Health inspection·June 15, 2023

F 0744 Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia. Level of Harm - Minimal harm or potential for actual harm Based on medical record review, staff interview, and review of facility policy, the facility failed to maintain a safe environment for residents residing on the secured memory care unit, when Resident #21 was able to retrieve a steak knife from behind the nursing station. This affected one resident (#21) of three residents reviewed for environment, and had the potential to affect all 23 residents (#1, #2, #3, #4, #5, #6, #7, #8, #9, #10, #11, #12, #13, #14, #15, #16, #17, #18, #19, #20, #21, #22, and #23) residing on the secured memory care unit. The facility census was 100. Residents Affected - Some Findings include: Review of Resident #21's medical record revealed an initial admission date of 02/08/23. Diagnoses included dementia, tremor, age-related debility, hypertension, and altered mental status. Review of Resident #21's most recent completed Minimum Data Set assessment, dated 04/30/23, identified the resident was cognitively impaired with a Brief Interview for Mental Status (BIMS) score of five. The resident exhibited verbal behaviors directed toward others and other behavioral symptoms not directed toward others between one and three days within the lookback period. The resident required supervision for a majority of the activities of daily living. Review of Resident #21's current plan of care, revised 03/17/23, revealed the resident was at risk for harm to self. Goals included remaining safe in a secure setting. Interventions included assisting with decision-making as needed, allowing time to perform tasks, and minimizing environmental stimulation. Review of Resident #21's current plan of care, revised 03/17/23, revealed there was a need to monitor behaviors, resident had potential for altered behavioral patterns, disruptive interactions, disruptive verbally, resistive to care, violence/anger, agitation and/or anxiety, agitation, altered thought process, dementia, wandered into other resident rooms, refused care, rummaged in other resident belongings, carried his belongings around, hid or slept in other resident beds, got combative, and agitated with staff providing care. Interventions included administering prescribed medications, praising positive behavior, and removing from public area when behavior was unacceptable. Review of Resident #21's nursing progress notes dated 05/10/23 and timed 6:10 P.M. revealed the resident's niece attempted to cut off the resident's wander management device. The niece was educated on the importance of the resident having the device on. The niece then handed the resident a long pointed end piece of metal so he could try to take it off himself. The object was removed from the resident's possession and was in a safe keeping place. Page 1 of 2 365865 365865 06/15/2023 Main Street Care Center 500 Community Drive Avon Lake, OH 44012

F 0744 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of Resident #21's nursing progress notes dated 06/12/23 and timed 5:07 P.M. revealed the resident cut off his wander management device. The resident was educated on the importance of the wander management device and not to cut it off. Another wander management device was placed on the resident. Review of Resident #21's nursing progress notes dated 06/14/23 revealed during care State Tested Nurse Aides (STNA) found a sharp steak knife wrapped in paper and stuffed inside socks and the resident was carrying it around. The knife was removed from the resident, the Nurse Practitioner was notified, and the resident was sent to the emergency room for a psychiatric evaluation. The resident returned to the facility on the evening of 06/14/23. Interview on 06/14/23 at 10:33 A.M. with STNA #365 revealed Resident #21 had previously been found with nail clippers which he used to cut or attempt to cut his wander management device of with. The resident had also been found to have scissors which staff believed the resident obtained from his family. STNA #365 reported on 06/14/23, the resident was found to have a steak knife. STNA #365 stated Resident #21 had been harmful before and residents residing on the memory care unit were not supposed to have sharp objects such as knives or scissors. Interview on 06/14/23 at 12:49 P.M. with Registered Nurse (RN) #403 revealed on 06/12/23, Resident #21 had obtained a pair of scissors and cut off his wander management device. RN #403 stated she believed the resident obtained the scissors from a family member. RN #403 also verified Resident #21 was found to have a steak knife hidden in a sock on 06/14/23. Interview on 06/14/23 at 5:38 P.M. with the Director of Nursing (DON) verified residents residing on the memory care unit were not supposed to have sharp objects such as scissors and knives. The DON also verified Resident #21 had and previously used nail clippers and scissors to cut off and/or attempt to cut off his wander management device. The DON reported the scissors were obtained from a family member and staff were unsure of how the resident obtained the nail clippers. The DON verified the resident was found with a steak knife on 06/14/23, which he had retrieved from behind the nursing station while staff were not in the area. The DON confirmed there are 23 residents (#1, #2, #3, #4, #5, #6, #7, #8, #9, #10, #11, #12, #13, #14, #15, #16, #17, #18, #19, #20, #21, #22, and #23) residing on the secured memory care unit that could have potentially been affected. Review of the facility-provided document titled Nursing Home Residents' [NAME] of Rights, not dated, revealed residents had the right to safe and clean living environment. This deficiency represents non-compliance investigated under Complaint Number OH00143144. 365865 Page 2 of 2