Health inspection·November 3, 2022

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to provide adequate supervision to ensure Resident #60 did not leave the facility unattended. This affected one resident (#60) of three reviewed for supervision. The facility census was 68. Findings include: Review of Resident #60's medical records revealed an admission date of 08/16/21. Diagnoses included dementia and cognitive impairment. Review of Resident #60's care plan dated 08/17/22 revealed the resident had an episode of anxiety related to being on the secured unit and was noted to have been beating on the door and was exit seeking. Exit seeking behaviors were also noted to have occurred when the resident believed it was time to smoke. Interventions included place a clock in resident's room to remind him of the smoking times. The care plan also indicated Resident #60 had a diagnosis of dementia that required resident to be placed on the secured unit. Interventions included review on a quarterly basis for continued placement on the secured unit. Review of an elopement assessment dated [DATE] revealed Resident #60 was at risk for elopement and would push on the memory care unit door. Review of Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #60 had impaired cognition. Review of an elopement assessment dated [DATE] revealed Resident #60 was appropriate to be on the secured unit. Review of progress note dated 10/29/22 revealed Resident #60 was observed outside of the facility by Activities Aide #860. The progress note stated the resident was brought back into the facility by Licensed Practical Nurse (LPN) #813 and was assessed for injuries with none noted. Interview on 10/31/22 at 8:33 A.M. with State Tested Nursing Assistant (STNA) #833 revealed Resident #60 had been reported as being outside of the facility on 10/27/22. STNA #833 stated Activities Aide #860 had seen the resident next door to the facility as she was driving home. STNA #833 stated she was not present during the incident, however she stated the resident had tried to open the doors to get out of the memory care on occasions because he always thought it was time to smoke. Observation of resident at time of interview revealed Resident #60 appeared to be calm and pleasant, however Page 1 of 6 365354 365354 11/03/2022 Longmeadow Care Center 565 Bryn Mawr Ravenna, OH 44266

F 0689 he was unable to answer questions appropriately. Level of Harm - Minimal harm or potential for actual harm Interview on 10/31/22 at 10:15 A.M. with Activities Aide #860 revealed on 10/27/22 she had left the facility between 3:15 P.M. and 3:30 P.M. and as she was leaving she observed Resident #60 outside in his wheelchair near a driveway next door to the facility. She stated she did not approach Resident #60 due to she did not want to scare him, and that she parked across the street and called the facility. She stated no one answered so she drove her car back to the facility and had gotten the nurse. The nurse and Activities Aide #860 came out and they both went to get the resident. The nurse assessed the resident and he did not appear to have any injuries. The nurse had pushed him back into the facility in his wheelchair. She stated she had last seen the resident around 2:00 P.M. and he was in a common area, he did not appear to be exit seeking and was sitting in his wheelchair watching TV. Residents Affected - Few Interview on 11/01/22 at 1:49 P.M. with the Director of Nursing (DON) revealed Resident #60 had been moved off of the memory care unit on 10/05/22 due to he had an altercation with another resident who had wandered into his room. The DON stated Resident #60 had not been exhibiting exit seeking behaviors during that time and the facility had discussed placing the resident in a room on the non secured units. The DON stated Resident #60 had not exhibited any exit seeking behaviors while off of the secure unit. The DON stated there had not been an elopement reassessment prior to moving the resident, however she stated an assessment had been done after he was observed to have been outside of the facility on 10/29/22 and he was placed back on the secured memory care unit. 365354 Page 2 of 6 365354 11/03/2022 Longmeadow Care Center 565 Bryn Mawr Ravenna, OH 44266

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview the facility failed to ensure timely incontinence care had been provided. This affected three residents (#37, #49 and #52) of four observed for incontinence care. The facility identified 44 incontinent residents. The facility census was 68. Findings include: Review of Resident #37's medical records revealed an admission date of 07/20/21. Diagnoses included muscle weakness, falls, and difficulty walking. Review of Resident #37's care plan dated 09/12/22 revealed the resident was incontinent of bowel and bladder. Interventions included provide incontinence care every two hours and as needed. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #37 had impaired cognition, required extensive assistance with toileting, and was incontinent of bowel and bladder. Review of Resident #49's medical records revealed an admission date of 11/18/21. Diagnoses included cognitive deficits, dementia and aphasia (difficulty speaking). Review of MDS assessment dated [DATE] revealed Resident #49 had impaired cognition, required extensive assistance with toileting, and was incontinent of bowel and bladder. Review of Resident #49's care plan dated 10/13/22 revealed the resident was incontinent of bowel and bladder. Interventions included provide incontinence care every two hours and as needed. Review of Resident #52's medical records revealed an admission date of 05/14/21. Diagnoses included dementia, muscle weakness and aphasia. Review of the MDS assessment dated [DATE] revealed Resident #52 had impaired cognition, required extensive assistance with toileting, and was incontinent of bowel and bladder. Observation of incontinence care on 10/31/22 at 9:26 A.M. for Resident #37 with State Tested Nursing Assistant (STNA) #833 revealed Resident #37 was not wearing an incontinence brief. STNA #833 stated she was unsure how long Resident #37 had been without an incontinence brief due to she had not provided care for him yet. Further observation revealed Resident #37 had been incontinent of stool that was dried on to his pants. Resident #37 was not interviewable. Observation of incontinence care on 10/31/22 at 9:34 A.M. for Resident #49 with STNA #833 revealed Resident #49 was incontinent of a large amount of urine that had saturated through his incontinence brief and on to his bed sheet. STNA #833 confirmed she had not provided care for Resident #49 since she started her shift and was unable to state when he had last received incontinence care. Resident #49 was not interviewable. Observation of incontinence care on 11/01/22 at 7:51 A.M. for Resident #52 with STNA #874 revealed Resident #52 was incontinent of urine that had saturated through his incontinence brief and also had saturated his tee-shirt. STNA #874 stated she had not provided care for the resident since she started her shift and was unable to state when he had last received care. Resident #52 was not interviewable. 365354 Page 3 of 6 365354 11/03/2022 Longmeadow Care Center 565 Bryn Mawr Ravenna, OH 44266

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure supplements were administered as ordered. This affected two (Residents #5 and #62) of four residents reviewed for nutrition and weight loss. Residents Affected - Few Findings include: 1. Review of Resident #5's medical record revealed he was admitted on [DATE] with diagnoses including multiple sclerosis, difficulty in walking and dysphagia. Review of Resident #5's physician orders revealed an order dated 09/23/22 for Boost plus eight ounces three times a day for nutrition support and wound healing. Review of Resident #5's medication administration records (MARS) from 10/28/22 to 11/02/22 revealed the Boost plus was not administered on 10/28/22 for lunch, 10/28/22 for dinner, 10/29/22 for breakfast, 10/29/22 for lunch, 10/30/22 for breakfast, 10/30/22 for lunch, 10/31/22 for lunch and 10/31/22 for dinner. Interview on 11/02/22 at 7:35 A.M. with Licensed Practical Nurse (LPN)/Assistant Director of Nursing (ADON) #818 revealed the facility ran out of Boost plus on 08/28/22 and it was on backorder. Resident #5 did not receive the Boost plus for eight administrations. Interview on 11/02/22 at 3:13 P.M. with the Director of Nursing (DON) revealed LPN #807 called her at home on [DATE] to report the facility was out of Boost plus and she was unable to provide the supplement to her residents. 2. Review of Resident #62's medical record revealed he was admitted on [DATE] with diagnoses including hospice services, Parkinson's disease and encounter for other orthopedic aftercare. Review of Resident #62's physician orders revealed an order dated 04/15/22 for Boost plus eight ounces two times a day for nutrition support related to weight loss. Review of Resident #62's MARS from 10/28/22 to 11/02/22 revealed the Boost plus was not administered on 10/28/22 for dinner, 10/29/22 for breakfast, 10/29/22 for dinner, 10/30/22 for breakfast, 10/30/22 for dinner and 10/31/22 for dinner. Interview on 11/02/22 at 7:35 A.M. with LPN/ADON #818 confirmed the facility ran out of Boost plus on 08/28/22, it was on backorder. Resident #62 did not receive the Boost plus for six administrations. Interview on 11/02/22 at 3:13 P.M. with the DON revealed LPN #807 called her at home on [DATE] to report the facility was out of Boost plus and she was unable to provide the supplement to her residents. 365354 Page 4 of 6 365354 11/03/2022 Longmeadow Care Center 565 Bryn Mawr Ravenna, OH 44266

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, observation and record review the facility failed to ensure adequate staffing on the memory care unit. This affected three residents (#37, #49 and #52) residing on the memory care unit. The memory care census was 10. Findings include: Review of Resident #37's medical records revealed an admission date of 07/20/21. Diagnoses included muscle weakness, falls, and difficulty walking. Review of Resident #37's care plan dated 09/12/22 revealed the resident was incontinent of bowel and bladder. Interventions included provide incontinence care every two hours and as needed. Review of Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #37 had impaired cognition, required extensive assistance with toileting, and was incontinent of bowel and bladder. Review of Resident #49's medical records revealed an admission date of 11/18/21. Diagnoses included cognitive deficits, dementia and aphasia (difficulty speaking). Review of the MDS assessment dated [DATE] revealed Resident #49 had impaired cognition, required extensive assistance with toileting, and was incontinent of bowel and bladder. Review of the care plan dated 10/13/22 revealed Resident #49 was incontinent of bowel and bladder. Interventions included provide incontinent care every two hours and as needed. Review of Resident #52's medical records revealed an admission date of 05/14/21. Diagnoses included dementia, muscle weakness and aphasia. Review of the MDS assessment dated [DATE] revealed Resident #52 had impaired cognition, required extensive assistance with toileting, and was incontinent of bowel and bladder. Interview on 10/31/22 at 8:33 A.M. with State Tested Nursing Assistant (STNA) #833 revealed the memory care unit usually only had one staff member present at all times. STNA #833 stated she had been aware of residents who had not received their scheduled showers due to the lack of staff. Observation of incontinence care on 10/31/22 at 9:26 A.M. for Resident #37 with STNA #833 revealed Resident #37 had been incontinent of stool that was dried on to his pants. Interview with STNA #833 confirmed the stool had dried on to the resident's pants, STNA #833 was unsure when he had last been checked for incontinence, she had not provided care for him yet. STNA #833 started her shift at 7:00 A.M. Resident #37 was not interviewable. Observation of incontinence care on 10/31/22 at 9:34 A.M. for Resident #49 with STNA # 833 revealed Resident #49 was incontinent of a large amount of urine that had saturated through his brief and on to his sheet. STNA #833 revealed she had not cared for Resident #49 yet and was unable to state when he had last received incontinence care. Resident #49 was not interviewable. Observation of incontinence care on 11/01/22 at 7:51 A.M. for Resident #52 with STNA #874 revealed Resident #52 was incontinent of urine that had saturated through his incontinence brief and also had saturated his tee-shirt. STNA #874 stated she had not provided care for the resident yet and was unable to state when he had last received care. Resident #52 was not interviewable. 365354 Page 5 of 6 365354 11/03/2022 Longmeadow Care Center 565 Bryn Mawr Ravenna, OH 44266

F 0725 Review of staffing schedules revealed the facility provided less than 2.5 hours of direct care per resident per day on 10/25/22, 10/28/22, 10/29/22 and 10/30/22. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 365354 Page 6 of 6