Health inspection·May 4, 2021

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, record review and interview the facility failed to ensure call lights were within reach and accessible for Residents #55, #63 and #74. This affected three residents of 32 residents reviewed for call light placement. Residents Affected - Few Findings include: 1. Resident #55 was admitted to the facility on [DATE] with diagnoses that included diabetes mellitus, chronic kidney disease, chronic obstructive pulmonary disease, and major depressive disorder. Review of the most recent Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #55 had intact cognition and needed supervision with one staff member for activities of daily living. Observation of Resident #55 on 04/26/21 at 12:35 P.M. revealed Resident #55 was in wheelchair with his pants around his knees. Resident #55 stated that he was not feeling well. The call light was noted to be clipped around the side of the bedrail approximately three feet from where Resident #55 was seated. Interview on 04/26/21 at 12:35 P.M. with the Director of Nursing (DON) verified the call light was out of Resident #25's reach and indicated he would be able to use the call light if it was within his reach. 2. Record review revealed Resident #63 was admitted to the facility on [DATE] with diagnoses that included diabetes mellitus, hyperlipidemia, and COVID-19. Review of the most recent MDS 3.0 assessment dated [DATE] revealed Resident #63 had intact cognition and required limited assistance with one staff member for activities of daily living. Observation of Resident #63 on 04/26/21 at 12:50 P.M. revealed Resident #63 was in lying in bed. Resident #63 stated he would use the call light if it was in reach. The call light was noted to be clipped around the side of the bedrail and the bedrail was in the down position. Interview at that time with DON in Training #86 verified Resident #63's call light was out of reach and indicated he would be able to use the call light if it was within his reach. 3. Record review revealed Resident #74 was admitted to the facility on [DATE] with diagnoses that included dysphagia, hyperlipidemia, and chronic obstructive pulmonary disease. Resident #74's care plan dated 05/26/18 revealed he was at risk for falls related to hemiplegia (paralysis on one side of the body) with left sided weakness. Interventions include for him to have the call light within reach. Page 1 of 5 366403 366403 05/04/2021 Bath Creek Estates 186 West Bath Road Cuyahoga Falls, OH 44223

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the most recent MDS 3.0 assessment dated [DATE] revealed Resident #74 had slightly impaired cognition and required extensive assistance with one to two staff members for activities of daily living. Observation of Resident #74 on 04/26/21 at 12:50 P.M. revealed Resident #63 was in lying in bed. Resident #63 stated he would use the call light if it was in reach. The call light was noted to be on the floor. This concern was verified on 04/26/21 at 12:50 P.M. with Licensed practical Nurse #59 at the time of the observation. 366403 Page 2 of 5 366403 05/04/2021 Bath Creek Estates 186 West Bath Road Cuyahoga Falls, OH 44223

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure resident's meal intakes were documented consistently for each meal. This affected three residents (Resident #4, Resident #19, and Resident #61) out of four residents reviewed for meal intakes. The facility census was 77 Findings Include: 1. Resident #19 was admitted to this facility on 01/28/21. Her admitting diagnoses included dementia, major depressive disorder, hypertension, chronic atrial fibrillation and open wound on the right ankle. Review of Resident #19's plan of care dated 01/29/21 revealed she had impaired skin integrity of her right ankle. Interventions for this plan of care were for staff to administer treatments as ordered, assess and document the status of the wound, elevate her heels off of the bed, monitor her nutritional status and consult the dietician as needed. Review of this resident's Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #19 had moderate cognitive impairment, needed extensive assistance of one staff person for most activities of daily living. Review of the documented meal intakes for April 2020 revealed the percentage of intake for breakfast intake was only monitored on 04/10/21, 04/12/21, 04/13/21, and 04/14/21. The percentage of lunch intakes was only documented on 04/10/21 and 04/13/21. The percentage of dinner intakes was only documented on 04/04/21, 04/05/21, 04/08/21, 04/09/21, 04/13/21, 04/14/21, 04/15/21, 04/15/21, 04/16/21, 04/20/21, 04/26/27, and 04/27/21 (12 days). Interview with the Director of Nursing (DON) on 04/28/21 at 12:15 P.M. verified the meal intakes were not consistently documented for all three meals each day for Resident #19 in order for staff to monitor her nutritional status as care planned. 2. Record review for Resident #61 revealed an admission date of 03/24/21. Diagnoses included muscle weakness, Alzheimer's disease, and failure to thrive. Review of the current, active care plan revealed Resident #61 was at increased nutrition risk related to Alzheimer's dementia and adult failure to thrive. Interventions included for staff to monitor dietary intake. The MDS assessment dated [DATE] revealed Resident #61 was cognitively impaired and required set-up help from staff for eating. Record review of the meal intake records dated 04/06/21 through 05/02/21 which included breakfast, lunch, and dinner for Resident #61 revealed five dates were documented for breakfast and lunch (04/06/21, 04/26/21, 04/27/21, 04/29/21 and 05/02/21). Record review revealed no further documentation was found in Resident #61's medical records to confirm documentation of meal intake. Interview with the DON on 04/28/21 at 12:15 P.M. verified the meal intakes were not consistently 366403 Page 3 of 5 366403 05/04/2021 Bath Creek Estates 186 West Bath Road Cuyahoga Falls, OH 44223

F 0656 Level of Harm - Minimal harm or potential for actual harm documented for all three meals each day for Resident #61 in order for staff to monitor nutritional status as care planned. 3. Resident #4 was readmitted to the facility on [DATE]. Her admitting diagnoses included dementia, major depressive disorder, hypertension, and dysphagia. Residents Affected - Few Review of the MDS assessment dated [DATE] revealed Resident #4 had severe cognitive impairment and required extensive assistance of one staff person for eating. Review of the plan of care dated 03/04/21 revealed Resident #4 was at nutritional risk related to a history of significant weight loss, medical diagnoses, and modified diet. Interventions for this plan of care included a fortified food program, staff to monitor dietary intake, and staff to monitor the need for increased nutritional interventions. Review of the documented meal intakes for April and May 2020 revealed the percentage for breakfast meal intakes was only recorded on 04/20/21, 04/21/21, 04/29/21 and 05/03/21. The percentage of lunch intakes was only documented on 04/05/21, 04/12/21 and 04/29/21. The percentage of dinner intakes was only documented on 04/04/21, 04/07/21, 04/08/21, 04/09/21, 04/14/21, 04/15/21, 04/16/21, 04/19/21, 04/22/21, 04/26/21, 04/27/21 and 04/28/21. Interview with the DON on 04/28/21 at 12:15 P.M. verified the meal intakes were not consistently documented for all three meals each day for Resident #4 in order for staff to monitor nutritional status as care planned. 366403 Page 4 of 5 366403 05/04/2021 Bath Creek Estates 186 West Bath Road Cuyahoga Falls, OH 44223

F 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review and interview, the facility failed to serve food at a safe/palatable temperatures on the Covid unit. This had the potential to affect all 16 residents (Residents #36, #41, #49, #50, #51, #53, #63, #70, #71, #76, #82, #210, #217, #225, #236, and #238) who ate meals on the Covid unit. The facility census was 77. Residents Affected - Some Finding include: Resident interviews conducted on the Covid unit on 04/26/21 between 11:00 A.M. and 1:00 P.M. with Residents #51, #53, #76, #82, #217 and #236 revealed their food was not served at palatable temperatures. Review of the food temperatures recorded on 04/28/21 prior to the dinner meal service revealed the meat (sloppy joe meat) temperature was 208 degrees, the vegetable (cole slaw) was 32 degrees, the starch (onion rings) were 187 degrees. On 04/28/21 at 5:00 P.M., a test tray was requested on the Covid unit. At 5:29 P.M. the meal tray cart was delivered to the Covid unit. There were 16 resident trays plus the test tray in the cart. Registered Nurse (RN) #51, State Tested Nursing Assistant (STNA) #20 and Unit Manager #41 were present to pass meal trays to the 16 residents (Residents #36, #41, #49, #50, #51, #53, #63, #70, #71, #76, #82, #210, #217, #225, #236, and #238) residing on the Covid unit. The last resident tray was delivered at 6:06 P.M. The test tray was then checked. The food temperatures were obtained by Unit Manager #41 at 6:06 P.M. using a digital thermometer. The sloppy joe sandwich was 114 degrees, the onion rings were 90 degrees, and the cole slaw was 52 degrees. Unit Manager #41 confirmed the hot foods were not hot and the cole slaw was too warm. Interview on 05/04/21 at 12:15 P.M. with Dietary Manager #2 and Registered Dietitian #85 revealed tray line is audited once a month for mealtimes, taste, temperature, and accuracy. Audits are done on diets and tray cards when assessing the residents, quarterly and as needed. They verified test trays had not been completed on the Covid unit for a while. Review of the dietary policy entitled, Food Temperatures, dated 08/28/19, revealed hot food items may not fall below 135 degrees F while holding after cooking. Cold foods must be served at a temperature of 41 degrees F or below. 366403 Page 5 of 5