Health inspection·July 2, 2019

F 0625 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to notify residents or their responsible party of the facility's bed hold policy. This affected one resident (Resident #42) of two reviewed for hospitalization. The facility census was 43. Findings include: Record review revealed Resident #42 was admitted on [DATE]. Diagnoses included chronic respiratory failure and chronic obstructive pulmonary disease. Review of Resident #42's progress notes revealed on 05/25/19 the resident was sent to the hospital via emergency medical services (911) per physician order for difficulty breathing, low oxygen saturation and diminished lung sounds. There was no documentation found in the medical record the resident and/or family member was notified of the facility's bed hold policy. Interview on 07/01/19 at 12:05 P.M. with Social Service Director (SSD) #559 verified there was no evidence of bed hold policy notification for Resident #42 when he was admitted to the hospital 05/25/19. SSD #559 revealed the facility had not been notifying family representatives of the bed hold policy. Review of facility's undated bed hold policy revealed the responsible party of the resident would be notified by certified mail on the day of the transfer or the day after the transfer. Notification would inform responsible parties of the transfer, the bed hold restriction and number of available bed hold days. Page 1 of 4 366277 366277 07/02/2019 Bel Air Care Center 2350 South Cherry Street Alliance, OH 44601

F 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on staff interview, record review, and policy review the facility failed to complete pre-dialysis and post-dialysis assessments for one resident (Resident #15) of two residents reviewed for dialysis care. The facility census was 42. Residents Affected - Few Findings Include: Resident #15 was admitted to the facility on [DATE] with diagnoses including diabetes, dialysis dependent due to chronic kidney disease, congestive heart failure, and seizures. The Minimum Data Set (MDS) 3.0 quarterly comprehensive assessment dated [DATE] revealed the resident was moderately cognitively impaired, needed extensive assistance for all personal care, and required dialysis treatments three times a week. Review of the progress notes from 06/01/19 through 07/02/19 revealed no documentation regarding Resident #15's dialysis port, if any bleeding was noted at the site, where the site was located, or assessments completed both before and after the resident returned from dialysis. Interview with the Assistant Director of Nursing (ADON) on 07/01/19 at 4:30 P.M. revealed Resident #15's dialysis provider did not provide the facility with updates regarding the resident's dialysis treatments on a routine basis. They submitted them to the facility approximately every six months. The facility requested monthly updates from the provider without success. Review of the facility's Policy # RC-30.0 Hemodialysis Therapy, dated 01/01/17, revealed no documentation requirements for nurses to complete with each dialysis treatment. Interview with the Director of Nursing on 07/02/19 at 10:25 A.M. confirmed nursing has not been assessing Resident #15 either prior to leaving for dialysis or upon return to the facility after dialysis treatment had been completed. 366277 Page 2 of 4 366277 07/02/2019 Bel Air Care Center 2350 South Cherry Street Alliance, OH 44601

F 0711 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure the resident's doctor reviews the resident's care, writes, signs and dates progress notes and orders, at each required visit. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview, and policy review, the facility failed to ensure Foley (urinary) catheter orders were in place for one resident (Resident #193) of two residents in the facility with Foley catheters. Findings include: Resident #193 was admitted to the facility on [DATE] with diagnoses including malignant neoplasm of anal canal, pressure ulcers of right hip and other sites, lymphedema, and injury of nerve root of sacral spine. Review of Resident #193's hospital discharge orders and instructions revealed an order for ongoing Foley catheter. Review of Resident #193's facility physician orders revealed no orders regarding the Foley catheter. Interview on 07/01/19 at 2:58 P.M. with the Director of Nursing (DON) verified Resident #193 did not have any Foley catheter orders since admission on [DATE]. Review of the facility policy titled Urinary Catheter Insertion, Maintenance and Removal, dated February 2017, revealed physician orders must be obtained for and to maintain Foley catheters. 366277 Page 3 of 4 366277 07/02/2019 Bel Air Care Center 2350 South Cherry Street Alliance, OH 44601

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview the facility failed to ensure proper infection control measures for respiratory equipment for two residents (Resident #22 and Resident #1) of eight receiving respiratory treatments. Residents Affected - Few Findings include: 1. Record review revealed Resident #22 was admitted on [DATE] with diagnoses of dementia, chronic obstructive pulmonary disease (COPD) and paralysis of the right side. There was a physician order for duoneb, an aerosol breathing treatment used for COPD, to be administered three times a day. Observation on 06/30/19 at 10:35 P.M. of Resident's #22's room revealed a nebulizer machine (device used to deliver breathing treatments) on the floor next to the bed. The mask through which the medicated mist was inhaled was covered in a plastic bag. Interview on 06/30/19 with Licensed Practical Nurse (LPN) #586 revealed the nebulizer machine was usually kept on the tray table, someone removed the table and set the machine on the floor. 2. Record review revealed Resident #1 was admitted on [DATE] with diagnoses of chronic obstructive pulmonary disease (COPD), respiratory failure, and sleep apnea. The quarterly Minimum Data Set (MDS) 3.0 assessment revealed the resident had a diagnosis of pneumonia and used oxygen and a BiPap/CPAP for treatment of sleep apnea. There was a physician order for a ventilation device to be applied four hours during the day and continuously at bedtime. Observation of Resident #1's room on 06/30/19 at 10:35 P.M. and on 07/01/19 at 10:45 A.M. revealed a portable ventilator device attached to a pole with a wire basket underneath that contained an uncovered full-face mask. Interview with Assistant Director of Nursing # 514 on 07/01/19 at 10:50 A.M. verified that no protective covering was around the ventilator face mask. 366277 Page 4 of 4