Health inspection·February 27, 2020

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview and facility policy, the facility failed to notify the physician when Resident #37 refused numerous doses of medication. This affected one resident (Resident #37) of five residents reviewed for unnecessary medications. Findings include: Review of the medical record revealed Resident #37 was admitted to the facility on [DATE] with diagnoses including cerebral atherosclerosis, cerebral infarction, vascular dementia, diabetes, delusional disorder, hypertension, encephalopathy, major depressive disorder and mixed receptive expressive language disorder. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] Resident #37 had severely impaired cognition and required extensive assistance with activities of daily living. Review of the February 2020 medication administration record (MAR) revealed Resident #37 refused: five milligrams (mg) of Abilify (antipsychotic) and 75 mg Effexor XR (antidepressant) at lunch on 02/09/20 and 02/19/20, 40 mg of Atorvastatin calcium (cholesterol), 30 mg of delsym (cough suppressant), 15 mg of Remeron (antidepressant), 1000 mg of metformin (diabetic) and 25 mg of Metoprolol tartrate (blood pressure) at bedtime on 02/02/20, 02/07/20, 02/08/20, 02/15/20, 02/17/20, 02/18/20, 02/20/20 and 02/22/20, 1000 mg of metformin, 81 mg of aspirin and 2.5 mg of Lisinopril (blood pressure) in the morning on on 02/13/20, 02/19/20 and 02/25/20. Review of the nursing progress notes from 02/01/20 to 02/25/20 revealed no documentation of the physician being notified Resident #37 had been refusing numerous medication on numerous days. Interview on 02/26/20 at 10:12 A.M., the Director of Nursing (DON) indicated the resident always refuses her medication, and the physician was aware. She verified there was no documentation the physician had been notified in the medical record. Review of the undated facility policy, Change in a Resident's Condition or Status, revealed the facility shall promptly notify the resident, his or her attending physician, and representative of changes in residents's medical/mental condition and/or status. The nurse would notify the residents attending physician or physic on call when there has been an refusal of treatment or medication two or more consecutive times. Page 1 of 5 365406 365406 02/27/2020 Pleasant View Health Care Center 401 Snyder Ave Barberton, OH 44203

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Review of the medical record revealed Resident #45 was admitted to the facility on [DATE] with the diagnoses of neuropathy, major depression, vitamin D deficiency, protein-calorie malnutrition, heart block, erosive osteoarthritis, atherosclerotic heart disease, end stage renal disease, dependence on renal dialysis, and non-Hodgkin lymphoma. Residents Affected - Few Review of the physician's order dated 09/26/19 revealed Resident #45 received dialysis on Tuesday, Thursday, and Saturday. Review of the quarterly MDS 3.0 assessment dated [DATE] revealed Resident #45 had severely impaired cognition and did not receive dialysis. Interview on 02/25/20 at 1:38 P.M. MDS Nurse #206 verified the quarterly MDS dated [DATE] was for Resident #45 was coded incorrectly indicating Resident #45 did not receive dialysis. 3. Review of the medical record revealed Resident #111 was admitted to the facility on [DATE] and discharged on 01/26/20 to home with the diagnoses of anemia, chronic kidney disease, pulmonary edema, bronchitis, pneumonia and respiratory failure. Review of the discharge return not anticipated assessment revealed Resident #111 was discharged to a acute hospital. Review of the progress notes dated 01/26/20 at 2:15 P.M. revealed Resident #111 was discharged to home. Interview on 02/25/20 at 11:27 A.M. MDS Nurse #206 verified Resident #111 was discharged to home and not an acute hospital. She verified the MDS was coded incorrectly. Based on record review and interview, the facility failed to ensure Minimum Data Set (MDS) 3.0 assessments were correct for three residents (Residents #29, #45, and #111) of 25 residents reviewed for MDS accuracy. Findings include: 1. Resident #29 was admitted to the facility with diagnoses including Alzheimer's disease, generalized anxiety disorder, and major depressive disorder. Review of Resident #29's medical record revealed a quarterly MDS 3.0 assessment dated [DATE]. The MDS revealed Resident #29 received the following medications in the previous seven days, one injection, six days of antipsychotics, seven days of antidepressants, seven days of anticoagulants, seven days of diuretics, and seven days of opioids. Review of Resident #29's December 2019 Medication Administration Record (MAR) revealed Resident #29 received one injection, six days of antipsychotics, seven days of antidepressants, seven days of anticoagulants, three days of diuretics, and seven days of opioids during the reference period of 12/05/19 through 12/11/19 . Staff interview with Licensed Practical Nurse (LPN) #500 on 02/25/20 at 2:22 P.M. verified Resident #29's 12/11/19 quarterly MDS 3.0 assessment was incorrect and verified the medication discrepancy. 365406 Page 2 of 5 365406 02/27/2020 Pleasant View Health Care Center 401 Snyder Ave Barberton, OH 44203

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure Resident #40's pressure ulcer interventions were in place at all times. This affected one (Resident #40) of three residents reviewed for pressure ulcers. Residents Affected - Few Findings include: Resident #40 was admitted on [DATE] with diagnoses including orthopedic aftercare, part of neck of left femur fracture, vascular dementia and muscle weakness. Resident #40's physician orders, dated 12/29/19, revealed he should have bilateral heel boots. Resident #40's admission Minimum Data Set (MDS) 3.0 assessment dated [DATE], revealed his cognition was moderately impaired, required two person extensive assistance for bed mobility, and was totally dependent on two people for transfers. Observation on 02/24/20 at 10:37 A.M. revealed Resident #40 was sitting in his wheelchair in his room, with his feet resting on food pedals. Resident #40 had a visible dressing to his left foot, with socks on both feet. Review of Resident #40's Wound Evaluation note dated 02/18/20 revealed he had a suspected deep tissue injury to his left heel. Observation on 02/25/20 at 7:41 A.M. with Licensed Practical Nurse (LPN) #200 revealed Resident #40 was lying in bed without bilateral heel protectors on. Both of Resident #40's feet were lying directly on his bed. Interview with LPN #200 at this time confirmed the observation. LPN #200 looked in Resident #40's closet and found one heel boot and was unsure if he should have two heel boots or not. Observation on 02/25/20 at 11:22 A.M. revealed Resident #40 was sitting in his wheelchair with his left foot on the ground and he had socks on. LPN #200 joined the observation and confirmed Resident #40 was wearing socks. LPN #200 revealed she was unsure if the resident should be wearing bilateral heel boots to his feet while out of bed. Interview on 02/25/20 at 11:25 A.M. with LPN #201 revealed Resident #40 should be wearing bilateral heel boots at all times per physician orders. 365406 Page 3 of 5 365406 02/27/2020 Pleasant View Health Care Center 401 Snyder Ave Barberton, OH 44203

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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 medications were secured at all times. This had the potential to affect 26 (Resident #5, Resident #6, Resident #8, Resident #11, Resident #12, Resident #17, Resident #26, Resident #27, Resident #29, Resident #33, Resident #35, Resident #37, Resident #46, Resident #47, Resident #54, Resident #59, Resident #63, Resident #67, Resident #68, Resident #70, Resident #76, Resident #78, Resident #84, Resident #89, Resident #95, Resident #99) of 26 residents who were cognitively impaired and independently mobile. Findings include: 1. Observation on 02/25/20 at 7:30 A.M. revealed a medication cart was unlocked on Side 1 in the facility. There were no staff in sight of the medication cart. Interview on 02/25/20 at 7:31 A.M. with Licensed Practical Nurse (LPN) #200 confirmed the medication cart was unlocked. 2. Observation on 02/26/20 at 11:43 A.M. revealed there was an unidentified loose pill in a medication cup on top of the medication cart near the Side 1 nurses station. There were no staff in sight of the medication cart. Interview on 02/26/20 at 11:43 A.M. with LPN #500 confirmed the loose pill on the medication cart and took it off the medication cart. Interview on 02/26/20 at 12:12 P.M. with Director of Nursing (DON) revealed the loose pill was Effexor 37.5 milligrams (anti-depressant medication), and Resident #102 received this medication. DON revealed the resident was administered multiple medication and the nurse who administered the medications thought she took all the medications. The facility believed the pill was found at bedside and someone had placed the loose pill in the medication cup on the medication cart. 3. Observation on 02/26/20 at 4:20 P.M. revealed the medication cart near the Side 1 nursing station revealed the cart was unlocked. There were no staff in sight of the medication cart. Administrator walked into the hall and confirmed the observation of the medication cart being unlocked. Review of a list of residents who are cognitively impaired and independently mobile revealed Resident #5, Resident #6, Resident #8, Resident #11, Resident #12, Resident #17, Resident #26, Resident #27, Resident #29, Resident #33, Resident #35, Resident #37, Resident #46, Resident #47, Resident #54, Resident #59, Resident #63, Resident #67, Resident #68, Resident #70, Resident #76, Resident #78, Resident #84, Resident #89, Resident #95, Resident #99 had the potential to be affected by unsecured medication. 365406 Page 4 of 5 365406 02/27/2020 Pleasant View Health Care Center 401 Snyder Ave Barberton, OH 44203

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. Based on observation, interview and record review, the facility failed to ensure Resident #11, Resident #14, Resident #28, Resident #43, Resident #56, Resident #77, Resident #114 were were served the proper portion of their pureed lunch according to the menu. This affected seven (Resident #11 Resident #14, Resident #28, Resident #43, Resident #69, Resident #77, and Resident #114 ) of seven residents that were served pureed meals in the small dining room, with the potential to affect all ten residents (Resident #11 Resident #14, Resident#16, Resident #28, Resident #43, Resident #56, Resident #69, Resident #77, Resident #114, and Resident #115) on a pureed diet. Findings include: Review of the facility lunch menu for 02/26/20 revealed residents on a pureed diet should be served pureed meatloaf with gravy using a number six scoop (5 and 1/3 ounces), and the pureed scalloped potatoes and pureed green beans did not have a scoop size listed. Residents on a regular diet were to receive a half cup (4 ounces) of scalloped potatoes and a half cup of green beans. Review of the Portion Control Chart (undated), revealed a number six size scoop is 5 and 1/3 ounces, a number eight size scoop is 4 ounces, and a number ten size scoop is 3 ounces. Review of a list of residents on pureed diet revealed Resident #11 Resident #14, Resident#16, Resident #28, Resident #43, Resident #56, Resident #69, Resident #77, Resident #114, and Resident #115 were on pureed diets. Review of the facility list of what dining rooms residents ate in, revealed Resident #11 Resident #14, Resident #28, Resident #43, Resident #69, Resident #77, and Resident #114 ate in the small dining room. Observation on 02/26/20 at 12:08 P.M. revealed [NAME] #203 had plated all trays for residents on a pureed diet, who ate in the small dining room. Interview on 02/26/20 at 12:08 P.M. with [NAME] #203 and [NAME] #204 revealed their was a number eight size scoop in the pureed meatloaf, pureed scalloped potatoes, and pureed green beans. Interview on 02/26/20 at 12:10 P.M. with Certified Dietary Manager #205 confirmed the above scoop sizes, and revealed the pureed meatloaf should have been served with a number six scoop and the pureed scalloped potatoes and green beans should have been served with a number eight scoop. 365406 Page 5 of 5