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 (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 3 Event ID: 365870 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365870 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Judson Park 2181 Ambleside Rd Cleveland, OH 44106 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)