Health inspection·January 11, 2024

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and observation the facility did not ensure there was sufficient linens including washcloths, towels and fitted sheets available. This affected 117 residents (all residents on unit one, all residents on unit two South and West, and all residents on unit three including Residents #1, #3, #4, #5, #6, #7, #8, #9, #10, #11, #13, #15, #16, #17, #19, #20, #21, #22, #23, 24, #25, #27, #28, #29, #30, #34, #35, #36, #37, #38, #39, #40, #41, #42, #43, #44, #45, #46, #48, #50, #52, #53, #54, #55, #56, #57, #58, #59, #60, #61, #62, #64, #65, #67, #68, #69, #72, #73, #74, #75, #76, #77, #78, #79, #80, #81, #82, #83, #84, #86, #87, #88, #89, #90, #93, #94, #95,#96, #97, #98, #99, #100, #101, #102, #103, #104, #107, #108, #109, #110, #111, #112, #113, #114, #115, #116, #117, #118, #119, #120, #122, #123, #125, #126, #127, #129, #130, #131, #132, #133, #134, #135, #136, #137, #242, #243, and #292). The facility census was 138. Findings included: 1. Review of medical record for Resident #50 revealed an admission date of 10/20/23 and diagnoses included cerebral infarction, diabetes, congestive heart failure, and neuromuscular dysfunction of bladder. Review of care plan dated 10/23/23 revealed Resident #50 had an activities of daily living self-care performance deficit related to schizophrenia and psychosis. Interventions included she was dependent on staff for her toileting, hygiene, dressing, and bed mobility needs. Review of admission Minimum Data Set (MDS) dated [DATE] revealed Resident #50 had intact cognition. She was dependent on staff assistance with toileting and rolling left and right. She was frequently incontinent of urine and bowel. Observation on 01/09/24 at 11:16 A.M. of incontinence care for Resident #50 completed by State Tested Nursing Assistants (STNA) #307 and STNA #345 revealed they did not have washcloths to use for her care, and they were only able to use towels as washcloths. They revealed frequently they did not have sufficient linen including wash clothes. Interview on 01/09/24 at 11:20 A.M. with Resident #50 revealed staff frequently do not have sufficient linen including washcloths, towels and fitted sheets. She often revealed the fitted sheet on her bed does not fit appropriately. Observation on 01/09/24 at 11:36 A.M. of second floor [NAME] linen closet with STNA's #307 and #345 revealed there were no wash clothes in the linen closet. Page 1 of 6 365608 365608 01/11/2024 Aristocrat Berea Healthcare and Rehabilitation 255 Front Street Berea, OH 44017

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 2. Interview and observation on 01/08/24 at 11:10 A.M. with STNA #330 revealed the facility did not have enough linen available in the morning to perform morning care including washcloths, towels, and sheets. Observation of the first-floor linen room with STNA #330 revealed there were no wash clothes and/ or towels. There were three bags of sheets on the floor of the linen closet that STNA #330 revealed were too small for the beds. She revealed that it was 11:10 A.M. and that linens still had not been delivered to the unit. Interview on 01/09/24 at 12:50 P.M. revealed STNA #330 approached the surveyor asking what was being done about the linen as she revealed the linen for the morning care still had not been delivered for the day. Interview on 01/10/24 at 8:36 A.M. with STNA #431 revealed she usually worked on the second floor[NAME] and South. She revealed frequently they do not have enough linen including appropriately sized fitted sheets. She revealed she was unable to make beds in a timely manner. Also, she revealed the facility did not have enough towels and washcloths. She revealed at times she had to use towels as washcloths. She revealed she had to wait for laundry to fill up the linen closets before she could do care as she does not have enough time with her work assignment to go to laundry looking for linen. Interview on 01/10/24 at 8:46 A.M. with STNA #306 revealed she usually worked on the third floor and that they ran out of linens including washcloths and towels and when asked how often she stated, a lot have to be honest it is a problem. She revealed she tried to provide hygiene care and does not have towels and washcloths to provide care so had to wait until laundry brought up the linens. She revealed working on the secured unit she was unable to leave the floor to go to laundry to retrieve linens as the residents required sufficient monitoring. She verified at times care was delayed and/ or she had to make do with what she had such as utilize towels as washcloths. Interview on 01/10/24 at 4:20 P.M. with Administrator #444 revealed they did not have a policy regarding sufficient linen. She revealed she did not have documentation of Periodic Automatic Replacement (PAR) levels (an inventory control system that tells what levels of inventory) that the facility had of linens. She revealed the laundry supervisor had been out on leave. 365608 Page 2 of 6 365608 01/11/2024 Aristocrat Berea Healthcare and Rehabilitation 255 Front Street Berea, OH 44017

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, observation, record review and review of facility incontinence policy ,the facility did not ensure timely incontinence care was completed for Resident #50. This affected one resident (Resident #50) out of two residents (Residents #50 and #96) reviewed for incontinence care. The facility census was 138. Findings included: Review of medical record for Resident #50 revealed an admission date of 10/20/23 and diagnoses included cerebral infarction, diabetes, congestive heart failure, and neuromuscular dysfunction of bladder. Review of care plan dated 10/23/23 revealed Resident #50 had an activities of daily living (ADL) self-care performance deficit related to schizophrenia and psychosis. Interventions included she was dependent on staff for her toileting, hygiene, dressing, and bed mobility needs. Review of admission Minimum Data Set (MDS) dated [DATE] revealed Resident #50 had intact cognition. She was dependent on staff assistance with toileting and rolling left and right. She was frequently incontinent of urine and bowel. Review of Bowel and Bladder Assessment- V3 dated 11/14/23 and completed by Licensed Practical Nurse (LPN) #354 revealed Resident #50 was always incontinent of bladder. The assessment revealed she was to be checked and changed. Interview on 01/08/24 at 10:22 A.M. with Resident #50 revealed she was not provided incontinence care timely. She revealed she laid in urine at times all night as they did not change her. She revealed her skin became sore and irritated because of the lack of timely incontinence care. Review of task bar for Urinary Control/ Frequency per electronic record for Resident #50 dated 01/08/24 through 01/09/24 revealed there was documentation Resident #50 was incontinent on 01/08/24 at 3:27 P.M. and on 01/09/24 at 4:57 A.M. There were no other times documented that she was checked. Interview on 01/09/24 at 11:11 A.M. with Resident #50 revealed she had not been changed since 01/08/24 at 10:30 P.M. She revealed the staff today, 01/09/24 had not been in to change her yet even though it was past 11:00 A.M. During the interview Resident #50 had put her call light on to ask to be changed. Observation on 01/09/24 at 11:16 A.M. of incontinence care for Resident #50 completed by State Tested Nursing Assistants (STNA) #307 and STNA #345 revealed she was wearing two briefs (incontinence care product) and when the STNA's opened the incontinent products a strong urine smell was noted. Both incontinence products were heavily saturated in urine. The first incontinent product contained dried dark yellow urine and her buttocks were red. The STNA's verified the above findings and revealed it appeared Resident #50 had urinated multiple times. The STNA's revealed they had come on duty on 01/09/24 at 7:00 A.M. and were assigned Resident #50. They verified this was the first time they had provided incontinence for Resident #50 since they had been on duty. They verified it was over four hours since they had been on duty. 365608 Page 3 of 6 365608 01/11/2024 Aristocrat Berea Healthcare and Rehabilitation 255 Front Street Berea, OH 44017

F 0690 Level of Harm - Minimal harm or potential for actual harm Review of facility policy labeled, Incontinence Care dated February 2022 revealed to maintain skin integrity, prevent skin breakdown, control odor, and provide comfort and self-esteem for the resident the protocol was to be used on residents that were incontinent of bowel and/ or bladder. The protocol revealed after each episode of incontinence the perineal area would be washed. Residents Affected - Few This deficiency represents non-compliance investigated under Master Complaint Number OH00149662. 365608 Page 4 of 6 365608 01/11/2024 Aristocrat Berea Healthcare and Rehabilitation 255 Front Street Berea, OH 44017

F 0883 Develop and implement policies and procedures for flu and pneumonia vaccinations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review and policy review, the facility failed to offer Resident #111 an influenza and pneumococcal vaccine. This affected one resident (Resident #111) out of five residents (Resident #34, #38, #69, #111, #242) reviewed for influenza and pneumococcal vaccines. The facility census is 138. Residents Affected - Few Findings include: Record review revealed Resident #111 admitted on [DATE] with diagnosis of unspecified dementia with behavioral disturbances, unspecified psychosis, cerebral palsy and Parkinson's. Resident #111's Brief Interview Mental Status (cognitive assessment) revealed Resident #111 was moderately impaired for cognition. Record review completed on 01/08/24 of Resident #111's immunizations revealed Resident #111 had not been offered the influenza or pneumococcal vaccine. Interview with Director of Nursing on 01/10/24 at 2:20 P. M. revealed Resident #111's Power of Attorney was asked for consent for the Influenza and Pneumococcal Vaccine on 01/09/24. The Power of Attorney agreed for the resident to obtain the vaccines. Director of Nursing verified Resident #111 was admitted on [DATE] and he had to order the influenza and pneumococcal vaccine as he did not have any in the facility. Review of facility policy Pneumococcal Vaccine last revised July 2022 revealed new admissions will be offered the education and vaccine upon admission. Review of facility policy Influenza Vaccine dated 2018 revealed residents admitted between October 1st and March 31st shall be offered the vaccine. 365608 Page 5 of 6 365608 01/11/2024 Aristocrat Berea Healthcare and Rehabilitation 255 Front Street Berea, OH 44017

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on observation, interview, and record review, the facility failed to ensure safe and even flooring for dietary staff who provide meal service for residents. This had the potential to affect 137 out of 138 residents in the facility as Resident #72 received nothing by mouth. Findings Include: Observation on 01/09/24 at 12:38 P.M. during lunch meal service revealed the floor in the kitchen had a depressed area for equipment. Part of the area no longer contained any food preparation equipment. The food plating area butted up against the area. The person serving had to step in and out of the uneven area. Interview on 01/09/24 at 12:38 P.M. with Dietary Manager #377 verified there was uneven flooring and the person serving meals stepped in and out of the area. Interview on 01/09/24 at 12:42 P.M. Administrator #444 verified the uneven flooring. Review of a facility list of resident diets revealed Resident #72 received nothing by mouth. 365608 Page 6 of 6