Health inspection·June 23, 2022

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. 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, facility policy and procedure review and interview the facility failed to ensure Resident #5 and Resident #8, who required staff assistance with activity of daily living (ADL) care were provided timely and adequate nail care to maintain proper hygiene. This affected two residents (#5 and #8) of three residents reviewed for activities of daily living. Residents Affected - Few Findings include: 1. Review of the medical record revealed Resident #5 was admitted to the facility on [DATE] with diagnoses including fracture of the left femur, compression fracture of the lumbar vertebra, compression fracture of the thoracic vertebra, head injury, myocardial infarction, mild cognitive impairment and dementia. Review of the admission Minimum Data Set (MDS) 3.0 assessment, dated 04/13/22 revealed Resident #5 had moderately impaired cognition. The assessment revealed the resident required limited assistance from one staff for personal hygiene. On 06/21/22 at 10:32 A.M., 06/22/22 at 7:44 A.M. and 06/23/22 at 8:50 A.M. Resident #5 was observed to have long dirty fingernails. On 06/22/22 at 1:20 P.M. interview with the Director of Nursing (DON) revealed nail care was to be completed by the staff with showers. On 06/23/22 at 8:50 A.M. interview with Licensed Practical Nurse (LPN) #803 verified the fingernails of Resident #5 were long and dirty Review of the facility policy titled Policy on Care of Resident fingernails/Toenails, dated 02/10/21 revealed State Tested Nursing Assistants, Certified Nursing Assistants, and appropriately credentialed activity staff should provide care to the fingernails of residents to ensure they were maintained to clinical standards. Residents who were unable to care for their own fingernails would require assistance in keeping nails clean and trimmed. 2. Review of the medical record revealed Resident #8 was admitted to the facility on [DATE] with diagnoses including chronic right heart failure, chronic respiratory failure, chronic pulmonary disease, pulmonary hypertension, chronic kidney disease, atrial fibrillation, benign prostatic hyperplasia, glaucoma and cerebral infarction. Review of the quarterly MDS 3.0 assessment, dated 04/29/22 revealed Resident #8 had moderately Page 1 of 7 366456 366456 06/23/2022 Windsor Medical Center Inc 1454 East Maple Street North Canton, OH 44720

F 0677 Level of Harm - Minimal harm or potential for actual harm impaired cognition. The assessment revealed the resident required extensive assistance from one staff for personal hygiene. On 06/21/22 at 10:21 A.M. and 06/23/22 at 8:40 A.M. Resident #8 was observed to have long dirty fingernails. Residents Affected - Few On 06/22/22 at 1:20 P.M. interview with the DON revealed nail care was to be completed by staff with showers. On 06/23/22 at 8:40 A.M. interview with Resident #8 revealed his nails were long and needed trimmed but nobody had cut them for him. Review of the facility policy titled Policy on Care of Resident fingernails/Toenails, dated 02/10/21 revealed State Tested Nursing Assistants, Certified Nursing Assistants, and appropriately credentialed activity staff should provide care to the fingernails of residents to ensure they were maintained to clinical standards. Residents who were unable to care for their own fingernails would require assistance in keeping nails clean and trimmed. 366456 Page 2 of 7 366456 06/23/2022 Windsor Medical Center Inc 1454 East Maple Street North Canton, OH 44720

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, facility policy and procedure review and interview the facility failed to ensure a pressure ulcer for Resident #5 was properly assessed on admission, failed to ensure treatments were completed as ordered (between 04/07/22 to 05/09/22) and failed to ensure the ulcer was properly staged following debridement. This affected one resident (#5) of three residents reviewed for pressure ulcers. Residents Affected - Few Finding include: Review of the medical record revealed Resident #5 was admitted to the facility on [DATE] with diagnoses including fracture of the left femur, compression fracture of the lumbar vertebra, compression fracture of the thoracic vertebra, head injury, myocardial infarction, mild cognitive impairment and dementia. Review of the admission orders, dated 04/07/22 revealed Resident #5 had an order for clean the mid spine with normal saline, pat dry and cover with a foam dressing everyday. The order was discontinued on 04/08/22. Review of the admission Braden (skin risk) scale, dated 04/07/22 revealed Resident #5 was at moderate risk for developing pressure injuries. Review of the admission assessment, dated 04/07/22 revealed Resident #5 had an unstageable (full thickness tissue loss in which the actual depth of the ulcer was obscured by slough (nonliving tissue) and or eschar (necrotic tissue) in the wound bed) pressure injury to her mid spine. However, there were no measurements of the area. Review of the skin assessment, dated 04/11/22 revealed Resident #5 had an unstageable pressure ulcer she had been admitted with which measured 4.5 centimeters (cm) in length by 2.5 cm in width by 0.0 in depth. The wound had 100 percent slough with a scant amount of serous drainage. The treatment was to cleanse the wound with wound cleanser and apply a bordered foam dressing daily. Review of the admission Minimum Data Set (MDS) 3.0 assessment, dated 04/13/22 revealed Resident #5 had moderately impaired cognition. The assessment revealed the resident required limited assistance from one staff for personal hygiene and had an unstageable pressure injury she was admitted with. Review of the skin assessment dated [DATE] revealed Resident #5 had an unstageable pressure ulcer which measured 4.5 cm in length by 2.5 cm in width by 0.0 in depth. The wound had 100 percent slough The treatment was to cleanse the wound with wound cleanser and apply a bordered foam dressing daily. Review of the skin assessment dated [DATE] revealed Resident #5 had an unstageable pressure which measured 4.5 cm in length by 2.5 cm in width by 0.1 in depth. The wound had 100 slough with a scant amount of serosanguinous drainage. The treatment was to cleanse the wound with wound cleanser and apply a bordered foam dressing daily. Review of the April 2022 Treatment Administration Record (TAR) revealed there was no documentation a treatment had been completed to the mid-spine of Resident #5 from 04/07/22 to 04/30/22. 366456 Page 3 of 7 366456 06/23/2022 Windsor Medical Center Inc 1454 East Maple Street North Canton, OH 44720

F 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the skin assessment dated [DATE] revealed Resident #5 had an unstageable pressure which measured 2.0 cm in length by 1.0 cm in width by 0.2 in depth. The wound had 100 slough with a scant amount of serosanguinous drainage. The treatment was changed to cleanse with wound cleaner and apply Dermafilm daily and as needed. Review of the physician's orders revealed an order, dated 05/03/22 to cleanse the mid-spine wound with wound cleanser, apply Dermafilm everyday and as needed. Review of the May 2022 TAR revealed no documentation a treatment had been completed to the mid-spine of Resident #5 from 05/01/22 to 05/09/22. Review of the skin assessment dated [DATE] revealed Resident #5 had an unstageable pressure which measured 2.0 cm in length by 1.0 cm in width by 0.2 in depth. The wound had 100 slough with a scant amount of consanguineous drainage. The assessment revealed the treatment was changed to cleanse with wound cleaner and apply Dermafilm daily and as needed. There was no evidence of any skin assessment for Resident #5 from 05/10/22 through 05/24/22. Review of the skin assessment dated [DATE] revealed Resident #5 had an unstageable pressure which measured 2.7 cm in length by 2.0 cm in width by 0.2 in depth. The wound had 100 slough with a scant amount of serosanguinous drainage. The note indicated the treatment was changed to cleanse with wound cleaner and apply Dermafilm daily and as needed. An appointment was made with the wound clinic. The note also indicated the wound had gotten worse. Review of the wound clinic notes dated 05/26/22 revealed Resident #5 had a wound to her back. The wound was covered with soft yellow eschar (necrotic tissue) with no odor and the peri-wound was clean. The wound measured 1.5 cm in length by 1.6 cm in width by 0.8 cm depth. There was a large amount of serosanguinous drainage noted. There was no granulation in the wound bed. There was a large amount of necrotic tissue within the wound bed including slough. The wound was debrided and post wound measurements were 1.6 cm in length by 1.0 cm in width by 0.6 cm depth. The wound was now assessed to be a Stage III (full thickness skin loss which may extend into the subcutaneous tissue). Review of the physician's orders revealed Resident #5 had an order (dated 05/26/22) for a waffle mattress to the and bed and a waffle cushion to the wheelchair every shift for offloading. Review of the physician's orders revealed Resident #5 had an order, dated 05/27/22 to cleanse the thoracic spine with wound cleanser, apply Mesalt to the wound bed, cover with an abdominal pad and secure with medifix tape. Review of the skin assessment, dated 05/31/22 revealed Resident #5 had an unstageable pressure which measured 1.8 cm in length by 1.5 cm in width by 0.5 in depth. The wound was derided on 05/26/22 and the slough was no longer present. On 06/22/22 at 2:19 P.M. interview with the Director of Nursing (DON) revealed no assessments/measurements were completed on admission due to the facility wound nurse not assessing the area until the following week. The DON revealed she did not feel the nurses on the floor were qualified to stage/measure wounds. On 06/23/22 at 1:51 P.M. during a follow up interview, the DON revealed the facility policy 366456 Page 4 of 7 366456 06/23/2022 Windsor Medical Center Inc 1454 East Maple Street North Canton, OH 44720

F 0686 Level of Harm - Minimal harm or potential for actual harm indicated it was in the nurses scope of practice to measure a wound. She verified there were no measurements from admission to determine how large the spine wound for Resident #5 was on admission, there was no documentation of a treatment being done from 04/07/22 to 05/09/22, and no documentation of a skin assessment from 05/10/22 to 05/24/22. The DON also revealed there were no measurements of the area from the hospital when the resident had been admitted . Residents Affected - Few On 06/23/22 at 2:39 P.M. interview with the DON verified the wound clinic documentation, dated 05/26/22 identified the area as a Stage III following the debridement of the wound on this date. However, the facility failed to include that information in their assessments or any subsequent assessments completed between 05/26/22 to present date. The DON revealed she had just been reviewing the measurements on the assessments and not the staging component. Review of the facility policy titled Wound Documentation, dated 03/31/22 revealed accurate documentation was an essential part of determining appropriate treatment and management of skin. It was within the scope of practice for registered nurses and licensed practical nurse to document wound measurements as applicable. The area wound be identified as pressure, surgical or other skin condition at the time of the initial findings with staging to be done as appropriate. 366456 Page 5 of 7 366456 06/23/2022 Windsor Medical Center Inc 1454 East Maple Street North Canton, OH 44720

F 0695 Provide safe and appropriate respiratory care for a resident when needed. 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 oxygen equipment for Resident #8 and #15 was dated as to when changed last and failed to properly store an oxygen nasal cannula when not in use in a clean and sanitary manner for Resident #15. This affected two residents (#8 and #15) of five residents observed with oxygen. Residents Affected - Few Findings include: 1. Review of the medical record revealed Resident #8 was admitted to the facility on [DATE] with diagnoses including chronic right heart failure, chronic respiratory failure, chronic pulmonary disease, pulmonary hypertension, chronic kidney disease, atrial fibrillation, benign prostatic hyperplasia, glaucoma and cerebral infarction. Review of the June 2022 physician's orders, revealed Resident #8 had and order, dated 04/10/22 to change his oxygen tubing on the tenth of every month on night shift. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 04/29/22 revealed Resident #8 had moderately impaired cognition, required extensive assistance from one staff for personal hygiene and had oxygen. On 06/21/22 at 10:21 A.M. observation of Resident #8's oxygen tubing and nasal cannula revealed they were undated as to when they had last been changed. On 06/21/22 at 10:22 A.M. interview with Licensed Practical Nurse (LPN) #804 revealed oxygen tubing and nasal cannulas were to be dated when they were changed. 2. Review of the medical record revealed Resident #15 was admitted to the facility on [DATE] with diagnoses including atrial fibrillation, paralysis of the larynx and vocal cords, gastrostomy, anoxia brain damage, benign prostatic hyperplasia, ataxia and anxiety disorder. Review of the quarterly MDS 3.0 assessment, dated 06/06/22 revealed Resident #15 had moderately impaired cognation and was not on oxygen therapy. On 06/21/22 at 10:25 A.M. observation revealed Resident #15 had oxygen tubing laying directly on the top of an oxygen concentrator in the resident's room. The tubing was not in any type of protective barrier/bag (storage). In addition, there was also no date as to when it had been changed last. On 06/21/22 at 10:25 A.M. interview with LPN #804 revealed the oxygen tubing for Resident #15 should have been stored in a protective barrier and dated as to when it was last changed. 366456 Page 6 of 7 366456 06/23/2022 Windsor Medical Center Inc 1454 East Maple Street North Canton, OH 44720

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 and staff interview the facility failed to ensure an ice scoop was properly stored in a clean and sanitary manner to prevent contamination. This had the potential to affect 16 of 16 residents residing in the facility. Findings include: On 06/22/2 at 7:19 A.M. Stated Tested Nursing Assistant (STNA) #800 was observed to retrieve an ice scoop from inside the ice machine. The ice scoop was observed directly on top of the ice. The STNA proceeded to fill a glass up with ice for a resident and then placed the ice scoop back into the ice machine directly on top of the ice without any type of protective barrier. On 06/22/22 at 7:19 A.M. interview with STNA #800 verified she had retrieved the ice scoop directly from inside the ice machine and after using it, she placed the scoop back in the machine. The STNA revealed she did not know what to do with the ice scoop because there was no where else to put it. Following the interview, the STNA obtained a paper towel, put the paper towel on the counter and placed the ice scoop on the paper towel. Review of the undated facility policy titled Cleaning Instructions: Ice Machine and Equipment, revealed the ice scoop was to be stored beside or on top of the machine in a clean non porous container that allowed the water to drain off and not pool around the scoop. 366456 Page 7 of 7