Health inspection·October 24, 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 of video from camera in room and record review, the facility failed to ensure call lights were kept within reach and residents were able to use if desired. This affected Resident #152, one of three sampled residents. The census was 62. Residents Affected - Few Findings include: Medical record review revealed Resident #152 was admitted to the facility on [DATE] with diagnoses including atherosclerotic heart disease, peripheral vascular disease with bilateral lower extremities wounds, hypertension, type 2 diabetes, dysphagia (difficulty swallowing), chronic obstructive pulmonary disease, dementia, cerebral infarction, protein-calorie malnutrition, osteomyelitis (bone infection), stage IV coccyx pressure wound and neuromuscular dysfunction of the bladder. Resident #152 was severely cognitively impaired and was totally dependent on staff for all activities of daily living including bed mobility, transfers, dressing, toileting, and personal hygiene. Review of Resident #152's care plan dated 07/27/23 revealed Resident #152 was at risk for falls characterized by history of falls, injury and/or multiple risk factors related t impaired gait and mobility. The care plan included multiple interventions to meet the goal, which was to minimize risk for falls and injuries related to falls, including maintain call bell within reach and educate resident to use call bell. Observation of a video dated 09/16/23 obtained from the surveillance camera located in Resident #152's room revealed State Tested Nurse Aide (STNA) #402 walked into the Resident 152's room. STNA #402 approached Resident #152, removed the call light and set it at the top of the bed, out of Resident #152's sight and reach. STNA #402 proceeded to check Resident #152 for incontinence then exit the room. Resident #152's call light remained out of the Resident 152's sight and reach. Page 1 of 4 366441 366441 10/24/2023 Seven Hills Health & Rehab Center 819 Rockside Road Seven Hills, OH 44131

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. 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 previously placed Fentanyl transdermal patches were removed prior to placing a new patch. This affected Resident #152, one of three sampled residents. The census was 62. Residents Affected - Few Findings include: Medical record review revealed Resident #152 was admitted to the facility on [DATE] with diagnoses including atherosclerotic heart disease, peripheral vascular disease with bilateral lower extremities wounds, hypertension, type 2 diabetes, dysphagia (difficulty swallowing), chronic obstructive pulmonary disease, dementia, cerebral infarction, protein-calorie malnutrition, osteomyelitis (bone infection), stage IV coccyx pressure wound and neuromuscular dysfunction of the bladder. Resident #152 was severely cognitively impaired and was totally dependent on staff for all activities of daily living including bed mobility, transfers, dressing, toileting, and personal hygiene. Review of current physician's orders indicated Resident #152 was to receive a Fentanyl transdermal patch 72 hour 12 microgram/hour, apply one patch transdermally one time a day every three days for pain and remove per schedule. Observation of a video dated 09/29/23 obtained from a camera placed in Resident #152's room revealed an unidentified nurse at Resident #152's bedside removing a patch from Resident #152's right arm and applying a new patch. At the same time, another caregiver at the bedside asked what is this? and indicated another patch on Resident #152's left arm. One patch was dated 09/23/23 and the other was dated 09/27/23. The nurse removed both patches and disposed of them in the waste basket in Resident 152's room. During interview on 10/16/23 at 2:37 P.M., the Administrator indicated that she was aware of the video and she had provided re-education to the nursing staff regarding the medications administration policy. The Administrator confirmed the patches observed being applied and removed in the video were the physician ordered Fentanyl patches. Review of the facility policy titled General Dose Preparation and Medication Administration (revised 01/01/22) indicated staff should comply with facility policy, applicable law and the State Operations Manual when administering medications. This deficiency represents non-compliance investigated under Complaint Number OH00146442. 366441 Page 2 of 4 366441 10/24/2023 Seven Hills Health & Rehab Center 819 Rockside Road Seven Hills, OH 44131

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview, the facility failed to ensure controlled substances (two Fentanyl transdermal patches) were disposed of properly after removal from resident. This affected Resident #152, one of three sampled residents. The total census was 62. Findings include: Medical record review revealed Resident #152 was admitted to the facility on [DATE] with diagnoses including atherosclerotic heart disease, peripheral vascular disease with bilateral lower extremities wounds, hypertension, type 2 diabetes, dysphagia (difficulty swallowing), chronic obstructive pulmonary disease, dementia, cerebral infarction, protein-calorie malnutrition, osteomyelitis (bone infection), stage IV coccyx pressure wound and neuromuscular dysfunction of the bladder. Resident #152 was severely cognitively impaired and was totally dependent on staff for all activities of daily Living including bed mobility, transfers, dressing, toileting, and personal hygiene. Review of physician's orders indicated Resident #152 was to receive a Fentanyl (a potent synthetic opioid) transdermal patch 72 hour 12 microgram/hour, apply one patch transdermally one time a day every three days for pain and remove per schedule. Observation of a video dated 09/29/23 obtained from a camera placed in Resident #152's room showed an unidentified nurse at Resident #152's bedside removing a patch from Resident #152's right arm. Another caregiver at the bedside identified another patch on Resident's 152's left arm which the unidentified nurse removed. The unidentified nurse was observed disposing the patches into the waste basket in Resident 152's room. During interview on 10/16/23 at 2:37 P.M., the Administrator indicated that she was aware of the video and she had provided re-education to the nursing staff regarding the medications administration policy. The Administrator confirmed the patches observed being removed and disposed into Resident #152's waste basket were the physician ordered Fentanyl patches. Review of the facility policy titled General Dose Preparation and Medication Administration (revised 01/01/22) indicated staff should comply with facility policy, applicable law and the State Operations Manual when disposing of controlled substances. This deficiency represents non-compliance investigated under Complaint Number OH00146442. 366441 Page 3 of 4 366441 10/24/2023 Seven Hills Health & Rehab Center 819 Rockside Road Seven Hills, OH 44131

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 of video from camera in room, record review, and interview, the facility failed to ensure infection control protocols were followed when providing resident care. This affected Resident #152. The total census was 62. Residents Affected - Few Findings include: Medical record review revealed Resident #152 was admitted to the facility on [DATE] with diagnoses including atherosclerotic heart disease, peripheral vascular disease with bilateral lower extremities wounds, hypertension, type 2 diabetes, dysphagia (difficulty swallowing), chronic obstructive pulmonary disease, dementia, cerebral infarction, protein-calorie malnutrition, osteomyelitis (bone infection), stage IV coccyx pressure wound and neuromuscular dysfunction of the bladder. Resident #152 was severely cognitively impaired and was totally dependent on staff for all activities of daily living including bed mobility, transfers, dressing, toileting, and personal hygiene. Observation of a video dated 09/16/23 obtained from the surveillance camera located in Resident #152's room revealed State Tested Nurse Aide (STNA) #402 walking into the Resident 152's room as she took a sip from her uncovered cup filled with an unknown liquid. STNA #402 proceeded to set the cup down in Resident #152's room, using her ungloved hand to wipe her nose. STNA #402 then approached Resident #152, removed the call light and set it at the top of the bed. STNA #402 proceeded to draw back the Resident 152's blanket and sheet and used her ungloved hands to unfasten, pull back and check Resident #152's brief for wetness. STNA #402 then replaced the blanket and sheet, retrieved her cup and without washing her hands or using hand sanitizer exited the room. During interview on 10/16/23 at 3:15 P.M., the Administrator and Director of Nursing (DON) viewed the video that showed STNA #402's breach in infection control protocols. The Administrator confirmed STNA #402 should not have brought her uncovered drink into the room. The DON confirmed STNA #402 should have worn gloves when checking Resident #152's incontinence brief and washed her hands or used hand sanitizer prior to retrieving her drink and exiting the room. The Administrator stated that a statement from STNA #402 indicated she used hand sanitizer once she exited Resident #152's room. Both the DON and Administrator stated that reeducation regarding infection control had been provided to the nursing staff. Review of facility policy titled Infection Control: General Policies (revised 05/11/23) indicated facility staff were to support resident safety by adhering to all policies and procedures related to infection prevention. This deficiency represents non-compliance investigated under Complaint Number OH11466442. 366441 Page 4 of 4