Health inspection·August 12, 2019

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, the facility failed to ensure a resident was treated with dignity at all times. This affected one (Resident #39) of 23 sampled residents. The census was 104. Findings include: Review of Resident #39's medical record revealed she was admitted to the facility on [DATE]. Diagnoses included dementia, high blood pressure, delusional disorder and a fractured femur. During observation of Resident #39 on 08/06/19 at 8:00 A.M., Licensed Practical Nurse (LPN) #21 came from behind Resident #39's high back Broda chair, grabbed the chair and pulled the resident backwards down the hall to her room. Resident #39 was startled and slightly raised her arms. LPN #21 did not inform Resident #39 prior to moving her and or pulling her backwards in her chair. During interview on 08/06/19 at 8:06 A.M, LPN #21 confirmed she did not tell Resident #39 that she was getting ready to move her and pulled her backwards from the dining room to her resident room. LPN #21 stated she should have notified Resident #39 she was going to move her and should have pushed her forwards so she could see where she was going. Page 1 of 5 365924 365924 08/12/2019 Amherst Manor Nursing Home 175 N Lake Street Amherst, OH 44001

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview the facility failed to ensure call lights were within reach and accessible. This affected three (Residents #45, #79 and #98) of 104 residents reviewed for call light placement. Residents Affected - Few Findings include: 1. Record review revealed Resident #45 was readmitted to the facility on [DATE] with diagnoses that included Parkinson's disease, dementia with behavioral disturbance, and atherosclerotic heart disease. Review of the most recent Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #45 was cognitively intact and required extensive assistance of activities of daily living. Review of Resident #45's care plan dated 05/05/18 revealed interventions state that call light should be within reach and resident is encourage to ask and use call light for assistance. During observation of Resident #45 on 08/05/19 at 10:01 A.M., she was sitting in her wheelchair located near the end of the bed and her call light was located at the head of the bed. Resident #45 stated that she could not reach the call light. This was verified at the time of observation by State Tested Nursing Assistant (STNA) #72. During observation of Resident #45 on 08/07/19 at 7:48 A.M., she was sitting in her wheelchair located near the end of the bed and her call light was located at the head of the bed. Resident #45 stated that she could not reach the call light. This was verified at the time of observation by Licensed Practical Nurse (LPN) #53. 2. Record review revealed Resident #79 was admitted to the facility on [DATE] with diagnoses that included chronic obstructive pulmonary disease, atrial fibrillation, major depressive disorder and dementia without behavioral disturbances. Review of the most recent MDS assessment dated [DATE] revealed Resident #79 was moderately cognitively impaired and required extensive assistance for activities of daily living. Review of Resident #79's care plan dated 09/09/16 revealed interventions state that call light should be within reach and resident is encourage to ask and use call light for assistance. During observation on 08/07/19 at 8:00 A.M. Resident #79 was sitting in her wheelchair next to the bed. Resident #79's call light was inside her night stand drawer and was out of her reach. This was verified at the time of observation by Licensed Practical Nurse (LPN) #53. 3. Review of the medical record for Resident #98 revealed the resident was admitted to the facility on [DATE] with diagnoses including cerebral palsy, anxiety disorder, and peripheral vascular disease. Review of the most recent MDS 3.0 assessment dated [DATE] revealed Resident #98 was moderately cognitively impaired and required extensive assistance for activities of daily living. Review of Resident #98's care plan dated 08/19/18 revealed interventions state that call light should be within reach and resident is encourage to ask and use call light for assistance. During observation on 08/07/19 at 8:15 A.M., Resident #98 was sitting in her wheelchair next to the foot of the bed. Resident #98's call light was wrapped around her bed rail and was out of her 365924 Page 2 of 5 365924 08/12/2019 Amherst Manor Nursing Home 175 N Lake Street Amherst, OH 44001

F 0558 reach. This was verified at the time of observation by State Tested Nursing Assistant (STNA) #68 Level of Harm - Minimal harm or potential for actual harm Interview with Assistant Director of Nursing #48 on 08/07/18 at 3:41 P.M. revealed that employees are told during orientation that call lights must be within reach, call lights should be answered as quickly as possible and there is a call light panel and the desk which will tell a person the room number and the amount of time the call light was on. Residents Affected - Few 365924 Page 3 of 5 365924 08/12/2019 Amherst Manor Nursing Home 175 N Lake Street Amherst, OH 44001

F 0770 Provide timely, quality laboratory services/tests to meet the needs of residents. Level of Harm - Minimal harm or potential for actual harm Based on record review and interview, the facility failed to ensure resident's laboratory orders were completed as ordered. This affected one of one resident (#60) reviewed for laboratory services. The facility census was 104 residents. Residents Affected - Few Findings include: Review of Resident #60's medical record revealed diagnoses including diabetes. The resident had a physician order dated 02/11/19 for a Glycohemoglobin-HGBA1C laboratory test (a blood test that checks the amount of glucose bound to the hemoglobin in the red blood cells) to be performed every three months for diabetes monitoring. Review of the medical record revealed the HGB A1C was completed on 02/11/19. There was no evidence the test was performed in May 2019 as ordered. Interview with 08/08/19 08:36 A.M. LPN #21 verified the only HGB A1C was drawn on 02/11/19. 365924 Page 4 of 5 365924 08/12/2019 Amherst Manor Nursing Home 175 N Lake Street Amherst, OH 44001

F 0839 Employ staff that are licensed, certified, or registered in accordance with state laws. Level of Harm - Minimal harm or potential for actual harm Based on record review and interview, the facility failed to thoroughly check the Nurse Aide Registry prior to hiring a nurse aide. This affected one (STNA #100) of five personnel files reviewed. This had the potential to affect all 102 residents who resided at the facility. Residents Affected - Many Findings include: Review of the personnel file for STNA #100, revealed date of hire 05/15/19; last day worked 08/02/19; and termination on 08/06/19 for no call no show. During interview on 08/12/19 at 10:13 A.M., Scheduling Resources (SR) #550 reported when searching the Ohio Nurse Aide Registry, the employee's first and last name along with the last four digits of the social security number are used. SR #550 stated she missed entering the last four digits of STNA #100 into the Nursing Aide Registry for verification. Observation on 08/12/19 at 11:05 A.M. of the Nurse's Aide Registry search with (SR) #550 revealed STNA #100's first and last name only yielded a registry number and good standing; however when STNA #100's name AND last four digits of the social security number was searched in the Ohio Nurse Aide Registry, it yielded no results. STNA #100 had the same first and last name as another STNA. The other STNA was on the registry in good standing; STNA #100 was actually not on the registry at all. Review of facility policy titled Ohio New Hire Policy, undated, revealed hiring manager reviews application and performs nurse aide registry check on all potential candidates prior to scheduling interview. This deficiency substantiates Complaint Number 106275. 365924 Page 5 of 5