Health inspection·January 31, 2024

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to provide a clean and sanitary environment for Resident #7 and #28, and failed to ensure Resident #57 had clean bed linens. This affected three (#7, #28 and #57) of ten residents observed for environment. The facility census was 83. Findings include: 1. Observations on 01/28/24 at 10:45 A.M. revealed Resident #7 was up in a wheelchair with his bedside table in front of him. Resident #7's wheelchair had dirty debris on the foot rests and on the cushioned leg brace to the left side. Resident #7's bedside table had various areas of dried spilled debris on the top of the table and in an open drawer of the table. Further observation revealed Resident #7's roommate (Resident #28) was receiving tube feeding. The tube feeding pole had various areas of dried tube feeding formula on it. Scattered debris was observed on the floor behind Resident #28's bed. Interview with Resident #28 at time of observation revealed They come in sometimes, but they don't look back there. Observations were confirmed by Licensed Practical Nurse (LPN) #587 on 01/28/24 at 11:00 A.M. 2. Observation on 01/30/24 at 7:07 A.M. revealed Resident #57 was out of bed. Observation of Resident #57's bed linens revealed multiple areas of dried blood and a large dried yellow stain on the middle of the bed sheet. Observation of and interview with Resident #57 revealed he could not say where the blood or yellow stains had come from or how long they had been there. Resident #57 said he was continent of urine and used the bathroom. Resident #57 did not have any obvious scratches, abrasions or skin tears. Interview on 01/30/24 at 10:30 A.M. with State Tested Nursing Assistant (STNA) #585 revealed Resident #57 was continent of urine and walked to the bathroom. STNA #585 had changed Residents #57's bed linens after being asked by the Administrator to change the sheets because they were soiled. STNA #585 confirmed the sheets had dried blood and a large dried yellow stain but he was unaware where the stains came from or how long they had been there. STNA #585 said Resident #57 did not have any scratches, abrasions, or skin tears that he was aware of and Resident #57 usually made his own bed in the mornings and kept his blankets pulled up over the sheets. Review of the Minimum Data Set assessment dated [DATE] revealed Resident #57 was independent with toileting, showering and ambulation. Resident #57 was incontinent of bowel and bladder. Page 1 of 2 366343 366343 01/31/2024 North Royalton Post Acute 9055 West Sprague Road Parma, OH 44133

F 0838 Level of Harm - Potential for minimal harm Residents Affected - Many Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to ensure the facility assessment was updated and accurate. This had the potential to affect all residents. The facility census was 83. Findings include: Review of the Facility assessment dated [DATE] revealed the paragraph listed under Resident Population included another facility's name and indicated that facility provided care and services to individuals with certain medical and cognitive disabilities. The facility assessment further indicated how the facility utilized the minimum data set (MDS) assessment in regard to the resident population and the type of residents they did not admit. Further review of the facility assessment revealed a test box under the staffing plan that listed the position of the staff and the range needed. The range did not include the numbers needed for each position; the hours per patient per day for the licensed nurses and nurse aides; the full time equivalent (FTE) per week for the nursing personnel with administrative duties; staff needed for behavioral healthcare and services and the dietitian, or the FTE per day for the food and nutrition services staff. The facility assessment also did not indicate the use of the contracted agency nursing staff under facility resources, section E, contracts/memorandums/agreements with third parties for services. Review of the facility's two nursing agency staffing contracts revealed they were effective as of 03/01/23 and 03/06/23. Interview on 01/29/24 at 11:54 A.M. with the Administrator verified the above identified findings. The Administrator stated they had used agency staffing periodically since she had been with the facility, which was about a year. 366343 Page 2 of 2