Health inspection·March 27, 2023

F 0580 Level of Harm - Minimal harm or potential for actual harm Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to notify the guardian of transfer to the emergency room. Residents Affected - Few This affected one Resident (Resident #16) of one reviewed for change of condition. The facility census was 84. Findings include: Review of the medical record for the Resident #16 revealed an admission date of 08/17/21. Diagnoses include paranoid schizophrenia, major depressive disorder, anxiety, and chronic obstructive pulmonary disease (COPD). Review of the care plan dated 08/17/22 revealed a plan for alternation in mood and behavior related to diagnoses of paranoid schizophrenia, major depressive disorder, and anxiety. The Resident exhibits behavior of noncompliance with medication, care needs, verbal and physical aggression, explosive outburst over smoking, impulsive and accusatory behaviors, delusional beliefs, and distorted thought pattern. Interventions included to provide activities for increased socialization and participation. Allow resident to make choices and speak in a calm manor. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE], revealed the Resident #16 had impaired cognition and wandering behaviors. Review of the progress notes dated 03/12/23 at 7:21 P.M. Resident #16 was refusing to leave the smoking room. Resident #16 struck the nurse causing her to fall and then struck her with a close fist in the back of the head. The resident remained in the room and all smoking materials were removed. The Certified Nurse Practitioner (CNP) was notified and gave an order to send to the emergency room for a psychological evaluation. There was no evidence of notification to Resident #16's Guardian. Interview on 03/22/23 at 1:59 P.M. with the Assistant Director of Nursing (ADON) #872 stated the was no evidence of Resident #16's guardian was notified of the behavior or transfer to the emergency room. Interview 03/23/23 2:04 P.M. with Licensed Practical Nurse #809, the nurse on duty at the time of the incident, stated she was not sure if Resident #16's Guardian was contacted for the behavior or transfer to the emergency room. Review of the facility's policy titled Change in Condition, revised December 2016 stated the nurse Page 1 of 7 365796 365796 03/27/2023 Westpark Healthcare Campus 4401 W 150th Street Cleveland, OH 44135

F 0580 will notify the resident's representative when: Level of Harm - Minimal harm or potential for actual harm a. The resident is involved in any accident or incident that results in an injury or unknown source. Residents Affected - Few b. There is a significant change in the resident's physical, mental, or psychosocial status. c. There is a need to change the resident's room assignment. d. A decision has been made to discharge the resident from the facility. e. It is necessary to transfer the resident to a hospital/treatment center. This deficiency was an incidental finding to OH 00141314. 365796 Page 2 of 7 365796 03/27/2023 Westpark Healthcare Campus 4401 W 150th Street Cleveland, OH 44135

F 0646 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Notify the appropriate authorities when residents with MD or ID services has a significant change in condition. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to notify the state mental health agency after Resident #79's significant mental health change and admission to a psychiatric hospital. This affected one of one resident reviewed for Pre-admission Screening and Resident Review (PAS-RR.) The census was 84. Findings include: Resident #79 was admitted to the facility on [DATE]. Her diagnoses included major depressive disorder, bipolar disorder, and cognitive communication deficit. Her Brief Interview for Mental Status (BIMS) score was 13, which indicated she was cognitively intact. This assessment was completed on 03/02/23. Review of Resident #79's medical records revealed on 03/03/23 at 12:01 P.M. staff reported the resident was presenting with suicidal ideation. The Certified Nurse Practitioner (CNP) was notified, and Resident #79 was placed on 15 minute checks and an immediate appointment was made with facility psychiatric services via Telehealth. At 4:00 P.M., after three attempts to start the Telehealth appointment, Resident #79 stated I just want to cut my throat and watch myself bleed out. The CNP was made aware, and she ordered the 15 minute checks to continue and for Resident #79 be transported to the local psychiatric hospital. At 5:16 P.M. Resident #79 was transported via ambulance to the local psychiatric hospital. At 9:38 P.M. the hospital intake worker called with a few questions regarding Resident #79's baseline behavior. Review of Resident #79's medical record revealed on 03/04/23 at 2:18 P.M. the resident returned to the facility by ambulance. Resident #79 had new orders and a follow up appointment to be scheduled. Further review of Resident #79's medical records revealed no new PAS-RR was initiated after the residents readmission from the psychiatric hospital. Interview with Licensed Social Worker (LSW) #875 on 03/22/23 at 2:32 P.M. confirmed she had not initiated a new PAS-RR for Resident #79. 365796 Page 3 of 7 365796 03/27/2023 Westpark Healthcare Campus 4401 W 150th Street Cleveland, OH 44135

F 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to monitor and conduct on going assessments for dialysis Resident #55. This affected one Resident (Resident #55) of one reviewed for dialysis. The facility census was 84. Residents Affected - Few Findings include: Review of the medical record for the Resident #55 revealed an admission date of 10/21/21. Diagnoses include end stage renal disease, chronic kidney disease, heart failure and colon cancer. Review of the care plan dated 10/21/22 revealed a plan for dialysis related to end stage renal disease. Intervention included to check and change dressing daily at the access site, to observe signs and symptoms of renal insufficiency, obtain vital signs and weight per protocol and report any significant changes. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE], revealed Resident #55 had intact cognition, receives a therapeutic diet, and attends dialysis. Review of the March 2023 physicians' orders revealed an order for dialysis on Monday, Wednesday, and Friday. There were no additional dialysis orders. Review of the medical record revealed no evidence of pre or post dialysis assessments or communication forms that accompanied the resident. There was no evidence of monitoring of the arteriovenous (AV) fistula a port and ensuring the dressing site was intact. Interview on 03/22/23 at 1:59 P.M. with Assistant Director of Nursing (ADON) #872 at 1:59 P.M. verified there was no pre and post dialysis assessments conducted. She verified there were no orders monitoring the AV fistula site and dressing. Interview on 03/23/23 at 1:10 P.M. with Licensed Practical Nurse #903, the Unit Manager, revealed she was new to the position and had no knowledge that there was no formal process for assessments, communication and monitoring for dialysis. LPN #903 stated new orders were added to monitor the AV fistula and dressing site and the facility has started a new process for communication with the off-site dialysis facility. Review of the facility's policy titled Hemodialysis Access Care, revised October 2010 stated the nurse should document in the resident's medical record every shift. Documentation includes: 1. The location of the catheter. 2. Condition of the dressing. 3. 365796 Page 4 of 7 365796 03/27/2023 Westpark Healthcare Campus 4401 W 150th Street Cleveland, OH 44135

F 0698 If dialysis was done during the shift. Level of Harm - Minimal harm or potential for actual harm 4. Any part of report from dialysis nurse post- assessment. Residents Affected - Few 5. Observations of post-dialysis. 365796 Page 5 of 7 365796 03/27/2023 Westpark Healthcare Campus 4401 W 150th Street Cleveland, OH 44135

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 and staff interview, the facility failed to ensure food was stored properly. This had the potential to affect 80 residents who the facility identified ate food from the kitchen. Residents #2, #59, #61, and #67 were identified as receiving tube feed with Nothing-By-Mouth (NPO) and received no food prepared from the kitchen. The facility census was 84. Findings include: An initial kitchen tour was conducted on 03/20/23 between 8:47 A.M. and 9:22 A.M. with Dietary Manager (DM) #886. The following was observed and verified at the time of observation. Observation of both the the walk-in cooler and walk-in freezer, revealed a box of sausage patties, a box of sliced bacon, a bag of chicken breast filets, and a bag of fried eggs observed open to air and undated. Review of the facility document titled Refrigerated/Frozen Storage revised 10/06/13, revealed the facility had a policy in place that food stored under refrigeration/freezer storage would be maintained in a safe and sanitary manner to prevent damage, spoilage, and contamination of products. Review of the document revealed the facility did not implement the policy. 365796 Page 6 of 7 365796 03/27/2023 Westpark Healthcare Campus 4401 W 150th Street Cleveland, OH 44135

F 0921 Level of Harm - Minimal harm or potential for actual harm Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on observations and interviews the facility failed to ensure the smoking area was maintained in a clean and safe manner. This had the potential to affect all residents. The facility census was 84. Residents Affected - Many Findings include: Observation during the tour of the smoking area located outside of Building B with Staff Aide (SA) #880 on 03/21/23 between 2:40 P.M. and 2:50 P.M. revealed a smoking area was not maintained properly. There were numerous cigarette butts located on the ground and grass-covered area, and not in the designated cans. Interview with SA #880 on 03/21/23 at 2:48 P.M. verified the condition of the smoking area. Observation during tour of the facility with the Maintenance Staff (MS) #861 and #867 on 03/22/23 between 1:00 P.M. and 1:30 P.M. revealed two trash bins with numerous cigarette butts and different types of paper products. Interview with MS #861 and #867 on 03/22/23 verified the condition of the trash bins at the time of the facility tour. Review of the facility document titled Westpark Environmental Services- General Policy undated, revealed the facility had a policy in place to maintain a clean and safe environment to ensure the daily upkeep of the facility to promote a pleasant, clean, odor free and safe environment. Review of the facility document revealed the facility did not implement the policy. 365796 Page 7 of 7