Health inspection·April 5, 2023

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. Based on interview and record review, the facility failed to ensure restorative programs were provided as ordered. This affected one Resident (#122) of three reviewed for restorative programs. The facility census was 156. Findings include: Review of the medical record for Resident #122 revealed an admission date of 09/28/22. Diagnoses included left sided hemiplegia, dysphagia, and speech and language deficits following non-traumatic subarachnoid hemorrhage. Review of the Medicare Quarterly Minimum Data Set assessment, dated 03/20/23, revealed Resident #122 had intact cognition. Resident #122 required extensive two staff assistance with bed mobility, dressing, personal hygiene, and toileting, locomotion on unit only occurred once or twice, and total two staff assistance with transfers. The assessment indicated Resident #122 was not on therapy services during the assessment period. Resident #122 was on restorative nursing programs for range of motion and transfers. Review of the plan of care dated 09/20/22 revealed Resident #122 was at risk for impaired function of range of motion and impaired physical mobility in transfers. Resident #122 required restorative programs. Interventions included cue and prompt resident to perform exercises, encourage to wear non-skid footwear, use gait belt for safety, praise resident efforts and success through entire restorative program, monitor for fatigue, reassess restorative program quarterly, and refer to therapy as needed. Review of physician's order dated 09/28/22 revealed Resident #122 was to have mobility per the plan of care. Review of plan of care response history for restorative active range of motion program revealed Resident #122 was to receive restorative exercises three to seven times per week for 15 minutes. Review of the look back period of 30 days revealed Resident #122 received restorative sessions on 03/09/23, 03/15/23, 03/27/23, and 03/28/23. Review of the plan of care response history for restorative sit to stand transfer program revealed Resident #122 was to receive restorative assistance three to seven times per week for 15 minutes. Review of the look back period of 30 days revealed Resident #122 received restorative sessions on 03/07/23 and 03/15/23. Page 1 of 5 365388 365388 04/05/2023 Franklin Plaza Extended Care 3600 Franklin Boulevard Cleveland, OH 44113

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 04/04/23 at 11:41 A.M. with Restorative Aide #13 revealed recently there had been two Restorative Aides rather than three. Restorative Aide #13 indicated when there were two staff in the department it was challenging to get all tasks completed. Restorative Aide #13 confirmed Resident #122 was currently on restorative programs. Interview on 04/05/23 at 8:42 A.M. with Restorative Nurse #18 confirmed Resident #122 had not received restorative program sessions as ordered. This deficiency represents non-compliance investigated under Complaint Number OH00141208. 365388 Page 2 of 5 365388 04/05/2023 Franklin Plaza Extended Care 3600 Franklin Boulevard Cleveland, OH 44113

F 0713 Provide or arrange emergency care by a doctor 24 hours a day. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure timely physician response to notification of a urinary tract infection. The affected one Resident (#122) of three reviewed for change in condition. The facility census was 156. Residents Affected - Few Findings include: Review of the medical record for Resident #122 revealed an admission date of 09/28/22. Diagnoses included chronic kidney disease, urinary tract infection, left sided hemiplegia, and neuromuscular dysfunction of bladder. Resident #122 was noted to be a patient of [NAME] Services (provides advanced practice nurses for day to day coverage for residents) and nurse practitioner was to be notified of any changes in resident condition. Review of the Medicare Quarterly Minimum Data Set assessment, dated 03/20/23, revealed Resident #122 had intact cognition. Resident #122 required extensive two staff assistance with toileting and total two staff assistance with transfers. The assessment indicated Resident #122 was occasionally incontinent of bladder and always incontinent of bowel. Review of Narrative Nurse's Note dated 03/14/23 revealed Resident #122 was not behaving normally and had increased confusion. Review of [NAME] Services Nurse Practitioner (NP) Note dated 03/14/23 revealed Resident #122 had change in mental status and was unable to recognize staff. Resident #122 was noted to be more quiet and tired than normal. NP ordered chest x-ray, lab draw, and urinalysis. Review of physician's order, dated 03/14/23, revealed Resident #122 was provided with intravenous fluids (IVF) for dehydration. Resident #122 received two liters of Sodium Chloride Solution at 75 milliliters per hour for two days. Resident #122 received order for urinalysis collected via straight catheter on 03/14/23. Resident #122 received order for 250 milligrams Ciprofloxacin by mouth three times per day for seven days for urinary tract infection (UTI) on 03/20/23. Review of [NAME] Services NP Note dated 03/15/23 revealed NP follow up for change in mental status. Stat (without delay) urinalysis and two liters IVF were ordered. Urinalysis was pending. Review of Narrative Nurse's Note dated 03/15/23 revealed urine was obtained via straight catheter. Resident was noted to be on menstrual cycle. Review of Nurse's Note dated 03/17/23 revealed Resident #122 continued to have increased confusion and drowsiness. Review of Urinalysis with Culture lab result dated 03/18/23 revealed the specimen was collected on 03/15/23 and was cloudy. Abnormalities included blood in urine, nitrites in urine, and bacteria noted. Culture resulted in Escherichia Coli (e. Coli) present and was susceptible to ciprofloxacin. The final report was provided to facility on 03/18/23. Review of the plan of care dated 03/20/23 revealed Resident #122 had a urinary tract infection. Interventions included educate staff and resident on importance of maintaining adequate hydration, give 365388 Page 3 of 5 365388 04/05/2023 Franklin Plaza Extended Care 3600 Franklin Boulevard Cleveland, OH 44113

F 0713 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few medications as ordered, monitor for signs and symptoms of infection, monitor urine, monitor vital signs, notify physician if lab work positive, and utilize personal protective equipment as indicated. Review of [NAME] Services NP Note dated 03/20/23 revealed urinalysis with culture showed e. Coli. Resident #122 was noted to be less interactive and less alert than usual with change in mental status. Noted to have urinary pain and urgency. NP gave order to start ciprofloxacin 250 milligrams for UTI and additional two liters of IVF at 75 milliliters per hour. Review of UTI Decision Flow Sheet dated 03/20/23 revealed urine was collected via straight catheter. Specimen showed greater than 100 colony forming units per milliliter (cfu/ml) of organisms. Resident #122 had gross hematuria and flank pain. UTI present according to McGreer's criteria. Interview on 04/04/23 at 2:14 P.M. with the Director of Nursing (DON) confirmed the results of the urinalysis were received on 03/18/23 and antibiotic was not ordered by NP until 03/20/23. Interview on 04/04/23 at 2:47 P.M. with Licensed Practical Nurse (LPN) #8 confirmed she received the results of the urinalysis. LPN #8 indicated she was the nurse supervisor and she had contacted Medical Director #19 (the physician for Resident #122) upon receiving. LPN #8 reported Medical Director #19 indicated he did not order the urinalysis and questioned LPN #8 why he was bothered on the weekend. LPN #19 indicated Medical Director #19 indicated to wait until Monday (03/20/23). LPN #8 indicated she then sent a secure message through electronic medical record (EMR) to NP #16. LPN #8 indicated NP #16 did not come to the facility on weekends and there was no on call service for NP or physicians. LPN #8 indicated NP #16 ordered the antibiotic for UTI on 03/20/23. Interview on 04/04/23 at 3:07 P.M. with NP #16 confirmed the antibiotic for Resident #122's UTI was not started until 03/20/23. NP #16 indicated she was not expected to take calls or come in on weekends and the results of the urinalysis should have defaulted to the physician. Review of facility policy Change in a Resident's Condition dated 11/13/19 revealed the nurse supervisor would notify the resident's attending physician when there was a change in status. Review of facility policy Physician Services dated 06/08/22 revealed the resident's attending physician was to monitor for changes in residents' medical status and provide consultation or treatment when called by the facility. This deficiency represents non-compliance investigated under Complaint Number OH00141208. 365388 Page 4 of 5 365388 04/05/2023 Franklin Plaza Extended Care 3600 Franklin Boulevard Cleveland, OH 44113

F 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. Level of Harm - Minimal harm or potential for actual harm Based on observation and interview, the facility failed to ensure a functional call light system for Resident #122. This affected one (Resident #122) of four resident reviewed for call lights. Residents Affected - Few Findings include: Observation on 04/04/23 at 7:49 A.M. revealed Resident #122 was lying in bed, sleeping, with a call light in reach, attached to the bed. Observation on 04/04/23 at 9:30 A.M. revealed Resident #122 was lying in bed with the head of the bed elevated, on her phone, with a call light in reach. Resident #122's call light was not lit outside her door. Resident #122 had no other device to alert staff for assistance within reach. Interview, during the observation, with Resident #122 revealed she had just pushed her call light because she urinated in her brief and need changed. Resident #122 spoke in a softspoken voice. Resident #122 then pushed her call light again. A yellow light was on where the call light cord entered the wall. The surveyor again observed the call light was not lit outside Resident #122's room. Interview, during the observation, with State Tested Nurse Aide (STNA) #11 verified Resident #122's call light was not lit outside her room nor at the nurses' station call light panel. Interview on 04/04/23 at 9:44 A.M. with STNA #5 verified Resident #122's call light was not working because the call light was not lit outside her door nor at the nursing station call light panel. Interview on 04/04/23 at 10:45 A.M. with the Administrator revealed Resident #122's brother notified him Resident #122's call light was not working. The Administrator revealed Resident #122's call light was not lighting up because the call light cord in Resident #122's bathroom (shared with three other residents) was halfway between activated and not activated which overrode Resident #122's call light. The Administrator stated the call light had been fixed when Resident #122's brother notified him. This deficiency represents non-compliance investigated under Complaint Number OH00141208. 365388 Page 5 of 5