Health inspection·August 29, 2023

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to complete wound care as ordered/care planned. This affected one resident (#58) of two observed for wound care. The facility identified seven residents (#2, #17, #27, #35, #45, #58, and #68) who required wound care. The facility census was 70. Residents Affected - Few Findings include: Review of Resident #58's medical records revealed an admission date of 05/01/23. Diagnoses included stage four pressure ulcer of the sacrum (tailbone) and osteomyelitis (bone infection). Review of the care plan dated 06/20/23 (revised 08/22/23) revealed Resident #58 had impaired skin integrity with a stage four pressure ulcer to the sacrum. Interventions included perform wound care as ordered. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #58 was rarely understood and was admitted with a stage four pressure ulcer to the sacral area. Review of Resident #58's current physician orders for August 2023 revealed orders to cleanse the left lateral leg with normal saline, apply collagen powder, apply Xeroform (petroleum based gauze dressing) and cover with absorbent dressing and gauze every other day and as needed; cleanse left ischium (hip) with normal saline, apply collagen powder, and cover with border gauze daily and as needed, and cleanse sacrum with normal saline, apply collagen powder, pack loosely with silver alginate (antibacterial alginate with silver) and cover with border gauze daily and as needed. Observation on 08/28/23 at 11:25 A.M. with State Tested Nursing Assistants (STNA) #281 revealed Resident #58 had gauze dressings to both legs that were dated 08/24/23. STNA #281 stated she was unaware if Resident #58 had wounds underneath of the gauze dressings. Further observation revealed Resident #58 had an undated foam dressing to the sacrum as well as an undated foam dressing to her left hip. The dressings to the sacrum and left hip were soiled and the sacral dressing was not intact. Observation and interview on 08/28/23 at 11:42 A.M. with the Assistant Director of Nursing (ADON) revealed Resident #58 had a wound to her left leg that was supposed to be changed daily and there was no wound to Resident #58's right leg. The ADON confirmed the gauze dressings to the legs were dated 08/24/23. The ADON further stated Resident #58's sacral wound dressing was supposed to be changed daily and as needed, if soiled, and the left hip dressing was to be changed every other day and as needed. Review of Treatment Administration Record for August 2023 on 08/28/23 at 2:11 P.M. with the ADON revealed and confirmed ordered treatments were documented as being completed, however the treatments had not been performed as ordered/care planned. Page 1 of 4 365705 365705 08/29/2023 Aventura at Walton Hills 19859 Alexander Rd Walton Hills, OH 44146

F 0686 This deficiency represents non-compliance investigated under Complaint Number OH00145486. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 365705 Page 2 of 4 365705 08/29/2023 Aventura at Walton Hills 19859 Alexander Rd Walton Hills, OH 44146

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, and record review the facility failed to ensure adequate urinary catheter care was provided. This affected one resident (#58) of one observed for urinary catheter care. The facility identified six residents (#17, #32, #44, #58, #67 and #68) with urinary catheters. The facility census was 70. Findings include: Review of Resident #58's medical records revealed an admission date of 05/01/23. Diagnoses included neuromuscular bladder, dementia and a sacral (tailbone) pressure ulcer. Review of the care plan dated 06/20/23 (revised 08/22/23) revealed Resident #58 had an indwelling urinary catheter. Interventions included to provide catheter care as ordered. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #58 was rarely understood, had a urinary catheter and was incontinent of bowel. Review of current physician orders for August 2023 revealed provide catheter care every shift and check placement of catheter tubing anchor every shift. Observation on 08/28/23 at 11:25 A.M. with State Tested Nursing Assistants (STNA) #281 revealed Resident #58 had a urinary catheter that had a thick mucus discharge around the tubing insertion site. Resident #58's urinary catheter anchoring device which was attached to the resident's right leg had a large amount of brown colored debris and a foul odor was detected. STNA #281 stated she had not provided catheter care for Resident #58 yet and was unable to state when catheter care had last been completed. Review of facility's undated policy titled Foley Catheter Management revealed catheter care was to be done on each shift. This deficiency represents non-compliance investigated under Complaint Number OH00145486. 365705 Page 3 of 4 365705 08/29/2023 Aventura at Walton Hills 19859 Alexander Rd Walton Hills, OH 44146

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, and interview the facility failed to ensure adequate Percutaneous Endoscopic Gastrostomy (PEG) tube (a tube that is placed directly into the stomach through an abdominal wall incision for administration of food, fluids and medications) care. This affected two residents (#55 and #58) of three observed for PEG tube care. The facility identified five residents (#24, #37, #35, #55 and #58) with PEG tubes. The facility census was 70. Findings include: 1. Review of Resident #58's medical records revealed an admission date of 05/01/23. Diagnoses included dysphasia (difficulty swallowing) and dementia. Review of the care plan dated 06/20/23 (revised 08/22/23) revealed Resident #58 was at risk for malnutrition related to dysphasia. Resident #58 relied on nutrition received via PEG tube. Interventions included provide tube feeding per orders and monitor skin integrity for changes. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #58 was rarely understood and was totally dependent for feeding. Observation on 08/28/23 at 11:25 A.M. with State Tested Nursing Assistant (STNA) #281 revealed Resident #58 had a PEG tube with a split gauze dressing around the PEG tube at the insertion site dated 08/25/23. There was dried bloody drainage on the gauze dressing. Observation and interview with the Assistant Director of Nursing (ADON) on 08/28/23 at 11:42 A.M. confirmed the 08/25/23 date on the dressing and the dried bloody drainage on the dressing and also around the insertion site. The ADON stated PEG tube dressing were to be changed daily and as needed. Resident #58 was non verbal. 2. Review of Resident #55's medical records revealed an admission date of 03/23/23. Diagnoses included malnutrition and dementia. Review of the care plan dated 03/25/23 revealed Resident #55 was at risk for malnutrition and required nutrition via a PEG tube. Interventions included provide tube feeding per physician orders. Review of the MDS assessment dated [DATE] revealed Resident #55 was rarely understood and was totally dependent for feeding. Review of current physician orders for August 2023 revealed to clean the tube feeding site and apply a split dressing to area daily. Observation on 08/28/23 at 12:30 P.M. revealed Licensed Practical Nurse (LPN) #227 changing Resident #55's PEG tube dressing. The dressing being changed had dried bloody drainage on it and was dated 08/25/23. There was also bloody drainage around the insertion site. LPN #227 stated PEG tube dressings were to be changed daily and as needed. Resident #55 was not interviewable. This deficiency represents non-compliance investigated under Complaint Number OH00145486. 365705 Page 4 of 4