared on the toilet seat. There was a cracked and partially missing bathroom tile piece next to the bathroom door leading toward Resident #76's bedroom. The damaged tile had rough edges exposed. • Resident #34, #51, #83, and #97's adjoining bathroom a clump of hair hanging from the toilet riser. The toilet paper roll was placed over the attached toilet faucet/sprayer used for cleaning excrement in lieu of a toilet paper holder. Interview at the time of the observations with MD #474 verified the above findings. This deficiency represents non-compliance investigated under Master Complaint Number OH00155690 and Complaint Number OH00155684 and is a recite to the surveys completed on 05/02/24 and 06/18/24. 365290 Page 17 of 17