Health inspection·July 6, 2021

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to provide personal hygiene for Resident #95. This affected one of three Resident's (#67, #95 and #160) reviewed for activities of daily living. The facility census was 107. Residents Affected - Few Findings include: Review of the medical record revealed Resident #95 was admitted to the facility on [DATE] with diagnoses including cirrhosis of the liver, hepatic failure, alcohol abuse, esophageal varices, portal hypertension, chronic obstructive pulmonary disease, rhabdomyolysis, polyneuropathy, urinary retention, viral hepatitis C, and dormant tuberculosis. Review of the significant change comprehensive assessment (MDS 3.0) dated 06/02/21 indicated he was alert, oriented and independent in daily decision making. No behaviors were identified. He required the extensive assistance of one staff for personal hygiene. Review of the activities of daily living plan of care dated 03/22/21 indicated he required extensive assistance of one staff for personal hygiene. Review of the electronic aide task section on bathing revealed he was provided one bath/shower in the last 30 days on 06/28/21. His preference was marked that he preferred a bath/shower once weekly. Interview and observation of Resident #95 on 06/28/21 at 3:25 P.M. revealed he had extremely long fingernails and some were jagged and had black substance underneath. Resident #95 verified his nails were too long and not of his preference. Resident #95 was observed with his fingernails in the same condition on 06/29/21 at 1:46 P.M. and at 3:40 P.M. Interview with State Tested Nurse Aide (STNA) #402 on 06/29/21 at 3:40 P.M. confirmed Resident #95's nails were long and dirty. STNA #402 reported the nurse was responsible for clipping fingernails and she would let the nurse know. On 06/29/21 at 3:51 P.M. STNA #402 informed Licensed Practical Nurse (LPN) #403 who requested STNA #402 soak his nails with denture tablets. Interview with LPN #403 on 06/29/21 at 3:55 P.M. reported the denture tables were very effective at cleaning under the nails and would not harm the resident. On 06/30/21 at 7:49 A.M. Resident #95's nails were observed in the same condition, and Resident #95 confirmed he was not provided nail care. On 06/30/21 at 9:34 A.M. Registered Nurse (RN) #404 verified Resident #95's nails were long, jagged with black substance underneath. Page 1 of 7 366079 366079 07/06/2021 Eliza Jennings Home 10603 Detroit Avenue Cleveland, OH 44102

F 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record and policy review, the facility failed to identify, evaluate and monitor Resident #95's new onset pain and notify the physician to manage his pain. This affected one of two Resident's (#75 and #95) reviewed for pain management. The facility census was 107. Residents Affected - Few Findings include: Review of the medical record revealed Resident #95 was admitted to the facility on [DATE] with diagnoses including cirrhosis of the liver, hepatic failure, alcohol abuse, esophageal varices, portal hypertension, chronic obstructive pulmonary disease, rhabdomyolysis, polyneuropathy, urinary retention, viral hepatitis C, and dormant tuberculosis. He entered palliative care on 06/16/21. Review of the physician orders indicated he was ordered Morphine Sulfate (a narcotic analgesic) 10 milligrams every two hours as needed for pain and shortness of breath beginning on 05/27/21. He received the medication on 06/25/21 at 3:05 P.M. for pain level 5, 06/26/21 at 5:41 A.M. for pain level 10, 06/27/21 at 9:43 P.M. for pain level 5, 06/28/21 at 5:39 A.M. for pain level 5, 06/29/21 at 9:51 P.M. for pain level 8 and on 06/30/21 at 7:45 A.M. for pain level 8. The physician orders indicated to assess for pain every shift. Review of the June 2021 medication administration record indicated the resident expressed pain on the day shift on 06/28/21 at a level 5 and on the night shift level 2 on 06/4, 10, 11, 12, 19, 20, 22, 25, and level 8 on 06/29/21. Review of the order administration notes revealed he was provided Morphine Sulfate on 06/25/21 at 3:05 P.M. for complaints of pain. On 06/26/21 at 5:41 A.M. for shortness of breath or pain. On 06/27/21 at 9:43 P.M. for shortness of breath or pain. On 06/28/21 at 5:39 A.M. for complaints of leg and indwelling catheter pain. It was noted the catheter was draining tea colored urine. On 06/29/21 at 9:51 P.M. for general pain. On 06/30/21 at 7:45 A.M. for complaints of scrotum pain. The notes lacked specific identification of the type of pain, location and non-pharmacological interventions attempted. Review of the corresponding progress notes lacked consistent indication of where the pain was located, the type, level, and no notification to the physician of his increased level of pain that began on 06/25/21. Review of the significant change comprehensive assessment (MDS 3.0) dated 06/02/21 indicated he was alert, oriented and independent in daily decision making. No behaviors were identified. He required extensive assistance of one staff for toilet use and hygiene. He had an indwelling urinary catheter and was incontinent of bowel. He was identified to have frequent pain affecting his sleep and limiting his day to day activities. He rated his pain as an eight out of 10 being the worst pain imaginable. Review of the pain plan of care dated 03/22/21 indicated he had pain/discomfort related to peripheral neuropathy and liver failure. Review of the interventions indicated to monitor for verbal and nonverbal signs of pain/discomfort every shift and provide pain interventions as needed. Notify the physician if the pain was not being relieved with the current regimen and offer non-pharmacological interventions such as positioning, relaxation and breathing, diversional activities, heat or cold packs and/or warm shower/bath. Interview with Resident #95 on 06/28/21 at 3:48 P.M. reported he had unrelieved groin pain he thought from his catheter. 366079 Page 2 of 7 366079 07/06/2021 Eliza Jennings Home 10603 Detroit Avenue Cleveland, OH 44102

F 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Observation of Resident #95 on 06/29/21 at 3:53 P.M. revealed a full urinary catheter bag that contained 2000 cubic centimeters (cc's) of orange colored urine, further observation revealed the resident had a piece of tape securing his urinary catheter tubing to his leg. Interview with Licensed Practical Nurse (LPN) #403 at time of observation revealed the resident should have had a leg strap and confirmed the amount of urine, further observation with LPN #403 revealed Resident #95 had a very swollen scrotal area and resident moaned in pain when area was touched. LPN #403 reported his scrotum had been edematous for a few weeks and confirmed there was no documentation related to his swollen and painful scrotum. Interview with LPN #407 on 06/30/21 at 7:49 A.M. reported he had not worked in a couple of days and had no idea his scrotum was swollen. Interview with State Tested Nurse Aide (STNA) #405 on 06/30/21 at 7:55 A.M. reported she worked on Saturday and noticed his scrotum was swollen and tender, so she informed LPN #406. Interview with Registered Nurse (RN) #404 and observation of Resident #95 on 06/30/21 at 9:34 A.M. verified the scrotal area was very swollen and his urine was dark with sediment in the tubing. Resident #95 complained of pain from the catheter. RN #404 reported no awareness of the resident's swollen scrotum and he would be notifying the physician of the pain and inquired about getting a urinalysis. On 06/30/21 at 11:24 A.M. the nurse noted the resident had a new onset of hydrocele with reports of discomfort to the scrotum/lower back that he rated a nine out of 10. Morphine Sulfate was administered with minimal effect. The urinary catheter bag had amber colored urine with moderate amounts of sediment. The nurse called the physician who ordered the resident be sent out to the hospital. On 07/01/21 at 4:16 A.M. he returned from the hospital with a diagnosis of a bladder infection and on antibiotic therapy. On 07/02/21 at 11:30 A.M. the nurse practitioner was made aware he was requesting Morphine Sulfate for scrotal pain and gave a new order to discontinue Morphine Sulfate and utilize Ultram (an opioid analgesic) 50 milligrams every eight hours as needed for complaints of generalized pain/discomfort. Review of the pain management policy dated 02/01/21 indicated to evaluate the resident for pain by asking the resident to rate the intensity of his/her pain using a numerical scale or a visual descriptor, identify key characteristics of the pain (duration, frequency, location, onset, pattern and radiation), descriptors of pain (aching, burning, throbbing, tingling, stabbing), determine factors that make the pain better or worse, how does the pain impact the quality of life, use non pharmacological and/or pharmacological interventions, effectiveness of the medication or treatments, if not controlled the practitioner should be notified, reassess the resident regularly. 366079 Page 3 of 7 366079 07/06/2021 Eliza Jennings Home 10603 Detroit Avenue Cleveland, OH 44102

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation and interview, the facility failed to ensure the kitchen was maintained in a clean and sanitary manner. This had the potential to affect 105 of the 107 residents. Two Resident's (#17 and #260) did not receive food from the facility. The facility census was 107. Findings include: Observations during the initial tour on 06/28/21 at 8:40 A.M. revealed the oven door had dried on spills down the front. The control knobs on the oven and stove top were dirty. The hood and overhead vents were greasy and dusty, the spigots for fire suppression system were greasy and dusty. These findings were verified by Dietary Manager #401 at the time of the observation. 366079 Page 4 of 7 366079 07/06/2021 Eliza Jennings Home 10603 Detroit Avenue Cleveland, OH 44102

F 0814 Dispose of garbage and refuse properly. Level of Harm - Potential for minimal harm Based on observation and staff interview, the facility failed to properly contain garbage in the outside dumpster. This had the potential to affect all 107 residents living in the facility. Residents Affected - Many Finding include: Observations during the initial tour on 06/28/21 at 8:40 A.M. revealed the side doors of two dumpsters were open. The dumpsters had debris around them, including numerous plastic gloves, a brief, and disposable plastic cups. This was verified by Dietary Manager #401 at the time of the observation. 366079 Page 5 of 7 366079 07/06/2021 Eliza Jennings Home 10603 Detroit Avenue Cleveland, OH 44102

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and policy review, the facility failed to implement an ongoing infection prevention and control program related to COVID 19. This affected six Resident's (#76, #84, #158, #159, #160 and #161) who resided on the observation for COVID 19 unit out of 107 residents in the facility. Residents Affected - Some Findings include: Interview with the Administrator on 06/28/21 at 9:00 A.M. reported the facility had no residents with COVID 19 but had one staff test positive so they were in outbreak testing. She reported the observation unit was located on the second floor and this was where new admissions spend their first 14 days. She indicated full personal protective equipment had to be worn in the resident rooms. On 06/28/21 at 10:00 A.M. during the initial tour of the facility, a small unit on the second floor had the double doors at both ends of the unit closed. Signs were posted for authorized employees only and had N95 masks at the entrance to the unit. There was no eye protection available and staff working the unit were not observed wearing eye protection. Resident's in the general population were observed congregating in the dining room or in areas where group activities were being held. No residents were observed wearing masks. On 06/28/21 at 3:25 P.M. Resident #160's sister was standing outside of his room calling out for help. The call light above his door was illuminated. The sister was wearing a surgical mask and no other personal protective equipment. The daughter was in the room with the resident explaining they had called for assistance but the staff did not come timely enough so she tried to assist him to the bathroom and he had an accident on the floor, his bed was wet with urine, there was medication residue on the carpet from where he spit out his medication. She found him wet and in need of toileting for the last two days and was very upset. The daughter reported she visited daily to help him eat and to explain things to him since he spoke little English. The daughter wore no personal protective equipment. On 06/29/21 at 3:21 P.M. the daughter was observed in his room not wearing any personal protective equipment. She was asked how she was educated when entering the building. She said she was told to wear a surgical mask. She pulled it out of her purse and said she removed it when in the room with her father. She acknowledged seeing the signs on the entry doors but did not think that was related to her father. Resident #76 also had a visitor at that time who wore no personal protective equipment. Interview on 06/29/21 at 3:25 P.M. with the infection preventionist Registered Nurse (RN) #408 reported the front desk didn't know where the visitors were going in the facility and told all to wear a surgical mask. She initially reported that was all that was necessary when visiting the observation unit. But was asked why the signage indicated to wear an N95, eye protection and gown when entering the resident rooms. She admitted then that the resident's families should be wearing the gown, gloves, eye protection when in the room. She was informed the direct care staff wore no eye protection for two days and today's State Tested Nurse Aide (STNA) also was not wearing a gown or gloves when going into resident rooms. She was informed Residents #76 and #160 had visitors wearing no personal protective equipment. On 06/29/21 at 4:06 P.M. Residents #76's and #160's visitors had N95 masks and gowns on. Interview 366079 Page 6 of 7 366079 07/06/2021 Eliza Jennings Home 10603 Detroit Avenue Cleveland, OH 44102

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some with Resident #160's daughter said she was educated to wear mask and gown when in the room and was upset she was not told this earlier because she did not want to bring COVID 19 home to her family. Further interview with RN #408 and the Administrator on 07/01/21 at 10:03 A.M. reported all staff and visitors were to complete screening upon entering the facility. This was a computerized system that could print out the screening logs. They reported visitors going to the observation unit were provided a leaflet on how to don and doff personal protective equipment. Staff and visitors were to wear N95 masks, goggles, and gowns. They call families weekly with updates and have a website for information. They reported 83% of residents were vaccinated for COVID 19 but only 64% of the staff were vaccinated. They reported residents on the observation unit should wear personal protective equipment when they left the unit and residents in the general population should wear a surgical mask when out of their rooms, but they could not force them. Review of the facility's policies on COVID 19 were based on the Centers for Disease Control. This deficiency substantiates Complaint Number OH00111256. 366079 Page 7 of 7