Health inspection·September 21, 2023

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, interview, and record review the facility failed to ensure call lights were within reach. This affected three residents (#23, #26, and #283) of 84 residents. The census was 84. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #23 revealed an admission date of 02/23/21. Pertinent diagnoses include diabetes mellitus type 1, sacrolitis, hydrocephalus, fibromyalgia, other vertebral disc displacement, presence of cerebral fluid drainage device and, ataxia. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed resident was dependent for toileting, hygiene, bathing, and dressing. Substantial assistance was needed for transfers between surfaces and bed mobility. Review of the care plan dated 02/24/21 revealed the resident required assistance by one staff to turn and reposition in bed every two hours and as necessary. The resident required assistance by one staff with bathing/showering. The resident required assistance by one staff with personal hygiene and oral care. The resident required assistance by two staff with sit to stand positioning to transfer. Interventions included a remind to call don't fall or ask for assistance when needed. Observation on 09/18/23 at 2:30 P.M. revealed Resident #23 was in a wheelchair next to bed facing the wall with the television on it. The call light was on the bed by pillow behind Resident #23. At the time of the observation, State Tested Nurses Assistant (STNA) #314 verified the call light was not in reach and handed it to Resident #23. 2. Review of the medical record for Resident #26 revealed an admission date of 06/01/16. Pertinent diagnoses include type II diabetes mellitus, muscle weakness, major depressive disorder, anxiety, unspecified psychosis, unspecified affective mood disorder. Pertinent orders include a hoyer lift for all transfers. A review of the Quarterly MDS assessment, section G dated 07/01/23 revealed the Need for extensive assistance for bed mobility and dependence on staff for transfers. It also revealed two or more staff for physical assistance with toileting and all other activities of daily living. Page 1 of 3 366431 366431 09/21/2023 Avenue at Aurora 425 South Chillicothe Road Aurora, OH 44202

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A review of the care plan dated 09/09/22 revealed Resident #26 is care planned for behaviors of being rude to staff. There is nothing documented about behaviors in regards to placing call light on floor. A review of behavior tracking revealed the last documentation of any behaviors was 05/18/2020. Observation on 09/21/23 at 9:15 A.M. revealed Resident #26 was in bed. The call light was noted on the floor by the right side of the bed. Interview with Resident #26 on 09/21/2023 at 9:15 A.M. verified they utilized their call light to notify staff of need for assistance, when I can find it. Interview with admission Director #200 on 09/21/2023 at 9:20 A.M. verified the call light was on the floor. 3. Review of the medical record for Resident #283 revealed an admission date of. 09/15/23 for hospice respite stay. Pertinent diagnoses included: Alzheimer's Dementia, congestive heart failure, anxiety, dementia with psychotic disturbance. There was no MDS data to review. A functional assessment dated [DATE] revealed Resident #283 was dependent for self-care and mobility. Maximal assistance was needed for feeding. Resident #283 was dependent on staff for all activities of daily living. Resident #283 was also dependent on staff for position changes and transfers. An admission care plan dated 09/17/23 revealed Resident #283 required assistance by one staff with bathing/showering. Resident #283 required assistance by one staff to turn and reposition in bed. Resident#283 required assistance by one staff for personal hygiene. The Resident #283 required assistance by one staff for toileting. Resident #283 required assistance by one staff to move between surfaces. Interventions included to encourage the Resident #283 to use call light to call for assistance. Observation on 09/18/23 10:05 A.M. revealed Resident #283 in bed on her left side attempting to eat cereal. The cereal was spilling down the front of Resident #283. The touch pad call button was under pillow on the left side of the bed. An interview at the time of the observation with STNA #274 verified the call light was not able to be reached by Resident #283 and that Resident #283 was in poor position to eat. A review of the policy titled Resident Call System dated March 2023 revealed no procedure for routine checks of call light placement. 366431 Page 2 of 3 366431 09/21/2023 Avenue at Aurora 425 South Chillicothe Road Aurora, OH 44202

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. Based on observation, interview, and record review the facility failed to ensure the kitchen was maintained in a clean and sanitary condition and staff properly wore hair restraints while in the kitchen. This had the potential to affect all residents except one resident (#73) who received nothing by mouth. The facility census was 84. Findings include: Tour of the kitchen on 09/18/23 from 8:57 A.M. through 9:10 A.M. with Certified Dietary Manager (CDM) #309 revealed observation of a clear container of thickener with a small, clear plastic bowl stored in it. Next to the prep table where the container of thickener was located was a silver rack where the spices were stored, on the bottom shelf of the rack were plastic tubs stored upside down. Observed on the plastic tubs were various food crumbs on top of it. Observation of the walk-in cooler revealed various debris on the floor and along the lower back wall behind the rack was a yellowish foam material that had multiple dark colored spots along it. Interview during this time with CDM #309 verified the observations. Observation on 09/20/23 from 11:00 A.M. through 11:17 A.M. of tray line service revealed observation of Dietary Staff (DS) #316 with long bangs, past her eyebrows exposed and not covered by the hairnet, putting items on resident meal trays, and then placing the trays onto the meal cart. Interview 09/20/23 at 11:20 A.M. with CDM #309 verified observation and stated DS #316's bangs should be covered by the hairnet. Follow-up interview on 09/20/23 at 12:09 P.M. with CDM #309 stated the dark spots on the yellow foam along the wall in the walk-in cooler was dirt. 366431 Page 3 of 3