Health inspection·April 28, 2022

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. Based on observation, record review and interview, the facility failed to ensure that one resident (Resident #4) was served their lunch meal at the same time as the other residents seated at the dining table. This affected one (Resident #4) of three (Resident #55 and Resident #57) seated at a table in first floor dining room. The facility census was 92. Findings included: Observation of lunch service on 04/26/22 at 12:05 P.M. in the first-floor dining room, Resident #4 was observed seated at a table with two other residents (Resident #55 and Resident #57). Resident #55 and Resident #57 had their lunch trays and were eating their meals. Resident #4 did not have her lunch meal. Other residents seated in the dining room continued to receive their meals. During continued observation from 12:05 P.M. to 12:35 P.M., Resident #4 remained seated at the dining table without her lunch tray. Resident #57 completed her meal at 12:25 P.M. Resident #4 did not receive her lunch tray until 12:35 P.M. Review of Resident #4's medical record indicated an admission date of 09/04/19. Diagnoses included altered mental status, vascular dementia with behavioral disturbance, hypertension, type II diabetes, hyperlipidemia, cerebral infarction with right side hemiplegia and hemiparesis, depression, and anxiety. Resident #4 was alert and oriented times one to two and able to eat with supervision and set-up assistance. An attempt to interview Resident #4 while she waited for her lunch tray was unsuccessful due to her incomprehensible responses. During interview on 04/26/22 at 12:16 P.M., State Tested Nurse Aide (STNA) #500 acknowledged Resident #4 did not have a lunch tray and indicated she did not know why. STNA #500 did not initiate any attempts to find out where Resident #4's lunch tray was. During interview on 04/28/22 at 4:35 P.M., Corporate Clinical Coordinator (CCC) #501 indicated that due to the inconsistency of residents eating in their rooms and eating in the dining rooms, it was difficult for staff to always know from one day to the next if the resident would be eating in their room or in the dining room. The CCC indicated that prior to Covid-19, meals were served buffet-style in the dining room, and it eliminated the issue of tracking down trays. The CCC #501 indicated that the plan is to return to buffet-style meal service to eliminate the issue of tracking down trays and ensure timely meal service. Page 1 of 6 365520 365520 04/28/2022 Phoenix of Maple Heights 19900 Clare Ave Maple Heights, OH 44137

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure accurate advance directive orders matched throughout the medical record for Resident #42. This affected one of 24 residents reviewed for advanced directives. The facility census was 92. Findings include: Resident #42's was admitted to the facility on [DATE] with diagnoses that included dementia, bipolar, and schizoaffective disorder. Review of the most recent Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #12 had impaired cognition and received hospice care. Review of the electronic medical record (EMR) physician's orders revealed an order dated [DATE] for a full code status (meaning to initiate cardiopulmonary resuscitation (CPR) if no heartbeat.) Review of the signed physicians' order for [DATE] revealed Resident #42 had a full code status. Review of the hard medical chart for Resident #42 revealed a signed Do Not Resuscitate Comfort Care (DNRCC) code status (meaning any care that eases pain and suffering but no rescuitative measure to save or sustain life) dated [DATE]. Interview with Licensed Practical Nurse (LPN) #700 on [DATE] at 1:49 P.M. revealed if she did not know a resident's code status she would look first in hard chart and then in EMR. LPN #700 verified Resident #42's code status was a DNRCC. LPN #200 stated when Resident #42 was admitted to hospice services the order was not changed to DNRCC in the EMR. Interview on [DATE] at 10:11 P.M. with the Chief Clinical Director #501 verified the above findings. 365520 Page 2 of 6 365520 04/28/2022 Phoenix of Maple Heights 19900 Clare Ave Maple Heights, OH 44137

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and observation, the facility failed to ensure nail care was provided. This affected three (Resident #37, Resident #53, and Resident #58) out of five residents (Resident #8 ad Resident #42). The facility census was 92. Residents Affected - Few Findings Include: 1. Review of the open record of Resident #37 revealed he was admitted to the facility on [DATE] and then readmitted on [DATE]. His admitting diagnoses included major depressive disorder, type II diabetes, dementia, severe protein calorie malnutrition, bipolar disorder and fracture of the neck of the left femur. Review of this resident's Minimum Data Set assessment dated [DATE] revealed this resident was alert and oriented times three. Review of his of activities of daily living revealed he needed supervision with set up for bed mobility, transfers, dressing, eating, toilet use and personal hygiene. Observation on 04/26/22 at 8:00 A.M. revealed the resident was appropriately dressed. The resident stated his showers were on time and as he liked. It was noted at this time the both had had long fingernails on every finger with blackish brown colored material underneath. The resident stated that he was not able to cut his own fingernails. He also stated that he talked with staff about cutting his nails but so far no one has cut them. Interview with Licensed Practical Nurse (LPN) #502 on 04/26/22 revealed he is non compliant and often will not the aides to cut his nails. Observation of the resident's Nails on 04/28/22 at 8:15 A.M. revealed his nails were still long with dirt/debris under them. State Tested Nursing Aide (STNA) #503 at this time was in the resident's room and verified his nails were long and dirty. This STNA then asked the resident if he could cut his nails and the resident agreed. Observation of Resident #37's nails on 04/28/22 at 1:30 revealed all of his fingernails were trimmed and clean. 2. Review of Resident #53's open record revealed an admission dated of 08/18/21. His admitting diagnoses included major depressive disorder, type II diabetes, dementia, and anemia. Review of this resident's Minimum Data Set Assessment revealed this resident was alert and oriented times three. Functionally this resident needed supervision with set up only for all activities of daily living including personal hygiene and toileting. Interview with this resident on 04/25/22 at 7:45 PM revealed he needed his fingernails and his toe nails cut and cleaned. Observation of the resident's nails on all fingers of both hands revealed very long nails with brown dirt beneath the nails. He further stated if his nails aren't cut soon he was afraid they were going to grow into his skin. Observation on 04/27/22 at 3:30 P.M. revealed the residents nails were still long with brown dirt underneath them. 365520 Page 3 of 6 365520 04/28/2022 Phoenix of Maple Heights 19900 Clare Ave Maple Heights, OH 44137

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 04/28/22 at 7:40 A.M. observation of this resident's nails again revealed this residents fingernails on both hands were long and brown dirt underneath. STNA #503 verified his nails were long and had dirt underneath and that they needed to be cut. 3. Review of Resident #57's open medical record revealed this resident was admitted to the facility on [DATE]. His admitting diagnoses included schizoaffective disorder, paraplegia, bipolar disorder and hypothyroidism. His Minimum Data Set assessment dated [DATE] revealed this resident had severe cognitive impairment. Functionally, he needed the extensive assistance of one to two people of all activities of daily living including toilet use and personal hygiene. Attempted interview with this resident on 04/25/22 at 7:30 P.M. revealed he was going to bed and did not want to talk. A second interview with this resident at 8:30 A.M. on 04/26/22 revealed his resident was not happy with his care. He stated he has not had his toe nails cared for and his finger nails were so long that it was hard for him pick small things up like his comb. Observation of this resident at 10:52 A.M. on 04/27/22 revealed this resident's fingernails were still long and did have dirt underneath. Observation of this resident's fingernails on 04/28/22 at 8:10 A.M. revealed his fingernails were still long and dirty. STNA #503 verified this resident's fingernails were long and dirty and stated he would make sure they were cut. Observation of this resident's fingernails on 04/28/22 at 2:00 P.M. verified his nails had been cut and cleaned. Review of the facility policy dated 03/12/21 and titled Bed Bath/Shower revealed that showers will be provided according to resident preference, Nail care will be provided with each bath/shower as needed and the resident's hair will be washed per the resident's preference. The facility failed to follow their policy in regards to fingernail care. 365520 Page 4 of 6 365520 04/28/2022 Phoenix of Maple Heights 19900 Clare Ave Maple Heights, OH 44137

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 observation and interview the facility failed to ensure the medical supplies inside the treatment cart were not expired, and failed to ensure medications opened were dated with the date they were opened. This has the potential to affect 14 residents (Resident #6, Resident #7, Resident #17, Resident #23, Resident #27, Resident #33, Resident #35, Resident #56, Resident #61, Resident #84, Resident #86, Resident #87, Resident #90 and Resident #292); three residents (Resident #15, Resident #43, Resident #87) out of three residents reviewed for insulin not dated and for eye drops not dated when opened; and it had the potential to affect five residents (Resident #18, Resident #33, Resident #52, Resident #80 and Resident #90) out of five residents reviewed for expired medications/supplies. The facility census was 92. Findings Include 1. Observation of the cart on 04/26/22 at 8:30 A.M. revealed the cart contained a small box of Epsom salts opened with an expiration date of 04/19; one Intravenous start kit dated 02/28/22; 2 Puertane Virus Trap Systems dated 10/30/19; Ammonia Lactate Lotion bottle for 07/07/21; an intravenous administration set dated 11/23/21; Nystatin Powder opened with an expiration date of 07/11/20; five Biscodyl 10 mg suppositories with an expiration date of 06/12/20; one betadine swab dated 10/19; and 5 female luer locks dated 2018. This was verified by State Tested Nurse Aide (STNA) #505 at this time. Residents #18, Resident #33, Resident #52, Resident #80, and Resident #90 were potentially affected regarding the Biscodyl suppositories. 3. On 04/28/22 at 7:30 A.M. observation of the medication cart down the 100 hall revealed an eye drop Brimonidine 0.2% which was opened but did not have an open date on it. This affected Resident #43. This was verified by Licensed Practical Nurse (LPN) #502. 4. A Insulin Pen of Lispro Insulin which was opened but did not have an open date on it for Resident #87. This was verified n 04/28/22 by the Director of Nursing at 8:00 A.M. 5. A bottle of insulin in the medication refrigerator down the 200 halls which revealed an open bottle of insulin for Resident #15 that was open and not dated. This was verified by LPN #504 on 04/28/22 at 8:10 A.M. 365520 Page 5 of 6 365520 04/28/2022 Phoenix of Maple Heights 19900 Clare Ave Maple Heights, OH 44137

F 0920 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide at least one room set aside to use as a resident dining room and for activities, that is a good size, with good lighting, air flow and furniture. Based on observation and interview the facility failed to ensure the dining room chairs were safe and in good working order. This had the potential to affect nine residents (Resident #13, #14, #16, #18, #20, #24, #40, #64 and #74) who used chairs in the dining room. The facility census was 92. Findings include: Observation on 04/26/22 at 12:15 P.M. of the second-floor dining room revealed three chairs with broken and cracked wooden supports. One chair was turned facing the wall and two chairs were placed at tables. Interview and observation on 04/26/22 at 12:28 P.M. with Minimum Data Set (MDS) Nurse #601 verified the above findings and revealed she was unaware of the three broken chairs in the dining room. MDS nurse #601 stated the facility had ordered new chairs that were arriving soon. MDS Nurse #601 removed two of the three broken chairs out of the dining room. Interview on 04/28/22 at 4:50 P.M. with the Maintenance Director #602 revealed he was new to the job and had not conducted any environmental rounds to ensure equipment is in working order. Review of the facility's policy titled Environmental Rounds, dated 11/19/20, revealed the maintenance department will complete environmental rounds monthly, to ensure all equipment, furnishings, doors, windows, and other items were free of hazards and in good working order. 365520 Page 6 of 6