Health inspection·July 11, 2019

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure the Minimum Data Set (MDS) assessment was coded accurately. This affected two of 11 sampled residents (Residents #2 and #23). Residents Affected - Few Findings include: 1. Record review revealed Resident #2 was admitted to the facility on [DATE] with diagnoses that included chronic atrial fibrillation, coronary heart disease, heart failure, pneumonia, and Alzheimer's disease. Review of Resident #2's MDS 3.0 assessment dated [DATE] indicated the resident exhibited severe cognitive impairment and received dialysis. Review of Resident #2's medical record, physician orders, medication administration records (MARS) and treatment administration records (TARS) for [DATE] revealed Resident #2 expired while on hospice in the facility. The discharged MDS was not completed for Resident #2. Interview on [DATE] at 11:06 A.M. with Director of Nursing confirmed Resident #2's discharged assessment dated [DATE] was not complete and the resident expired in the facility on hospice. 2. Record review revealed Resident #23 was readmitted to the facility on [DATE] with diagnoses that included end stage renal disease, anxiety disorder, bipolar disorder, and peripheral vascular angioplasty status. Review of Resident #23's MDS 3.0 assessment dated [DATE] indicated the resident exhibited intact cognitive impairment and received an anticoagulant. Review of Resident #23's medical record, physician orders, medication administration records (MARS) for [DATE] revealed Resident #23 received Plavix, an antiplatelet agent, and not an anticoagulant. Interview on [DATE] at 11:06 A.M. with Director of Nursing confirmed Resident #23's MDS 3.0 assessment dated [DATE] was inaccurate and the resident did not receive an anticoagulant. Page 1 of 3 366390 366390 07/11/2019 North Park Care Center 14801 Holland Road Brook Park, OH 44142

F 0810 Provide special eating equipment and utensils for residents who need them and appropriate assistance. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure consistent use of adaptive equipment. This affected one resident (Resident #15) of three residents observed for adaptive equipment. The facility census was 30 residents. Residents Affected - Few Findings include: Review of Resident #15's medical record revealed a readmission date of 08/23/18 and diagnoses including heart failure, major depressive disorder, and cerebrovascular disease. Review of the quarterly minimum data set (MDS) 3.0 assessment dated [DATE] revealed Resident #15 was moderately impaired and had no diet restrictions. Review of Resident #15's meal ticket revealed that Resident #15's food should be cut up prior to serving, all beverages in a two handled cup with a lid and a divided dish for meals. Review of a nutritional care plan updated 07/09/19 revealed Resident #15 was to use sipper cup for fluids and a divided plate. Observation of the lunch meal on 07/08/19 at 12:53 P.M. revealed that Resident #15 was being assisted with eating with a glass of juice at her place setting instead of a sipper cup and entrée was not served on a divided plate. This was verified by Licensed Practical Nurse (LPN) #100 at the time of observation. Observation of the breakfast meal on 07/10/19 at 8:03 A.M. revealed that Resident #15 was feeding herself with a two handled cup with no lid and the entrée was not served on a divided plate. This was verified by State Tested Nursing Assistant #102 at the time of the observation. Review of policy entitled, North Park Retirement Community Policy and Procedure- Assistive Devices revealed that assistive devices shall be provided to residents who need them. 366390 Page 2 of 3 366390 07/11/2019 North Park Care Center 14801 Holland Road Brook Park, OH 44142

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, staff interview and review of infection control policies and procedures, the facility failed to ensure proper placement of urine collection bag. This affected one resident (Resident #16) of one resident with a urine collection bag. Residents Affected - Few Findings include: Record review revealed Resident #16 was readmitted to the facility on [DATE] with diagnoses including methicillin resistant staphylococcus aureus, atherosclerotic heart disease and chronic atrial fibrillation. Review of the quarterly minimum data set (MDS) 3.0 assessment dated [DATE] revealed Resident #15 was cognitively intact and required extensive assistance with one person for most Activities of Daily Living. Review of physician orders revealed Resident #16 was ordered a catheter for urine output. Observation of Resident #16 on 07/08/19 at 11:09 A.M. revealed Resident #16's urine collection bag and tubing were on the floor. Interview with State Tested Nurse Aide (STNA) #103 on 07/08/19 at 11:09 A.M. verified the catheter bag and tubing were on the floor and stated that it should not have been on the floor and got a nurse to change it. Review of Catheter policy, not dated, revealed that catheter or tubing should not be left on the floor. 366390 Page 3 of 3