Health inspection·December 7, 2023

F 0558 Reasonably accommodate the needs and preferences of each resident. 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 #470's call light was available and accessible for the resident's use. This affected one (Resident #470) of 18 residents (Residents #4, #10, #11, #48, #50, #52, #53, #54, #63, #85, #107, #112, #118, #470, #471, #472, #475 and #570) who were observed for call lights within reach. The facility census was 123. Residents Affected - Few Findings include: Review of Resident #470's medical record revealed the resident was initially admitted on [DATE] and readmitted on [DATE] with diagnoses including acute respiratory failure with hypoxia, shortness of breath and acquired clubfoot. Review of Resident #470's Minimum Data Set (MDS) 3.0 assessment dated [DATE] indicated Resident #470 exhibited intact cognition. Observation on 12/04/23 at 8:30 A.M. revealed Resident #470's call light was not plugged into the wall for Resident #470 to call the nursing staff for assistance. Interview on 12/04/23 at 8:30 A.M. with Resident #470 revealed they had not had a call light since admission on [DATE]. Interview on 12/04/23 at 3:46 P.M. with Licensed Practical Nurse (LPN) #873 verified Resident #470 did not have a call light and there was no call light plugged into the wall. A search of the room revealed the unplugged call system in the bed of Resident #470's roommate. The call system was plugged in and tested by LPN #873. Residents #4, #10, #11, #48, #50, #52, #53, #54, #63, #85, #107, #112, #118, #470, #471, #472, #475 and #570 were alert and oriented and capable of using a call light to request staff assistance. Review of the policy titled: Resident Communication and Call Light Policy dated 02/24/23 revealed it was the policy of the facility to provide residents with a means of communicating with staff. A call system was to be installed in each resident room and toilet/bath areas. Page 1 of 17 365847 365847 12/07/2023 Bath Manor Special Care Centre 2330 Smith Road Akron, OH 44333

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility failed to ensure Residents #82's and #470's bathrooms were maintained at a comfortable ambient temperature. This affected two (Residents #82 and #470) of nine residents (Residents #10, #54, #55, #78, #82, #116, #470, #471 and #473) whose bathroom temperatures were checked. The census was 123. Findings include: Interview on 12/04/23 at 9:00 A.M. with Resident #82 revealed the resident's bathroom was cold. Resident #82 was observed in bed across from the bathroom with three blankets on and was wearing a stocking cap. Resident #82 stated cold air blew on them from the bathroom. Upon entering the bathroom it felt cold. Interview on 12/04/23 at 9:15 A.M. with Resident #470 revealed the resident's bathroom was cold. Interview and observation on 12/06/23 at 8:10 A.M. with Maintenance Director (MD) #856 revealed the ambient temperature on the 300 hall was 73.9 degrees Fahrenheit (F). The temperature in resident rooms was controlled by the thermostat in room [ROOM NUMBER]. Resident rooms did not have individual thermostats to control the temperatures in their rooms. Resident #82's room temperature was 75.3 degrees F and the temperature in the bathroom was 61.5 degrees F. The ambient temperature in Resident #470's bathroom was 62.2 degrees F. All temperatures were taken and verified by MD #856. A review of the policy titled; Temperature dated January 2016 revealed a comfortable temperature would be maintained in all resident areas within the home. The temperature range was to be maintained between 71 and 81 degrees F. 365847 Page 2 of 17 365847 12/07/2023 Bath Manor Special Care Centre 2330 Smith Road Akron, OH 44333

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure assessments were accurately completed. This affected four (Residents #4, #52, #93 and #112) of four residents reviewed for Minimum Data Set (MDS) 3.0 assessments. The facility census was 123. Residents Affected - Some Findings include: 1. Review of the medical record for Resident #4 revealed an admission date of 09/03/21 with diagnoses including chronic respiratory failure, depression and adult failure to thrive. Review of the physician's orders for November 2023 revealed Resident #4 had an order for a regular diet dated 08/11/23. Review of the quarterly MDS 3.0 assessment dated [DATE] for Resident #4 revealed under section K0520 that she did not have a feeding tube or parenteral/intravenous feedings. However, section K0710 was documented as receiving 25% or less total calories through parenteral or tube feeding as well as 500 cubic centimeters (cc)/day or less fluid intake per day by IV or tube feeding. Section K0710 stated to complete

K0710 only if checked in section K0520 for intake by artificial route. Interview on 12/05/23 at 2:25 P.M. with Dietitian #817 verified she had completed this section incorrectly. 2. Review of the medical record for Resident #52 revealed an admission date of 02/21/22 with diagnoses including dementia, hypertension (high blood pressure) and Parkinson's Disease. Review of the physician's orders for November 2023 revealed Resident #52 had an order for a regular diet with mechanical soft texture dated 10/03/23. Review of the quarterly MDS 3.0 assessment dated [DATE] for Resident #52 revealed under section K0520 that he did not have a feeding tube or parenteral/intravenous feedings. However, section K0710 was documented as receiving 25% or less total calories through parenteral or tube feeding as well as 500 cc/day or less fluid intake per day by IV or tube feeding. Section K0710 stated to complete K0710 only if checked in section K0520 for intake by artificial route. Interview on 12/05/23 at 2:25 P.M. with Dietitian #817 verified she had completed this section incorrectly. 3. Review of the medical record for Resident #93 revealed an admission date of 10/13/21 with diagnoses including diabetes mellitus, chronic kidney disease and anxiety. Review of the physician's orders for November 2023 revealed Resident #93 had an order for a regular diet with pureed texture dated 10/03/23. Review of the annual MDS 3.0 assessment dated [DATE] for Resident #93 revealed under section K0520 that she did not have a feeding tube or parenteral/intravenous feedings. However, section K0710 was documented as receiving 25% or less total calories through parenteral or tube feeding as well as 500 cc/day or less fluid intake per day by IV or tube feeding. Section K0710 stated to complete K0710 365847 Page 3 of 17 365847 12/07/2023 Bath Manor Special Care Centre 2330 Smith Road Akron, OH 44333

F 0641 only if checked in section K0520 for intake by artificial route. Level of Harm - Minimal harm or potential for actual harm Interview on 12/05/23 at 2:25 P.M. with Dietitian #817 verified she had completed this section incorrectly. Residents Affected - Some 4. Review of the medical record for Resident #112 revealed an admission date of 09/07/23 with diagnoses including chronic kidney disease, anxiety, depression and hypertension. Review of the physician's orders for November 2023 revealed Resident #112 had an order for a regular diet with regular texture dated 09/28/23. Review of the admission MDS 3.0 assessment dated [DATE] for Resident #112 revealed under section

K0520 that she did not have a feeding tube or parenteral/intravenous feedings. However, section K0710 was documented as receiving 25% or less total calories through parenteral or tube feeding as well as 500 cc/day or less fluid intake per day by IV or tube feeding. Section K0710 stated to complete K0710 only if checked in section K0520 for intake by artificial route. Interview on 12/05/23 at 2:25 P.M. with Dietitian #817 verified she had completed this section incorrectly. 365847 Page 4 of 17 365847 12/07/2023 Bath Manor Special Care Centre 2330 Smith Road Akron, OH 44333

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, interview and record review, the facility failed to provide timely incontinence care for residents. This affected one (Resident #4) of one resident reviewed for incontinence care. The facility census was 123. Residents Affected - Few Findings include: Review of the medical record for Resident #4 revealed an admission date of 09/03/21 with diagnoses including adult failure to thrive, need for assistance with personal care, and muscle weakness. Review of the care plan for Resident #4 dated 05/11/23 revealed she was incontinent of bladder. Staff were to provide incontinence care as needed. Review of the physician's orders for December 2023 revealed Resident #4 had an order for staff to check and change Resident #4 every two to three hours and as needed dated 08/11/23. Review the Treatment Administration Record (TAR) for October 2023 revealed staff had not documented that they had checked and changed Resident #4 every two to three hours on 10/05/23 and 10/15/23 for the 7:00 P.M. shift. Review of the TAR for November 2023 revealed staff had not documented that they had checked and changed Resident #4 every two to three hours on 11/07/23, 11/17/23 and 11/28/23 on the 7:00 P.M. shift as well as on 11/11/23 and 11/24/23 on the 7:00 A.M. shift. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #4 had no behaviors, did not refuse care and had an intact cognition. She was dependent on staff for toileting and was always incontinent of urine. Observation and interview on 12/04/23 at 9:02 A.M. of Resident #4 revealed she was in bed and eating breakfast. Resident #4 stated the staff did not provide incontinence care timely and she had not had incontinence care this morning. Observation and interview on 12/07/23 at 8:35 A.M. of Resident #4 revealed she was still in bed. She stated staff had not provided incontinence care for her today and care was never timely. Observation and interview on 12/07/23 at 10:25 A.M. of Resident #4 revealed she was in her wheelchair and dressed for the day. State Tested Nurse Aide (STNA) #951 was present in the room and finishing morning care. The bed was unmade and the draw sheet was wet and had a yellow circled area on it. When STNA #951 removed the draw sheet, the bed pad underneath was also wet and had yellow coloring on it. The room had an odor of urine. Resident #4 stated she had not been provided incontinence care since she went to bed the night before. STNA #951 stated she arrived at the facility at 6:00 A.M. and had not been able to provide care to Resident #4 because she had been taking care of other residents. Interview on 12/07/23 at 11:08 A.M. with Licensed Practical Nurse (LPN) #876 revealed Resident #4 had put on her call light at 8:30 A.M. and stated she was ready to get up, get cleaned up and dressed for the day. LPN #876 stated she checked Resident #4's colostomy. LPN #876 stated she updated STNA 365847 Page 5 of 17 365847 12/07/2023 Bath Manor Special Care Centre 2330 Smith Road Akron, OH 44333

F 0677 #951 that Resident #4 was ready to get out of bed. Level of Harm - Minimal harm or potential for actual harm Review of the policy titled, Morning Care/AM Care, revised on 11/08/23, revealed morning care would be offered each day to promote resident comfort, cleanliness, grooming and general well-being. Residents Affected - Few 365847 Page 6 of 17 365847 12/07/2023 Bath Manor Special Care Centre 2330 Smith Road Akron, OH 44333

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, the facility failed to ensure Resident #107's tube feeding was infused per the physician's orders. This affected one resident (Resident #107) of one resident reviewed for tube feedings. The facility census was 123. Findings include: Review of Resident #107's medical record revealed the resident was admitted on [DATE] with diagnoses including hemiplegia and hemiparesis, gastrostomy status and cognitive communication deficit. Review of Resident #107's physician orders revealed an order dated 08/01/23 for Isosource 1.5 at 60 cubic centimeters (cc) via a percutaneous endoscopic gastrostomy tube (PEG) for 20 hours per day. Turn off the tube feed solution at 12:00 P.M. and turn back on at 4:00 P.M. Review of Resident #107's Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident exhibited moderate cognitive impairment. Observation on 12/07/23 at 9:45 A.M. revealed Resident #117 in bed. The tube feeding pump was turned off. The end of the tube was hanging over the tube feeding pole and not connected to the resident. Interview on 12/07/23 at 9:50 A.M. with Licensed Practical Nurse (LPN) #607 verified the tube feeding was disconnected and not running. LPN #607 stated medications were administered via the PEG tube at 8:15 A.M. and the tube feed was reconnected at that time. LPN #607 was unaware how or when the feeding for Resident #117 became disconnected/turned off. Interview on 12/07/23 at 3:15 P.M. with the Director of Nursing (DON) revealed the feeding was disconnected by her at approximately 9:15 A.M. due to Resident #117 complaining of abdominal pain. The DON confirmed there was no documentation as to why it was turned off and the DON did not notify anyone about the disconnection of the feeding or the abdominal pain. A review of the policy titled; Enteral Feeding Tube Policy dated 09/29/21 revealed the feeding tube should not be used if there was any doubt as to placement. The physician or provider should be contacted for guidance. 365847 Page 7 of 17 365847 12/07/2023 Bath Manor Special Care Centre 2330 Smith Road Akron, OH 44333

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on record review and interview, the facility failed to ensure medications were obtained timely from the pharmacy and were administered as ordered. This affected one (Resident #48) of three residents reviewed for pain medications being administered as ordered. The facility census was 123. Findings include: Review of the medical record for Resident #48 revealed an admission date of 06/28/23 with diagnoses including anxiety disorder, epilepsy, restlessness/agitation, polyneuropathy, and diffuse traumatic brain injury (TBI) with loss of consciousness. Review of the physician's order dated 06/29/23 revealed an order for hospice services related to TBI with loss of consciousness. Review of the plan of care dated 06/29/23 revealed Resident #48 had chronic pain related to TBI and polyneuropathy. Interventions included to administer pharmacological interventions as ordered. Review of the physician's order dated 06/30/23 revealed an order for Hydromorphone Hydrochloride (HCl) eight milligrams (mg) every four hours for pain. Review of the plan of care dated 07/02/23 revealed Resident #48 required hospice services. Interventions included to maintain Resident #48's comfort level. Review of the Medication Administration Record (MAR) for July 2023 revealed Resident #48's order for Hydromorphone HCl eight mg was reduced from every four hours to every six hours on 07/07/23. There was no evidence of administration of Hydromorphone HCl eight mg on 07/01/23 at 9:00 P.M., 07/02/23 at 1:00 A.M., 07/02/23 at 5:00 A.M., 07/02/23 at 9:00 A.M., 07/02/23 at 1:00 P.M., 07/02/23 9:00 P.M., 07/03/23 at 1:00 A.M., 07/04/23 at 9:00 A.M., 07/22/23 at 6:00 A.M., 07/29/23 at 6:00 A.M. Review of Medication Administration Note dated 07/02/23 at 8:47 A.M. revealed Hydromorphone HCl was unavailable. Review of Medication Administration Note dated 07/02/23 at 10:12 P.M. revealed the facility was awaiting Hydromorphone HCl from pharmacy. Review of Medication Administration Note dated 07/03/23 at 5:45 A.M. revealed the facility was awaiting Hydromorphone HCl from pharmacy. Review of the physician's order dated 07/07/23 revealed an order for Hydromorphone Hydrochloride (HCl) eight milligrams (mg) every six hours for pain. Review of the MAR for September 2023 revealed there was no evidence of administration of Hydromorphone HCl eight mg on 09/29/23 at 12:00 P.M. Review of Medication Administration Note dated 09/29/23 at 1:38 P.M. revealed Hydromorphone HCl was unavailable and pending delivery from pharmacy. 365847 Page 8 of 17 365847 12/07/2023 Bath Manor Special Care Centre 2330 Smith Road Akron, OH 44333

F 0755 Level of Harm - Minimal harm or potential for actual harm Review of Nursing Note dated 09/29/23 at 3:29 P.M. revealed Resident #48 was very tearful and emotional. Resident #48 expressed feelings towards dying and hospice was contacted. Review of Medication Administration Note dated 09/29/23 at 5:27 P.M. revealed Hydromorphone HCl was not available and pending delivery from pharmacy. Residents Affected - Few Review of Medication Administration Note dated 09/29/23 at 6:13 P.M. revealed Resident #48 was administered Alprazolam for displaying signs and symptoms of anxiety and agitation. Review of Nursing Note dated 09/29/23 at 6:33 P.M. revealed Hospice services nurse visited Resident #48 and assured him comfort medications were available and prescriptions were up to date. Review of the MAR for October 2023 revealed there was no evidence of administration of Hydromorphone HCL eight mg on 10/27/23 at 6:00 P.M. Review of the MAR for November 2023 revealed there was no evidence of administration of Hydromorphone HCL eight mg on 11/04/23 at 12:00 A.M., 11/11/23 at 12:00 P.M., and 11/11/23 at 6:00 P.M. Review of Medication Administration Note dated 11/04/23 at 5:48 A.M. revealed Hydromorphone HCl was unavailable and pharmacy was notified for drop shipment. Review of Medication Administration Note dated 11/11/23 at 2:03 P.M. revealed Hydromorphone HCl was on order. Review of Medication Administration Note dated 11/11/23 at 6:00 P.M. revealed Hydromorphone HCl was unavailable and awaiting delivery from pharmacy. Interview on 12/04/23 at 11:54 A.M. with Resident #48 and his wife revealed he frequently ran out of medications including pain medication Hydromorphone HCl. Resident #48 indicated he was told by hospice the order was standing and he should not have trouble getting refills on medications. Attempts on 12/07/23 at 1:28 P.M. and 12/07/23 2:49 P.M. to review missing medication administration with the Director of Nursing (DON) were unsuccessful. The DON indicated she needed more time to obtain documentation. Attempts to obtain documentation were made on 12/06/23 at 4:39 P.M., 12/07/23 at 10:00 A.M., 10:50 A.M., and 11:39 A.M. The DON indicated there were concerns with pharmacy and reported plans to change pharmacy services to another company. The DON indicated there was a limited amount of medications in the emergency/starter kit for use and with the size of the facility they needed a better starter kit. Interview on 12/07/23 at 4:00 P.M. with the Administrator, Regional Nurse, and DON revealed no additional evidence related to missing Hydromorphone HCl administrations on MARs was provided. 365847 Page 9 of 17 365847 12/07/2023 Bath Manor Special Care Centre 2330 Smith Road Akron, OH 44333

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to dispose of medications when they expired. This affected two (Residents #30 and #69) of four residents reviewed for medication storage. The facility census was 123. Findings include: 1. Review of the medical record for Resident #30 revealed an admission date of [DATE] with diagnoses including stroke, diabetes mellitus and depression. Review of the physician's orders for [DATE] revealed Resident #30 had an order for Humalog KwikPen 100 units/milliliter (mL), inject six units with meals for diabetes dated [DATE]. Review of the Medication Administration Record (MAR) for [DATE] revealed Resident #30 had received Humalog medication at meals on [DATE], [DATE], [DATE], [DATE] and [DATE]. Observation and interview on [DATE] at 11:10 A.M. with Licensed Practical Nurse (LPN) #919 of the medication cart for the 200 hall revealed Resident #30's Humalog Kwik Pen to be expired as it stated on the pen date opened on [DATE]. LPN #919 verified the insulin had been opened and used longer than 28 days. Review of the facility policy titled, Storage and Expiration Dating of Medications, revised [DATE] revealed the facility should destroy or return all discontinued, outdated/expired or deteriorated medications. Review of manufacturer guidance for use of Humalog KwikPen, revised 07/2023, revealed in use Humalog KwikPen should be stored at room temperature, below 86 degrees Fahrenheit (F) and must be used within 28 days or be discarded even if it still contains Humalog. 2. Review of the medical record for Resident #69 revealed an admission date of [DATE] with diagnoses including altered mental status, depression and diabetes mellitus. Review of the physician's orders for [DATE] revealed Resident #69 had an order for Insulin Lispro 100 units/milliliter (mL), inject per sliding scale three times a day dated [DATE]. Review of the Medication Administration Record (MAR) for [DATE] revealed Resident #69 had received Insulin Lispro medication three times a day as ordered on [DATE], [DATE], [DATE], [DATE] and [DATE]. Observation and interview on [DATE] at 11:10 A.M. with Licensed Practical Nurse (LPN) #919 of the medication cart for 200 hall revealed Resident #69's Novolog Flex Pen (therapeutic interchange for Insulin Lispro) to be expired as it stated on the pen date opened on [DATE]. LPN #919 verified the insulin had been opened and used longer than 28 days. Review of the facility policy titled, Storage and Expiration Dating of Medications, revised [DATE] revealed the facility should destroy or return all discontinued, outdated/expired or deteriorated 365847 Page 10 of 17 365847 12/07/2023 Bath Manor Special Care Centre 2330 Smith Road Akron, OH 44333

F 0761 medications. Level of Harm - Minimal harm or potential for actual harm Review of the manufacture package insert for Novolog Flex Pen, revised 03/2023, revealed in use (opened) single patient use FlexPen were to be stored at room temperature for 28 days. Residents Affected - Few 365847 Page 11 of 17 365847 12/07/2023 Bath Manor Special Care Centre 2330 Smith Road Akron, OH 44333

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure a clean and sanitary kitchen area. This had the potential to affect all residents who received meals from the kitchen. The facility identified 12 residents (#2, #13, #15, #41, #62, #77, #80, #88, #94, #96, #420, and #670) that had a nothing by mouth (NPO) diet. The facility census was 123. Findings include: Observations of the facility kitchen on 12/04/23 at 8:22 A.M. revealed a fan located by the ice machine covered in dust. The ice machine had a white colored build up at the gaskets and the down sides. There was an unidentified brown substance on the inside of the ice machine. There were juice concentrate boxes (cranberry, fruit punch, orange, and apple) on the floor in front of the juice and coffee preparation table. Observation of the dish machine area revealed the walls were splattered with dried on food debris/drips. The floor of the dish machine area had a sticky residue with food debris throughout. There was a strong odor coming from garbage disposal and observation revealed there was large amount of food blocking the drain. The dish machine had food residue down the sides and front. Interview on 12/04/23 at 8:24 A.M. with Dietitian #817 revealed she did not typically spend much time in the kitchen. Dietitian #817 indicated she did sanitation audits and had identified issues in the past. The findings were confirmed with Dietitian #817. Observations of the dry storage area on 12/04/23 at 8:28 A.M. revealed multiple boxes resting on the floor including bags of egg noodles, boxes of fudge rounds, cans of white potato, cans of peaches, cans of chicken noodle soup, containers of mayonnaise, cans of banana pudding, cans of mandarin oranges, cans of pear, cans of creamed corn, box of orange juice concentrate, box of lemonade concentrate, boxes of cornbread mix, bag of rice, and containers of ketchup. There was a large bin of granulated sugar that was uncovered. Kitchen staff coats and purses were on the racks containing food. The floors in the dry storage area, including under storage racks were coated in food residue and debris. Interview on 12/04/23 at 8:31 A.M. with Dietitian #817 confirmed the findings in the dry storage area. Dietitian #817 indicated dry storage deliveries were on Thursdays. Observations of the walk-in cooler on 12/04/23 at 8:32 A.M. revealed the floors were coated in food debris and dark sticky residue in the walkway and under the storage racks. A plastic tub of left over canned pears was covered in plastic wrap unlabeled and undated with a serving spoon resting inside, a half bag of shredded cheddar cheese was wrapped in plastic wrap with no date or label, sliced cheese was wrapped in plastic wrap with no date or label, there was an uncovered packet of sliced cheese with no open date or label, deli ham was wrapped in plastic wrap with no label or date, an onion was wrapped in plastic wrap with no label or date, a half of an onion was wrapped in plastic wrap with no label or date, there was a bag of shredded mozzarella cheese with a bag clip on top however the bag was not fully sealed with no label or date, an open bag of shredded parmesan cheese with no label or date, and a second open bag of shredded mozzarella cheese with no label or date. There was a tray of dished pudding not covered or dated. There was an unidentified white substance in an eight-quart bin with no label or date and the top of the food product was covered in mold. There was an 365847 Page 12 of 17 365847 12/07/2023 Bath Manor Special Care Centre 2330 Smith Road Akron, OH 44333

F 0812 open bin of hard-boiled eggs. Level of Harm - Minimal harm or potential for actual harm Observation of the walk-in freezer on 12/04/23 at 8:37 A.M. revealed ice buildup at the freezer condenser and a food storage rack below. There were boxes of pancakes, dinner rolls, and pizza resting on the floor. Residents Affected - Many Observation of the food preparation area on 12/04/23 at 8:38 A.M. revealed the outside of oven with drips of food debris and burnt on grease buildup. The kitchen ventilation hood grates were covered in thick layer of dust. The four-burner range had a layer of burnt on grease on grates and drips of food debris on sides of equipment. There was a preparation table with food debris on the lower rack. The can opener had dark dried on debris. The tilt skillet had dried food splatters down the front. The toaster had dark dried on food debris. The floors in preparation areas were sticky with food debris and debris under equipment. Interview on 12/04/23 at 8:42 A.M. with Dietitian #817 confirmed the findings in the walk-in cooler, walk-in freezer, and food preparation areas. Review of the facility Storage of Dry Food Policy dated 06/21/21 revealed dry goods would be stored in a manner to avoid contamination, optimize food safety, and protect food quality. Food would be stored a minimum of six inches above the floor. When the original packaging was opened food must be stored in a container that could be sealed or covered. Dry storage rooms would be neat and orderly. Review of the facility Storage of Refrigerated Foods Policy dated 08/02/23 revealed perishable foods would be stored in order to maximize food safety and quality. All food and leftovers would be stored in covered approved food grade containers. Food items would be marked to indicate the date the food would be consumed or discarded by. Review of the facilityFood Preparation Area Policy dated 06/07/21 revealed the facility would maintain clean, sanitary and safe food preparation areas. All machines and equipment would be cleaned after use. Review of Daily Cleaning Assignments undated revealed each position had daily cleaning assignments including preparation equipment, floors, walls, dish machine area, ice machine, coolers, and freezers. Review of facility Delivery Schedule undated revealed the facility received deliveries from US Foods on Thursdays, Prairie Farms Dairy on Tuesdays, and [NAME] Breads on Saturdays. 365847 Page 13 of 17 365847 12/07/2023 Bath Manor Special Care Centre 2330 Smith Road Akron, OH 44333

F 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure the dumpster area was maintained in a clean and sanitary manner. This had the potential to affect all residents. The facility census was 123. Residents Affected - Many Findings include: Observation on 12/04/23 at 8:45 A.M. revealed three dumpsters. One dumpster was propped open with a white post. Observation behind and around the sides of the dumpsters revealed significant debris including gloves, boxes, plastic bags, plastic cups, a gas can, a wheelchair, stack of wooden pallets, and an upholstered chair. Interview on 12/04/23 at 8:47 A.M. with Dietitian #817 confirmed the findings. Dietitian #817 indicated she was unsure of who was responsible for keeping the area clean and clear. Review of the facility Waste Disposal Policy dated 06/05/18 revealed trash bags would be sealed prior to removing them from the facility. Trash would be deposited into a sealed container outside the premises. Outside dumpster lids and doors would remain closed and secure when not in use. 365847 Page 14 of 17 365847 12/07/2023 Bath Manor Special Care Centre 2330 Smith Road Akron, OH 44333

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure Resident #10's medical record was complete and accurate. This affected one resident (#10) of two residents reviewed for antibiotic use. The facility census was 123. Findings include: Review of Resident #10's medical record revealed the resident was admitted on [DATE] with diagnoses including diabetes, neuromuscular dysfunction of the bladder and osteomyelitis. Review of Resident #10's physician orders revealed an order dated 11/04/23 for Vancomycin intravenous solution (antibiotic) infuse 1.5 grams intravenously every 12 hours for osteomyelitis until 11/20/23 and an order dated 11/04/23 for piperacillin sod-tazobactam intravenous solution (antibiotic) 3.375 grams infuse 3.375 grams every eight hours for osteomyelitis until 11/20/23. Review of Resident #10's Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident exhibited intact cognition. Review of Resident #10's medication administration records (MARS) from 11/04/23 to 11/20/23 did not reveal evidence the vancomycin antibiotic was administered as ordered on 11/07/23 at 9:00 A.M., 11/08/23 at 9:00 A.M., 11/16/23 at 9:00 A.M., 11/17/23 at 9:00 A.M. and 11/20/23 at 9:00 A.M. The MARS did did not reveal evidence the piperacillin-sod-tazobactam antibiotic was administered as ordered on 11/05/23 at 6:00 A.M., 11/06/23 at 2:00 P.M., 11/07/23 at 2:00 P.M., 11/08/23 at 2:00 P.M. and 11/20/23 at 2:00 P.M. Interview with Registered Nurse (RN) #861 on 12/07/23 at 11:30 A.M. revealed the antibiotics were given as ordered by her. RN #861 verified the medications were not signed off as administered. Interview with Resident #10 on 12/07/23 at 1:00 P.M. verified that all antibiotics were administered as ordered. Review of the Medication Administration policy dated 01/01/22 revealed, After medication administration, facility staff should take all measures required by facility policy and applicable law including but not limited to the the following: Document medication administration/treatment information on appropriate forms. 365847 Page 15 of 17 365847 12/07/2023 Bath Manor Special Care Centre 2330 Smith Road Akron, OH 44333

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review, the facility failed to maintain adequate infection control practices during administration of medications to residents. This affected one (Resident #6) of six residents observed during medication administration. The facility census was 123. Residents Affected - Few Findings include: Review of the medical record for Resident #6 revealed an admission date of 12/02/22 with diagnoses including hypertension (high blood pressure), anxiety and altered mental status. Review of the physician's orders for December 2023 revealed Resident #6 had orders for venlafaxine (medication for depression) 150 milligrams (mg), furosemide (diuretic) 40 mg, clonazepam (medication for anxiety) 1 mg and oxybutynin chloride (medication for overactive bladder) 5 mg. Observation on 12/05/23 at 8:05 A.M. of the medication administration to Resident #6 by Licensed Practical Nurse (LPN) #917 revealed LPN #917 pulled the clonazepam medication card from the narcotic drawer, popped the pill in her hand and placed the card back in the narcotic drawer. When asked to see the medication card and pill, LPN #917 held her hand out and the medication was in her bare hand. LPN #917 then placed the medication into a medication cup. LPN #917 then continued with Resident #6's medication administration and placed oxybutynin, furosemide and venlafaxine into the medication cup. LPN #917 moved the medication cup which then spilled the medications on to the top of the medication cart. LPN #917 picked up the medications in her bare hand and placed them back in the medication cup. LPN #917 then administered the medications to Resident #6. Review of the facility policy titled, General Dose Preparation and Medication Administration, revised 01/01/22, revealed staff should not touch the medication when opening a bottle or unit dose package. 365847 Page 16 of 17 365847 12/07/2023 Bath Manor Special Care Centre 2330 Smith Road Akron, OH 44333

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on observation and interview, the facility failed to ensure space heaters were not used by residents in the facility. This affected one resident (Resident #116) and had the potential to affect an additional 28 residents (Residents #1, #10, #17, #25, #26, #39, #50, #54, #58, #63, #66, #67, #82, #84, #85, #101, #107, #110, #120, #470, #471, #472, #473, #474, #475, #476, #477 and #670) residing on the 300 hall. The census was 123. Findings include: Observation on 12/05/23 at 9:00 A.M. revealed a space heater in use in Resident #116's room. Interview with Resident #116's wife at the time of the observation revealed the space heater was used to keep the room warm. An interview on 12/05/23 at 1:45 P.M. with the Administrator revealed space heaters were prohibited in the building. The administrator stated the space heater had since been removed. Review of the Census form revealed 29 residents resided on the 300 hall including Residents #1, #10, #17, #25, #26, #39, #50, #54, #58, #63, #66, #67, #82, #84, #85, #101, #107, #110, #116, #120, #470, #471, #472, #473, #474, #475, #476, #477 and #670. Review of policy titled Prohibition on Use of Space Heaters dated March 2020 revealed the facility prohibited the use of any portable space heating devices. 365847 Page 17 of 17