Health inspection·August 2, 2022

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 observations, interviews, and record reviews the facility failed to provide reasonable accommodations during meals for Resident #128 with visual impairments and failed to provide appropriate length beds for Resident's #5 and #140. This affected three (Resident's #128, #5 and #140) of eight residents reviewed for reasonable accommodation of needs. The facility census was 169. Residents Affected - Few Findings include: 1. Review of the medical record revealed Resident #128 was admitted to the facility on [DATE] with diagnoses including legal blindness, as defined in United States of America and primary open-angle glaucoma, bilateral, indeterminate stage. Review of the comprehensive Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #128 had intact cognition and required supervision for eating. Review of the plan of care dated 06/10/20 revealed Resident #128 had impaired visual function related to blindness in right and left eye. Interventions included to adapt environment to the residents individual needs to ensure the resident could recognize objects/own environment. Interview on 07/25/22 at 10:15 A.M., Resident #128 stated he had difficulty consuming foods that were placed on a flat plate like spaghetti and rice. Resident #128 stated items like that slid off the plate. Observations and interview on 07/25/22 at 12:51 P.M., Nurse Aide Trainee (NAT) #735 was observed placing Resident #128's tray down on the table in front of the resident. NAT #735 did not indicate what/where the items were on the tray. Resident #128 scanned the tray with both hands feeling for food and drinks. Interview immediately after observation, NAT #735 provided little input related to policy and procedures related to adaptive ware and/or informing the resident of items on the tray. Interview on 07/27/22 at 10:00 A.M., Occupational Therapist (OT) #755 stated Resident #128 was referred to occupational therapy and an evaluation was completed on 07/25/22. OT #755 indicated the goal for Resident #128 would be to safely perform self-feeding tasks with independence with use of divided plate/scoop bowl/adaptive equipment as needed. Review of the staff training dated 07/25/22 revealed staff received training including how to set-up trays, explaining where food items were located on the tray and assisting with removing lids and/or cutting up food. Page 1 of 5 365388 365388 08/02/2022 Franklin Plaza Extended Care 3600 Franklin Boulevard Cleveland, OH 44113

F 0558 Level of Harm - Minimal harm or potential for actual harm 2. Review of the medical record revealed Resident #5 was admitted to the facility on [DATE] with diagnosis including hemiplegia and hemiparesis following cerebral infarction affecting the left non-dominant side. Review of the quarterly MDS 3.0 assessment dated [DATE] revealed Resident #5 had impaired cognition and required extensive assistance for bed mobility, transfers, and toilet use. Residents Affected - Few Review of the medical record revealed Resident #140 was admitted to the facility on [DATE] with diagnosis including vascular dementia with behavioral disturbances and history of falls. Review of the quarterly MDS 3.0 assessment dated [DATE] revealed Resident #140 had impaired cognition and required extensive assistance for bed mobility and was dependent for transfers. Observations on 07/25/22 at 11:30 A.M. and 11:45 A.M. of Resident's #5 and #140 revealed both residents lying on their backs in bed. Both residents' feet were flat against the foot board with bent knees. Interviews with Resident's #5 and #140 during the observation revealed the beds were too short and they were unable to extend their legs completely. Both residents stated the beds were uncomfortable due to not being able to extend their legs completely. Observations and interview on 07/25/22 at 12:17 P.M. Licensed Practical Nurse (LPN) #679 observed the beds of Resident's #5 and #140 and verified the residents were not able to extend their legs completely. Interview on 07/26/22 at 4:48 P.M., the Director of Nursing (DON) stated maintenance observed the beds and were adjusting the beds. Interview on 07/27/22 at 9:30 A.M., the DON stated Resident #5 was assessed by the occupational therapist for positioning. The DON stated maintenance staff pulled out the extension frame on Resident #140's bed providing more room. This deficiency substantiates Complaint Number OH00134457. 365388 Page 2 of 5 365388 08/02/2022 Franklin Plaza Extended Care 3600 Franklin Boulevard Cleveland, OH 44113

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observations, and interview the facility failed to date and/or change supplemental oxygen tubing in a timely manner. This affected two (Resident's #27 and #38) of 12 residents reviewed for oxygen therapy. The facility census was 169. Residents Affected - Few Findings Included: Review of the medical record revealed Resident #27 was admitted to the facility on [DATE] with diagnoses including unspecified dementia and chronic obstructive pulmonary disease. Review of the comprehensive Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #27 had intact cognition. Review of physician order dated 04/13/22 revealed Resident #27 was to receive supplemental oxygen via nasal cannula every shift for shortness of breath. Review of the medical record revealed Resident #38 was admitted to the facility on [DATE] with diagnoses including chronic obstructive pulmonary disease and encephalopathy, unspecified. Review of the quarterly MDS 3.0 assessment dated [DATE] revealed Resident #38 had intact cognition. Review of the physician order dated 04/13/22 revealed Resident #38 was to receive supplemental oxygen via nasal cannula every shift for shortness of breath. Observations on 07/25/22 from 10:20 A.M. to 10:36 A.M. revealed oxygen tubing for Resident's #27 and #38 were note dated. Both residents were unaware of when the tubing was last changed. Observations and interview on 07/25/22 at 10:41 A.M., Licensed Practical Nurse (LPN) #679 verified the oxygen tubing for Resident's #27 and #38 was not dated. LPN# 679 had little knowledge of policy and procedures for maintaining oxygen tubing. Interview on 07/25/22 at 3:22 P.M., the Director of Nursing (DON) stated all oxygen tubing should be changed and dated every Thursday. The DON stated she would immediately provide training for staff. 365388 Page 3 of 5 365388 08/02/2022 Franklin Plaza Extended Care 3600 Franklin Boulevard Cleveland, OH 44113

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 observations, interviews, and record reviews the facility failed to date opened insulin vials to ensure purity and potency. This affected four (Resident's #1, #41, #80 and #122) of 29 residents reviewed for insulins. The facility census was 169. Findings include: Review of the medical record for Resident #1 revealed an admission date of 02/12/22 with diagnosis including diabetes mellitus. Review of the physician's orders revealed an order dated 07/26/22 for Lantus Solostar solution pen. Review of the medical record for Resident #41 revealed an admission date of 05/02/22 with diagnosis including type two diabetes mellitus. Review of the physician's orders revealed an order dated 07/05/22 for a Basaglar KwikPen and an order dated 07/17/22 for NovoLog solution. Review of the medical record for Resident #80 revealed an admission date of 11/23/20 with diagnosis including type two diabetes mellitus. Review of physician's orders revealed an order dated 11/23/20 for a Lantus Solostar solution pen. Review of medical record for Resident #122 revealed an admission date of 06/22/22 with diagnosis including type two diabetes mellitus. Review of the physician's orders revealed an order dated for a Lantus Solostar solution pen. Observation of the medication cart on 07/28/22 at 9:15 A.M. revealed opened insulin vial and a KwikPen not dated for Resident #41. Further observations revealed an opened KwikPen for Resident #80. Interview during the observation, LPN #671 verified the opened vial and pens were not dated. Observation of the medication cart on 07/28/22 at 9:28 A.M. revealed an opened insulin vial not dated for Resident #122. Interview during the observation, LPN #675 verified that the opened vial was not dated. Observation of the medication cart on 07/28/22 at 9:33 A.M. revealed a KwikPen of Lantus for Resident #1 that was not dated. Interview during the observation, LPN #601 verified the pen was not dated. 365388 Page 4 of 5 365388 08/02/2022 Franklin Plaza Extended Care 3600 Franklin Boulevard Cleveland, OH 44113

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interviews, the facility failed to maintain infection control standards when serving food. This affected one (Resident #20) of 20 residents observed for dining. The facility census was 169. Findings include: Review of the medical record revealed Resident #20 was admitted to the facility on [DATE] with diagnoses including chronic obstructive pulmonary disease, monoplegia of upper limb, and cerebrovascular disease affecting unspecified side. Observations on 07/25/22 at 12:46 P.M., Nurse Aide Trainee (NAT) #735 was observed handling Resident #20's ham sandwich with bare hands. Interview immediately after the observation, NAT #735 verified touching the sandwich with her bare hands. Interview on 07/26/22 at 5:00 P.M., the Director of Nursing (DON) stated staff should be wearing gloves when touching food. Interview on 07/27/22 at 11:20 A.M., the DON stated staff received training related to hand hygiene during tray pass. Review of training signature sheet verified the training was completed. 365388 Page 5 of 5