Health inspection·August 15, 2019

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. 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 interview the facility failed to ensure Resident #39, who required staff assistance with toileting received timely and adequate care related to the use of a bedside commode. This affected one resident (#39) of one resident reviewed for activities of daily living (ADLs). Residents Affected - Few Findings include: Record review revealed Resident #39 was admitted to the facility on [DATE] with a diagnosis including closed fractures of the lower end femur and left tibia. The admission Minimum Data Set (MDS) 3.0 assessment, dated 07/12/19 revealed Resident #39 had intact cognition and required extensive assistance of two staff for transfers and toilet use. Interview on 08/12/19 at 11:06 A.M. with Resident #39 revealed she used the bedside commode and often it took staff a long time to empty it. Resident #39 stated she needed assistance on and off the bedside commode, so staff were aware it needed to be emptied. Resident #39 stated one day six hours went by before it was emptied. Observation on 08/14/19 at 9:44 A.M. while talking with Resident #39's roommate revealed Resident #39's bedside commode with urine in it. Resident #39 was not present in her room at the time of the observation. Interview on 08/14/19 at 10:57 A.M. with State Tested Nursing Assistant (STNA) #504 revealed Resident #39 required assistance to the bedside commode and supervision off the commode to her wheelchair. STNA #504 stated the bedside commode was to be emptied when the resident was finished using it. Observation at this time with STNA #504 verified the bedside commode had not been emptied timely following the resident use. Review of the facility policy titled Bedside Commode, Offering/Removing, dated February 2018 revealed after allowing the resident to wash his or her hands, take the bedpan into the bathroom. After checking the output empty and clean the bedpan. Page 1 of 5 365834 365834 08/15/2019 Majestic Care of Kent 1290 Fairchild Avenue Kent, OH 44240

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, record review and interview the facility failed to maintain sanitary conditions in the kitchen to prevent contamination and/or food borne illness. This had the potential to affect 71 of 71 residents residing in the facility who received meal trays. The facility identified two residents, Resident #9 and #64 who received nothing by mouth. The facility census was 73. Findings include: A tour of the kitchen on 08/12/19 from 8:30 A.M. to 8:50 A.M. with Dietary Manager (DM) #503, revealed the following observations: On the bottom shelf of the prep sink there were various dried food crumbs scattered throughout. Stored on this shelf were two blenders and attachments, and a silver rack that held cutting boards. The top of the dish machine had a moderate amount of a tannish, wet residue. The prep table next to the steam table, the outer surface appeared worn and rusted. The side of this prep table that faced the steam table had a moderate layer of blackish grease and various dried food splatters. The bottom shelve of the steam table had various dried food crumbs and splatter. Stored on this shelf were multiple large pans. The stove located across from the steam table had a heavy amount of brunt grease build-up, a moderate amount of various dried and burnt food crumbs throughout. There was a two shelved rolling rack next to the stove, the bottom shelf that house miscellaneous items one being a box of hot cereal, had a moderate amount of various food crumbs and food splatters. Interview on 08/12/19 from 8:30 A.M. to 8:50 A.M. with DM #503 verified the above findings. DM #503 stated she had been in that position for one month and was aware of the concerns. Review of the facility policy titled Cleaning Standards, dated August 2015 revealed equipment, food contact surfaces and utensils shall be clean to sight and touch, non-food contact surfaces of equipment shall be free of accumulation of dust, dirt, food residue, and other debris. 365834 Page 2 of 5 365834 08/15/2019 Majestic Care of Kent 1290 Fairchild Avenue Kent, OH 44240

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on record review and interview the facility failed to ensure resident medical record documentation was accurate and complete related to antibiotic use. This affected three residents (#48, #62 and #63) of three residents reviewed for antibiotic use. Findings include: A review of Resident #48's physician's orders revealed an order for Azithromycin Tablet 500 milligrams (mg), one tablet by mouth at bedtime for upper respiratory infection (URI), to start 08/05/19 for seven days. A review of Resident #48's progress notes revealed only one entry regarding a reaction to the antibiotic. A review of Resident #62's physician's orders revealed an order for Cephalexin 500 mg, one tablet by mouth twice daily for urinary tract infection (UTI), to start on 08/07/19 for seven days. A review of Resident #62's progress notes revealed no entries regarding the start of treatment nor follow up of antibiotic treatment to show progress, resident condition, or any adverse reactions. A review of Resident #63's physician's orders revealed an order for Cephalexin 500 mg, two tablets by mouth once daily for cellulitis, to start on 07/19/19 for three days. A review of Resident #63's progress notes revealed no entries regarding the start of treatment nor follow up of antibiotic treatment to show progress, resident condition, or any adverse reactions. An interview on 08/14/19 at 1:12 P.M. with the Director of Nursing (DON) and Assistant Director of Nursing (ADON) both confirmed the lack of documentation for Resident #48, #62 and #63 related to the use of antibiotic medications as noted above. 365834 Page 3 of 5 365834 08/15/2019 Majestic Care of Kent 1290 Fairchild Avenue Kent, OH 44240

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review and interview the facility failed to maintain adequate infection control practices during meal delivery, blood glucose monitoring and during housekeeping services to prevent the spread of infection. This affected two residents (#4 and #19) observed receiving meal trays, two residents (#16 and #8) observed during blood glucose monitoring, one resident (#219) observed in contact precautions and had the potential to affect all 73 residents residing in the facility. Residents Affected - Many Findings include: 1. Observation on 08/12/19 at 12:15 P.M. revealed State Tested Nurse Assistant (STNA) #500 was observed passing a meal tray to Resident #19. STNA #500 entered the resident's room, placed the tray down and moved the bed tray closer to the resident who was laying in bed. The STNA then exited the room, obtained a meal tray for Resident #4 without first washing hands or using hand sanitizer and proceeded to obtain a meal tray for Resident #4. STNA #500 opened the door to Resident #4's room using the left hand and placed the tray down on the resident's bed tray. STNA #500 lifted the top cover off the plate, grabbed a hotdog in a bun using his/her left hand and gave it to Resident #4 without first washing hands, using any type of hand sanitizer or wearing gloves. Interview on 08/12/19 at 12:30 P.M. with STNA #500 revealed staff were to wash hands after delivering two meal trays. STNA #500 verified she did not wash hands between handling trays and/or after touching door handles and other equipment during the delivery of meal trays for Resident #19 and Resident #4. Review of handwashing/hand hygiene policy, dated 2001 revealed staff were to wash hands after contact with objects (e.g., medical equipment) in the near vicinity of the residents, before and after handling food, and after assisting residents with meals. 2. On 08/13/19 at 11:56 A.M. Registered Nurse (RN) #501 was observed using the glucometer (a device that measures the concentration of glucose (sugar) in the blood) for residents who have diabetes. RN #501 finished checking the blood sugar of Resident #8 and placed the glucometer on top of the medication cart. On 08/13/19 at 12:10 P.M. RN #501 obtained the same glucometer used for Resident #8 and without first cleaning or disinfecting the unit entered Resident #16's room. RN #501 proceeded to check the resident's blood sugar. RN #501 left the room, returned to the medication cart and placed the glucometer in the top drawer of cart without first cleaning or disinfecting it. Interview on 08/13/19 at 12:20 P.M., with RN #501 revealed the facility policy was to clean the glucometer after each resident. RN #501 verified the glucometer was not sanitized after each use. Review of undated blood glucose point of care testing policy revealed an unclean glucometer should not be placed on top of medication cart without a clean barrier under the device. The policy did not state when staff were to sanitize (clean/disinfect) the glucometer. 3. Record review revealed Resident #219 was admitted to the facility on on 07/18/19 with a readmission date of 08/01/19. The resident had diagnoses including perforation of intestine (non-traumatic) ileostomy status and alcohol dependence. The admission Minimum Data Set (MDS) 3.0 assessment, dated 365834 Page 4 of 5 365834 08/15/2019 Majestic Care of Kent 1290 Fairchild Avenue Kent, OH 44240

F 0880 07/25/19 revealed Resident #219 had impaired cognition. Level of Harm - Minimal harm or potential for actual harm Review of the August 2019 physician's orders revealed a discontinued order for Vancomycin 125 milligrams (mg) every 6 hours, orally for Clostridium difficile (C-Diff) for 28 administrations, take for seven days from 08/02/19 to 08/09/19. Residents Affected - Many Interview on 08/12/19 at 2:31 P.M. with Registered Nurse (RN) #509 revealed Resident #219 was in contact precautions for C-Diff but the resident's stool was contained as the resident had an ileostomy. RN #509 stated nursing staff provided the ileostomy care. Interview on 08/12/19 at 2:55 P.M. with Resident #219 revealed he was on contact precautions because he had C-Diff. Resident #219 stated he was aware of the procedures for the contact precautions. During an interview on 08/12/19 at 1:46 A.M. Housekeeper (HSK) #506 revealed the procedures used to clean Resident #219's room. HSK #506 stated she used bleach wipes to wipe everything down but used another solution to mop the floor. HSK #506 stated she was unsure what the solution was and that Housekeeping Director (HD) #505 would know. Interview on 08/13/19 from 2:44 P.M. to 2:48 P.M. with HD #503 revealed solution for mopping the floors were used for mopping all rooms including the isolation rooms. HD #503 stated the solution was 3M disinfectant used in hospital and provided a container. Observation at this of the container read 3M Neutral Quat Disinfectant Cleaner Concentrate and listed the pathogens it killed except it was silent for killing C-Diff. HD #503 verified this finding. Review of the facility policy titled Clostridium Difficile- Prevention and Management, dated 2015 revealed quaternary ammonium compounds (Quat) was not effective against C-Diff spores and should not be used. 365834 Page 5 of 5