Health inspection·May 9, 2023

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, policy review and interview, the facility failed to honor Residents #2's preferences. This affected one of three residents reviewed for transfer assistance. The census was 88. Findings include: Review of the medical record for Resident #2 revealed an admission date of 09/29/21 with diagnoses of multiple sclerosis, B-cell lymphoma, history of falling, seizures, need for personal assistance and major depressive disorder. Review of the activities of daily living (ADL) care plan, updated 05/10/22 revealed Resident #2 had an activities of daily living self-care performance deficit related to disease process. Resident #2 required staff assistance to complete ADL tasks daily. Resident #2 required extensive by one staff to move between surfaces daily and as necessary. Review of the nursing admission/readmission assessment dated [DATE] revealed Resident #2 usually woke up between 5:00 A.M. and 6:00 A.M. Review of the Minimum Data Set (MDS) 3.0 annual assessment dated [DATE] revealed Resident #2 was cognitively intact, required extensive physical assistance of two-person for transferring and utilized a wheelchair for mobility. Review of the nutrition/hydration status assessment dated [DATE] revealed Resident #2 fed herself, used a wheelchair and had meals in the dining room. Observation on 05/02/23 at 8:48 A.M. revealed Resident #2 was lying in bed, wearing a hospital gown, with an untouched breakfast tray on her overbed table. Interview, during the observation, with Resident #2 revealed she woke up around 5:30 A.M. and liked to be out of bed by 9:00 A.M. but there were not enough aides to get her up on time. Observation on 05/02/23 at 8:50 A.M. revealed Agency State Tested Nurse Aide (STNA) #6 was passing out breakfast trays while Registered Nurse (RN) #5 was sitting at the nursing station working on the computer on the Purple unit. Interview, during the observation, with RN #5 revealed Agency STNA #6 arrived late to work at 8:15 A.M. so RN #5 directed STNA #6 to pass breakfast trays then get Resident #2 out of bed. RN #5 stated she was passing medications. RN #5 verified Resident #2 was not out of bed and verified Resident #2 was supposed to be out of bed before breakfast as she liked to come to the dining room before breakfast. RN #5 also revealed Resident #2 would always complain that she Page 1 of 3 366179 366179 05/09/2023 Solon Pointe at Emerald Ridge 5625 Emerald Ridge Parkway Solon, OH 44139

F 0561 Level of Harm - Minimal harm or potential for actual harm was not out of bed on time then unable to eat in the dining room. RN #5 said Agency STNA #6's shift began at 7:00 A.M. and there was not a STNA on the unit with 15 residents from approximately 7:00 A.M. to 8:15 A.M. Interview on 05/02/23 at 8:55 A.M. with Agency STNA #6 revealed this day was her first time in the facility. Residents Affected - Few Observation on 05/02/23 at 8:59 A.M. revealed Resident #2 continued to lay in bed and had eaten her cold cereal. At 9:02 A.M., STNA #6 entered Resident #2's room and asked RN #5 if she should get Resident #2 up and ready. RN #5 replied, yes and STNA #6 closed the door. At 9:36 A.M., STNA #6 exited Resident #2's room and Resident #2 was dressed in street clothes, self-propelling into her bathroom. Review of the facility's Quality of Life - Accommodation of Needs policy revised August 2009 revealed the resident's individual needs and preferences shall be accommodated to the extent possible, except when the health and safety of the individual or other residents would be endangered. This deficiency represents non-compliance investigated under Complaint Number OH00142180. 366179 Page 2 of 3 366179 05/09/2023 Solon Pointe at Emerald Ridge 5625 Emerald Ridge Parkway Solon, OH 44139

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 and interview the facility failed to provide timely incontinence care. This affected one resident (#31) of two observed for incontinence care. The facility census was 88. Findings include: Review of Resident #31's medical records revealed an admission date of 01/10/23. Diagnoses included psoriasis and cellulitis (bacterial skin infection). Review of Resident #31's Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #31 had intact cognition. Resident #31 required extensive assistance with toileting and personal hygiene and was incontinent of bowel and bladder. Review of Resident #31's care plan dated 02/17/23 revealed Resident #31 had self care deficits. Interventions included staff to provide care daily. Observation on 05/04/23 at 7:51 A.M. revealed Resident #31's call light was on outside of her room. Upon entering Resident #31's room a strong pungent odor of urine was noted. Interview with Resident #31 at time of observation revealed she had been changed the previous evening prior to bedtime. Further observation revealed Resident #31 had been incontinent of urine with a large visible wet area underneath of the resident. Observation of incontinence care for Resident #31 on 05/04/23 at 8:00 A.M. with State Tested Nursing Assistant (STNA) #105 revealed Resident #31 had been incontinent of a large amount of urine and liquid stool that had saturated through her incontinence brief and incontinence liner, two bath blankets and onto her mattress. STNA #105 stated she had started her shift at 7:00 A.M. and had not provided incontinence care to Resident #31 yet. STNA #105 stated she had not observed an STNA present on the unit when she arrived and did not know when not Resident #31 had last received incontinence care. This deficiency represents non-compliance investigated under Complaint Number OH00142180. 366179 Page 3 of 3