Health inspection·February 29, 2024

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, interview and review of policy the facility failed to ensure residents were invited to participate in care conference meetings regarding their care. This affected two of two residents (#20, #56) reviewed for care planning. The facility census was 87. Findings include 1. Review of the medical record revealed Resident #20 had an admission date of 12/05/21. Diagnoses included depressive disorder, delusional disorder, anxiety disorder, type two diabetes mellitus, hypertension, chronic obstructive pulmonary disease and chronic kidney disease. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had intact cognition. Review of the resident's Care Conference Summary dated 09/22/23 revealed the resident's last care plan meeting was held on this date. There were no care conference meeting notes since 09/22/23. Interview on 02/26/24 at 8:52 A.M., Resident #20 would like a care plan meeting and had not been invited to one recently. Interview on 02/27/24 at 11:14 A.M. with Social Service Designee (SSD) #126 verified the resident had no care conference meetings since 09/22/23. SSD #126 revealed the resident should have had a care conference meeting in December of 2023. SSD #126 verified she was behind on conducting resident care conferences. 2. Review of the medical record revealed Resident #56 had an admission date of 04/30/22 and a readmission date of 04/30/22. Diagnoses included schizoaffective disorder bipolar type, type two diabetes mellitus, hypertension, major depressive disorder, and hallucinations. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident was cognitively intact. Review of an Interdisciplinary Care Plan Conference Summary dated 04/07/22 revealed the resident's last documented care plan meeting was held on 04/07/22. Page 1 of 6 365645 365645 02/29/2024 Northridge Health Center, The 35990 Westminster Ave North Ridgeville, OH 44039

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 02/26/24 at 9:42 A.M., Resident #56 stated she had not been invited to participate in a care conference and would like to attend those meetings about her care. Interview on 02/27/24 at 11:14 A.M., SSD #126 revealed there was no documentation of the resident having a care planning meeting in the past year. SSD #126 verified she was behind on care plan conference meetings. Interview on 02/27/24 at 1:00 P.M., the Administrator revealed SSD #126 was new to the position and was not correctly documenting care plan conferences. Review of the undated facility policy Care Planning -- Resident Participation, revealed the facility would discuss the plan of care with the resident and/or representative at regularly scheduled care plan conferences, and allow them to see the care plan, initially, at routine intervals, and after significant changes. The facility would make an effort to schedule the conference at the best time of day for the resident/resident's representative. The facility would obtain a signature from the resident and/or resident representative after discussion or viewing the care plan. If participation of the resident and/or resident representative was determined not practicable for the development of the resident's care plan, an explanation would be documented in the resident's medical record. 365645 Page 2 of 6 365645 02/29/2024 Northridge Health Center, The 35990 Westminster Ave North Ridgeville, OH 44039

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, resident and staff interviews, the facility failed to ensure skin assessments were completed accurately and the facility failed to follow physician orders for oxygen administration. This affected one of one resident (#45) reviewed for skin assessments and oxygen administration. The facility census was 87. Residents Affected - Few Findings Include: 1. Review of Resident #45 medical records identified Resident #45 was admitted into the facility on [DATE] with diagnoses of unspecified dementia, psychotic disturbance, mood disturbance, anxiety, chronic respiratory failure with hypoxia ,legal blindness, and personal history of traumatic brain injury. Review of the most recent annual Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #45 was severely cognitively impaired and required substantial to maximal assistance from staff to aide in completing his activities of daily living. A. Review of Resident #45 current physician orders identified skin checks were to be completed weekly during showers. Review of Resident #45's shower sheets/ skin assessments dated 02/25/24, 02/22/24, 02/18/24, 02/15/24, 02/08/24, 02/04/24, 02/01/24, 01/28/24, 01/23/24, 01/12/24, 01/09/24 for review. Review of Resident #45's shower sheets /skin assessments revealed inaccurate documentation related to the condition of Resident #45's skin. Further review of Resident #45's shower sheets/ skin assessments revealed shower/ skin assessments stating Resident #45's skin was intact and without any rashes, bruising, or redness. Review of facility's Skin Policy (revised on 11/2018) revealed number one on the policy stated skin will be observed upon admission and routinely throughout the residents stay. Number seven on the policy stated to notify Wound Nurse, MD/NP, RD, and Resident Representative upon observation of new skin area. Observation on 02/26/24 at 10:58 A.M. revealed Resident #45's left arm and left hand had multiple purplish discolorations. Interview on 02/26/24 at 10:58 A.M. with Resident #45 revealed he was unable to recall how these purplish discolorations on his hand and arm occurred. Interview on 02/27/24 at 11:47 A.M. with Licensed Practical Nurse (LPN)#161 revealed she was not sure why Resident #45 had black and blue discolorations on his arm. Interview on 02/27/24 at 11:53 A.M. with Assistant Director of Nursing (ADON)#199 revealed she was not aware of anything on Resident #45's arm. Interview on 02/27/24 at 1:33 P.M. with ADON #199 confirmed that after looking at Resident #45's shower sheets/ skin assessments, Resident #45's skin assessments were documented inaccurately. B. Record review of Resident #45's Medication Administration Record (MAR) revealed that Resident #45 had Oxygen orders dated 01/10/24 for 2 Liters O2 via nasal cannula continuously every shift and 365645 Page 3 of 6 365645 02/29/2024 Northridge Health Center, The 35990 Westminster Ave North Ridgeville, OH 44039

F 0684 monitor SpO2 (oxygen saturation). Level of Harm - Minimal harm or potential for actual harm Review of an undated Oxygen Administration Policy revealed: Oxygen is administered under orders of a Physician, except in the case of an emergency. The resident's care plan shall identify the interventions for oxygen therapy, based upon the resident's assessment and orders, such as but not limited to the type of oxygen delivery system. When to administer such as continuous or intermittent and /or when to discontinue. Equipment settings for the prescribed flow rates. Residents Affected - Few Observation on 02/26/24 at 10:53 A.M. revealed Resident #45 lying in bed with oxygen being administered at 4 liters per nasal cannula. Interview on 02/26/24 at 2:24 P.M. with Licensed Practical Nurse (LPN) #186 verified Resident #45's oxygen was currently set at 4 liters. After LPN #186 looked at Resident #45 MAR, LPN #186 confirmed Resident #45 was receiving the incorrect amount of oxygen per the physician orders. 365645 Page 4 of 6 365645 02/29/2024 Northridge Health Center, The 35990 Westminster Ave North Ridgeville, OH 44039

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. Based on observation, medical record review and staff interview, the facility failed to administer tube feeding formula according to directions for use. This affected one of two residents (#78) reviewed for enteral tube feedings. The facility census was 87. Findings include: Review of the medical record for Resident #78 revealed an admission date of 05/30/23. Diagnoses included but were not limited to hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side, history of pneumonitis due to inhalation of food and vomit, dysphagia, aphasia, tracheotomy, chronic obstructive pulmonary disease, stage three chronic kidney disease, and neuromuscular dysfunction of bladder. Review of 1/18/24 significant change Minimum Data Set (MDS) 3.0 for Resident #78 revealed a Brief Interview of Mental Status (BIMS) score of 03 which indicated the resident had severely impaired cognition. Review of activities of daily living (ADLs) revealed Resident #78 was dependent for all ADLs, was noted to have a history of pocketing food, coughing with meals, used oxygen, and was receiving hospice services. Review of physician orders dated 01/05/24 for Resident #78 revealed an order for enteral feeding of Isosource 1.5 calorie running at 55 cubic centimeters (cc) per hour with 40 cc per hour flush continuously. Observation on 02/26/24 at 10:04 A.M. revealed Resident #78's enteral feeding bag and water flush bag running through an automatic tube feeding pump, were dated 02/22/24 and timed at 7:04 A.M. Interview at the time of the observation with Licensed Practical Nurse (LPN) #153 confirmed the date on the enteral feeding and flush bag was 2/22/24 timed at 7:04 A.M. LPN #153 stated when she was in checking on Resident #78 earlier in the morning, she saw the tube feeding running but did not check the date. LPN #153 confirmed it was ordered to be changed on the night shift and should have been changed to a new bag. Review of the manufacturer's product label for a 1500 milliliter (mL) bag of Nestle Isosource 1.5 enteral tube feeding revealed under the directions for use: use for a maximum of 48 hours after connection when proper technique is followed. 365645 Page 5 of 6 365645 02/29/2024 Northridge Health Center, The 35990 Westminster Ave North Ridgeville, OH 44039

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, medical record review, resident and staff interviews, the facility failed to ensure a resident's medications were kept secured against unauthorized access. This affected one of one resident (#50) reviewed for medication administration. The facility census was 87. Findings Include: Record review revealed Resident #50 was admitted into the facility on [DATE] with diagnoses of arteriosclerotic heart disease, heart failure, benign prostatic hyperpiesia with lower urinary tract symptoms, muscle weakness, difficulty in walking. Review of the most recent annual Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #50 was cognitively intact and required moderate assistance from staff to aide in completing his activities of daily living. Review of the Medication Administration Policy (dated 08/22/22) stated under number 15: observe resident consumption of medication. Observation on 02/26/24 at 11:05 A.M. revealed a small plastic medication cup containing six (6) pills sitting on Resident #50's bedside table. Resident #50 was not in his room at this time, but was observed using his manual wheelchair to enter his room while this observation was made. Resident #50 revealed the nurses will sometimes leave his pills on his bedside table for him to take. Observation on 02/26/24 at 11:13 A.M. revealed an aide walked into Resident #50's room. The nurse was requested by the surveyor. Interview on 02/26/24 at 11:16 A.M. with Licensed Practical Nurse (LPN)#186 verified after she came into Resident #50's room, that six (6) pills were sitting inside the medication cup on Resident #50's bedside table. 365645 Page 6 of 6