Health inspection·March 5, 2020

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and policy review, the facility did not ensure two residents (Residents #20 and #137) of five residents reviewed for unnecessary medications had as needed psychotropic medications addressed for necessity and a duration. The facility identified three additional residents who received as needed psychotropic medications, Residents #3, #4, and #8. Findings include: 1. Review of the medical record for Resident #20 revealed an admission on [DATE]. Diagnoses included pleural effusion, shortness of breath, irregular heartbeats, cancer, congestive heart failure and adjustment disorder with other symptoms. The medical record reflected on 02/05/20 the physician had placed an initial order for Lorazepam, an antianxiety medication, 0.5 milligram (mg) every two hours as needed for anxiety or restlessness. No stop date was indicated or stated on the order. An interview was completed on 03/03/20 at 4:50 P.M. with the Registered Nurse (RN) #502 and verified the lack of evidence of a 14-day re-evaluation for the use of the anti-anxiety medication. Upon entrance to the facility on [DATE] at 7:30 A.M. no information was provided to evidence the 14-day reevaluation requirement. A note was left at the surveyor's desk to indicate the medication was discontinued. No evidence of the 14-day requirement was presented. An interview on 03/04/20 at 3:05 P.M. was conducted with the Administrator and these findings were verified. Review of the document titled, Psychotropic Medications, last revision 01/2019, was completed, and this policy stated under bullet point #8, The physician or advanced practice nurse provides documentation in the clinical record to support the need for medications. If as needed medications are used, the documentation should be reviewed every 14 days and the rationale documented in the clinical record. 2. Resident #137 was admitted to the facility on [DATE] with diagnoses including multiple sclerosis, anxiety disorder, and major depressive disorder. Review of Resident #137's March 2020 physician orders revealed an order for Ativan (antianxiety medication) 0.5 mg every four hours as needed for pain ordered 02/05/20 without a stop date and Prochlorperazine Maleate (antipsychotic medication) 10 mg every eight hours as needed for nausea without a stop date. Review of Resident #137's medical record revealed Resident #137 had been seen by the physician on Page 1 of 3 365870 365870 03/05/2020 Judson Park 2181 Ambleside Rd Cleveland, OH 44106

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 02/06/20 who documented the order of the as needed antianxiety medication and on 02/05/20 and 02/19/20 by the nurse practitioner who documented in the 02/19/20 note to continue as needed medications, not currently using at this time. None of the three visit notes specifically documented Resident #137's receipt of the as needed antipsychotic medication or a duration for the as needed antianxiety medication. Resident #137's medical record did reveal the pharmacy had reviewed the physician orders on 02/14/20 and only identified a need for a diagnosis related to Resident #137's antidepressant medication. Review of Resident #137's Medication Administration Record (MAR) since admission revealed neither the antianxiety or antipsychotic medications had been used. Interview with RN #502 on 03/03/20 at 4:50 P.M. verified the presence of the antianxiety and antipsychotic medication orders without stop dates and physician justification. Review of the facility policy titled, Psychotropic Medications, revised January 2019, stated the physician or advanced practice nurse provides documentation in the clinical record to support the need for medications and if as needed medications are used, the documentation should be reviewed every 14 days and the rationale documented in the clinical record. 365870 Page 2 of 3 365870 03/05/2020 Judson Park 2181 Ambleside Rd Cleveland, OH 44106

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 observations, interview and record review, the facility failed to ensure medication was administered and secure for one resident (Resident #131) of 33 residents observed during the annual survey. The facility identified nine residents (Residents #1, #11, #13, #14, #15, #127, #129, #135 and #139) who were independently mobile with or without an assistive device. Findings include: Resident #131 was admitted to the facility on [DATE] with diagnoses including lung cancer, breast cancer, ovarian cancer, and status post intestinal obstruction with surgical repair. Review of Resident #131's medical record revealed a Brief Interview for Mental Status (BIMS) was completed on 02/28/20 where Resident #131 scored a 14 which demonstrated no cognitive impairment. Observation of Resident #131's bedside table on 03/02/20 at 9:55 A.M. revealed a breakfast tray which the resident was still eating off of, numerous toiletry items including tissues, a mirror, and brush, and a small plastic cup with five pills. During Resident #131's interview on 03/02/20 at 9:55 A.M., Resident #131 stated the facility staff leave her medications for her to take after she finishes her breakfast. Staff interview with Registered Nurse (RN) #500 on 03/02/20 at 10:02 A.M. verified the cup of medications at Resident #131's bedside and stated the medications should not have been left, and RN #500 then took the medications from Resident #131's room. On 03/02/20 at 10:05 A.M., RN #501 verified she had left the medications and identified the medications as Losartan (used to treat high blood pressure), Loperamide (antidiarrheal), Norvasc (used to treat high blood pressure), Tylenol (pain medication), and Singulair (asthma medication). 365870 Page 3 of 3