Health inspection·September 6, 2023

F 0604 Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** THE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NON-COMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Residents Affected - Few Based on observation, medical record review, witness statements, policy review and interview, the facility failed to assure a physical restraint was used for treatment of a medical symptoms rather than staff convenience for Resident #65. This affected one (Resident #65) of three residents reviewed for restraints. The census was 121. Findings include: Review of the medical record for Resident #65 revealed an admission date of 08/10/23 with diagnoses of dementia with anxiety, anxiety disorder, depression, aphasia, and hemiplegia and hemiparesis following cerebral infarction affecting the right side. Review of the Minimum Data Set (MDS) 3.0 admission assessment dated [DATE] revealed Resident #65 had short and long-term memory problems, was moderately impaired with daily decision making, needed extensive assistance of two-person physical assistance to walk in her room and use a cane/crutch or wheelchair for mobility. Review of the cognitive function care plan dated 08/15/23 revealed Resident #65 had impaired cognitive function due to altered dementia, cerebral vascular accident (CVA), infection, unable to make safe decisions, and experiences of confusion and periods of restlessness. Interventions included to provide a calm and relaxing environment and be patient with the resident. There was no invention to restrain the resident. Review of the fall care plan updated 08/23/23 revealed Resident #65 was at risk for falls due to acute/unstable medication condition, debilitation, weakness, dementia, impaired cognition, infection, memory impairments, poor decision-making skills, restlessness and impulsiveness. There was no invention to restrain the resident. Review of the physician orders from August 2023 revealed there was no order to physically restrain Resident #65. Review of a witness statement dated 08/15/23 authored by Licensed Practical Nurse (LPN) #8 revealed, Resident #65 was very anxious and trying to get out of bed several times, so we put her in the wheelchair for a change of scenery. She then kept trying to get out of the wheelchair. I became worried for her safety when I would have to leave the unit. I put a sheet on her and lightly tied it to where she could stand if she wanted to but as a reminder to not stand. Page 1 of 4 366180 366180 09/06/2023 Riverview Pointe Care Center 9027 Columbia Road Olmsted Falls, OH 44138

F 0604 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the witness statement dated 08/15/23 authored by State Tested Nurse Aide (STNA) #7 revealed, on Sunday 08/13/23 during night shift, I worked Pleasant Valley with LPN #8. We heard alarm sounding again. We went to the room. LPN #8 used a sheet to keep the resident in the chair. I told her I didn't think she could do that. She brought the resident in the hall by the lounge where we could see her. Observation on 09/06/23 at 8:27 A.M. revealed Resident #65 was lying in a low bed, with the left side of her bed against the wall and a mattress to the right side of the bed. Interview, during the observation, with Resident #65 was attempted however unsuccessful due to cognitive impairment. Interview on 09/06/23 at 8:39 A.M. with Registered Nurse (RN) #4 revealed Resident #65 had been at the facility for a month. Resident #65 had recently had a stroke and was paralyzed on the right side. Resident #65 was very anxious and attempted to get up by herself. RN #4 revealed LPN #8 admitted to RN #4 that she could not get Resident #65 to calm down, so she took a sheet and tied her to the chair. Interview on 09/06/23 at 11:00 A.M. with LPN #8 revealed Resident #65 was very, very confused when she first admitted and wanted to communicate however she was unable to. Resident #65 was very restless and would try to stand up to walk when she first arrived at the facility. LPN #8 verified she applied a sheet to Resident #65's lap and tied the ends of the sheet behind the wheelchair in a loose knot to act as reminder not to get up from the chair. LPN #8 did this because she was afraid Resident #65 was going to fall. LPN #8 verified she did not obtain a physician order for the restraint (sheet applied to Resident #65's lap with the ends of the sheet tied in a knot behind the back of the wheelchair to prevent Resident #65 from rising from the wheelchair). Interview on 09/06/23 at 12:35 P.M. with STNA #7 revealed on the night of 08/12/23 into the morning of 08/13/23, STNA #7 got pulled from another hall to work on Pleasant Valley (where Resident #65 resided). STNA #7 was returning from a break when she heard an alarm sounding and saw LPN #8 and another STNA enter Resident #65's room. Resident #65 was trying to stand and LPN #8 assisted Resident #65 into the wheelchair and wheeled her out to the nursing station. LPN #8 had placed a sheet over Resident #65's stomach, took the ends of the sheet and tied a tight knot behind the back of the wheelchair. STNA #7 stated the knot was tied very tight and Resident #65 was struggling in the seat because the sheet was tight up against the resident. STNA #7 stated Resident #65 was unable to untie the knot to get up. Interview on 09/06/23 at 12:48 P.M. with STNA #10 revealed STNA #7 asked STNA #10 to assist with check and changing residents on the Pleasant Valley unit when STNA #10 observed Resident #65 being restrained with a sheet across Resident #65's breast down to her stomach with the ends of the sheet tied tight behind the back of the wheelchair. STNA #10 revealed Resident #65 was crying as she tried to get out of the sheet while sitting by the nurses' station. Observation on 09/06/23 at 1:00 P.M. with the Administrator and Director of Nursing (DON) revealed of a picture of the back of a female resident while sitting in a wheelchair near the nurse's station. The picture showed a folded sheet tightly secured around the backrest of the wheelchair and the ends tightly tied in a knot around the back of the backrest of wheelchair. The resident in the picture appeared to be Resident #65. Interview on 09/06/23 at 1:00 P.M. with the Administrator and DON revealed they were aware of a sheet being used on Resident #65 while she was sitting in a chair. The Administrator and DON said after 366180 Page 2 of 4 366180 09/06/2023 Riverview Pointe Care Center 9027 Columbia Road Olmsted Falls, OH 44138

F 0604 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few investigating, the evidence was inconclusive as to whether the sheet was acting as a physical restraint for Resident #65. The DON verified LPN #8 did not obtain a physician order to use a sheet tied behind Resident #65's wheelchair and verified a restraint assessment was not completed for use of the sheet tied behind the wheelchair for Resident #65. Follow up interview on 09/06/23 at 1:20 P.M. with the Administrator verified she was aware that two STNAs observed the sheet tied behind the back of the wheelchair for Resident #65. Review of the facility's Restraint Use policy dated 06/20/15 revealed the facility created and maintained an environment that fostered minimal use of restraints. Physical restraints were defined as any manual method or physical or mechanical device, material or equipment attached or adjacent to the resident's body that the individual could not remove easily which restricted freedom of movement or normal access to one's body. The need of each resident for restraint use was assessed upon admission and as needed. Informed consent for the physical restraint would be obtained from the resident or the legal representative. The plan of care for restraint use as well as the potential risks and benefits would be discussed. A physician's order for the restraint would be obtained. The deficient practice was corrected on 08/17/23 when the facility implemented the following corrective actions: • On 08/15/23, all nursing staff was educated on restraint use by the DON/designee. • On 08/15/23, an audit of all residents was completed which included a skin check and/or interview. • On 08/15/23, LPN #8 was educated on using an inappropriate safety intervention by the DON. • On 08/17/23, LPN #8 completed two continuing education modules on Falls in Senior Care: Exploring Prevention, Causes and Treatment and Behavior Management Strategies for Cognitively Impaired Residents. • On 08/22/23 and on 08/28/23, a weekly audit of three residents for restraint use was conducted with no concerns by the DON/designee. The audit would continue for another two weeks. • On 08/25/23, all nurses were reeducated on restraint use during the nurses meeting by the DON. • 366180 Page 3 of 4 366180 09/06/2023 Riverview Pointe Care Center 9027 Columbia Road Olmsted Falls, OH 44138

F 0604 On 09/06/23, observations revealed no restraint use. Level of Harm - Minimal harm or potential for actual harm This deficiency represents non-compliance investigated under Complaint Number OH00145733. Residents Affected - Few 366180 Page 4 of 4