Health inspection·June 10, 2024

F 0759 Ensure medication error rates are not 5 percent or greater. 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, staff interview, review of the facility policy, and review of the reference website Medscape.com, the facility failed to ensure staff administered medication with less than a five percent error rate. This affected one (#43) out of three residents observed for medication administration with a 8.69% error rate observed. The facility census was 69. Residents Affected - Few Findings include: Review of the medical record revealed Resident #43 was admitted on [DATE]. Diagnoses included dementia, peripheral vascular disease, high blood pressure, obesity, schizophrenia, anxiety, hypothyroidism, and dysphagia. Resident #43's physician orders, dated 06/01/24 to 06/30/24, revealed to administer the following medications in the morning: calcium-Vitamin D-minerals oral tablet chewable 600-400 milligram (mg)-unit one tablet for supplement, cholecalciferol tablet 50 micrograms (mcg) one table orally for supplement, lisinopril one tablet 20 mg, metoprolol succinate 24 hour Extended Release (ER) one 50 mg tablet for high blood pressure, trazadone hydrochloride (hcl) 25 mg orally for schizophrenia, and Klor-Con M20 extended release one tablet orally for hypertension. Observation of medication administration on 06/05/24 at 8:26 A.M. revealed Registered Nurse (RN) #273 administered medications to Resident #43. RN #273 administered calcium-vitamin D mineral 600-400 mg tablet, lisinopril 20 mg tablet, metoprolol succinate 50 mg extended release tablet, and trazadone hcl 25 mg tablet medications by placing the medications in a plastic envelope and crushing the medications using a pill crusher device. RN #273 then poured the crushed medications in a medication cup and added applesauce, mixed the crushed medications in applesauce, entered Resident #43's room and administered the medications to Resident #43. No cholecalciferol 50 mcg tablet was administered. An interview with RN #273 on 06/05/24 at 8:44 A.M. and 9:45 A.M. verified she should not have crushed the metoprolol succinate medication and had failed to administer the cholecalciferol 50 mcg tablet as ordered by the physician. A review of the facility policy titled Administering Medications dated April, 2019 revealed medications are administered in a safe and timely manner as prescribed. Bullet point #4 states medications are administered in accordance with prescriber orders, including any required timeframe. Review of Medscape.com revealed at https://reference.medscape.com/drug/lopressor-toprol-xl-metoprolol, metoprolol succinate should not be chewed or crushed. Page 1 of 6 365667 365667 06/10/2024 Medina Center for Rehabilitation and Nursing 555 Springbrook Dr Medina, OH 44256

F 0759 A total of two medication errors out of 23 opportunities were observed for medication error rate of 8.69%. Level of Harm - Minimal harm or potential for actual harm This deficiency represents non-compliance investigated under Complaint Number OH00152957. Residents Affected - Few 365667 Page 2 of 6 365667 06/10/2024 Medina Center for Rehabilitation and Nursing 555 Springbrook Dr Medina, OH 44256

F 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm Based on observation, staff interview, and review ofreview of the reference website Medscape.com, the facility failed to ensure medications were administered without a significant error. This affected one (#43) out of three residents observed during medication administration. The facility census was 69. Residents Affected - Few Findings include: Observation of medication administration on 06/05/24 at 8:26 A.M. revealed Registered Nurse (RN) #273 administered medications to Resident #43. RN #273 administered calcium-vitamin D mineral 600-400 mg tablet, lisinopril 20 mg tablet, metoprolol succinate 50 mg extended release tablet, and trazadone hcl 25 mg tablet medications by placing the medications in a plastic envelope and crushing the medications using a pill crusher device. RN #273 then poured the crushed medications in a medication cup and added applesauce, mixed the crushed medications in applesauce, entered Resident #43's room and administered the medications to Resident #43. An interview with RN #273 on 06/05/24 at 8:44 A.M. verified she should not have crushed the metoprolol succinate medication. Review of Medscape.com revealed at https://reference.medscape.com/drug/lopressor-toprol-xl-metoprolol, metoprolol succinate should not be chewed or crushed. This deficiency represents non-compliance investigated under Complaint Number OH00152957. 365667 Page 3 of 6 365667 06/10/2024 Medina Center for Rehabilitation and Nursing 555 Springbrook Dr Medina, OH 44256

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. Based on observation, interview with fire marshall, review of diswasher temperature monitoring logs, review of the Food and Drug Administration (FDA) Food Code, and staff interview, the failed to maintain the range hood vents in a sanitary manner and failed to ensure the dishwasher washing temperature was maintained to properly sanitize the kitchen dishware, utensils and equipment. This had the potential to affect all the residents who ate their meals in the facility. The facility census was 69. Findings include: An interview with the Fire Marshall on 06/06/24 at 11:00 A.M. revealed she was in the facility for the fire safety inspection and wanted to alert the surveyor of the failure of the facility to maintain a clean and sanitary range hood in the kitchen. Observations during a tour of the kitchen on 06/06/24 at 11:16 A.M. revealed the range hood vents were coated with a thick layer of grease and debris. The range hood plaque, located on the outside of the hood cover, revealed the last time the range hood was cleaned was October 2023. The dishwasher was ran through two cycles with the temperature during the wash cycle measuring 145 degrees Fahrenheit (F) and the rinse cycle was 175 degrees F. Interview with Dietary Supervisor #219 on 06/06/24 at the time of the observation at 11:16 A.M. verified the range hood needed to be cleaned more often. Dietary Supervisor #219 was unable to say how often the range hood vents should be cleaned. Dietary Supervisor #219 stated the dishwasher had a heat sanitizing system and the washing temperature should reach 150 degrees F and rinsing temperature should reach 180 degrees F for proper sanitization. Dietary Supervisor #219 was unaware of a routine cleaning schedule for the cleaning of the range hood vents in the facility. A review of the dishwashing temperature monitoring log dated 06/01/24 to 06/06/24 revealed several days when the dishwasher washing/rinsing temperature were below the temperature needed to properly ensure sanitization when used to clean the kitchen equipment/utensils, and dish/silverware. The temperature during the washing cycle during the dinner service reached 140 degrees F on 06/04/24 and 147 degrees F on 06/05/24. The dishwasher rinsing temperature was 173 degrees F on 07/04/24 and 175 degrees F on 06/05/24 during the breakfast meal service and was 178 degrees F, 173 degrees F and 175 degrees F during the dinner meal from 06/03/24 to 06/05/24. The FDA Food Code updated on 12/22/2023 required commercial dishwashers achieve a utensil surface temperature of 160 degrees F as measured by an irreversible registering temperature indicator during the washing cycle and at least 180 degrees F during the final rinse cycle. For equipment and utensil cleaning and sanitization there is a potential cause of foodborne outbreaks if improper cleaning (washing and sanitizing) of equipment and protecting equipment from contamination via splash, dust, grease, etc. For cleaning fixed equipment (e.g., mixers, slicers, and other equipment that cannot readily be immersed in water), the removable parts must be washed and sanitized and non-removable parts cleaned with detergent and hot water, rinsed, air-dried and sprayed with a sanitizing solution (at the effective concentration). Finally, the equipment is reassembled and any food contact surfaces that may have been contaminated during the process are re-sanitized (according to the manufacturer's instructions). Service area wiping cloths are cleaned and dried or placed in a chemical sanitizing solution of appropriate concentration. 365667 Page 4 of 6 365667 06/10/2024 Medina Center for Rehabilitation and Nursing 555 Springbrook Dr Medina, OH 44256

F 0812 This deficiency represents non-compliance investigated under Complaint Number OH00154565. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many 365667 Page 5 of 6 365667 06/10/2024 Medina Center for Rehabilitation and Nursing 555 Springbrook Dr Medina, OH 44256

F 0880 Provide and implement an infection prevention and control program. 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, staff interview, and review of facility policy, the facility failed to ensure staff adhered to infection control standards during colostomy care. This affected one (#27) out of three residents reviewed for colostomy care. The facility census was 69. Residents Affected - Few Findings include: Review of the medical record revealed Resident #27 was admitted on [DATE]. Diagnoses included aortic aneurysm, heart failure with cardiac pacemaker, Parkinson's disease, depression, anxiety, diabetes mellitus, high blood pressure, obesity, partial intestinal obstruction with colostomy, and anemia. A review of Resident #27's physician order dated 05/29/24 revealed to change the colostomy wafer and bag every three days, apply calmoseptine to peristoma area every Monday, Wednesday and Friday for ostomy care. Observation on 06/06/24 at 9:05 A.M. revealed Licensed Practical Nurse (LPN) #274 gathered the supplies needed to perform Resident #27's colostomy care. LPN #274 placed the supplies on Resident #27's bedside table after placing a clean paper towel over the bedside table. LPN #274 then removed her scissors from her pocket and placed the scissors on the table with the supplies. LPN #274 did not clean or sanitize the scissors. LPN #274 had donned gloves for the procedure. LPN #274 proceeded to removed the colostomy bag from Resident #27's stoma and placed the feces soiled bag in the waste receptacle. LPN #274 the proceeded to remove her gloves and donn another pair of gloves without performing hand hygiene. LPN #274 continued to perform the colostomy care changing her gloves four more times during the task without performing hand hygiene. LPN #274 the obtained Resident #27's colostomy wafer and used the scissors to cut the opening to fit the stoma site. LPN #274 snapped the colostomy bag in place on the wafer, removed her gloves, and exited the room without performing hand hygiene. LPN #274 proceeded to the medication cart, obtained an alcohol wipe from the cart, and cleaned the scissors. LPN #274 stated she was ready to start administering medications to a resident. LPN #274 was asked to perform hand hygiene prior to starting the medication administration to the resident. Interview with LPN #274 during the observation on 06/06/24 between 9:05 A.M. and 9:30 A.M. revealed she felt she had contaminated her hands several times during the colostomy care and that was the reason she had changed her gloves so many times. A follow-up interview on 06/06/24 at 9:30 A.M. with LPN #274 verified she forgot to perform hand hygiene between glove changes, clean/sanitize her scissors and perform hand hygiene prior to exiting Resident #27's room upon completion of the colostomy care. Review of the facility policy titled Handwashing/Hand Hygiene, revised August 2019, revealed to perform handwashing when hands were visibly soiled, after contact with a resident with infectious diarrhea. Use alcohol based hand rub before and after coming on duty, coming in direct contact with a resident, after handling an invasive device, when moving from a contaminated body site to a clean body site, after contact with blood or body fluids, after removing gloves, and after handling contaminated equipment. Hand hygiene was the final step after removing and disposing of personal protective equipment. This was an incidental finding of non-compliance discovered during the investigation. 365667 Page 6 of 6