Health inspection·February 13, 2019

F 0578 Level of Harm - Minimal harm or potential for actual harm 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. Based on record review and staff interview the facility failed to comply with Resident #51's code status This affected one of 19 sampled residents. Residents Affected - Few Findings include: Review of the closed record for Resident #51 revealed a re-admission date of 03/26/18. Diagnoses included paranoid schizophrenia, idiopathic epilepsy, and peripheral vascular disease. Physician orders for December 2018 revealed a code status of Do Not Resuscitate Comfort Care Arrest (DNRCC- Arrest) dated 07/18/18. DNRCC- Arrest indicated the resident did not wish to receive cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest. Review of the DNRCC form signed by both the physician and Resident #51's responsible party dated 07/19/18 revealed Resident #51's code status was DNRCC-Arrest. Review of the care plan dated 07/31/18 revealed Resident #51 and family had chosen a DNR status and CPR measures would not be attempted during a cardiac arrest. Review of nursing notes dated 12/18/18 at 7:07 P.M. revealed at 6:25 P.M. Licensed Practical Nurse (LPN) #11 was notified Resident #51 was leaning in his chair and something was wrong. LPN #11 observed Resident #51 leaning to the right in his chair, unresponsive and absent of all vital signs. CPR was started and emergency medical services ( 911) was called. LPN #11 and another nurse continued CPR until emergency medical services (EMS) arrived and took over. Review of the facility's investigation dated 12/19/18 revealed on 12/18/19 at 6:15 P.M. Resident #51 was found slumped over in the chair seated at the table, leaning over the right arm rest. Resident #51 was found to have food in his mouth and LPN #11 suctioned out some liquid, and noted the resident had pieces of bread in his mouth. Resident #51 did not have a pulse and was removed from his chair by staff members and placed on the ground. CPR was initiated and 911 was called. EMS arrived and they took over care of Resident #51 and indicated that there was nothing more they could do. The coroner was called, visited the facility and released the body to the funeral home. Interview on 02/12/19 at 9:18 A.M. with LPN #11 revealed she was aware Resident #51 had orders for DNRCC-Arrest but performed CPR on the resident anyway. Review of the facility policy titled, Advanced Care Planning, revised July 2018 revealed the resident's preference for advanced directives would be recorded in their medical record and further used in the development of the resident's plan of care. Page 1 of 5 366183 366183 02/13/2019 Seasons Nursing and Rehab 456 Seasons Rd Stow, OH 44224

F 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, staff interview, and record review, the facility failed to prepare and distribute food in a sanitary manner This had Residents Affected - Many the potential to affect all 50 residents residing in the facility. Findings include: Observations during the initial tour of the kitchen on 02/10/19 from 9:30 A.M. to 9:49 A.M. with Dietary Manager (DM) #55 revealed two plastic dish racks sitting on the clean side of the dish machine. The dish racks were empty, slightly frayed, and appeared dirty, with tannish, brown buildup. The microwave appeared old and in the inside back bottom corners there where quarter sized rust stains. The industrial sized can opener had a dried, reddish substance on the blade. Interview on 02/10/19 at 9:39 A.M. and 9:49 A.M. with DM #55 confirmed the above observations. DM #55 stated the tannish brown buildup on the dish racks was possibly lime buildup from the hard water. DM #55 stated the dish racks and the microwave needed to replaced and that the can opener blade needed to be cleaned. Review of the facility's policy titled, Environment revised September 2017 revealed all food preparation areas, food service areas, and dining areas would be maintained in a clean and sanitary condition. 366183 Page 2 of 5 366183 02/13/2019 Seasons Nursing and Rehab 456 Seasons Rd Stow, OH 44224

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation and interview the facility failed to ensure proper infection prevention while passing meal trays to residents who ate in their rooms. This affected two of six residents whose meals trays were delivered to their room, Residents #26 and #18. Residents Affected - Few Findings include: Observation on 02/10/19 at 1:06 P.M. revealed State Tested Nursing Assistant (STNA) #38 remove a lunch tray from the transport cart, walk into Resident #43's room, set the lunch tray on the bedside table, rub Resident's #43 chest to wake him up, and walk out of the room with out washing or sanitizing her hands. STNA #38 picked up another tray from the transport cart, walked into Resident #26's room, set up the lunch tray, put a clothing protector on Resident #26 and walked out of the room without washing or sanitizing her hands. STNA #38 proceeded back to cart and removed another tray, walked into Resident #18's room, set the lunch tray on the bedside table and walked out of the room without washing or sanitizing her hands. Interview with STNA #38 on 02/10/19 at 1:14 P.M. confirmed she did not wash or sanitize her hands between delivering trays to Resident #43, #26 and #18. Interview with the Director of Nursing on 02/10/18 at 5:50 P.M. verified STNA #38 did not follow the facility's hand washing guidelines to prevent the spread of infection. Review of the facility's hand Washing Guidelines dated 07/18 revealed hands should be washed/sanitized after contact with residents and after direct contact with inanimate objects. 366183 Page 3 of 5 366183 02/13/2019 Seasons Nursing and Rehab 456 Seasons Rd Stow, OH 44224

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, and record review, the facility failed to maintain a clean, sanitary, and homelike environment. This had the potential to affect all 50 residents. Findings include: Upon entering the facility on 02/10/19 at 8:00 A.M. a strong odor of stale urine was noted. This odor was noted in the lobby and hallways to the conference room and in the conference room which was located between the library and physical therapy department. The conference room had cloth chairs which were dry and odor free. The origination of the odor was not determined. A tour of the facility on 02/10/19 between 9:00 A.M. to 9:30 A.M. revealed residents in various stages of activities of daily living. Staff were assisting residents with care. The facility had a strong, pervasive odor of stale urine. Interview on 02/10/19 at 9:30 A.M. with Resident #101 revealed it smelled like urine and bowel and the building needed to be torn down. Interview on 02/10/19 at 10:21 A.M. with Resident #6 revealed there was a strong odor of urine in the hallway. Interview on 02/10/19 at 1:26 P.M. with a visiting family revealed they visited often and there was an overpowering smell of urine in the facility. Upon entering the facility on 02/11/19 at 8:42 P.M. the odor of stale urine was again noted. The urine odor was also present in the conference room. Interview on 02/12/19 at 6:15 P.M. with the Administrator confirmed an odor of stale urine in the conference room. An environmental tour on 02/13/19 from 10:40 A.M. to 11:20 A.M. revealed a telephone outlet located on the wall near the television in the library had exposed wires. Multiple dark colored stains were noted on the carpet in the library and lobby. In the dayroom where the vending machine was located, there were two windows, one facing the courtyard that had missing pieces of molding on the bottom of the window and one near the couch on the back wall that was missing all the molding on the bottom of the window. The bathroom across from room [ROOM NUMBER] had missing floor tile in various places and a capped PVC pipe protruding from the floor approximately three to four inches above the ground. The shower area was missing molding along the wall and appeared dirty. On the opposite wall the molding was warped and dirty. Scattered areas of the laminate flooring in the conference room, day room and corridors in the resident room areas were cracked and lifting from the subflooring. Interview on 02/13/19 at 11:30 A.M. with Housekeeping Manager (HM) #56 revealed the carpet was cleaned twice weekly or as needed. The couches and cloth seat cushions were cleaned as needed. HM #56 did not know where the urine odor originated. Observations on 02/13/19 from 12:39 P.M. to 1:01 P.M. with Maintenance Director (MD) #46 and MD #47 366183 Page 4 of 5 366183 02/13/2019 Seasons Nursing and Rehab 456 Seasons Rd Stow, OH 44224

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many confirmed the observations made during the environmental tour from 10:40 A.M. to 11:20 A.M. Interview at the time of the observations with MD #46 and MD #47 revealed the exposed telephone wire was a low voltage and would not hurt anyone. Interview on 02/13/19 at 2:12 P.M. with HM #56 revealed the various dark stains in the carpet in the lobby area was from oil spilled from the popcorn machine two months ago. Review of the facility's undated cleaning procedures revealed staff were to enter the facility through the front door approaching and viewing the facility as a resident, family member, and guest. Tour the entire facility and immediately address any housekeeping issues. 366183 Page 5 of 5