Health inspection·April 6, 2023

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 record review and interview the facility failed to ensure Resident #48 was treated with respect and dignity. This affected one resident (#48) of one resident reviewed for resident rights. The facility census was 58. Findings include: Record review revealed Resident #48 was re-admitted to the facility on [DATE] with diagnoses that included ataxia, muscle weakness, and unspecified mood disorder. Review of a progress note dated 02/14/23 at 12:05 P.M. revealed Resident #48 requested assistance regarding Social Security benefits from Former Social Services (FSS) #900. FSS #900 changed the time for Resident #48 to meet with her and Resident #48 became verbally aggressive. FSS #900 informed Resident #48 she was disrespectful, and her behavior was unacceptable. Review of a progress note dated 02/15/23 at 11:00 A.M. revealed Resident #48 went to FSS #900's office and asked if they were going to continue to work on her Social Security benefits by stating are we going to make the call or what. FSS #900 told Resident #48 that unless she apologized for her behavior the previous day, she would not assist her. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 03/29/23 revealed Resident #48 was alert and oriented to person, place, time, and required one-person assist for activities of daily living (ADL) care. Interview on 04/04/23 with Resident #48 revealed she had not received assistance with her Social Security benefits. Resident #48 revealed FSS #900 did not like her and always ignored her request. Resident #48 revealed she attempted to start the process on her social security benefits so she could discharge home. Interview on 04/05/23 at 9:19 A.M. with Social Work Director (SWD) #533 revealed she was aware Resident #48 required assistance with her social security benefits but had not been assisted as of the time of the annual survey. Interview on 04/06/23 at 8:48 A.M. with the Administrator and Director of Nursing (DON) verified the above findings. Interview also revealed FSS #900 was no longer employed at the facility. The administrative staff indicated they were unaware of the interactions between FSS #900 and Resident #48, despite it being documented in the resident's electronic medical record. Page 1 of 11 365594 365594 04/06/2023 Gardens of Euclid Beach 16101 Euclid Beach Blvd Cleveland, OH 44110

F 0550 Level of Harm - Minimal harm or potential for actual harm Review of the facility document titled Dignity revised February 2021, revealed residents would be treated with dignity and respect, and staff would speak respectfully to residents, at all times. This deficiency represents non-compliance investigated under Complaint Number OH00141540. Residents Affected - Few 365594 Page 2 of 11 365594 04/06/2023 Gardens of Euclid Beach 16101 Euclid Beach Blvd Cleveland, OH 44110

F 0623 Level of Harm - Potential for minimal harm Residents Affected - Many Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview the facility failed to ensure the State Ombudsman was notified of resident transfers to the hospital. This affected three residents (#4, #19 and #164) and had the potential to affect all 58 residents residing in the facility. Findings include: 1. Record review revealed Resident #4 was admitted to the facility on [DATE] with diagnoses including spondylosis, malnutrition, chronic obstructive pulmonary disease, major depressive, dementia, hypertension, irritable bowel syndrome, insomnia, incisional hernia, dysthymic disorder (mild form of depression), colon cancer, and migraine. Review of the nursing progress note dated 02/17/23 at 1:43 P.M. revealed Resident #4 was admitted to the hospital for suicidal ideations. Review of the electronic medical record revealed no evidence the State Ombudsman was notified of Resident #4's transfer to the hospital. Interview with the Administrator on 04/04/23 at 6:30 P.M. confirmed the facility did not notify the State Ombudsman of Resident 4's transfer to the hospital. Review of the facility's undated policy titled Transfer and Discharge (including AMA [agains medical advice]) revealed the facility would maintain evidence the notice of transfer and/or discharge was sent to the ombudsman. 2. Record review revealed Resident #19 was admitted to the facility on [DATE] with diagnoses that included hemiplegia and hemiparesis following cerebral infarction, chronic obstructive pulmonary disease, and type two diabetes mellitus. Review of nursing progress notes dated 03/28/23 timed 8:22 P.M. and 03/29/23 timed 3:38 A.M. revealed Resident #19 was sent out and subsequently admitted to the local hospital for a kidney infection. Review of the electronic medical record revealed no evidence the State Ombudsman was notified of Resident #19's transfer to the hospital. Interview with the Administrator on 04/04/23 at 6:30 P.M. confirmed the facility did not notify the State Ombudsman of Resident 19's transfer to the hospital. Review of the facility's undated policy titled Transfer and Discharge (including AMA [agains medical advice]) revealed the facility would maintain evidence the notice of transfer and/or discharge was sent to the ombudsman. 3. Record review revealed Resident #164 was admitted to the facility on [DATE] with diagnoses including syringomyelia/syringobulbia (fluid filled cyst on spinal cord), hemiplegia/hemiparesis, stroke, epilepsy, chronic obstructive pulmonary disease, asthma, diabetes, morbid obesity, aphasia following stroke, major depressive, schizophrenia, and bipolar. 365594 Page 3 of 11 365594 04/06/2023 Gardens of Euclid Beach 16101 Euclid Beach Blvd Cleveland, OH 44110

F 0623 Level of Harm - Potential for minimal harm Review of nursing progress note dated 03/20/23 timed 4:08 P.M. revealed Resident #164 was sent out and subsequently admitted to the hospital for suicidal ideation and self-harm. Review of the electronic medical record revealed no evidence the State Ombudsman was notified of Resident #164's transfer to the hospital. Residents Affected - Many Interview with the Administrator on 04/04/23 at 6:30 P.M. confirmed the facility did not notify the State Ombudsman of Resident 164's transfer to the hospital. Review of the facility's undated policy titled Transfer and Discharge (including AMA [agains medical advice]) revealed the facility would maintain evidence the notice of transfer and/or discharge was sent to the ombudsman. 365594 Page 4 of 11 365594 04/06/2023 Gardens of Euclid Beach 16101 Euclid Beach Blvd Cleveland, OH 44110

F 0645 PASARR screening for Mental disorders or Intellectual Disabilities Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview the facility failed to ensure Resident #48 was screened for services and placement in the nursing facility. The facility also failed to notify the appropriate State agency (the Ohio Department of Mental Health) when two residents (#4 and #48) with a level two mental illness had a significant change in condition. This affected two residents (#4 and #48) of two residents reviewed for Pre-admission Screen and Resident Review (PASARR). The facility census was 58. Residents Affected - Few Findings include: 1. Record review revealed Resident #48 was re-admitted to the facility on [DATE] with diagnoses that included ataxia, muscle weakness, and unspecified mood disorder. Review of a PASARR evaluation dated 01/04/23 revealed Resident #48 had a level two mental illness. In addition, the PASARR result notice dated 01/04/23 revealed a referral was made for a level two evaluation. Further review of Resident #48's hard chart and electronic medical record (EMR) revealed no level two evaluation results. Review of the progress note dated 03/20/23 timed 4:30 P.M. revealed Resident #48 was sent out to and subsequently admitted to a local psychiatric hospital. Review of Resident #48's electronic medical record (EMR) revealed Resident #48 returned to the facility on [DATE]. There was no evidence the Ohio Department of Mental Health was notified of Resident #48's admission to the psychiatric hospital. Review of the quarterly, Minimum Data Set (MDS) assessment, dated 03/29/23 revealed Resident #48 was alert and oriented to person, place, time, and required a one-person assist for activities of daily Living (ADLs). Interview with the Administrator on 04/04/23 at 11:00 A.M. confirmed the lack of notification to the Ohio Department of Mental Health for Resident #48. Interview with Social Work Director (SWD) #533 on 04/05/23 at 9:19 A.M. confirmed the above findings. Resident #48 required a significant change PASARR and level two evaluation which were not completed as required. 2. Record review revealed Resident #4 was admitted to the hospital on [DATE] for suicidal ideations. Resident #4 had diagnoses including spondylosis, malnutrition, chronic obstructive pulmonary disease, major depressive, dementia, hypertension, irritable bowel syndrome, insomnia, incisional hernia, dysthymic disorder (mild form of depression), colon cancer, and migraine. Review of the PASARR evaluation dated 02/06/23 revealed Resident #4 had a level two mental illness. Review of the EMR revealed Resident #4 returned to the facility on [DATE]. There was no evidence the facility notified the Ohio Department of Mental Health of Resident #4's admission to the psychiatric hospital. 365594 Page 5 of 11 365594 04/06/2023 Gardens of Euclid Beach 16101 Euclid Beach Blvd Cleveland, OH 44110

F 0645 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview with the Administrator on 04/04/23 at 11:00 A.M. confirmed the lack of notification to the Ohio Department of Mental Health for Resident #4. Interview with Social Work Director (SWD) #533 on 04/05/23 at 9:19 A.M. confirmed the above findings. Resident #4 required a significant change PASARR and level two evaluation which were not completed as required. This deficiency represents non-compliance investigated under Complaint Number OH00141540. 365594 Page 6 of 11 365594 04/06/2023 Gardens of Euclid Beach 16101 Euclid Beach Blvd Cleveland, OH 44110

F 0745 Provide medically-related social services to help each resident achieve the highest possible quality of life. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to ensure Resident #48 received timely assistance with applying for Social Security benefits from social service staff. This affected one resident (#48) of one resident reviewed for resident rights. The facility census was 58. Residents Affected - Few Findings include: Record review revealed Resident #48 was re-admitted to the facility on [DATE] with diagnoses that included ataxia, muscle weakness, and unspecified mood disorder. Review of a progress note dated 02/14/23 at 12:05 P.M. revealed Resident #48 requested assistance regarding Social Security benefits from Former Social Services (FSS) #900. FSS #900 changed the time for Resident #48 to meet with her and Resident #48 became verbally aggressive. FSS #900 informed Resident #48 she was disrespectful, and her behavior was unacceptable. Review of a progress note dated 02/15/23 at 11:00 A.M. revealed Resident #48 went to FSS #900's office and asked if they were going to continue to work on her Social Security benefits by stating are we going to make the call or what. FSS #900 told Resident #48 that unless she apologized for her behavior the previous day, she would not assist her. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 03/29/23 revealed Resident #48 was alert and oriented to person, place, time, and required one-person assist for activities of daily living (ADL) care. Interview on 04/04/23 with Resident #48 revealed she had not received assistance with her Social Security benefits. Resident #48 revealed FSS #900 did not like her and always ignored her request. Resident #48 revealed she attempted to start the process on her social security benefits so she could discharge home. Interview on 04/05/23 at 9:19 A.M. with Social Work Director (SWD) #533 revealed she was aware Resident #48 required assistance with her social security benefits but had not been assisted as of the time of the annual survey. Interview on 04/06/23 at 8:48 A.M. with the Administrator and Director of Nursing (DON) verified the above findings. Interview also revealed FSS #900 was no longer employed at the facility. 365594 Page 7 of 11 365594 04/06/2023 Gardens of Euclid Beach 16101 Euclid Beach Blvd Cleveland, OH 44110

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many 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** 2. Observation of medication cart 1 on 04/04/23 at 1:36 P.M. revealed 43 loose unidentifiable medications at the bottom of the drawers. Interview during the observation with Licensed Practical Nurse (LPN) #580 verified the findings. 3. Observation of medication cart 2 on 04/04/23 at 1:50 P.M. revealed 30 loose unidentifiable medications at the bottom of the drawers. Interview during the observation with LPN #579 verified the findings. 4. Observation of medication cart 3 on 04/04/23 at 2:15 P.M. revealed 44 loose unidentifiable medications at the bottom of the drawers. Interview during the observation with LPN #579 verified the findings. 5. Review of medical record for Resident #15 revealed an admission date of 11/23/21. Diagnoses included type two diabetes mellitus with diabetic peripheral angiopathy without gangrene. Review of plan of care dated 12/23/21 revealed Resident #15 had diabetes. Review of the medication administration record revealed Resident #15 was ordered 19 units of Humalog solution (11/29/21) before meals and 10 units of Glargine solution (11/29/21) at bedtime. On 04/04/23 at 2:15 P.M. observation of cart 3 revealed an opened vial of Lantus insulin for Resident #15 which was not dated. Interview during the observation with LPN #579 verified the findings. 6. Review of medical record for Resident #51 revealed an admission date of 08/12/22. Diagnoses included type two diabetes mellitus, long term use of insulin, and sarcoidosis of the lung. Review of the medication administration record revealed Resident #51 was ordered 20 units of Novolog flexpen solution (09/23/22) at bedtime. On 04/04/23 at 2:15 P.M. observation of cart 3 revealed an insulin flexpen for Resident #51 that was not dated. In addition, observation of the medication cart revealed an opened insulin vial of Humulin and Glargine with no resident name or date opened documented. Interview during the observation with LPN #579 verified the findings. 7. Observation of medication cart 4 on 04/04/23 at 1:36 P.M. revealed 41 loose unidentifiable medications at the bottom of the drawers. 365594 Page 8 of 11 365594 04/06/2023 Gardens of Euclid Beach 16101 Euclid Beach Blvd Cleveland, OH 44110

F 0761 Interview during the observation with LPN #583 verified the findings. Level of Harm - Minimal harm or potential for actual harm Review of the facility policy titled Medication Administration, dated 2021 revealed staff were to maintain a clean an organized medication cart. Residents Affected - Many This deficiency represents non-compliance investigated under Complaint Number OH00141540. Based on observation, record review and interview the facility failed to ensure medications were stored in a secure manner and medications where labeled with residents' names and date opened. This affected three residents (#48, #15 and #51) and had the potential to affect all 58 residents in the facility who received medications from medication carts 1, 2, 3 and 4. Findings include: 1. Record review revealed Resident #48 was re-admitted to the facility on [DATE] with diagnoses that included ataxia, muscle weakness, and unspecified mood disorder. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 03/29/23 revealed Resident #48 was alert and oriented to person, place, time and required a one-person assist for activities of daily living. Observation on 04/04/23 at 8:18 A.M. of Resident #48's bedside table revealed two unidentified white pills, circular in shape, sitting in a small plastic cup. Interview on 04/04/23 at 8:18 A.M. with Resident #48 revealed she was provided the pills by overnight staff but did not take them. Resident #48 revealed staff did not monitor if she swallowed the pills or not. Interview on 04/04/23 at 8:33 A.M. with State Tested Nursing Assistant (STNA) #584 confirmed the two identified white pills sitting on Resident #48's bedside table. Interview on 04/04/23 at 8:50 A.M. with Registered Nurse (RN) #517 revealed pills should not be left at the bedside and residents should be monitored during administration. Observation on 04/04/23 at 8:50 A.M. revealed RN #517 entered Resident #48's room and removed the pills. 365594 Page 9 of 11 365594 04/06/2023 Gardens of Euclid Beach 16101 Euclid Beach Blvd Cleveland, OH 44110

F 0921 Level of Harm - Minimal harm or potential for actual harm Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on observation and interview the facility failed to maintain a safe and sanitary environment for residents. This affected five residents (#10, #16, #21, #54 and #164) of 58 residents residing in the facility. Residents Affected - Many Findings include: 1. On 04/04/23 from 9:45 A.M. to 10:05 A.M. environmental observations revealed the following concerns: Resident #10 had approximately 10 strips of clothing/fabric hanging over the electrical outlet and the baseboard heating unit of the room. The base baseboard molding located by Resident #16's headboard was peeled back and hanging from the wall. There was also a drywall patch behind the headboard that needed sanding; the drywall plaster was uneven and spread haphazardly over the patch. Observation of Resident #21 and #54's room revealed the baseboard heater did not have a cover over the heating elements. On 04/04/23 at 1:38 P.M. interview with the Administrator and Maintenance staff verified the above findings. 2. On 04/03/23 at 10:37 A.M. Resident #164's privacy curtain was observed to have dark brown stains and splatter marks on the left bottom corner. On 04/03/23 at 10:40 A.M. interview and observation with Housekeeper #503 confirmed the curtain stains and splatter marks. 365594 Page 10 of 11 365594 04/06/2023 Gardens of Euclid Beach 16101 Euclid Beach Blvd Cleveland, OH 44110

F 0926 Have policies on smoking. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, the facility failed to implement safe and responsible smoking practices and policies. This affected one resident (#48) of one resident reviewed for smoking and had the potential to affect all 58 residents residing in the facility. Residents Affected - Many Findings include: 1. Record review revealed Resident #48 was re-admitted to the facility on [DATE] with diagnoses that included ataxia, muscle weakness, and unspecified mood disorder. Review of a smoking safety screen assessment. dated 12/19/22 revealed Resident #48 was safe to smoke without supervision upon admission. Further review of the assessment revealed Resident #48 required supervision to smoke during assigned smoke breaks, although she was an independent smoker. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 03/29/23 revealed Resident #48 was alert and oriented to person, place, time, and required one-person assist for activities of daily living. Review of the care plan dated 04/01/23 revealed Resident #48 was found smoking in her room on 02/06/23. Observation of Resident #48's room on 04/04/23 at 8:18 A.M. revealed a green lighter located on Resident #48's bedside table and a white lighter located near the sink adjacent to her bed. Interview with State Tested Nursing Assistant #584 at the time of observation verified the resident had a lighter in her room. 2. Observation on 04/03/23 at 11:38 A.M. revealed more than 10 cigarette butts in the courtyard's combustible trash containers. Further observation revealed ash trays and metal containers with self-closing cover devices were available in the courtyard. Interview with the maintenance director verified this finding at the time of observation. The maintenance director verified the courtyard was a smoking area and residents should not be placing butts in the trash container. 365594 Page 11 of 11