Health inspection·November 7, 2019

F 0623 Level of Harm - Potential for minimal harm Residents Affected - Many 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** 2. Review of the medical record for Resident #23 revealed an admission date of 11/27/18. Diagnoses included sepsis, hemiplegia and hemiparesis (weakness on one side of the body) following a cerebral infarction, end stage kidney disease, type two diabetes with diabetic neuropathy, and morbid obesity. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed the resident was alert and cognitively intact. The annual MDS assessment dated [DATE] revealed the resident was still alert and cognitively intact. Review of the nursing progress notes revealed Resident #23 was hospitalized from [DATE] to 10/01/19 for a right great toe amputation due to gangrene. Resident #23 was also hospitalized on [DATE], and 10/22/19 with gangrene/infection to the right toe wound site. Resident #22's medical record contained no evidence the written transfer/discharge notice was provided at any time. Interview on 11/06/19 at 11:18 A.M. with the Administrator verified the written transfer notice was not given to the Resident #23 for any of the resident's transfers to the hospital, either at the time, after transfer, or readmission to the facility. Based on record review and staff interview, the facility failed to notify the resident and/or their representative in writing of a transfer/discharge to the hospital. This affected two (Resident #23 and #27) of three residents reviewed for hospitalization and had the potential to affect all 100 residents residing in the facility. Findings include: 1. Review of Resident #27's medical record revealed an initial admission date of 02/15/17. Diagnoses included cerebral infarction (stroke), dysarthria (speech disorder) following cerebral infarction, hemiplegia,(paralysis on one side of the body), aphasia (inability to formulate or comprehend language), schizoaffective disorder, pain, major depressive disorder, and repeated falls. Progress notes indicated Resident #27 was transferred to the hospital on [DATE] with slurred speech and trouble talking. He was readmitted on [DATE]. No documentation was located indicating the resident representative was provided, in writing, a transfer/discharge notice indicating the reasons for the transfer/discharge, the effective date of the transfer/discharge, location to which the resident was transferred/discharged , a statement of the resident's appeal rights, including the name, address (mailing and email), and telephone number of the entity which receives such requests; and information on how to obtain an appeal form and assistance in completing the form and submitting the appeal hearing request; and the name, address (mailing and email) and telephone number of the Office of Page 1 of 3 365340 365340 11/07/2019 Barberton Post Acute 85 Third Street SE Barberton, OH 44203

F 0623 the State Long-Term Care Ombudsman. Level of Harm - Potential for minimal harm On 11/06/19 at 11:18 A.M., the Administrator verified the facility did not notify the representative of Resident #27 of the transfer/discharge to the hospital. The Administrator indicted no transfer/discharge notices had been issued to anyone in the last year. Residents Affected - Many 365340 Page 2 of 3 365340 11/07/2019 Barberton Post Acute 85 Third Street SE Barberton, OH 44203

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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, interview and record review, the facility failed to ensure all insulin pens were properly dated when opened. This affected three residents (Resident #43, Resident #45 and Resident #258) of five residents ordered Humalog insulin. The facility census was 100 Findings include: 1. Observation of the medication cart for rooms 40 to 49 on Medbridge Hall on 11/04/19 at 5:20 P.M. revealed a Humalog insulin pen for Resident #43 that was opened but not dated with the date it was opened. Interview with Licensed Practical Nurse (LPN) #300 on 11/04/19 at 5:30 P.M. verified the insulin pen was open but not dated with the day it was opened. Insulin is good for 28 days after opening and then should be discarded. 2. Observation of the medication cart on 11/04/19 at 5:30 P.M. for rooms 50 and up, also on the Medbridge Hall, revealed one insulin pen of Humalog insulin for Resident #258 which was opened but not dated. Interview with LPN #300 on 11/04/19 at 5:30 P.M. verified the insulin pen was open but not dated with the day it was opened. Insulin is good for 28 days after opening and then should be discarded. 3. Observation of the [NAME] Medication Cart on 11/04/19 at 5:35 P.M. revealed an insulin pen of Humalog insulin for Resident #45 which was opened but not dated with the date it was opened. Interview with LPN #301 at 5:40 P.M. verified the insulin pen for this resident was opened and was not dated with the date the insulin pen was opened. Insulin is good for 28 days after opening and then should be discarded. 365340 Page 3 of 3