Health inspection·June 4, 2021

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 interview and record review, revealed the facility failed to ensure Resident #301 who had an order to test her stool for occult blood (a test to check for hidden blood in the stool) was completed as ordered and/ or the physician or nurse practitioner was notified the ordered test was not completed. This affected one resident (Resident #301) out of one resident (Resident #301) reviewed for change in condition. The facility census was 93. Residents Affected - Few Finding include: Review of medical record for Resident #301 revealed an admission date of 05/06/21 and diagnoses included gastro-esophageal reflux, diabetes, cerebral infarction, repeated falls, dementia, and heart failure. Review of lab report dated 05/10/21 revealed Resident #301 had a complete blood count (CBC) completed that showed a hemoglobin level of 11.8 which was within normal limits and a low hematocrit of 35.4. Review of bowel pattern per point click documentation revealed Resident #301 had a large bowel movement on 05/11/21, large bowel movement on 05/14/21, large bowel movement on 05/16/21, medium bowel movement on 05/17/21, medium bowel movement on 05/18/21, large bowel movement on 05/20/21, and a large and medium bowel movement on 05/21/21. The documentation revealed no documentation for bowel movements from 05/23/21 to 06/03/21. Review of Medicare five-day Minimum Data Set (MDS) dated 05/12/ 21 revealed Resident #301 had impaired cognition. She required extensive assist of two person assist with bed mobility, transfers, and toileting. She was always incontinent of bowel. Review of Nurse Practitioner #900 progress note dated 05/17/21 at 1:40 P.M. revealed she reviewed Resident #301 lab work and noted her hemoglobin and hematocrit was trending down and she ordered her stool to be tested for occult blood and to repeat lab work of a CBC on 05/20/21. Review of physician order dated 05/17/21 revealed Resident #301 had an order to check for occult blood in her stool times three and report results to the physician. Review of nursing notes and lab reports for Resident #301 dated 05/17/21 to 06/02/21 revealed no documentation Resident #301's stool was checked for occult blood per physician order or the physician or nurse practitioner was notified of unable to complete at ordered. Page 1 of 3 366335 366335 06/04/2021 Snf-the Villa at Marymount 5200 Marymount Village Drive Garfield Heights, OH 44125

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of lab report dated 05/20/21 revealed Resident #301 had a CBC completed that showed a decrease with her hemoglobin level from 11.8 to 10.5 and her hematocrit level decreased from 35.4 to 31.5. Review of lab report dated 05/26/21 revealed Resident #301 had CBC completed that showed a further decrease in her hemoglobin level from 10.5 to 8.8 and a further decrease with her hematocrit level from 31.5 to 26.8. Review of lab report dated 05/28/21 revealed Resident #301 had a CBC completed that showed her hemoglobin level was 9.2 and her hematocrit level was 28. Review of nursing notes dated 05/30/21 at 2:04 P.M. revealed no stool this shift as still need sample for occult. Review of lab report dated 06/01/21 revealed Resident #301 had CBC completed that showed her hemoglobin level was 9.0 and her hematocrit level was 27.6. Interview on 06/02/21 at 1:17 P.M. with Registered Nurse (RN)/ Unit Manager #107 verified there was an order dated 05/17/21 for Resident #301 to have her stool checked for occult blood since her hemoglobin and hematocrit were trending downward and she verified she had no documentation this was completed or that the physician had been contacted that the facility was unable to obtain. Review of care plan dated 06/03/21 revealed Resident #301 was on anticoagulant therapy related to atrial fibrillation. Interventions included encourage not to bump self, labs as ordered and report abnormal results to the physician and monitor, document and report to physician sign and symptoms of anticoagulant complications including black tarry stools, dark and bright red blood in stools, diarrhea and significant or sudden changes. Interview on 06/03/21 at 12:45 P.M. with Registered Nurse/ Unit Manager #107 revealed Resident #301 had bowel movements on 05/25/21, 05/28/21 and a bowel movement on 06/02/21. Review of undated facility procedure labeled, Determining the Presence of Occult Blood in Stool revealed the facility was to refer to medical record, care plan or [NAME] and then gather supplies. The procedure did include if unable to obtain stool sample and notification to the physician if unable to obtain. Review of facility policy, Change in a Resident's Condition or Status dated August 2011 revealed the facility shall promptly notify the resident, his or her attending physician, and resident representative of changes in the resident's medical or mental status. The facility failed to implement the policy as the policy indicated the nurse would notify the residents physician when there was refusal of treatment or medications two or more consecutive times. 366335 Page 2 of 3 366335 06/04/2021 Snf-the Villa at Marymount 5200 Marymount Village Drive Garfield Heights, OH 44125

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview the facility failed to maintain a clean and sanitary kitchen to prepare food. This had the potential to affect 92 out of 93 residents residing in the facility. One resident (Resident #32) did not receive food from the kitchen. Facility census was 93. Finding Include: 1. On 06/01/21 the initial tour of the kitchen from 8:43 A.M. through 9: 21 A.M. revealed the oven, shelf over the oven, stovetop, fryer, and steamer all had dried food spatters down the sides, and accumulated grease, dust, and/or grime on them. The handles and knobs of the equipment had accumulated grease and grime. The vents over the equipment were greasy. The small [NAME] mixer stand had dried spatters on the side of the mixer and on the stand. 2. On 06/01/21 at 12:47 P.M. dietary aide #345 was observed taking temperatures of the foods on the steam table in the memory care unit using a probe thermometer. Dietary aide #345 pulled the probe thermometer from the cover and stuck the probe into the noodles, chicken, fish, carrots, pureed chicken, pureed fish, pureed vegetables, mechanical chicken and pureed noodles one after the other without wiping off the food residue and without sanitizing the probe. Proper procedure to prevent cross contamination was not followed when checking the food temperatures. Interview with Registered Nurse #35 on 06/01/21 at 12:55 P.M. reported no resident on the memory care unit had an allergy to fish to her knowledge. These observations were verified at the time of observation by Dietary Director #157. 366335 Page 3 of 3