Health inspection·April 4, 2019

F 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. Based upon interview and record review the facility failed to notify the ombudsman's office when Resident #22 and Resident # 88. This affected two of three residents who were reviewed for discharge from the facility to alternate settings. The facility census was 87. Findings include: 1. Review of the medical record for Resident #22 revealed an admission date of 11/01/18. Diagnoses included congestive heart failure, cerebrovascular disease, anxiety, psychosis, hypertension, and obesity. Review of the nurses notes on 12/10/18 revealed the resident had become lethargic and was noted to have abnormal lab values. The doctor was notified and the resident was discharged to the hospital via emergency transport and was admitted with leukocytosis. Interview with the Administrator on 04/04/19 at 2:17 P.M. confirmed that the facility had not had a system in place to assure the Ombudsman's office was notified when residents were discharged to the hospital and confirmed the office had not been notified when Resident #22 was discharged to the hospital. 2. Review of the medical record for Resident #88 revealed an admission date of 09/18/17. Diagnoses included paranoid schizophrenia, human immunodeficiency virus, hepatitis, dementia, diabetes mellitus and major depression. Review of the nurses notes on 02/22/19 revealed Social Service Designee #400 was discussing an incident that happened earlier that day in the smoking area when Resident #88 resident stated he became upset with another resident who he had seen going in his room and looking at his belongings. The facility called the guardian and the police to come in and discuss the plan to send Resident #88 to the hospital. The resident became fixated on the fact that he was going to jail although it was explained that the doctor had ordered a transfer to the hospital due to his behaviors. The resident did not return to the facility. Interview with the Administrator on at 2:55 P.M. revealed the decision was made that alternate placement would be necessary. She stated the Ombudsman's office had not been notified of the discharge to the hospital for Resident #88, stating although there had been conversation with the resident's guardian regarding alternate placement the facility had not sent the required notice to the Ombudsman's office. Page 1 of 6 365670 365670 04/04/2019 Willows Health and Rehab Ctr 1500 E 191st St Euclid, OH 44117

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 interview and record review the facility failed to ensure care conferences were held. This affected one resident of one resident (Resident #17) reviewed for care conferences. The facility census was 87. Findings Include: Review of the medical record revealed Resident # 17 was admitted to the facility on [DATE] with diagnosis including hemiplegia and hemiparesis following cerebral infarction, convulsions, chronic kidney disease, major depressive disorder, schizophrenia, anxiety disorder, heart failure, diabetes, atherosclerotic heart disease, alcohol dependence and cocaine dependence. The annual minimum data set (MDS) dated [DATE] revealed Resident #17 required extensive assistance of one person for bed mobility, transfers, walking, locomotion off unit, dressing, toileting and personal hygiene. Supervision was needed for locomotion on the unit. The brief interview mental status (BIMS) score of 15 indicated the resident was cognitively intact. A review of the Resident #17's care plans revealed no indication of refusal of care plan conferences. Care plans were revised on 04/03/19 to include resident refusal of care plan conferences. A review of the progress notes and assessments from 02/12/18 through 04/01/19 revealed no record of a care conferences. Interview on 04/01/19 at 12:07 P.M. with #17 Resident revealed he didn't know about care plan conferences and had never had one at this facility. Interview on 04/03/19 at 10:59 A.M. with social services designee (SSD) #400 revealed invitations were mailed out to families and guardians, the resident would sometimes get a letter, but was usually just told about the care conference. Resident #17 didn't have family to invite, it was just the resident. SSD #400 stated she had been here since 06/18 but had not been responsible for writing the care conference notes until 02/19. SSD #400 stated resident #17 usually refused care conferences. The resident's last care conference was scheduled in 01/19. SSD #400 stated she knew the resident had refused, but it was not documented. Interview on 04/03/19 at 11:27 A.M. SSD #400 verified no care conference notes for Resident #17 were available. There was no evidence the resident was invited to or participated in the care planning process over the past year. 365670 Page 2 of 6 365670 04/04/2019 Willows Health and Rehab Ctr 1500 E 191st St Euclid, OH 44117

F 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm Based on observation, taste test, interview and record review, the facility failed to serve room trays at palatable temperatures. This had the potential to affect the 73 residents who usually ate their meals in their rooms. The facility census was 78. Residents Affected - Some Findings Include: Observation on 04/02/19 at 11:28 A.M. of tray line temperatures taken by assistant dietary manager #401 revealed all food temperature taken were within the safe temperature zone for serving. The hot food was held at 135 degrees or higher and the cold food was held at 41 degrees or lower. On 04/02/19 at 11:58 A.M. a test tray was completed. Food temperatures were taken by corporate registered dietitian (RD) #403 and the food tasted by the surveyor and RD #403. The green beans and carrots were 125 degrees tasted warm enough. The potatoes were 105 degrees and did not taste warm enough. The pot roast was 110 degrees and did not taste hot enough. The flavor of the food items was good. On 04/02/19 at 11:58 A.M. RD #403 verified the test tray temperatures. Review of Resident Council/Food Committee minutes revealed there had been concerns of cold food brought up at meetings held on 4/6/18, 5/23/18, 9/26/18 and 12/26/18. Residents # 76, #9, #28, and #79 usually ate in the dining room. Resident #42 was on a tube feeding. 365670 Page 3 of 6 365670 04/04/2019 Willows Health and Rehab Ctr 1500 E 191st St Euclid, OH 44117

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview and record review the facility failed to ensure the kitchen was maintained in a clean and sanitary manner. This had the potential to affect 77 out of 78 residents who received meals from the facility's kitchen. One resident (Residents #42) received enteral nutrition and did not receive meals from the kitchen. The facility census was 78. Findings include: Observations during the initial tour of the kitchen 04/01/19 at 9:16 A.M. with assistant dietary manager #401 revealed the shelf above the oven/stove was covered with a layer of greasy dust, the oven handles were dirty, and the hood vent nozzles had grease and dust coating them. The dish machine and the hood above it were spattered with food and had a greasy buildup. There was no record of when the ice machine had been cleaned and sanitized. Interview with the Dietary Manager on 04/01/19 at 9:35 A.M. confirmed all observations. Record review revealed a maintenance record of ice machine cleaning, sanitize and repair completed 11/15/18. On 04/04/19 at 3:30 P.M. the administrator verified the ice machine had not been emptied cleaned and sanitized since 11/15/18. 365670 Page 4 of 6 365670 04/04/2019 Willows Health and Rehab Ctr 1500 E 191st St Euclid, OH 44117

F 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation and staff interview the facility failed to ensure its garbage disposal area was maintained in a clean and sanitary condition. This had the potential to affect all residents. The facility census was 78. Residents Affected - Few Findings Include: Observation of the facilities garbage dumpster area with the assistant dietary manager (ADM) #401 on 04/01/19 at 9:16 A.M. revealed the area was noted to have empty cardboard boxes, disposable gloves, empty containers and other various items around the outside dumpster. ADM #401 verified the above observations at the time of discovery. 365670 Page 5 of 6 365670 04/04/2019 Willows Health and Rehab Ctr 1500 E 191st St Euclid, OH 44117

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 and interview the facility failed to ensure public bathrooms were in safe operating condition. This affected four of five of the bathrooms available to staff and visitors. The facility census was 78. Findings include: During the survey process from 04/01/19 through 04/04/19 three public bathrooms were noted near the 500 unit. Bathroom #A (to the left of the reception desk, and Men and Women's bathrooms to the right of the reception desk. Bathroom #A had a toilet seat that was broken at the hinges causing it to slide off the rim of the toilet bowl when used. This bathroom was deemed out of order on 04/02/19 when the tank of the toilet was found to be cracked. The Men's bathroom could not be utilized due to a lost key. The Women's bathroom had a extremely loose door handle that had to be wiggled and jostled in a attempt to lineup the locking mechanism with the key. The inside of the bathroom had a sink faucet that was missing the base of the unit, exposing the black plastic type jagged inner surface that could not be cleaned. The bathroom near the reception desk at the ambulance entrance, had a none functioning door handled that would cause the user to become locked inside. The administrator, and administrator in training were made aware of the bathroom disrepair's at the point of discovery. Staff could not explain the procedure for notifying the maintenance department of needed repairs. There was no system in place for work orders. The facility is in the process of hiring a new maintenance director. 365670 Page 6 of 6