Health inspection·November 18, 2021

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 record review, facility policy and procedure review and interview the facility failed to ensure quarterly care conferences were conducted for Resident #39 and included the resident's family. This affected one resident (#39) of four residents reviewed for care planning. Findings include: Record review revealed Resident #39 was admitted to the facility on [DATE] with diagnoses including traumatic brain injury, adult failure to thrive, tracheostomy (trach), gastrostomy and paraplegia. Review of care conference documentation revealed there was an admission care conference held on 05/05/21. The meeting notes revealed a desire to wean off trach, to see a neurologist and determine if weaning weaning was a possibility. The resident's sister wanted the resident on a routine dose of the anti-anxiety medication, Ativan Review of the 07/03/21 quarterly Minimum Data Set (MDS) 3.0 assessment revealed Resident #39 was cognitively impaired and not able to make his needs known. Record review revealed no evidence of a quarterly multidisciplinary team (IDT) conference since the admission conference. On 11/16/21 at 5:11 P.M. interview with the resident's sister revealed concerns that communication with the facility was poor. The resident's sister denied having any type of quarterly care conference or meeting to discuss the resident's care. On 11/16/21 at 6:40 P.M. interview with the Administrator, Director of Nursing and Social Service Designee (SSD) #70 verified there were no evidence of any care conferences since the admission conference for Resident #39. Review of the facility undated policy titled Process for Care Plan Meetings revealed MDS and SSD work in identifying when a care plan meeting should be completed. A care plan note must be created at the time of the meeting to include a brief discussion of the meeting, concerns and follow-up. The note should include a list of all who attended the meeting both from the resident/representatives and facility staff. The note could be found in Point Click Care (electronic documentation) under progress notes. Page 1 of 6 365732 365732 11/18/2021 Austintown Healthcare Center 650 S Meridian Road Youngstown, OH 44509

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, record review and staff interview the facility failed to ensure a pressure ulcer was comprehensively assessed and treatment initiated when first observed. This affected one resident (#39) of four residents reviewed for pressure ulcers. The facility identified eight residents with pressure ulcers. Residents Affected - Few Findings include: Record review revealed Resident #39 was admitted to the facility on [DATE] with diagnoses including traumatic brain injury, adult failure to thrive, tracheostomy, gastrostomy and paraplegia. Review of a 6/28/21 Braden Observation Tool revealed the resident was at high risk for pressure ulcers due to being bedfast, completely immobile, having limited sensory, moisture problems, inadequate nutrition and friction/shear problems. A physician order, dated 08/13/21 revealed to cleanse open area to right sacrum with normal saline, apply Calcium Alginate and cover with foam dressing daily and as needed every night shift. Review of the August 2021 treatment administration records revealed the treatment to the right sacrum was initially signed off as completed on 08/14/21. A 08/18/21 Skin Grid Pressure for a facility acquired right gluteal pressure ulcer revealed the pressure ulcer was discovered 08/11/21. However, there was no mention of a new pressure ulcer in any of the documentation on 08/11/21. There was no evidence of the location, size, appearance and characteristics or treatment for the pressure ulcer. The 08/18/21 Skin Grid Pressure for a facility acquired right gluteal pressure ulcer revealed the pressure ulcer was first observed 08/11/21. The pressure ulcer measured 2.0 centimeter (cm) in length by 1.6 cm width with 0.3 cm depth and was assessed to be a Stage IV (full thickness tissue loss with exposed bone, tendon, or muscle. Slough or eschar may be present. Often include undermining and tunneling). Epithelialization tissue and eschar were present, with a necrotic and yellow wound bed. No exudates with a pink or normal peri wound with undermining from 10-2. A physician note, dated 08/28/21 documented the Resident #39 developed new abrasive wounds to bilateral right glutei on 08/11/21 and reopened a Stage IV right gluteal pressure injury. There was no evidence a treatment was initiated to the right gluteal until 08/14/21 and no evidence of a comprehensive assessment was completed until 08/18/21. Review of the 10/21/21 quarterly Minimum Data Set (MDS) 3.0 assessment revealed the resident was severely impaired for daily decision making. The resident was totally dependent on two for bed mobility and transfers, totally dependent on one staff for eating and had bilateral upper and lower extremity impairment. The assessment reflect no weight gain or loss, noted 51% or more of calories were received through tube feeding, and 501 milliliters or more of fluid. The resident had two Stage IV pressure ulcers, an open lesion on the foot, received anti-anxiety medication and opioids, oxygen, suctioning and had a tracheostomy. On 11/17/21 at 3:20 P.M. observation of Resident #39's skin with Licensed Practical Nurse (LPN) 365732 Page 2 of 6 365732 11/18/2021 Austintown Healthcare Center 650 S Meridian Road Youngstown, OH 44509

F 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few #125 and the wound physician revealed the resident had a pressure ulcer to the right gluteal fold. The area was cleaned with Pure and Clean, cauterized with silver nitrate, covered with silver alginate, and a foam dressing. The pressure ulcer measured 1.2 cm in length by 0.7 cm width and was classified as a historical Stage IV with pink scar tissue surrounding the area. On 11/17/21 at 6:22 P.M. interview with the Director of Nursing (DON) verified there was no evidence of a comprehensive assessment or treatment initiated for Resident #39's right gluteal pressure ulcer when first observed on 08/11/21. Review of the Skin Care and Wound Management Stage III and IV pressure ulcer policy, reviewed 05/30/19 revealed obtain an order for treatment and document measurements and characteristics on the skin grid no less than weekly. This deficiency substantiates Complaint Number OH00127326. 365732 Page 3 of 6 365732 11/18/2021 Austintown Healthcare Center 650 S Meridian Road Youngstown, OH 44509

F 0692 Provide enough food/fluids to maintain a resident's health. 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 and staff interview the facility failed to ensure Resident #39's ordered enteral (tube) feeding was being administered. This affected one resident (#39) of one resident reviewed for enteral feedings. The facility identified five residents receiving nutrition through a tube feeding. Residents Affected - Few Findings include: Record review revealed Resident #39 was admitted to the facility on [DATE] with diagnoses including traumatic brain injury, adult failure to thrive, tracheostomy, gastrostomy and paraplegia. Review of the 10/21/21 quarterly Minimum Data Set (MDS) 3.0 assessment revealed the resident was severely impaired for daily decision making. The resident was totally dependent on two staff for bed mobility and transfers, totally dependent on one staff for eating and had bilateral upper and lower extremity impairment. The assessment reflected no weight gain or loss, noted the resident received 51% or more of calories through tube feeding and 501 milliliters or more of fluid. The resident had two Stage IV pressure ulcers, an open lesion on the foot, received an anti-anxiety medication and opioids, oxygen, suctioning and had a tracheostomy. Review of the physician's orders revealed an order for the enteral feeding, Glucerna 1.5 calorie via gastrostomy (peg) tube at 55 ml/hour (hr) for 22 hours a day. The resident had an order to received nothing by mouth (NPO), receiving all nutrition through the peg tube. On 11/17/21 at 10:11 A.M. Resident #39 was observed to have Glucerna 1.2 calorie being administered at 55 ml an hour. The bottle was dated 11/17/21 at 2:00 A.M. (as the time hung for feeding). On 11/17/21 at 10:21 A.M. interview with Licensed Practical Nurse (LPN) #81 verified the incorrect tube feeding was being administered to the resident. LPN #81 verified Glucerna 1.5 calorie was to be provided at 55 cc an hour instead of the 1.2 calorie that was being administered. This deficiency substantiates Complaint Number OH00127326. 365732 Page 4 of 6 365732 11/18/2021 Austintown Healthcare Center 650 S Meridian Road Youngstown, OH 44509

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 provide a safe, sanitary and comfortable environment for all residents. This affected eight residents (#11, #16, #19, #28, #39, #40, #53 and #56) of 61 residents residing in the facility. Findings include: 1. On 11/15/21 at 4:22 P.M. observation of Resident's #39's room revealed the wall was gouged with paint and plaster off the headboard wall near the bed. The side wall and back wall were dirty as well as the privacy curtain which was dirty on the bottom right corner. On 11/16/21 at 5:11 P.M. observation of the resident's room and interview with the resident's sister revealed the floor at the head of the bed had a large hair ball, dust and debris. The walls and window had dried enteral (tube) feeding on them. The resident's sister also noted the dirty privacy curtain, a dirty tube feeding pole, the walls splashed with dry tube feeding, the window splashed with what she thought was tube feeding and the dirt on the floor including the hair ball. On 11/16/21 at 6:40 P.M. observation and interview with the Administrator verified the condition of the resident's room. The Administrator verified the soiled floor, walls, window, privacy curtain and equipment. The Administrator had been notified of the concerns earlier in the day and indicated he had housekeeping in the room and pointed out to them what needed cleaned. At the time of this observation, about 50 percent of the walls were cleaned. The floor had not been cleaned, the privacy curtain was changed and the tube feed equipment had been cleaned. 2. On 11/15/21 at 1:32 P.M. observation of Resident #40's room revealed the bed was lengthways on the wall. There was a one foot span with gouged drywall alongside the bed. The plaster and paint were off the wall. The painted door frames in the room had the paint scraped off. On 11/18/21 at 1:09 P.M. interview with the Administrator verified the facility rooms need updated as well as painted. 3. On 11/18/21 at 12:05 P.M. the following environmental concerns were noted: Resident #19's top dresser drawer had the whole front of the wooden door broken off. Blue walls had the plaster gouged along the bed exposing white drywall in a two foot by one foot area as well as a one foot by two inch gouge out of the plaster. Resident #16 had two large gouges in the drywall in the room, one being two feet by four inches. The resident's bedside table trim was delaminating. Resident #56 had gouged drywall to both sides of the back corner walls near the recliner. Resident #11 had debris behind the bed and nightstand that included food and paper trash. On 11/18/21 at 1:09 P.M. interview with the Administrator verified the facility rooms need updated as well as painted. 365732 Page 5 of 6 365732 11/18/2021 Austintown Healthcare Center 650 S Meridian Road Youngstown, OH 44509

F 0921 4. A tour of the facility on 11/17/21 from 2:00 P.M. through 2:45 P.M. with the Administrator revealed: Level of Harm - Minimal harm or potential for actual harm Residents #39 and Resident #53 had damaged walls that needed repaired and painted. Resident #28 had gnats in his bathroom, clustered along the walls toward the ceiling. Residents Affected - Some Numerous doorways, including Resident #53's doorway, had damage and chipped paint that needed repaired. The shower room, on the long term care unit, had a lower broken panel which created the potential for injury to residents' being wheeled in and out of the shower. The Administrator verified the above observations during the tour of facility. 365732 Page 6 of 6