Health inspection·January 10, 2024

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 record review, interview, and facility policy review the facility failed to ensure physician's orders were followed for Resident #187. This affected one resident (#187) of three residents reviewed for admission and discharge procedures. The facility census was 187. Residents Affected - Few Findings include: Review of the medical record for Resident #187 revealed an admission date of 11/11/23 and a discharge date of 11/22/23. Diagnoses included dementia, chronic kidney disease, heart failure, fracture of the right shoulder, depression, and arthritis. Review of the comprehensive Minimum Data Set (MDS)assessment dated [DATE] revealed Resident #187 was cognitively intact. She required some substantial/maximum assistance for eating and oral hygiene and was dependent for toileting, showering, hygiene, and upper and lower body dressing. She had an impairment to her upper extremity on one side. Review of the hospital discharge instructions provided to the facility dated 11/11/23 revealed Resident #187 had an appointment on 11/13/23 to see a neurologist. She also had an order to remain non weight bearing to her right upper extremity and to wear a sling until her follow-up appointment. Review of the physician's orders for November 2023 revealed an appointment to see a neurologist on 4/30/24. Special instructions included a physician to verify all orders regardless of date or time. Review of the admission progress note dated 11/11/23 at 3:43 P.M. revealed Resident #187 was admitted and accompanied by her son, and orders for reviewed and clarified with the doctor. Review of the nursing note dated 11/11/23 at 6:07 P.M. revealed Resident #187 had an ace wrap on her right hand and arm. There was no documented evidence that the resident was wearing a sling at the time of the observation. Interview on 01/04/24 at 2:31 P.M. with Licensed Practical Nurse (LPN) #506 revealed she worked with Resident #187 but could not recall whether or not she used a sling to either upper extremity at any time. Interview on 01/04/24 at 2:33 P.M. with the Director of Nursing (DON) revealed when a resident was admitted from the hospital the facility reviewed the discharge orders from the hospital and followed whatever the orders said, verifying the orders with the facility physician. She revealed the facility would schedule transportation if an appointment was already scheduled. She revealed Resident #187 Page 1 of 2 365757 365757 01/10/2024 Broadview Multi Care Center 5520 Broadview Rd Parma, OH 44134

F 0684 Level of Harm - Minimal harm or potential for actual harm was admitted on a Saturday and no one was available to schedule transportation for the appointment. She confirmed the physician was not notified of the appointment, and the residents' family was not contacted to see if they could provide transportation. She confirmed there was no documented evidence the resident was wearing a sling while at the facility, there was no order for a sling, and nothing related to a fractured arm in the resident's care plan. Residents Affected - Few Review of the facility policy titled Physician Services, dated 11/13/19, revealed the facility was to follow physician's orders as written. This deficiency represents noncompliance investigated under Complaint Number OH00148697. 365757 Page 2 of 2