Health inspection·August 24, 2023

F 0800 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs. Based on observations, interviews, and record review the facility failed to take into consideration the preferences of residents and did not ensure residents on a renal diet and carbohydrate consistent diet received a diet that met their special dietary needs. The facility identified two residents (#20 and #39) on a renal diet and 17 residents (#8, #10, #11, #16, #21, #23, #25, #32, #38, #50, #51, #56, #60, #61, #62, #65, and #68) on a carbohydrate consistent diet. This had the potential to affect all 68 residents who received meals from the kitchen. Findings include: Interview on 08/23/23 at 9:35 A.M. with Dietary Director #322 revealed she made the menus and there were no spreadsheets for the menus. Interview on 08/23/23 at 10:20 A.M. with Resident #36 revealed she had been asked in the past what she wanted for the meal, but currently she wasn't being asked. Interview on 08/23/23 at 10:34 A.M. with Resident #61 revealed he was a diabetic and he didn't feel the facility was following a diabetic diet, since he was getting two Danishes at a time at breakfast. Interview on 08/23/23 at 10:41 A.M. with Resident #60 revealed he was never asked what he wanted for the meal, and he got what they gave him. Interview on 08/23/23 at 10:58 A.M. with Resident #38 revealed he did not get a choice with his meals, and he either took what was served or he left it. Interview on 08/23/23 at 11:07 A.M. with Resident #12 revealed she had never been asked what she wanted for the meal, she received meals she didn't like, and she ate what she could. Interview on 08/23/23 at 11:18 A.M. with Resident #11 revealed his meal order was never taken and if he didn't like it, he didn't eat. He stated he didn't eat ham and they kept serving it to him. Observation on 08/23/23 of tray line from 12:40 P.M. to 1:27 P.M. revealed there was no spreadsheet, and the residents on a carbohydrate consistent diet received the same diet as the regular diet, which consisted of pork loin with gravy, mashed potatoes, cauliflower, and cheesecake. The residents on a renal diet received the same diet as the regular diet but received a smaller portion of gravy. Interview on 08/23/23 at 1:12 P.M. with Dietary Cook/Aide #314 revealed residents on a carbohydrate Page 1 of 6 365784 365784 08/24/2023 Washington Square Healthcare Center 202 Washington Street NW Warren, OH 44483

F 0800 consistent diet wouldn't receive sugar. A resident on a renal diet would receive a supplement drink. Level of Harm - Minimal harm or potential for actual harm Interview on 08/23/23 at 2:44 P.M. with Dietary Aide #328 and Dietary Aide/Cook #358 revealed there were no spreadsheets for the menus. The residents on a carbohydrate consistent diet were to receive the same meal as the regular diet, except they would sugar free condiments. The residents on a renal diet were to receive the same diet as the regular diet except they were to receive smaller portions of gravy and red sauce. The residents' likes and dislikes were on the tray cards in the past and had since been cleared from the dietary tray cards. Residents Affected - Some Interview on 08/24/23 at 10:58 A.M. with Dietitian #386 revealed Dietary Director #322 made menus and told her she had spreadsheets for the menus, but Dietitian #386 never looked at the spreadsheets to ensure accuracy. Dietitian #386 had no answer to why she hadn't checked to ensure there were accurate spreadsheets for the menus. Dietitian #386 confirmed the spread sheets for the menu would specify what should be provided for the renal and carbohydrate consistent diet. A renal diet would not receive the same diet as a regular diet except light gravy and light red sauce, and a carbohydrate consistent diet would not receive the same diet as a regular diet, except sugar free condiments. Interview on 08/24/23 at 2:26 P.M. with Resident #62 revealed he was a diabetic and he didn't feel he was getting the correct items for being a diabetic since he was being given glazed donuts for breakfast. Review of residents' tray cards revealed fourteen residents (#3, #6, #14, #19, #21, #25, #27, #33, #36, #46, #53, #64, #65, #68) out of 68 residents who received meals from the kitchen had dislikes identified on their tray cards. Review of dietary card for Residents #61 and #62 revealed a carbohydrate consistent diet order. Review of the undated facility document Review of Consistent Carbohydrate Diet revealed the quantity of carbohydrates would be determined by the registered dietitian, and carbohydrate management was the standard method for meal planning for dietary management of diabetes. Review of the undated facility document General Renal Diet Properties revealed assessment by the registered dietitian would determine the need of restriction of foods in the diet. This deficiency was an incidental finding discovered during the course of the complaint investigation. 365784 Page 2 of 6 365784 08/24/2023 Washington Square Healthcare Center 202 Washington Street NW Warren, OH 44483

F 0802 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. Based on observation and staff and resident interviews, the facility failed to ensure competent dietary support staff to ensure residents on renal diets and carbohydrate consistent diets received meals per the physician's orders. The facility identified two residents (#20 and #39) on a renal diet and 17 residents (#8, #10, #11, #16, #21, #23, #25, #32, #38, #50, #51, #56, #60, #61, #62, #65, and #68) on a carbohydrate consistent diet. The facility census was 68. Findings include: Interview on 08/23/23 at 9:35 A.M. with Dietary Director #322 revealed she made the menus and there were no spreadsheets for the menus. Interview on 08/23/23 at 10:34 A.M. with Resident #61 revealed he was a diabetic and he didn't feel the facility was following a diabetic diet, since he was getting two Danishes at a time at breakfast. Observation on 08/23/23 of tray line from 12:40 P.M. to 1:27 P.M. revealed there was no spreadsheets, and the residents on a carbohydrate consistent diet received the same diet as the regular diet, which consisted of pork loin with gravy, mashed potatoes, cauliflower, and cheesecake. The residents on a renal diet received the same diet as the regular diet but received a smaller portion of gravy. Interview on 08/23/23 at 1:12 P.M. with Dietary Cook/Aide #314 revealed residents on a carbohydrate consistent diet wouldn't receive sugar. A resident on a renal diet would receive a supplement drink. Interview on 08/23/23 at 2:44 P.M. with Dietary Aide #328 and Dietary Aide/Cook #358 revealed there were no spreadsheets for the menus. The residents on a carbohydrate consistent diet were to receive the same meal as the regular diet, except they would sugar free condiments. The residents on a renal diet were to receive the same diet as the regular diet except they were to receive smaller portions of gravy and red sauce. Interview on 08/24/23 at 10:58 A.M. with Dietitian #386 revealed Dietary Director #322 had made menus and told her she had spreadsheets for the menus, but Dietitian #386 never looked at the spreadsheets to ensure accuracy. Dietitian #386 had no answer to why she hadn't checked to ensure there were accurate spreadsheets for the menus. Dietitian #386 confirmed the spread sheets for the menu would specify what should be provided for the renal and carbohydrate consistent diet, and a renal diet would not receive the same diet as a regular diet except light gravy and light red sauce and a carbohydrate consistent diet would not receive the same diet as a regular diet, except sugar free condiments. Interview on 08/24/23 at 2:26 P.M. with Resident #62 revealed he was a diabetic and he didn't feel he was getting the correct items for being a diabetic since he was being given glazed donuts for breakfast. Review of dietary cards for Residents #61 and #62 revealed a carbohydrate consistent diet order. Review of the undated facility document Review of Consistent Carbohydrate Diet revealed the 365784 Page 3 of 6 365784 08/24/2023 Washington Square Healthcare Center 202 Washington Street NW Warren, OH 44483

F 0802 Level of Harm - Minimal harm or potential for actual harm quantity of carbohydrates would be determined by the registered dietitian, and carbohydrate management was the standard methods for meal planning for dietary management of diabetes. Review of the undated facility document General Renal Diet Properties revealed assessment by the registered dietitian would determine the need of restriction of foods in the diet. Residents Affected - Some This deficiency was an incidental finding discovered during the course of the complaint investigation. 365784 Page 4 of 6 365784 08/24/2023 Washington Square Healthcare Center 202 Washington Street NW Warren, OH 44483

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and staff interviews, the facility did not ensure the facility menus were followed and were reviewed by the facility registered dietitian as required for nutritional adequacy. The facility identified all 68 residents' received meals from the kitchen. Findings include: Interview on 08/23/23 at 10:25 A.M. with Registered Nurse (RN) #357 revealed menus were not being followed. Interview on 08/23/23 at 2:44 P.M. with Dietary Aide #328 and Dietary Cook/Aide #358 revealed menu items had to be frequently substituted, since menu items were not available in the facility. Review of facility menu for 08/23/23 lunch revealed roast pork, roasted potatoes, vegetable blend, and cheesecake were to be served. Review of spreadsheets for facility menus from 08/20/23 to 08/26/23 revealed there were no spreadsheets. Observation of tray line on 08/23/23 from 12:01 P.M. to 1:27 P.M. revealed residents were served pork loin, cauliflower, mashed potatoes, and cheesecake. At the time of observation, Dietary Director #322 stated since the facility did not have roasted potatoes, mashed potatoes were being substituted for the roast potatoes. Dietary Director #322 stated there were no substitution logs or spreadsheets since she did not have a chance to create them. Review of the facility menu for 08/24/23 breakfast revealed vegetable egg bake, toast, and bacon were to be served. Observation on 08/24/23 from 8:40 A.M. to 8:51 A.M. of breakfast being served in the [NAME] dining room revealed residents received fried eggs instead of the vegetable egg bake, toast, and bacon. Interview on 08/24/23 at 9:15 A.M. with Dietary Cook/Aide #358 revealed she did not have a recipe for the vegetable egg bake, so she substituted fried egg for the vegetable egg bake. Interview on 08/24/23 at 10:58 A.M. with Dietitian #386 revealed Dietary Director #322 made the menus and Dietary Director#322 told her she had spread sheets for menus. Dietitian #386 confirmed she had not checked to ensure there were spreadsheets, and if the menus were nutritionally adequate as required. Dietitian #386 stated she was never told the facility had no substitution log, and that the facility was substituting items on the menu. Review of the facility menu for 08/24/23 lunch revealed beef stroganoff, vegetable blend, dinner roll, and chocolate fluff were to be served. Observation on 08/24/23 from 12:22 P.M. to 12:39 P.M. of the lunch being served in the [NAME] dining room revealed residents received beef stroganoff, vegetable blend, a biscuit, and chocolate pudding were served. 365784 Page 5 of 6 365784 08/24/2023 Washington Square Healthcare Center 202 Washington Street NW Warren, OH 44483

F 0803 Level of Harm - Minimal harm or potential for actual harm Interview on 08/24/23 at 12:40 P.M. with Dietary Cook/Aide #358 revealed biscuits were being substituted for dinner rolls since there were no dinner rolls, and chocolate pudding was being substituted for chocolate fluff since she misread the menu. This deficiency was an incidental finding discovered during the course of the complaint investigation. Residents Affected - Many 365784 Page 6 of 6