Health inspection·December 28, 2019

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, resident interview, and staff interview, the facility failed to provide access to the remote control to change position of an electric recliner chair for one for one (#200) of one resident reviewed for accommodation of needs. The facility census was 51. Residents Affected - Few Findings include: Review of the medical record for Resident #200 revealed the resident was admitted on [DATE]. Diagnoses included unspecified fracture of T11-T12 vertebra, low back pain, hypertensive chronic kidney disease stage 3, heart failure, atrial fibrillation, hyperlipidemia, insomnia, osteoarthritis, history of falling, and hypertension. Review of the admission Minimum Data Set (MDS) 3.0 assessment, dated 09/27/19, revealed the resident had no cognitive issues. The resident required extensive assistance with bed mobility, transfer, locomotion, dressing, toilet use, and personal hygiene. Interview on 12/26/19 at 9:36 A.M., Resident #200 revealed she was not able to access the remote control to her electric recliner chair. Resident #200 stated the facility does not want her to get out of her chair without assistance. Observation on 12/26/19 at 9:38 A.M. revealed Resident #200 was reclined in the electric recliner chair in the resident's room. The recliner chair had a remote control, which was attached to a cord, and located in the side pocket of the recliner chair. The remote controlled the back and foot rest. On the remote was taped a handwritten note reading Remote to stay in side pocket. Resident #200 was unable to access the remote to make adjustments to the chair for comfort. Additional observations on 12/27/19 at 9:26 A.M. and 3:29 P.M. revealed the remote control to the recliner was located in the side pocket of the recliner. Interview on 12/26/19 at 11:45 A.M., State Tested Nurse Aide (STNA) #600 verified Resident #200 was unable to reach the remote control to the recliner. STNA #600 stated about three to four weeks ago there was a note to keep the remote control in the side pocket of the recliner. Resident #200 was to use the call light when needed. Interview on 12/27/19 at 10:56 A.M., STNA #650 verified Resident #200 was not to have access to the remote control for the recliner and the remote was to be kept in the side pocket. STNA #650 stated the resident was to use the call light when needed. Page 1 of 4 366365 366365 12/28/2019 Willows at Bellevue 101 Auxiliary Drive Bellevue, OH 44811

F 0558 Level of Harm - Minimal harm or potential for actual harm Review of facility policy titled Resident Rights Guidelines, revised May 2017, verified the residents have the right to be given the information to participate in decisions which affect them both individually and corporately. Residents Affected - Few 366365 Page 2 of 4 366365 12/28/2019 Willows at Bellevue 101 Auxiliary Drive Bellevue, OH 44811

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on observation, staff interview, and review of a facility policy, the facility failed to ensure medications were secured from unauthorized access when a medication cart was left unlocked and unattended by staff. This affected one (#50) resident the facility identified as the only independently mobile and cognitively impaired resident residing on the 300 Hall. The census was 51. Findings include: Observation on 12/27/19 at approximately 3:30 P.M. revealed Registered Nurse (RN) #375 administering medications to residents on the 300 Hall from the 300 Hall medication cart. At 3:38 P.M., RN #375 removed medications from the 300 Hall medication cart, prepared them for administration, and walked away from the medication cart without locking it. RN #375 walked down the 300 Hall and entered a resident's room to administer the medications, leaving the unlocked medication cart out of her sight. At 3:42 P.M., RN #375 walked back to the 300 Hall medication cart, prepared another resident's medications for administration, and again, walked away from the medication cart without locking it. RN #375 walked down the 300 Hall and entered another resident's room to administer the medications, leaving the unlocked medication cart out of her sight. Interview on 12/27/19 at 3:47 P.M. with RN #375 verified she did not lock the 300 Hall medication cart for two different resident medication administrations in a row. RN #375 stated the medication cart should be locked every time a nurse steps away from the cart. Review of a facility policy titled Medication Storage in the Facility, revised August 2014, revealed medications and biologicals are stored safely, securely, and properly, following manufacturer's recommendations or those of the supplier. Only licensed nurses, pharmacy personnel and those lawfully authorized to administer medications (such as medication aides) are permitted to access medications. Medication rooms, carts, and medication supplies are locked when not attended by persons with authorized access. The facility identified Resident #50 as the only resident residing on the 300 Hall who was cognitively impaired and independently mobile. 366365 Page 3 of 4 366365 12/28/2019 Willows at Bellevue 101 Auxiliary Drive Bellevue, OH 44811

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. Based on observation, staff interview, medical record review, and review of a facility policy, the facility failed to ensure a resident's urinary catheter collection bag was kept off the ground. This affected one (#48) of one residents reviewed for urinary catheters. The facility identified two residents in the facility with urinary catheters. The census was 51. Findings include: Review of Resident #48's medical record revealed and admission date of 06/17/15. Diagnoses included hemiplagia and hemiparesis, vascular dementia with behavioral disturbances, anxiety, insomnia, retension of urine, neuromuscular dysfunction of bladder, and muscle wasting and atrophy. Review of the most recent Minimum Data Set (MDS) assessment, dated 12/04/19, revealed Resident #48 was assessed with an indwelling urinary catheter. Review of a care plan dated 12/10/19 for Resident #48's urinary catheter, revealed an intervention to maintain a closed system with the urinary collection bag below the resident's bladder and keep the bag covered. Observation on 12/26/19 at 01:27 PM revealed Resident #48 sitting in a wheelchair in the dining room with his urinary catheter collection bag suspended from under his wheelchair and the bag resting on the floor. Subsequent observations on 12/27/19 at 10:20 A.M. and 5:26 P.M., revealed Resident #48's urinary catheter collection bag remained suspended from under his wheelchair with the bag resting on the floor. Observations on 12/27/19 at 10:26 A.M. and 12:49 P.M., revealed Resident #48 was propelling himself in his wheelchair and his urinary catheter collection bag could be heard and seen dragging on the floor as Resident #48 moved down the hallway. Observation on 12/28/19 at 7:56 A.M., revealed Resident #48 sitting in his wheelchair in his room with his urinary catheter collection bag resting on the floor. Interview on 12/28/19 at 8:00 A.M., Licensed Practical Nurse (LPN) #480 verified Resident #48's urinary catheter collection bag was on the floor and stated it should not be touching the ground at anytime. LPN #480 stated Resident #480 would not be able to reach under his wheelchair and move the placement of his urinary catheter collection bag on his own. Resident #48 was observed once again on 12/28/19 at 11:34 A.M. sitting in the dining room with his urinary catheter collection bag suspended from underneath his wheelchair and resting on the floor. Review of a facility policy titled Urinary Catheter Care, dated 05/11/16, revealed staff should be sure the catheter tubing and drainage bag are kept off the floor. 366365 Page 4 of 4