Health inspection·December 12, 2019

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed ensure a Pre-admission Screening and Resident Review (PASARR) level 2 had been completed. This affected one (Resident #6) of one resident reviewed for PASARR screening. The facility census was 66. Findings include: Review of Resident #6's medical record revealed an admission date of 11/09/18. Diagnoses included multiple sclerosis, bipolar disorder, peripheral vascular disease, history of urinary tract infections, mood disorder, neuromuscular dysfunction of bladder, depressive disorder, and osteoarthritis. Review of Resident #6's annual minimum data set (MDS) assessment dated [DATE] revealed the resident had no cognitive deficits, and listed the resident as not having a serious mental illness. Further review of the assessment revealed a level 2 screen had not been completed. Review of Resident #6's PASARR screening dated 12/28/16 revealed the resident had no indications of serious mental illness. Review of Resident #6's diagnosis report revealed a diagnosis of bipolar disorder unspecified dated 07/18/18. Interview on 12/11/19 at 1:38 P.M. with Licensed Social Worker (LSW) #502 verified with Resident #6 did not have a level 2 PASARR completed after a diagnosis of bipolar disorder. Page 1 of 4 365510 365510 12/12/2019 Bethesda Care Center 600 N Brush St Fremont, OH 43420

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observation, record review and policy review, the facility failed to ensure medications were not left at a resident's bedside. This affected one (Resident #32) resident but had the potential to affect six residents on 100 hall who were mobile and had cognitive impairment. The facility census was 66. Findings include: During observation on 12/09/19 at 9:40 A.M., Resident #32 had two medication cups filled with medications sitting on the bedside stand. The resident was doing an aerosol treatment. Interview on 12/09/19 at 9:45 A.M. with Registered Nurse (RN) #504 verified she had left Resident #32's morning medications in the room for the resident to take. Review of facility policy titled General Dose Preparation and Medication Administration, dated 01/01/13, revealed the resident will be observed for consumption of the medication(s). 365510 Page 2 of 4 365510 12/12/2019 Bethesda Care Center 600 N Brush St Fremont, OH 43420

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, manufacturer's recommendations and facility policy review, the facility failed to ensure medications were properly stored and labeled. This affected two (Residents #39 and #322) residents. The facility census was 66. Findings include: 1. Observation conducted on [DATE] at 8:42 A.M. of the 400-hall medication cart with Licensed Practical Nurse (LPN) #330 revealed the 400-hall medication cart contained one bottle of multivitamins with the expiration date rubbed off and unreadable and one bottle of prescription Latanoprost 0.005% for Resident #39, opened and undated Interview with LPN #330 at the time of the observation verified the above findings. 2. Observation conducted on [DATE] at 9:19 A.M. of the 100-hall medication cart with LPN #340 revealed the 100-hall medication cart contained one medication cup in the top drawer of the medication cart which contained seven unidentified pills. The number 108-1 was hand written on the outside of the cup. Interview with LPN #340 at the time of the observation she stated the medication cup belonged to Resident #322. LPN #340 verified the medications were not in their prescription package and had no identifying information regarding the medication names, doses, routes, time of administration or who they were prescribed to. Interview on [DATE] at 9:02 A.M. with Director of Nursing (DON) she verified all eye drops should be dated when opened. DON stated the policy was the medication expire after 28 days unless otherwise specified by manufacture's recommendations. Review of the manufacturer's recommendations for Latanoprost 0.005% revealed once a bottle is opened for use, it may be stored at room temperature for six weeks. Review of the facility policy titled Storage and Expiration Dating of Medications, Biologicals, Syringes and Needles, revised [DATE], revealed the facility should ensure that medications and biologicals that have expired are stored separately from other medications until they are destroyed or returned to the pharmacy or supplier. Once any medication or biological package is opened, the facility should follow manufacturer/supplier guidelines with respect to expiration dates for opened medications. Facility staff should record the date opened on the primary medication container when the medication has a shortened expiration date one it is opened. 365510 Page 3 of 4 365510 12/12/2019 Bethesda Care Center 600 N Brush St Fremont, OH 43420

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many 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 observation, staff interview, facility policy, and manufacturer instructions for use, the facility failed to ensure the appropriate low temperature dishwasher water temperature was reached to properly sanitize dishes and utensils. This had the potential to affect 66 residents identified by the facility to receive food from the facility kitchen. The census was of 66. During the initial kitchen tour on 12/09/19 from 8:40 A.M. to 8:59. A.M., the dishwasher cycle was observed. The dishwasher only reached 156 degrees Fahrenheit (F) for the wash cycle, and 90 degrees F for rinse cycle. The [NAME] manufacturer temperature sticker on the outside of the dishwasher revealed the wash and rinse temp needed to be at minimum of 120 degrees F. During interview at the time of the observation, Dietary Staff (DS) #320 verified the rinse temperature only reached 90 degrees F. DS #320 revealed the facility had a technician from [NAME] come out in the last couple of weeks and put new doors on the dishwasher and told them it would take a while for the rinse temp to maintain 120 degrees F. The technician would be back to fix the dishwasher with an additional part that needed to be ordered. DS #320 confirmed the dishwasher temps had not reached 120 degrees F in several weeks. Interview on 12/10/19 at 10:41 A.M. with Dietary Director (DD) #300 verified the technician from [NAME] was ordering the needed part to fix the dishwasher. DD #300 revealed the technician was not able to get the temperature to exceed 116 degrees F for the rinse cycle. DD #300 confirmed all 66 residents in the building eat from the kitchen. DD #300 revealed she had used paper products for a couple of weeks when she realized the temperature was not correct. On Thanksgiving she implemented going back to regular dishes and since 11/28/19 the facility has used dishes from the kitchen and the dishwasher has not reached the appropriate temperature during this time. Review of the facility policy titled Cleaning Dishes and Utensils-Dish Machine Operation, dated 2009, from the [NAME] Nutrition Management resource, revealed the low temperature using sanitizer should be 120 to 150 degrees F. 365510 Page 4 of 4