Health inspection·April 3, 2025

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, interview and review of the facility policies, the facility failed to maintain an accurate care plan for Residents #35 and #168 related to their care needs. This affected two resident (#35 and #168) reviewed for care planning. The facility census was 68. Findings include: 1. Review of the medical record for Resident #35 revealed an admission date of 01/01/25. Diagnoses included chronic respiratory failure with hypoxia, congestive heart failure, orthostatic hypertension, and chronic kidney disease stage V. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #35 had intact cognition. Resident #35 required moderate assistance for all activities of daily living. Review of the care plan dated 03/17/25 revealed Resident #35 had peritoneal dialysis with a potential for infection. Interventions included educating the resident on diet restrictions and providing the diet as ordered. No interventions were found to assist the resident with the dialysis, how to troubleshoot if problems arise, and weight monitoring. Review of the physician's order dated 04/01/25 revealed that Resident #35 was to manage his daily peritoneal dialysis. Interview on 04/01/25 at 5:10 P.M. with Licensed Practical Nurse (LPN) MDS Coordinator #500 and the Director of Nursing (DON) confirmed Resident #35 had no interventions related to his peritoneal dialysis. They confirmed that the staff was trained and so was Resident #35. They reported that the dialysis center does have an emergency hotline for problems for the staff to use. Review of the undated facility policy peritoneal dialysis revealed staff must monitor the residents for the following problems associated with renal failure and/or dialysis. To include fluid and electrolyte imbalance, cardiovascular/hemodynamic instability, pain, infection, altered nutrition, and immobility. 2. Review of the medical record for Resident #168 revealed an admission date of 01/23/25 and a discharge date of 02/03/25. Diagnoses included spontaneous rupture of extensor tendons of the right thigh, chronic kidney disease stage three, type two diabetes mellitus, and congestive heart failure. Review of the five-day MDS assessment dated [DATE] revealed Resident #168 had moderate cognitive Page 1 of 9 366186 366186 04/03/2025 Aventura at Humility House 755 Ohltown Road Austintown, OH 44515

F 0656 Level of Harm - Minimal harm or potential for actual harm impairment. Resident #168 required moderate assistance for all activities of daily living. Resident #168 was identified as being at risk for developing pressure ulcers but did not have any at the time of the assessment. Review of the baseline care plan and care plan dated 01/23/25 revealed no skin interventions and no focus of skin breakdown. Residents Affected - Few Review of the hospital paperwork dated 02/03/25 revealed Resident #168 was discharged to the emergency room and was diagnosed as having two stage IV pressure ulcers (Full thickness tissue loss with exposed bone, tendon or muscle. Slough may be present on some parts of the wound bed. Often include undermining and tunneling.) on his anterior and posterior knee where a leg brace was in place and bilateral unstageable heel pressure ulcers full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed.) Interview on 04/01/25 at 5:10 P.M. with LPN/MDS Coordinator #500 and the DON confirmed that Resident #168 had no skin interventions in either of his care plans. Review of the facility policy titled Prevention of Pressure Injuries, revised September 2022, revealed that medical devices will be monitored regularly for comfort and signs of pressure related injuries and for prevention measures associated with specific devices, consult clinical practice guidelines. 366186 Page 2 of 9 366186 04/03/2025 Aventura at Humility House 755 Ohltown Road Austintown, OH 44515

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and facility policy review, the facility failed obtain daily weights as ordered by the physician for Resident #12 who had a diagnosis of congestive heart failure (CHF). This affected one resident (#12) of three residents reviewed for quality of care. The facility census was 68. Residents Affected - Few Findings include: Review of Resident #12's medical record revealed an admission date of 02/21/25 with medical diagnosis including CHF, chronic embolism and thrombosis of the femoral vein, cerebral infarction, occlusion of the left carotid artery, pulmonary hypertension, Bell's Palsy, dysphasia, chronic kidney disease stage four (CKD), Alzheimer's disease, hypertension, and multiple myeloma. Review of Resident #12's plan of care start date 02/21/25 revealed nutritional risk related to CHF. Interventions included labs as ordered, recording and monitoring weights. Review of the Minimum Data Set (MDS) 3.0 admission assessment dated [DATE] revealed Resident #12's cognition was severely impaired. Resident #12 did not reject care and had no behavior symptoms. Resident #12 required minimal assistance with toilet hygiene and personal hygiene. Supervision or touching assistance was required to roll left and right in bed, sit on the side of the bed, lie back on the bed. Moderate assistance to stand from sitting, bed transfers and toilet transfers. Resident #12 was dependent on staff to walk ten feet and was always incontinent of urine. The resident was short of breath with exertion, and short of breath when lying flat. Resident #12 was on a therapeutic diet and was on an anticoagulant medication, antibiotic medication, antiplatelet medication, and anticonvulsant medication. Resident #12 received chemotherapy and oxygen therapy. Review of Resident #12's physician order dated 03/17/25 revealed an order for daily weight in the A.M. (before breakfast due to CHF and chronic kidney disease, notify the doctor of weight gain of three pounds or more in a day or five pounds in a week. Review of Certified Nurse Practitioner (CNP) #601's progress note dated 03/19/25 revealed Resident #12 was receiving skilled care after returning from the hospital. Resident #12 was in the hospital from [DATE] to 03/17/25 for dementia, weakness, and right arm swelling. Resident #12 was seen by the CHF team, infectious disease, nephrology and the vascular team in the hospital. The assessment and plan included acute on chronic CHF, follow weights and vital signs. Continue with Bumex (diuretic) and isosorbide (vasodilator to treat cardiac disease) and follow the CHF clinic recommendations. Review of Resident #12's weights in the medical record, including the medication administration record (MAR) and treatment administration record (TAR), included: • 03/18/25 at 6:18 A.M. 106.4 pounds • 03/19/25 at 6:17 A.M. 106.2 pounds 366186 Page 3 of 9 366186 04/03/2025 Aventura at Humility House 755 Ohltown Road Austintown, OH 44515

F 0684 • Level of Harm - Minimal harm or potential for actual harm 03/20/25 at 6:00 A.M.108.2 pounds • Residents Affected - Few 03/21/25 at 6:34 A.M. 104.8 pounds • 03/22/25 no documented evidence Resident #12's weight was obtained • 03/23/25 no documented evidence Resident #12's weight was obtained • 03/24/25 no documented evidence Resident #12's weight was obtained • 03/25/25 no documented evidence Resident #12's weight was obtained • 03/26/25 no documented evidence Resident #12's weight was obtained • 03/27/25 at 7:16 A.M. 104.0 pounds • 03/28/25 at 6:10 A.M. 104.6 pounds • 03/29/25 at 7:44 A.M. 104.2 pounds • 03/30/25 no documented evidence Resident #12's weight was obtained • 03/31/25 no documented evidence Resident #12's weight was obtained Interview on 04/01/25 at 9:17 A.M. with Licensed Practical Nurse (LPN) #589 revealed weekly weights 366186 Page 4 of 9 366186 04/03/2025 Aventura at Humility House 755 Ohltown Road Austintown, OH 44515

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few and daily weights were done by the nursing assistant and documented in the electronic medical record for residents who have an order, and the weights would show in the MAR and TAR. Resident #12 needed her weight to be monitored due to CHF, fluid retention, and because Resident #12 attended the CHF clinic. Resident # 12 seldom rejected care and was very cooperative. LPN #589 verified a physician order for daily weights was on 03/18/25 and verified weights were not obtained on 03/22/25, 03/23/25, 03/24/25, 03/25/25, 03/26/25, 03/30/25 and 03/31/25. LPN #589 stated the daily weights were not obtained, and Resident # 12 was in the facility. Interview on 04/01/25 at 9:26 A.M. Resident #12 stated, I think I am supposed to get weighed, but I cannot remember the last time I was weighed. Interview on 04/01/25 at 9:29 A.M. with Certified Nursing Assistant (CNA)#600 revealed the nurse aide would know a weight needed to be obtained by reviewing the paper care plan in the morning. The nurse aide could enter the weight into the resident's electric medical record. Interview 04/02/25 at 4:25 P.M. with the Director of Nursing (DON) verified weights were not obtained on 03/22/25, 03/23/25, 03/24/25, 03/25/25, 03/26/25, 03/30/25 and 03/31/25. Review of the facility policy titled Weight Assessment and Intervention, revision date August 2022, revealed weights were recorded in each unit's weight record and individual medical record. Review of the facility policy titled Heart Failure, revision date November 2018, revealed the physician would review and make recommendations for relevant aspects of nursing care such as how often and what weights to monitor and when to report to the physician. 366186 Page 5 of 9 366186 04/03/2025 Aventura at Humility House 755 Ohltown Road Austintown, OH 44515

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview, review of hospital paperwork, and review of facility polices, the facility failed to implement an adequate and effective pressure ulcer prevention program for Resident #168. This affected one Resident #168 of two residents reviewed for pressure ulcers. The facility census was 68. Residents Affected - Few Actual Harm occurred on 02/03/25 when Resident #168 developed an in-house acquired Stage IV pressure ulcer (Full thickness tissue loss with exposed bone, tendon or muscle. Slough may be present on some parts of the wound bed. Often include undermining and tunneling.) to the right leg from an Ace wrap and immobilizer brace. Resident #168 was admitted to the facility from the hospital on [DATE] with an Ace wrap and a knee immobilizer brace on his right leg. There were no orders on admission to manage the right knee immobilizer brace and/or the Ace wrap. The admitting nurse documented that the unit manager was to clarify the order with the orthopedic physician on 01/24/25, and no orders were obtained. There was no documented evidence that the orthopedic physician was called for orders during Resident #168's 12-day stay at the facility. The Ace wrap and leg brace were never removed from Resident #168's leg from admission on [DATE]. Resident #168 was sent to the emergency room on [DATE] with red and yellow drainage draining from his right leg under the Ace wrap and right knee immobilizer brace and was diagnosed with an infected Stage IV pressure ulcer at the hospital. Findings include: Review of the medical record for Resident #168 revealed an admission date of 01/23/25 and a discharge date of 02/03/25. Diagnoses included spontaneous rupture of extensor tendons of the right thigh, chronic kidney disease, type two diabetes mellitus, and congestive heart failure. Review of the orthopedic note from his hospital stay dated 01/22/25 revealed Resident #168 had a spontaneous rupture of his right thigh tendons. Due to Resident #168's age and comorbidities an Ace wrap and knee brace were ordered for his right leg as well as rehabilitation. Review of the after-visit summary from Resident #168's hospital discharge date d 01/23/25 revealed the resident was to be admitted to the facility for rehabilitation. No orders to maintain his right leg knee brace and Ace wrap were included. Review of the admission assessment dated [DATE] revealed Resident #168 had multiple ecchymotic (bruises) areas on his bilateral arms and legs. The nurse was unable to fully assess Resident #168 due to an Ace wrap and brace intact to his right leg. Review of the pressure ulcer risk scale completed on admission revealed Resident #168 was at risk for developing pressure ulcers. Review of the physician's order dated 01/23/25 and discontinued on 01/24/25 revealed Ace wrap and immobilizer brace to remain on right leg until orders clarified with the orthopedic doctor by the unit manager. Review of further orders revealed no clarification order and/or orders for monitoring Resident #186's skin for pressure from the Ace wrap and immobilizer brace to the right leg. Review of the baseline care plan and care plan dated 01/23/25 revealed no skin focus areas and no skin interventions and no baseline care plan related to the use of the Ace wrap and immobilizer brace to the right leg. Review of the wound physician note from 01/29/25 revealed Resident #168 had bilateral heel blisters 366186 Page 6 of 9 366186 04/03/2025 Aventura at Humility House 755 Ohltown Road Austintown, OH 44515

F 0686 Level of Harm - Actual harm Residents Affected - Few and treatments were put into place for both heels to be cleansed with Dakin's solution (topical antiseptic), apply Skin Prep (forms a film to reduce friction) to the border, apply hydrogel (promote healing by providing moisture), and covered with bordered gauze daily and as needed. During that visit Resident #168 refused to have the wound physician remove his ace wrap and immobilizer brace. There was no follow-up after that encounter. Review of the five-day Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #168 had moderate cognitive impairment. Resident #168 had lived independently prior to his hospitalization and now required set-up to moderate assistance for all activities of daily living. Resident #168 was at risk for developing pressure ulcers but did not have one at the time of the assessment. Review of the medical record and therapy notes, revealed no documented evidence in the medical record during Resident #168's 12-day stay that staff monitored the resident's skin, checked pedal pulses, monitored for edema, and monitored for pain related to the right knee immobilizer brace and Ace wrap to the right leg. There was also no documented evidence staff attempted to call the orthopedic physician at any time to get orders for the right knee immobilizer brace and Ace wrap to the right leg that Resident #168 was admitted to the facility with. Review of the nurse's note dated 02/03/25 at 1:10 P.M. revealed therapy notified the nurse that Resident #168 was bleeding from his right leg under his surgical dressing. No orders had been given to change the dressing. The physician and family were notified, and Resident #168 was sent to the emergency room. Review of the nurse's note dated 02/03/25 at 6:01 P.M. revealed Resident #168 was still in the emergency room and being admitted with a diagnosis of wound infection. Review of the emergency room paperwork dated 02/03/25 revealed Resident #168 presented to the emergency room from a nursing home where Resident #168 was said to have pus coming from a surgical wound. Resident #168 denied ever having surgery recently and stated he realized he had a wound. He was diagnosed with chronic decubitus ulcers on bilateral heels, large ulcer on right anterior knee, and large ulcers on the posterior calf. The paperwork stated to see pictures. Review of the picture of the anterior right knee wound revealed edges dry, base had slough and eschar with visible tendon and bone. The right posterior knee wound was macerated with full skin thickness loss. Resident #168 was admitted to the hospital with a diagnosis of wound infection and had to receive intravenous antibiotics and wound care. Interview on 04/01/25 at 5:10 P.M. with the Director of Nursing (DON) confirmed when Resident #168 was admitted , the admitting nurse placed an order for the unit manager to clarify whether the right knee immobilizer brace and Ace wrap could be removed in the morning. The unit manager never clarified the order, and Resident #168's right knee immobilizer brace and Ace wrap was never removed during his 12-day stay. The DON reported when Resident #168 began bleeding from his right leg where the immobilizer brace and Ace wrap were intact, he had developed a pressure ulcer (Stage IV) from the brace that had become infected, and he was admitted to the hospital. The DON also confirmed Resident #168's family did not send him back to the facility after the hospitalization. She verified that no staff attempted to clarify the orders with the orthopedic physician, and no staff assessed Resident #168's skin, pedal pulses, pain, and/or monitored for edema at any point during the 12-day stay. Review of the facility policy titled Prevention of Pressure Injuries, revised September 2022, revealed that medical devices will be monitored regularly for comfort and signs of pressure related 366186 Page 7 of 9 366186 04/03/2025 Aventura at Humility House 755 Ohltown Road Austintown, OH 44515

F 0686 injuries and for prevention measures associated with specific devices, consult clinical practice guidelines. Level of Harm - Actual harm This deficiency represents noncompliance investigated under Complaint Numbers OH00162679 and OH00162590. Residents Affected - Few 366186 Page 8 of 9 366186 04/03/2025 Aventura at Humility House 755 Ohltown Road Austintown, OH 44515

F 0847 Inform resident or representatives choice to enter into binding arbitration agreement and right to refuse. Level of Harm - Minimal harm or potential for actual harm Based on review of the facility arbitration agreement and interview, the facility failed to clearly state that residents or their representatives could consult with local, state, or federal officials before signing or within thirty days of signing the agreement. This affected Residents #3, #12, #14, #16, #21, #24, #26, #29, #32, #35, #38, #41, #43, #45, #49, #50, #52, #53, #58, #61, #62, and #119 who signed the arbitration agreement. The facility census was 68. Residents Affected - Some Findings include: Review of the arbitration agreement, undated, revealed that disputes not to be arbitrated include any communications with federal, state, or local officials, including but not limited to, federal and state surveyors, other federal or state health department employees, and representatives of the Office of the State Long-Term Care Ombudsman. The agreement also stated that the resident or authorized representative has the right to cancel this agreement by notifying the facility in writing. Such notice must be sent via certified mail to the attention of the administrator of the facility, and the notice must be post marked within sixty days of the date upon which this agreement was signed. The agreement also did not state that the residents or their representative could reach out to federal, state, or local officials before signing just that they could seek legal counsel before signing. Interview on 04/02/25 at 9:55 A.M. with Admissions #509 confirmed that she does go over every arbitration agreement when the residents are admitted . She confirmed that the arbitration agreement does state that disputes involving communication with federal, state, or local officials would not go to arbitration based on the wording. She reported she was unaware that residents or their representatives could reach out to federal, state, or local officials before signing the agreement. Admissions #509 also confirmed that residents or their representatives have sixty days to rescind the agreement after signing it by mail. 366186 Page 9 of 9