Health inspection·November 8, 2022

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 for Residents #6 and #19. This affected two (Residents #6 and #19) of 54 residents reviewed for call light placement. The facility census was 54. Residents Affected - Few Findings include: 1. Record review revealed Resident #6 was admitted to the facility on [DATE] with diagnoses including peripheral vascular disease, difficulty walking, muscle weakness, dysphagia, and severe morbid obesity. Review of the most recent Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #6 was cognitively intact and required extensive assistance of activities of daily living. Review of the care plan dated 10/05/22 for Resident #6 revealed Resident #6 was a risk for falls. Interventions included to have commonly used articles within easy reach such as water, call light, remote control, and telephone. Maintain a clear pathway. Observation of Resident #6 on 11/06/22 at 9:03 A.M. revealed Resident #6 was lying in bed and call light was not within reach, it was on the floor. Interview with Licensed Practical Nurse (LPN) #442 on 11/06/22 at 9:03 A.M. verified the call light was out of reach. 2. Record review revealed Resident #19 was readmitted to the facility on [DATE] with diagnoses including hemorrhage of the cerebrum, dysphagia, cognitive communication deficit, hemiplegia affecting the left non-dominant side, acute kidney failure, encephalopathy, and dysphagia Review of the Annual MDS 3.0 assessment dated [DATE] revealed Resident #19 had moderately impaired cognition and required total assistance of activities of daily living. Review of the care plan dated 11/06/22 for Resident #19 revealed Resident #19 was a risk for falls. Interventions included be sure the resident's call light was within reach. Observation of Resident #19 on 11/06/22 at 9:24 A.M. revealed Resident #19 was lying in bed. Her call light/touch pad was located on floor behind the bed and not within reach. Page 1 of 4 366058 366058 11/08/2022 Aristos Nursing and Rehabilitation 4650 Rocky River Dr Cleveland, OH 44135

F 0558 Interview with State Tested Nursing Assistant (STNA) #426 on 12/06/22 at 9:33 A.M. verified the call light was out of reach and Resident #19 would be able to use the call light if it was within reach. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 366058 Page 2 of 4 366058 11/08/2022 Aristos Nursing and Rehabilitation 4650 Rocky River Dr Cleveland, OH 44135

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 and interviews, the facility failed to serve hot and palatable foods. This had the potential to affect all residents, except two (Residents #13 and #35) identified as receiving no food by mouth (NPO). The facility census was 54. Residents Affected - Many Findings include: Observation on 11/07/22 at 3:45 P.M. with Food Service Manager (FSM) #409 revealed the dinner meal consisted of chicken parmesan, noodles, green beans, salad, and red grapes. Temperatures taken prior to the start of tray line revealed that not all hot food items were above 165 degrees Fahrenheit. Temperatures taken with Dietary [NAME] (DC) #450 on 11/07/22 at 3:45 P.M. revealed the chicken parmesan was at 168 degrees Fahrenheit, noodles were at 158 degrees Fahrenheit, and the green beans were at 154 degrees Fahrenheit. This was verified by DC #450 at the time of the observation. 366058 Page 3 of 4 366058 11/08/2022 Aristos Nursing and Rehabilitation 4650 Rocky River Dr Cleveland, OH 44135

F 0809 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times. Based on staff interview, resident interview, meal schedule review, and menu review the facility failed to provide a substantial snack when 16 hours elapsed between the evening meal and breakfast. This had the potential to affect 43 out of 50 residents that received meals from the kitchen. Nine (Residents #21, #33, #44, #46, #100, #101, #102, #104 and #105) who participated in intense therapy located on the substance abuse (GATE) unit received snacks regularly. Two (Residents #13 and #35) were identified as receiving no food by mouth (NPO). The facility census was 54. Findings include: Observation and interview on 11/06/22 at 4:40 P.M. with Dietary Aide #449 and [NAME] #450 revealed that snacks are made and distributed every night. Observation of the snack tray for Gate Unit revealed nine sandwiches and 12 packages of two-piece graham crackers. For the rest of the building, there was a snack tray with six peanut butter and jelly sandwiches, six deli meat sandwiches and six bags of potato chips. Dietary Aide #449 stated that she delivers the snacks every evening around 6:00 P.M. Dietary Aide #449 stated that she doesn't document who received a snack. Interview on 11/07/22 at 11:40 A.M. with Dietary Manager (DM) #409 revealed dietary is only allotted a certain number of hours which is related to the census for dietary staff. The staff must be out of the kitchen around 6:00 P.M. DM #409 stated that the number of snacks should be changed, so there would be enough for all residents and stated she tried to start breakfast around 7:30 A.M. but couldn't make it work for the allotted dollar amount in the budget. Review of Resident council minutes for February 2022 revealed that residents want more snacks at night. Review of the facility menus revealed snacks were listed on the menu every evening. Review of scheduled mealtimes revealed dinner was at 4:00 P.M. and breakfast was at 8:00 A.M. Review of the posted memo dated 02/23/22 to dietary staff from DM #409 regarding after dinner snacks revealed for Gate unit, every night either a peanut butter and jelly or meat with cheese sandwich plus either yogurt, graham crackers, or cookies. Memo also indicated that for the rest of the facility (Center) the following number of snacks each night: six meat and cheese sandwiches, six peanut butter and jelly, six bags of chips, six cookies, six graham crackers and any extra fruit/dessert from that day. The footer of the memo stated, If you have any questions, please ask me (DM #409). We should be following this list exactly. 366058 Page 4 of 4