Health inspection·December 5, 2019

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to ensure advance directives for Resident #64 were accurately and consistently noted throughout the resident's medical record. This affected one resident (#64) of one resident reviewed for advance directives. Findings include: Review of the medical record for Resident #64 revealed the resident was admitted to the facility on [DATE] with diagnoses of chronic obstructive pulmonary disease (COPD), morbid obesity, acute respiratory failure with hypoxia, and obstructive sleep apnea. Review of Resident #64's electronic physician's orders, dated 09/25/19 revealed an advance directive for Do Not Resuscitate Comfort Care- Arrest (DNRCC-Arrest), resuscitative therapies before an arrest, but not during or after an arrest. Review of the hard copy of medical record for Resident #64 revealed a signed advance directive for Do Not Resuscitate Comfort Care (DNRCC), care that eases pain and suffering but no resuscitative therapies. Interview on 12/03/19 at 8:52 A.M. with Unit Manager (UM) #400 confirmed a DNRCC-Arrest order was noted in the electronic record and a DNRCC directive was noted in the hard copy of the medical record. Follow up interview on 12/03/19 at 11:24 A.M. with UM #400 revealed Resident #64's desired advance directive was DNRCC-Arrest, and the social worker marked the wrong box on the advance directive in the hard chart. Interview on 12/04/19 at 4:03 P.M. with Licensed Practical Nurse (LPN) #401 revealed if she was unaware of a residents code status she could look for advance directives/code status under the patients name in the electronic medical record, and also in a sleeve in the front of the hard copy of the chart. Page 1 of 3 365883 365883 12/05/2019 St Augustine Manor 7801 Detroit Ave Cleveland, OH 44102

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview the facility failed to ensure Resident #72, who had a urinary (Foley) catheter had timely orders, assessments and documentation of care appropriate for the management of the catheter. This affected one resident (#72) of one resident reviewed for urinary catheter care. Findings include: Record review for Resident #72 revealed the resident was admitted to the facility on [DATE] with diagnoses including pressure ulcer of the hip, cognitive communication deficit, and major depressive disorder. Review of the diagnosis list revealed no diagnosis that was appropriate for long-term Foley use (such as neuromuscular bladder dysfunction, obstructive uropathy, or other diagnoses involving a blockage of the bladder or failure in its function). Review of the resident's progress notes revealed on 10/12/19 the resident experienced urinary retention and staff inserted a Foley. There were no physician orders received in regards to the Foley to remain in place or to receive regular hygienic care and/or bag changes until 12/04/19. The record included no specific documentation of Foley care, Foley bag changes, or assessment for potential to restore bladder functions or remove the Foley catheter. Observation of a Foley care procedure for Resident #72 by State Tested Nursing Assistant (STNA) #402 on 12/04/19 at 9:02 A.M. revealed the resident had a Foley catheter in place. There were no signs of infection noted. Interview with Registered Nurse #403 on 12/04/19 at 2:25 P.M. confirmed the above findings. Review of the facility urinary catheter maintenance policy, dated 10/2014 revealed Foley bags in the facility were to be changed every two weeks. 365883 Page 2 of 3 365883 12/05/2019 St Augustine Manor 7801 Detroit Ave Cleveland, OH 44102

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on observation, record review and interview the facility failed to provide Resident #171 with a comfortable home like environment. This affected one resident (#171) of 79 residents who resided on the second floor unit. Findings include: A tour of the environment was conducted with the Outside Electrical Contractor, (OEC) #500 who was an employee of the facility's maintenance team was conducted on 12/05/19 from 12:05 P.M. to 12:20 P.M. During the tour, observation of Resident #171's room revealed wall damage under the face bowl in need of plastering, sanding and painting. While standing in front of the face bowl, the bottom portion of the wall to the right was damaged and the lath and plaster screen used for wall plastering was exposed. Review of the daily maintenance work request log from 10/2019 to 12/5/2019 revealed no request for maintenance work for the room belonging to Resident #171. Interview with (OEC) #500 on 12/05/19 at 12:21 P.M. revealed all staff were responsible for reporting any maintenance concerns regarding the residents' room. Moreover, the maintenance department does not have the man power to conduct routine room checks for a large facility like this one and was dependent upon aides, nurses, and housekeeping to report concerns in the maintenance log book. The findings were confirmed with (OEC) #500 during the interview and repair work for the damaged walls would be taken care of. 365883 Page 3 of 3