Health inspection·July 25, 2023

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, medical record review, policy review and interview, the facility failed to provide a secured and locked location for Resident #9 to store medications for self-administration. This affected one of one resident who self administered medications. The census was 28. Findings include: Review of the medical record for Resident #9 revealed an admission date of 11/28/22 with diagnoses of depression, generalized anxiety disorder, alcohol induced pancreatitis, alcohol abuse and limitation of activities due to disability. Review of the Self-Administration Skills assessment dated [DATE] revealed Resident #9 could correctly secure medications. Review of the nursing note dated 06/23/23 revealed the Director of Nursing (DON) and Assistant Director of Nursing (ADON) spoke with Physician #10 and agreed that Resident #9 was able to self-administer his own medications and that his orders in the electronic medical record would now reflect self-administering of his medications. The nurse was aware of this, and he had been given all his medications. Review of the Minimum Data Set (MDS) 3.0 quarterly assessment dated [DATE] revealed Resident #9 was cognitively intact, independent with transfers, dressing, toilet use and personal hygiene. Review of the physician orders from July 2023 revealed Resident #9 was ordered the following medication for self-administration: Folic Acid (a vitamin) 1 milligram (mg) by mouth one time a day, Magnesium Oxide (a nutritional supplement) 400 mg by mouth one time a day, multivitamin tablet by mouth once a day, Methocarbamol 500 mg tablet (a muscle relaxant) give 1000 mg by mouth three times a day, Oxybutynin Chloride 5 mg tablet (a bladder relaxant) by mouth one time a day, Carvedilol 12.5 mg tablet (used to treat high blood pressure and heart failure) by mouth every morning and at bedtime, Finasteride 5 mg tablet (used to treat urinary retention) by mouth one time a day, Meloxicam 15 mg tablet (an anti-inflammatory medication) by mouth in the morning, Paroxetine 40 mg tablet (an antidepressant medication) by mouth in the morning, Tamsulosin HCl 0.4 mg tablet (used to treat urinary retention) by mouth two times a day, Trazadone HCl 100 mg tablet (an antidepressant medication) by mouth at bedtime, Buspirone HCl 30 mg tablet (used to treat anxiety) by mouth two times a day, and Omeprazole 40 mg one capsule (treats stomach problems) by mouth one time a day. Page 1 of 3 365874 365874 07/25/2023 Hudson Elms Nursing Center 563 W Streetsboro Road Hudson, OH 44236

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Observation on 07/24/23 at 10:33 A.M. revealed Resident #9 had a bottle of Magnesium Oxide 400 milligrams (mg), a bottle of folic acid 800 mg, and a bottle of multivitamin on his overbed table in his room. Further observation with Resident #9 revealed a medication bubble pack of 30-tablets of Finasteride 5 mg and another medication bubble pack of 30-tablets of Buspirone HCl 30 mg that were stored in a green plastic bag on the floor of Resident #9's room. Interview, during the observation, with Resident #9 revealed he self-administered his own medication except for Norco (a narcotic pain reliever). Interview on 07/24/23 at 1:25 P.M. with the DON revealed Resident #9 began self-administering medications on 06/23/23. The DON believed his medications were kept in his backpack in his room. The DON verified Resident #9's medications were not stored in a locked and secured location. The DON also verified Resident #9 was not provided a locked box to store his medications. Another observation on 07/24/23 at 1:45 P.M. with Resident #9 revealed all his medications that were stored in 30-tablet medication bubble packs were stored in three green plastic bags by his bed on the floor of his room. The three green plastic bags contained the following 30-tablet medication bubble packs: 11 bubble packets of Methocarbamol tablets, five bubble packs of Tamsulosin HCl tablets, one bubble pack of Oxybutynin tablets, two bubble packs of Meloxicam tablets, two bubble packs of Trazadone tablets, two bubble packs of Omeprazole tablets, two bubble packets of Paroxetine tablets and four bubble packs of Carvedilol tablets. Review of the facility's Self-Administration of Medications policy dated February 2021 revealed the interdisciplinary team considered the following when determining whether self-administration of medications was safe and appropriate for the resident. The resident was able to safely and securely store the medication. Self-administered medications were stored in a safe and secure place, which was not accessible by other residents. If safe storage was not possible in the resident's room, the medications of residents permitted to self-administer were stored on a central medication cart or in the medication room. Review of the facility's Storage of Medications policy dated November 2020 revealed drugs and biologicals used in the facility were to be stored in locked compartments under proper temperature, light and humidity controls. Only persons authorized to prepare and administer medications were to have access to locked medications. This deficiency represents non-compliance investigated under Complaint Number OH00144188. 365874 Page 2 of 3 365874 07/25/2023 Hudson Elms Nursing Center 563 W Streetsboro Road Hudson, OH 44236

F 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm Based on observation, policy review, and interview, the facility failed to serve palatable food at a preferred temperature. This affected three residents (Residents #9, #6 and #29) and had the potential to affect 21 additional residents (Residents #3, #5, #7, #8, #11, #12, #13, #14, #15, #16, #17, #19, #20, #21, #22, #23, #24, #25, #26, #27 and #28) who were ordered a regular or mechanical soft diet. The census was 28. Residents Affected - Some Findings include: Observation on 07/24/23 at 8:34 A.M. revealed [NAME] #1 serving breakfast for the residents who ate in their rooms. At 8:42 A.M., [NAME] #1 plated a test tray. The test plate was enclosed by an insulated plate cover and base and placed in a covered uninsulated meal cart. At 8:44 A.M., the meal cart was delivered to the 200-unit and the Director of Nursing began serving the meal trays to residents residing on the 200-unit. At 8:51 A.M., the same meal cart was transported to the 100-unit and staff began serving the meal trays to residents residing on the 100-unit. At 8:54 A.M., all the residents had received their meal tray on both units. The test tray included sausage gravy over biscuits. Dietary Manager (DM) #3 used a thermometer to take the temperature of the food. The temperature of the sausage gravy over biscuit was 100 degrees Fahrenheit (F). The sausage gravy was runny/watery and tasted room-temperature. Interview, during completion of the test tray, with DM #3 verified the temperature of the sausage gravy over biscuit. Interview on 07/24/23 at 10:33 A.M. with Resident #9 revealed the food was not good. Interview on 07/24/23 at 12:01 P.M. with Resident #6 revealed the food was terrible and hot food was served cold. Interview on 07/24/23 at 3:00 P.M. with DM #3 verified the sausage gravy was too runny/watery and [NAME] #1 added too much water to the gravy mix. Interview on 07/25/23 at 7:50 A.M. with Resident #29 revealed the food was not good; the taste of the food was poor. Interview on 07/25/23 at 8:55 A.M. with Regional Dietary Manager (RDM) #11 verified the 100 degree F temperature of the sausage gravy at the point of service was unsatisfactory. RDM #11 revealed it was his expectation for food to be 135 degrees F or above when served. Review of the undated facility Food Temperature policy revealed foods sent to the units for distribution (such as meals, snacks, nourishments, oral supplements) would be transported and delivered to unit storage areas to maintain temperatures at or above 135 degrees F for hot foods. This deficiency represents non-compliance investigated under Complaint Number OH00144188. 365874 Page 3 of 3