Health inspection·January 16, 2019

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview the facility failed to ensure Resident #247 was treated with dignity and respect. The affected one resident (Resident #247) of two residents reviewed for dignified treatment in the facility. Findings include: Record review revealed Resident #247 was admitted to the facility on [DATE] with diagnoses including heart and lung disease, multiple fractures of the ribs which resulted from a fall prior to admission to the facility, spinal stenosis (narrowing of the spinal canal causing numbness, weakness or pain in the arms and/or legs) spondylosis (spinal arthritis) and macular degeneration (blurred or no vision). The resident was admitted for rehabilitation following a fall at home. Review of Resident #247's Minimum Data Set (MDS) 3.0 assessment dated [DATE] indicated he needed extensive assistance of one staff member with bed mobility (how one moves to and from a lying position, turns side to side, and positions body while in bed). Interview with Resident #247 on 01/13/19 at 10:36 P.M. revealed he was frustrated with the staff answering his call light and not providing requested assistance at the time they answered. He reported when staff finally provided the needed assistance, they rushed out of his room before he could ask for anything else. He then had to push the call light again to ask for additional assistance and the process repeated in the same manner. During observation of medication pass with Registered Nurse (RN) #400 on 01/15/19 at 8:40 A.M., RN #400 entered Resident #52's room to administer medications through the resident's gastrostomy (feeding) tube. The tube wasn't functional and RN #400 was attempting measures to unclog it. Resident #247, the roommate, was in the bed near the door and called out in a loud voice saying he couldn't find his call light. RN #400 continued to attempt to unclog Resident #52's gastrostomy tube. After a brief pause she walked over to Resident #247 and told the resident it's right here, you have it. Resident #247 responded that he did not have it and when the covers were pulled back he in fact had the TV remote but the call light was in the sheets. RN #400 gave the call light to Resident #247 and without comment or apology for being mistaken walked back to Resident #52's bedside. As RN #400 again sat near Resident #52 waiting for another nurse to bring supplies to unclog the tube at 8:47 A.M., Resident #247 stated loudly, I wondered if I could be pulled up. RN #400 did not respond to the resident. After several minutes, RN #400 asked the surveyor questions about the survey process. Resident #247 continued to watch the surveyor and RN #400 conversing. After about 5 Page 1 of 4 365406 365406 01/16/2019 Pleasant View Health Care Center 401 Snyder Ave Barberton, OH 44203

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few minutes, Resident #247 loudly said, I need to lay on my side. RN #400 said to him, Well, roll to your side. The resident said, That's what they tell me. She did not get up to assist the resident. At about 9:05 A.M., another surveyor walked by the room and looked in to say hello to the resident. He asked her, Could you help me to roll to my side? They tell me I have a wound and I need to lay on my side. She stated that she was a visitor to the facility but would get help for him. RN #400 initially did not add to the conversation, but when asked by the second surveyor who the nursing assistant was, she told the other surveyor who to look for. On 01/15/19, at 10:07 A.M., RN #400 was interviewed about the interaction with Resident #247. She stated he wanted to go home, but consistently would not do anything for himself. She stated he thinks he is paralyzed and we are getting nowhere with him. She verified the record indicated he needed assistance with care but stated he was able to do more for himself that he often did. RN #400 verified the resident had called for assistance to move up in bed and she had not responded to him verbally or physically with help. She stated she had not responded because I would have had to yell for him to hear me. She verified she did not explain to Resident #247 that she was helping the other resident, nor did she call for other staff assistance. RN #400 also verified when the resident asked again for help to roll to his side, she instructed him to roll on his own, did not approach to assist him and did not call for other staff to assist him. Help was not solicited until another surveyor requested staff assistance for the resident. This information was confirmed with the director of nursing on 01/15/19 at 10:50 A.M. She verified the nurse had not treated the resident in a polite, respectful or dignified manner. Resident #247 was interviewed again on 01/15/19 at 11:00 A.M. He stated he did not feel staff responded to his needs and did not think the nurse had heard his initial requests when he called for help earlier in the day. He stated the staff often leave without ensuring he has everything he needs. 365406 Page 2 of 4 365406 01/16/2019 Pleasant View Health Care Center 401 Snyder Ave Barberton, OH 44203

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** Based on record review and interview the facility failed to ensure accurate documentation of Resident #72's and Resident #247's toileting programs was maintained in the resident's medical records. This affected two residents (Resident #72 and #247) of 24 residents whose records were reviewed for accuracy of documentation. Findings include: 1. Resident #72 was admitted to the facility on [DATE] with diagnoses including dementia, heart, cerebral vascular and lung disease, urinary incontinence and altered mental status. A review of Resident #72's Minimum Data Set (MDS) 3.0 assessment dated [DATE] indicated frequent urinary incontinence with a toileting program initiated. A review of the restorative toileting program initiated on 08/30/18 indicated to check Resident #72 for incontinence and offer to assist to the bathroom at 9:00 A.M., 11:00 A.M., 2:00 P.M., 5:00 P.M. and 8:00 P.M. An review of the documentation dated 01/01/19 to 01/14/19 of the scheduled toileting program indicated inaccurate documentation of the time the toileting was provided. On 01/01/19 the documentation indicated at 10:52 P.M. two entries were documented for 10:52 P.M. which indicated Resident #72 was continent and urinated in toilet/bedpan/urinal, and incontinence brief was dry. On 01/06/19 the documentation indicated Resident #72 was continent and urinated in toilet/bedpan/urinal, and incontinence brief was dry three entries each timed at 2:24 P.M. On 01/07/19 at 8:47 P.M. there were two separate entries at 8:47 P.M. indicating continent and urinated in toilet/bedpan/urinal, and incontinence brief was dry. On 01/09/19 at 2:01 P.M. there were three separate entries documenting Resident #72 was continent and urinated in toilet/bedpan/urinal, and incontinence brief was dry. On 01/11/19 there were three separate entries at 1:50 P.M., 1:51 P.M. and 1:52 P.M. that Resident #72 was continent and urinated in toilet/bedpan/urinal, and incontinence brief was dry. On 01/12/19 there were three entries documented at 1:12 P.M., 1:13 P.M., 1:14 P.M. that Resident #72 was continent and urinated in toilet/bedpan/urinal, and incontinence brief was dry. An interview with Registered Nurse (RN) #1 on 01/14/19 at 2:24 P.M. indicated some of the State Tested Nursing Assistants (STNAs) were documenting the number of times the resident was continent/incontinent at the end of their shift, rather than the actual time of the occurrence. RN #1 indicated the STNAs had been inserviced to enter the actual time incontinence care was provided and not to wait until the end of their shift to document the care. RN #1 verified the documentation was inaccurate. 2. Resident #247 was admitted to the facility on [DATE] with diagnoses including heart/vascular disease, pulmonary disease, spinal stenosis, macular degeneration and rib fractures resulting from a fall prior to admission. A review of Resident #247's MDS 3.0 assessment, dated 01/10/19 indicated Resident #24 was occasionally incontinent of urine and provided a scheduled toileting program. A review of the scheduled toileting program indicated to provide incontinence care and offer to assist to the bathroom at 8:00 A.M., 12:00 P.M., 4:00 P.M. and 8:00 P.M. 365406 Page 3 of 4 365406 01/16/2019 Pleasant View Health Care Center 401 Snyder Ave Barberton, OH 44203

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A review of Resident #247's documentation of the scheduled toileting program dated 01/07/19 to 01/14/19 indicated on 01/08/19 at 1:59 P.M. and 1:59 P.M. Resident #247 was continent and urinated in toilet/bedpan/urinal, and incontinence brief was dry. On 01/09/19 the documentation indicated two entries timed at 9:31 P.M. that Resident #247 was continent and urinated in toilet/bedpan/urinal, and incontinence brief was dry. On 01/10/19 at 7:02 P.M. two entries indicated Resident #24 was continent and urinated in toilet/bedpan/urinal, and incontinence brief was dry. On 01/13/19 two entries timed at 10:30 P.M. indicated Resident #247 was continent and urinated in toilet/bedpan/urinal, and incontinence brief was dry. An interview with Registered Nurse (RN) #1 on 01/14/19 at 2:24 P.M. indicated some of the State Tested Nursing Assistants (STNAs) were documenting the number of times the resident was continent/incontinent at the end of their shift, rather than the actual time of the occurrence. RN #1 indicated the STNAs had been inserviced to enter the actual time incontinence care was provided and not to wait until the end of their shift to document the care. RN #1 verified the documentation was inaccurate. 365406 Page 4 of 4