Health inspection·February 22, 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 residents had accurate advance directive orders and information in place through out the medical record for Resident #12. This affected one of one residents reviewed for advanced directives. Findings include: Review of Resident #12's medical record revealed the resident was admitted to the the facility on 07/27/92 with diagnoses that included dementia, depressive disorder and high cholesterol . Review of the most recent Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #12 was severely cognitively impaired and required extensive assistance for activities of daily living. Review of the physician's orders for Resident #12 revealed an order dated 03/14/18 for a Do Not Resuscitate Comfort Care (DNRCC) code status (meaning only comfort measures would be initiated in the event of a medical emergency). Review of the social service progress noted dated 11/25/18 revealed, Resident is a DNRCC and a LTC (long term care) resident. Review of the hard medical chart for Resident #12 revealed a signed Do Not Resuscitate Comfort CareArrest (DNRCCA) code status (meaning invasive or extreme life-supporting measures were allowed under any circumstance except for cardiac or respiratory arrest. In the event of cardiac or respiratory arrest only comfort measures would be initiated) dated 11/23/04. Interview with Licensed Practical Nurse (LPN) #1 at 7:52 A.M. on 02/21/19 revealed if she didn't know a resident's code status she would look in either the physician orders portion of the electronic chart or in the front of the hard medical chart. When asked, LPN #1 indicated Resident #12's code status was a DNRCC, which was incorrect. LPN #1 reviewed and verified the electronic physician's orders and the information in Resident #12's hard medical chart gave a different code status. Page 1 of 3 366110 366110 02/22/2019 Crawford Manor Healthcare Center 1802 Crawford Rd Cleveland, OH 44106

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure comprehensive care plans were developed related to substance abuse for Resident #18 and for oxygen level monitoring for Resident #5. This affected two residents of 14 residents whose care plans were reviewed. Findings include: 1. Resident #5 was admitted to this facility on 01/06/17. His admitting diagnoses included chronic obstructive pulmonary disease (COPD), type II diabetes, cirrhosis of the liver, and supraventricular tachycardia. According to the minimum data set 3.0 (MDS) assessment dated [DATE], Resident #5 was alert, oriented and cognitively intact. The health condition section of this MDS showed that the resident did have shortness of breath and trouble breathing with exertion, while sitting at rest and when lying flat. His therapy and treatments showed that the resident was receiving oxygen. Functionally, this resident was totally dependent on staff for toilet use, personal hygiene, locomotion on and of the unit and walking in the corridor. He needed extensive assistance from staff for bed mobility, transfers and dressing. Review of the physician orders for this resident revealed an order dated 04/29/18 for the nursing staff to monitor him via pulse oximetry (a device placed on the finger to monitor oxygen levels) every shift. Review of the resident's current care plan revealed a care plan for emphysema/COPD related to a history of smoking, dated 10/13/17, revealed no intervention for nursing staff to monitor Resident #5 via pulse oximetry. A second care plan for shortness of breath related to decreased lung expansion, hypoxia, COPD and asthma was initiated on 10/18/17. This care plan revealed no intervention for nursing staff to monitor Resident #5 via pulse oximetry. Interview with the acting Director of Nursing (DON) on 02/21/19 at 2:10 P.M. verified Resident #5's current care plans were not updated to reflect the physician ordered pulse oximetry checks every shift. 2. Resident #18 was admitted to the facility on [DATE] with diagnoses including pain in the leg and shoulder, alcohol abuse and other psychoactive substance abuse. Review of the most recent MDS 3.0 assessment dated [DATE] revealed Resident #18 was alert, oriented and cognitively intact and needed limited assistance from staff for his activities of daily living. Review of the hospital transfer paper work dated 12/17/18 revealed Resident #18 had a history of polysubstance abuse including cocaine and marijuana and said he had smoked over 40 years. Review of toxicology test results from 02/07/19 revealed Resident #18 tested positive for cocaine after returning to the facility from a leave of absence to the community. Review of the current care plan for Resident #18 revealed no care plan was developed to address Resident #18's history of and continued drug use. 366110 Page 2 of 3 366110 02/22/2019 Crawford Manor Healthcare Center 1802 Crawford Rd Cleveland, OH 44106

F 0656 On 02/22/19 at 10:11 A.M., the acting DON verified no care plan had been initiated to address Resident #18's polysubstance abuse. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 366110 Page 3 of 3