Health inspection·November 13, 2023

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews the facility failed to report an allegation of misappropriation for Resident #86. This affected one resident (#86) of three residents reviewed for reporting of abuse or misappropriation. The census was 83. Findings include: Review of the medical record for Resident #83 revealed an admisison date of 06/16/23 and a discharge date of 08/09/23. Diagnoses included automatice dysreflexia, quadriplegia c1-c4 incomplete and neuromuscular dysfunction of bladder. Reivew of medical record revealed no inventory list of personal belongings. Interview on 10/31/23 at 3:32 P.M. with Administrator and Director of Rehab/Administrator in Training (DOR/AIT) #240 revealed they did not report misappropriation when Resident # 86 stated he was missing items after he had been discharged to the the hospital then subsequently another facility. They stated he did not accuse the facility of stealing the items plus he was already discharged therefore they did not believe it was necessary to make a self-reported incident. The Administrator stated a policeman came to the facility on [DATE] to discuss a report Resident #86 made. The Administrator did not believe it was necessary to make a self-reported incident at that time either as she believed they sent everything he had to the other facility with their driver. At a subsequent interview on 10/31/23 the Administrator stated she initiated a self-reported incident for misappropriation on this date. Review of the facility policy titled Abuse, Neglect, Exploitation and Misappropriation Prevention Program, revised April 2021 revealed the facility should report and investigate in a timely manner. This deficiency represents non-compliance investigated under Complaint Number OH00147110 and Complaint Number OH00147037. Page 1 of 3 365845 365845 11/13/2023 Rae Ann Suburban 29505 Detroit Rd Westlake, OH 44145

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 observation, record review, and interview, the facility failed to ensure residents received wound care for a vascular sore according to the physician order for wound care. This affected one resident (Resident #43) of three residents reviewed for wound care. The facility census was 83. Residents Affected - Few Findings include: Record review of Resident #43 revealed he was admitted to the facility on [DATE] and had diagnoses including cellulitis, diabetes, morbid obesity, and peripheral vascular disease. He had active orders dated 11/01/23 for dressing changes to both legs to include cleansing with soap and water followed by application of calcium alginate, super absorbent dressing, kerlix, and unna boot (a type of gauze dressing) to be done three times per week. His last wound assessment on 11/01/23 identified him as having a right leg vascular wound measuring 4.0 centimeters (cm) by 2.5 cm, and a left leg vascular wound measuring 11.0 cm by 3.0 cm. The assessment called for both sites to be cleaned with normal saline then dressed with alginate, super absorbent dressing, kerlix, and unna boot three times per week. Observation of wound care for Resident #43 on 11/13/23 at 10:01 A.M. by Licensed Practical Nurse (LPN) #201 revealed she cleansed the wound with Dakin's solution instead of soap and water, then applied alginate, absorbent pads, and unna boot without any use of kerlix. Interview with LPN #201 on 11/13/23 at 10:35 A.M. confirmed she did not change the dressing according to the orders. She said she recalled discussing the change with the wound nurse practitioner and would clarify. Interview with LPN #201 on 11/13/23 at 1:00 P.M. revealed she clarified with the nurse practitioner and received new orders to clean the wounds with Dakin's and apply alginate, super absorbent dressing, kerlix, and unna boot. She confirmed the observed dressing still did not match this order due to not using kerlix, and said she would reapply it. This deficiency represents non-compliance investigated under Complaint Number OH00147105. 365845 Page 2 of 3 365845 11/13/2023 Rae Ann Suburban 29505 Detroit Rd Westlake, OH 44145

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews, record reviews and observation the facility failed to ensure Resident #73 wore a smoking apron while smoking. This affected one resident (#73) of three residents reviewed for smoking. The facility census was 83. Findings include: Review of the medical record for Resident #73 revealed an admission date of 09/01/23. Diganoses included Huntington's Disease, dementia and post-traumatic stress syndrome. Review of the Minimum Date Set (MDS) assessment dated [DATE] revealed cognitive status was not assessed at that time. She required extensive assistance for all of her activities of daily living. Review of the smoking assessment dated [DATE] revealed she should have one on one assistance and to wear an apron. Review of the care plan dated 09/05/23 revealed Resident #73 should wear apron while smoking. Observation on 10/31/23 from 1:13 P.M. through 1:29 P.M. revealed Resident #73 was being assisted by another resident with her cigarette. Resident #73 was not wearing an apron while smoking. Resident gave her cigarette to the other resident to dispose of in the ashtray. Interview and observation on 10/31/23 at 1:48 P.M. with Resident #73 revealed she was not wearing an apron while smoking. She stated she probably should wear one. Interview on 10/31/23 at 2:01 P.M. with Activity Director (AD) #207 revealed it was her first time monitoring the residents who smoke. She stated she offered a smoking blanket, which was with the cigarettes, to Resident #73 however resident denied wanting it. AD #207 stated she did not know about an apron. When asked how she knew what each resident needed, she stated their names were on the cigarettes. She was not aware of who needed a blanket or apron. AD #207 verified Resident #73 was not wearing an apron during the smoke break. This deficiency represents non-compliance investigated under Complaint Number OH00147105. 365845 Page 3 of 3