Avenue at Wooster

Inspectors wroteBased on observation , medical record review, review of policy, staff interviews and resident interview, the facility failed to ensure a resident who required physical assitance to get out of bed waa provided timely assitance. This affected one (#34) of three residents observed for assitance. The facility census was 79.

Inspectors wroteBased on record review, observation, interview, and facility policy review, the facility failed to maintain pressure reducing measures for a resident with a skin pressure injury. This deficient practice affected one resident (Resident #13) out of two residents reviewed for skin pressure injuries. The facility census was 79.

Inspectors wroteBased on record review, interview, and facility policy review, the facility failed to implement safety measures for a resident who sustained impaired skin integrity from a hot liquid spill. This deficient practice affected one resident (Resident #1) out three residents reviewed for impaired skin integrity. The facility census was 79.

Inspectors wroteBased on record review, observation, interview, and facility policy review, the facility failed to implement Enhanced Barrier Precautions (EBP) for a resident with a skin wound. This deficient practice affected one resident (Resident #13) out of three residents reviewed for skin wounds. The facility census was 79.

Inspectors wroteBased on observation, interview, and review of the facility policy and procedures, the facility failed to ensure the kitchen was maintained in a clean and sanitary manner and failed to ensure food was stored properly. This had the potential to affect all residents living at the facility. The facility census 81.

Inspectors wroteBased on record review, Psychotropic Drug Use policy review, Medication Regimen review, and interview the facility failed to ensure pharmacy recommendations were addressed appropriately by the physician for Resident #9, #16, and #41. The facility also failed to ensure an abnormal involuntary movement scale (AIMS) assessment was completed for Resident #70. This affected four (Resident #9, #16, #41, and #70) out of five residents reviewed for unnecessary medications. The facility census was 81.

Inspectors wroteBased of closed record review, policy review, review of the facility self-reported incidents, facility investigation review, and interviews, the facility failed to report to the state survey agency an allegation of abuse by a staff member to Resident #72. This affected one (Resident #72) out of one residents reviewed for abuse. The facility census was 81.

Inspectors wroteBased of record review, Abuse Prohibition policy review, facility investigation, and interviews, the facility failed to thoroughly investigate an allegation of possible abuse by a staff member to Resident #72. This affected one (Resident #72) out of one residents reviewed for abuse. Facility census was 81.

Inspectors wroteBased on observation, medical record review, interview and policy review the facility failed to ensure residents were provided their hearing aides/amplifiers to assist with their identified hearing loss. This affected one (Resident #16) three residents reviewed for activities of daily living. Findings Include: Review of Resident #6's medical record revealed the resident was admitted to the facility on [DATE]. Diagnoses included dementia with psychotic and mood disturbance, heart disease, anxiety and depression. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #16 had severe impaired cognition, and moderate hearing impairment. Review of the Care Plan dated 03/01/25 revealed the resident was at risk for communication related to a hearing deficit and dementia. [...]

Inspectors wroteBased on medical record review, observations, and staff interviews the facility failed to ensure pressure reducing devices were in place for residents at risk for developing pressure injuries. This affected one resident (Resident #1) of two residents reviewed for pressure injuries. The facility census was 81.

Inspectors wroteBased on closed record review, facility investigation review, and interview, the facility failed to implement appropriate fall prevention interventions for Resident #9 after a fall. This affected one (Resident #9) of four residents reviewed for accidents. The facility census was 81.

Inspectors wroteBased on record review, policy review, and interview, the facility failed to ensure there was consistent communication between the facility and the dialysis center regarding Resident #15's hemodialysis treatments. This affected one (Resident #15) of one residents reviewed for dialysis. The facility census was 81.

Inspectors wroteBased on medical record review, observations, staff interview, and facility policy review the facility failed to ensure dietary dining equipment was made available for residents requiring adaptive dining equipment to maintain independence with eating. This deficient practice affected one Resident (Resident #14) out of one resident reviewed for use of dining adaptive equipment. The facility census was 81. Findings Include: Review of Resident #17's medical record revealed admission date 02/29/22 with diagnoses including but not limited to stroke with right side hemiplegia, squamous cell carcinoma of the scalp, and type two Diabetes. Resident #14 had moderate cognitive impairment with a Brief Interview of Mental Status (BIMS) score of nine out of a possible 15 dated 01/28/25. [...]

Inspectors wroteBased on record review, Antibiotic Stewardship policy review, and interviews, the facility failed to ensure the appropriate antibiotics were administered for Resident #9 and #23. The facility also failed to ensure Resident #46 did not receive duplicate antibiotic therapy. This affected three (Resident #9, #23, and #46) out of five residents reviewed for unnecessary medications. Facility census was 81.

Inspectors wroteBased on observation, open and closed medical record review, resident, staff and Wound Care Certified Nurse Practitioner (WCCNP) interviews and review of facility policies, the facility failed to develop and implement a comprehensive and individualized pressure ulcer prevention and treatment program to ensure residents' skin impairments were assessed, physician notification was made for treatment orders and treatment was initiated timely. Actual Harm occurred on 09/29/24 to Resident #54, who was at risk for developing pressure ulcers, when the facility identified the resident had impaired skin upon readmission from the hospital but failed to assess and describe the wound, failed to notify the physician for treatment orders and further failed to initiate any treatments until 10/11/24. [...]

Inspectors wroteBased on medical record review, staff interview and review of facility policy, the facility failed to implement treatment for a venous wound timely. This affected one resident (#56) of three residents reviewed for wounds. The facility census was 80.

Inspectors wroteBased on medical record review, staff interview and policy review, the facility failed to notify the physician or nurse practitioner regarding significant weight loss and ensure the dietitian's recommendations for weight loss were addressed. This affected two (Residents #63 and #66) of three residents (#57, #63 and #66) who were identified as having an unplanned weight loss. The facility census was 79.

Inspectors wroteBased on observation, interview with staff, and review of facility policy, the facility failed to ensure the kitchen staff wore beard nets and hair nets appropriately to prevent contamination of food. This affected all 76 residents in the facility who ate meals from the kitchen except Resident #37 who the facility identified as receiving nothing by mouth (NPO). The facility census was 77.

Inspectors wroteBased on observation, record review, interviews with staff and review of facility policy, the facility failed to ensure appropriate meal substitutions were given to residents ordered pureed and mechanical soft diets. This affected 11 residents (Resident #2, #5, #10, #13, #19, #23, #26, #43, #50, #54, #63) the facility identified as requiring a pureed or mechanical soft diet of 76 residents receiving meals from the kitchen. The facility identified Resident #37 as receiving nothing by mouth (NPO) The facility census was 77.

Inspectors wroteBased on record review and staff interviews, the facility did not ensure timely notification to the physician or nurse practitioner (NP) of abnormal laboratory values for Resident #68. This affected one resident (Resident #68) of three reviewed for laboratory tests. The facility census was 77.

Inspectors wroteBased on observation and interview, the facility failed to ensure meals were palatable and served at an appetizing temperature. This finding had the potential to affect 77 residents who received meals from the kitchen. The facility census was 77.

Inspectors wroteBased on observation, record review, interview, and facility policy review the facility failed to ensure staff donned the appropriate personal protective equipment (PPE) when testing residents and staff for COVID-19 and failed to ensure staff completed appropriate hand-hygiene when exiting resident rooms who were placed on contact isolation precautions. This finding affected Resident #66 and had the potential to affect all other residents and staff who entered the facility. The facility census was 77.

Inspectors wroteBased on record review, self-reported incident review, facility investigation review, policy and procedure review, and interview the facility failed to ensure misappropriation of medications did not occur for Residents #17, #44, #188, and #190. This affected four (Residents #17, #44, #188, and #190) out of six residents reviewed for misappropriation. The facility census was 77.

Inspectors wroteBased on record review, self-reported incident review, facility investigation review, policy and procedure review, and interview the facility failed to follow their policy for the prevention of misappropriation of resident medication for Residents #17, #44, #188, and #190. This affected four (Residents #17, #44, #188, and #190) out of six residents reviewed for misappropriation. The facility census was 77.

Inspectors wroteBased on observation, record review, and interview the facility failed to ensure expired medications were discarded as appropriate. This finding affected four Residents (#20, #24, #36 and #182) during review of four medication administration carts.

Inspectors wroteBased on observation and interview, the facility failed to ensure residents who received pureed diets were served the correct portion sizes. This finding affected seven Residents (#6, #13, #22, #31, #35, #57 and #73) of seven residents who required a pureed consistency diet. The facility census was 77.

Inspectors wroteBased on observation, record review, and interview the facility failed to ensure residents were assisted with meals timely. This finding affected of one (Resident #185) of ten residents (Residents #13, #26, #31, #35, #57, #62, #73, #185, #227 and #277) who required direct assistance with meals. The facility census was 77 and all residents receive meals from the kitchen.

Inspectors wroteBased on observation, record review, interview, and facility policy review the facility failed to deliver meal trays in a timely manner. This finding affected two Residents (#10 and #227) of 77 residents who receive meals from the kitchen.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure food was served in a sanitary manner. This had the potential to affect 77 of 78 residents receiving food from the kitchen (Resident #21 received nothing by mouth). The facility census was 78 residents.

Inspectors wroteBased on record review, interview and observation, the facility failed to ensure a resident with a percutaneous endoscopic gastrostomy (PEG) tube had appropriate care and services provided during medication administration This affected one resident (Resident #21) out of five residents reviewed for unnecessary medications. Findings Included: Record review revealed Resident #21 was admitted to the facility with diagnoses including cerebral infarction, protein calorie malnutrition, flaccid hemiplegia, hypovolemic shock, and metabolic encephalopathy. According to this resident's Minimum Data Set assessment dated [DATE] this resident had severe cognitive impairment. Functionally he needed extensive assistance of two people for bed mobility and transfers. He was totally dependent on staff for eating, toileting and personal hygiene. On 02/19/20 at 11:00 A.M. [...]

Inspectors wroteBased on interview and record review the facility failed to ensure pharmacy services were provided to meet the needs of the residents. This affected one (Resident #41) of seven residents reviewed for medication availability. The census was 78. Findings Included: Review of the medical record for Resident #41 revealed admission date of 02/15/19. Diagnoses included cardiomegaly, atrial fibrillation, cardiomyopathy, cardiac pacemaker, aortocoronary bypass graft and heart failure. Review of the quarterly Minimum Data Set (MDS) assessment, dated 01/04/20, revealed the resident had intact cognition. Review of the physician orders for February 2020 revealed the resident had an order for diltiazem CD ER (heart medication) 120 milligram (mg) daily for cardiomegaly. Review of the Medication Administration Record (MAR) 02/2020 revealed diltiazem was not given on 2/15 and 2/16. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure pureed pulled pork was the proper texture. This had the potential to affect all seven (Resident #6, Resident #16, Resident #19, Resident #59, Resident #79, Resident #80, and Resident #283) of seven residents on a pureed diet.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure water temperatures were maintained within safe parameters. This affected three (Resident #31, Resident #44, and Resident #81) of eight residents whose bathroom water temperatures were tested.