Continuing Healthcare of Toledo

Inspectors wroteBased on medical record review, staff and resident interviews, review of incidents and accident policy, review of hospital documentation, and review of emergency medical services (EMS) reports, the facility failed to provide assessments, care planning, and monitoring for two residents (#2 and #3) identified with a substance abuse history and failed to investigate incidents when two residents were discovered to have experienced an overdose. [...]

Inspectors wroteBased on medical record review and staff interview, the facility failed to ensure develop a baseline care plan at admission to address substance use disorder. This affected one (#2) out of five residents reviewed for resident care plan development. The facility identified 16 residents with a history of substance use disorder in a facility census of 64.

Inspectors wroteBased on medical record review, and staff interview, the facility failed to develop a comprehensive plan of care to address a resident's substance use disorder. This affected one (#3) of five residents reviewed for care plan development. The facility identified 16 residents with a history of substance use disorder in a facility census of 64.

Inspectors wroteBased on medical record reviews, staff interviews, and review of facility policy, the facility failed to notify residents' representatives when they experienced a change in condition. This affected two (Residents #54 and #58) of three residents reviewed for notifications. The facility census was 60.

Inspectors wroteBased on medical record reviews, observations, staff interviews, and review of facility policy, the facility failed to ensure respiratory equipment was maintained and stored in a sanitary manner. This affected two (Residents #54 and #58) of two residents reviewed for respiratory equipment. The facility census was 60.

Inspectors wroteBased on medical record review, observation, staff interviews, and review of facility policy, the facility failed to ensure medication was administered and stored in a secure manner. This affected one (Resident #58) of one resident reviewed for medication administration and storage. The facility census was 60.

Inspectors wroteBased on record review, observation, resident interview, staff interview, and facility policy review, the facility failed to ensure residents received timely incontinence care. This affected one resident (#62) of three residents reviewed for incontinence. This had the potential to affect 39 residents who the facility identified as incontinent. The facility census was 70.

Inspectors wroteBased on record review, observation, resident interview, staff interview, and policy review, the facility failed to ensure resident water cups were clean and free from mold. The facility also failed to ensure there were no strong odors of urine in the facility. This affected one resident (#62) of four residents reviewed for a safe, clean environment. The facility census was 70.

Inspectors wroteBased on observation, medical record review, staff interview and facility policy review, the facility failed to maintain and monitor a resident's urinary catheter system. This affected one (#1) of two residents reviewed for a urinary catheter. The facility identified two residents (#1 and #3) with an indwelling urinary catheter. The facility census was 61. Review of the medical record revealed Resident #1 admitted to the facility on [DATE] with diagnoses including, quadriplegia, seizure disorder, mood disorder, neuromuscular dysfunction of bladder, protein calorie malnutrition, tracheostomy, gastrostomy, supra pubic catheter, urinary tract infection, and a tibia fracture. [...]

Inspectors wroteBased on observation, test tray review, resident interview, staff interview, review of facility policy, and review of Food and Drug Administration (FDA) guidelines, the facility failed to ensure foods were served at a proper temperature and were palatable. This affected four residents (#32, #51, #54, and #62) of seven residents reviewed for food and had the potential to affect an additional 64 residents who received meals prepared by the kitchen. The facility identified Resident #66 as receiving no food from the kitchen. The facility census was 69.

Inspectors wroteBased on observation, staff interview, and review of a facility policy, the facility failed to provide a clean, well-maintained, and homelike environment. This had the potential to affect all 69 residents residing in the facility.

Inspectors wroteBased on medical record review, staff interview, and review of facility policy, the facility failed to ensure the physician was notified when the resident refused their anti-seizure medications. This affected one (Resident #10) of three residents reviewed for notification of change.

Inspectors wroteBased on observation, medical record review, staff interview, and facility policy, the facility failed to ensure residents were provided with interventions to prevent skin breakdown in accordance with physician orders and nursing plans of care. This affected three (#1, #2, #3) of three sampled residents reviewed for skin integrity. Facility census was 69.

Inspectors wroteBased on observation, medical record review, and staff interview, the facility failed to ensure incontinence interventions were implemented in a timely manner and in accordance with nursing plans of care. This affected three (#1, #2, #3) of three sampled residents reviewed for incontinence care and treatment. Facility census was 69.

Inspectors wroteBased on observation, medical record review, staff interview, and review of a facility policy, the facility failed to ensure interventions and treatments were implemented for a resident assessed at risk for pressure ulcers to prevent deterioration of an existing stage four pressure ulcer (full-thickness skin and tissue loss) and the development of additional pressure ulcers and failed to ensure pressure ulcer treatments were applied as ordered by the physician. Actual harm occurred to Resident #31 when the facility failed to initiate an alternative pressure relieving cushion or additional pressure reliving intervention to the resident's wheelchair after an existing cushion was damaged and removed and treatments were not administered as ordered. [...]

Inspectors wroteBased on staff interview, record review, and review of the Certification and Survey Provider Enhanced Reporting system (CASPER) Report, the facility failed to have an effective quality assurance program to address repeated quality concerns identified during three consecutive annual surveys. This affected all 61 residents in the facility. The census was 61.

Inspectors wroteBased on observation, medical record review, resident and staff interview, and facility policy review, the facility failed to ensure the facility environment was maintained in a safe and sanitary manner. This affected five (#35, #36, #43, #46, and #47) of five residents reviewed for physical environment. The census was 61.

Inspectors wroteBased on observation, staff interview, and review of the facility policy, the facility failed to ensure hand hygiene was practiced during meal service. This affected six (#24, #155, #160, #161, #162, and #154) of six residents observed during meal service. The facility census was 61.

Inspectors wroteBased on medical record review, resident interview, and staff interview, the facility failed to ensure Minimum Data Set (MDS) assessments were completed accurately. This affected two (#47 and #155) of 30 residents reviewed for MDS assessments. The facility census was 61.

Inspectors wroteBased on observation medical record review, resident interview, and staff interview, the facility failed to adequate ensure nail care was provided to residents dependent on staff for care. This affected two (#24 and #44) of three residents reviewed for assistance with activities of daily life (ADLs). The facility census was 61.

Inspectors wroteBased on observation, resident and staff interviews, review of the medical record, review of a bowel protocol, and review of a facility policy, the facility failed to ensure wound dressings were completed per physician orders and failed to implement the facility bowel protocol as indicated. This affected one (#155) of two residents reviewed for wounds and two (#24 and #49) of two residents review for bowel movements. The facility census was 61.

Inspectors wroteBased on observation, medical record review, staff interview, and review of the facility policy, the facility failed to ensure residents were adequately supervised while smoking and failed to ensure smoking materials were maintained in a safe manner. This affected two (#21 and #156) of two residents reviewed for smoking. The facility census was 61.

Inspectors wroteBased on observation, medical record review, staff interview, and facility policy review, the facility failed to ensure timely incontinence care and interventions were provided following an episode of urinary incontinence. This affected one (#36) of three residents reviewed for urinary tract infections in a facility census of 61.

Inspectors wroteBased on observation, staff interview, medical record review, and review of the facility policy, the facility failed to ensure enhanced barrier precautions (EBP) were followed during personal care and failed to ensure appropriate infection control procedures were practiced. This affected one (#24) of one residents reviewed for enhanced barrier precautions. The facility census was 61.

Inspectors wroteBased on medical record review of vaccinations, staff interview, review of a facility policy, and review of the Centers for Disease Control and Prevention (CDC) website, the facility failed to offer COVID-19 booster vaccines for residents as indicated. This affected three (#12, #15, and #34) of five reviewed for COVID-19 vaccinations. The facility census was 61.

Inspectors wroteBased on observation, medical record review, and staff interview, the facility failed to ensure the facility had an effective pest control program to promote an environment that was free from pests. This affected one (#36) of five residents reviewed for the environment. The census was 61.

Inspectors wroteBased on review of personnel files and staff interviews, the facility failed to ensure state tested nurse aides (STNAs) completed training on dementia care and completed 12 hours of continuing education annually. This had the potential to affect all 61 residents in the facility. The census was 61.

Inspectors wroteBased on observations, resident and staff interview, and policy review, the facility failed to maintain a homelike and clean environment for residents. This affected 20 resident rooms (#103, #109, #110, #111, #114, #115, #116, #117, #118, #119, #121, #122, #123, #125, #126, #127, #208, #210, #216, and #221) of 51 resident rooms. The facility census was 53.

Inspectors wroteBased on record review, resident interview, and staff interview, the facility failed to ensure Resident #44 received showers per his preference. This affected one (Resident #44) of three residents reviewed for choices. The facility census was 53.

Inspectors wroteBased on record review, review of resident funds, staff interview, and review of the facility's policy, the facility failed to ensure a resident's funds was returned to the estate within 30 days of the resident's death. This affected one (Resident #256) of three residents reviewed for funds. The facility census was 53.

Inspectors wroteBased on record review and staff interview, the facility failed to ensure Resident 26's advance directive information was complete. This affected one (Resident #26) of nine residents reviewed for advanced directives. The facility census was 53.

Inspectors wroteBased on record review and staff interview, the facility failed to ensure bed hold notices were given to residents upon discharge to the hospital. This affected one (Resident #31) of two residents reviewed for hospitalization. The facility census was 53.

Inspectors wroteBased on record review, staff interview, and review of the facility's policy, the facility failed to ensure Minimum Data Set (MDS) 3.0 assessments were completed accurately for Residents #25 and #57. This affected two (#25 and #57) of nineteen residents whose MDS assessments were reviewed. The facility census was 53.

Inspectors wroteBased on record review, resident interview, staff interview, and policy review, the facility failed to complete activities of daily living (ADL) for residents who required assistance on staff for assistance with bathing/showering. This affected two (#14 and #24) of three residents reviewed for ADLs. The facility identified 44 residents who required assistance from staff with bathing/showering. The facility census was 53.

Inspectors wroteBased on observations, record review, staff interview, and policy review, the facility failed to administer medication as physician ordered resulting in medication errors exceeding five percent. There were five medication errors out of 29 medications opportunities or a medication error rate of 17.24%. This affected two (Residents #48 and #52) of six residents reviewed observed for medication administration. The facility census was 53.

Inspectors wroteBased on staff interview, observation of the medication cart, review of the facility's policy for medication storage, and review of insulin manufacturer instructions, the facility failed to ensure insulin products were marked with open dates. This affected two of the three medication carts observed for drug storage. This affected three residents (Residents #00, #22 and #29). The facility census was 53.

Inspectors wroteBased on record review and staff interview, the facility failed to ensure there was documentation of completion of physician's orders. This affected one (Resident #36) of nineteen residents review accuracy of medical records. The facility census was 53.

Inspectors wroteBased on observation, staff interview and review of the facility's policy, the facility failed to ensure proper infection control practices and procedures were in place when administering medications to residents. This affected three (Residents #37, #49 and #50) of 29 residents observed for medication administration. The facility census was 53.

Inspectors wroteBased on record review and staff interview, the facility failed to complete evaluations for two of eight employees reviewed for evaluations. This had the potential to affect all 53 residents residing in the facility.

Inspectors wroteBased on observation, staff interview, and review of the facility's policy, the facility failed to ensure the daily posted nursing staff information was updated timely as required. This had the potential to affect all 53 residents residing in the facility.

Inspectors wroteBased on record review and staff interview, the facility failed to ensure the assessment used to determine what resources were necessary to care for its residents competently during both day-to-day operations and emergencies was reviewed and updated at least annually. This had the potential to affect all 53 residents residing in the facility.

Inspectors wroteBased on the unprecedented global pandemic that resulted in the Presidential declaration of a State of National Emergency dated 03/13/20, review of Centers for Medicare and Medicaid Services (CMS) memorandum QSO-22-09-ALL, record review, review of an employee COVID-19 vaccination matrix, staff interview, and review of the facility's COVID-19 vaccination policy, the facility failed to implement the facility's COVID-19 vaccination policy and grant exemptions for the staff qualifying for an exemption. The vaccination rate for the facility was calculated at 100%. The facility census was 53.

Inspectors wroteBased on medical record review, observation, staff interview, and review of a facility policy, the facility failed to remove a brace to the left lower extremity which was causing pressure to areas of the skin. This resulted in actual harm when Resident #43 had a brace applied to the left lower extremity, the facility staff never contacted the prescribing physician for directions for removing the device, the device was left in place for an extended period of time and Resident #43 developed three unstageable pressure ulcers on her left leg as a result. This affected one (#43) of three (#10, #38, #43) residents reviewed for pressure ulcers. The facility census was 53.

Inspectors wroteBased on review of facility staffing schedules, staff interview and review of a facility policy, the facility failed to ensure they were adequately staffed when the facility failed to schedule a Registered Nurse (RN) for a minimum of eight consecutive hours, seven days a week. This had the potential to affect all 53 residents of the facility.

Inspectors wroteBased on personnel file review, and staff interview, the facility failed to ensure two State Tested Nursing Assistants (STNAs)( #129 and #145) of five reveiwed received 12 hours of inservice education annually. This had the potential to affect all 53 residents of the facility.

Inspectors wroteBased on medical record review, resident interview, staff interview, and review of facility policy, the facility failed to ensure residents were provided the opportunity to participate in the care planning process and have their care plans reviewed and revised for accuracy. This affected 14 (#2, #3, #14, #15, #16, #20, #26, #36, #38, #39, #43, #44, #49, and #50) of 22 residents reviewed for care plans. The facility census was 53.

Inspectors wroteBased on observations, interview with facility staff, and review of facility policy, the facility failed to properly store and label medications in the 100 and 200 hall carts. This affected two of two medication carts observed. The facility census was 53.

Inspectors wroteBased on observation and staff interview, the facility failed to ensure food was stored properly when staff failed to cover 40 slices of cheesecake that was stored in the walk-in cooler. This had the potential to affect all residents in the facility except for 17 (#43, #48, #29, #25, #53, #50, #44, #14, #47, #2, #46, #31, #39, #106, #104, #103, and #33) residents identified by the facility who did not receive a piece of cheesecake. The facility census was 53.

Inspectors wroteBased on medical record review, observation, resident interview, staff interview, and review of facility policy, the facility failed to notify the physician of a change in skin condition for one (#38) of two residents reviewed for skin conditions. The facility identified five resident's with non-pressure skin conditions. The facility census was 53.

Inspectors wroteBased on medical record review, observation, resident interview, staff interview, and review of facility policy, the facility failed to maintain the environment free from offensive odors for one (Resident #26) of 22 resident bathrooms in the final sample. In addition the facility failed to follow their policy to locate missing personal property for one (#14) of three sampled residents. The facility census was 53.

Inspectors wroteBased on medical record review, resident interview, review of Self-Reported Incidents (SRI), staff interview, review of facility investigations, and review of facility policy, the facility failed to implement their abuse policy to investigate allegations of abuse and injuries of unknown origin and failed to report these allegations to the State Survey Agency. This affected three (#19, #15, #53), of four residents reviewed for abuse. The facility census was 53.

Inspectors wroteBased on medical record review, resident interview, review of Self-Reported Incidents (SRI), staff interview, review of facility investigations, and review of facility policy, the facility failed to report these allegations of abuse and injuries of unknown origirn to the State Survey Agency. This affected three (#19, #15, #53), of four residents reviewed for abuse. The facility census was 53.

Inspectors wroteBased on medical record review, resident interview, review of Self-Reported Incidents (SRI), staff interview, review of facility investigations, and review of facility policy, the facility failed to investigate allegations of abuse. This affected two (#19 and #53), of four residents reviewed for abuse. The facility census was 53.

Inspectors wroteBased on review of medical records and staff interview, the facility failed to accurately assess behaviors on the Minimum Data Set (MDS) assessment for one (#53) of 22 residents reviewed for accurate MDS assessments. The census was 53.

Inspectors wroteBased on observation, resident interview, and staff interview, the facility failed to ensure residents with impaired verbal communication had assistive devices available to assist with communicating their wants and needs. This affected one (#47) of one resident reviewed for communication. The facility identified one resident with tracheostomy status and impaired communication. In addition, the facility failed to provide necessary services to prevent a decline in activities of daily living (ADL) for one (#3) of 22 residents reviewed for a decline in ADLs. The facility census was 53.

Inspectors wroteBased on observation, resident interview, review of the medical record, and staff interview, the facility failed to provide fingernail care for two(#3 and #49) of 22 residents reviewed for activities of daily living (ADL) care. The facility census was 53. 1. Review of Resident #3's medical chart revealed he admitted to the facility on [DATE]. Diagnoses included quadriplegia, muscle spasm, shortness of breath, muscle weakness, and chronic pain. Review of Resident #3's Minimum Data Set (MDS) assessment, dated 07/29/19, revealed he was cognitively intact and dependent on staff for ADLs. Observations on 08/04/19 at 11:59 A.M., and 08/05/19 at 11:57 A.M., revealed Resident #3 had extremely long fingernails with dirt under them. Interview on 08/04/19 at 11:59 A.M., Resident #3 stated staff helps him with his nails if they notice they are long. [...]

Inspectors wroteBased on medical record review, observation, resident interview, and staff interview, the facility failed to apply compression stockings per physician order for one (#26) of one sampled residents for edema. The facility census was 53.

Inspectors wroteBased on medical record review and staff interview, the facility failed to follow recommendations by the optometrist for one (#49) of 22 residents reviewed for appropriate assistive devices. The facility census was 53.

Inspectors wroteBased on review of medical record, observation, resident interview, physician interview, and staff interview, the facility failed to provide appropriate foot care for one (Resident #20) of 22 residents reviewed for appropriate foot care. The census was 53.

Inspectors wroteBased on medical record review, observation, resident interview, staff interview, and review of facility policy, the facility failed to ensure proper infections control procedures were used during tracheostomy care. In addition, the facility failed to ensure tracheostomy care was provided as ordered. This affected one resident (#47) of one reveiwed for tracheostomy care. The facility census was 53.

Inspectors wroteBased on medical record review, resident interview, staff interview, and review of facility policy, the facility failed to ensure residents who received dialysis treatments had their dialysis fistulas monitored and weights completed as ordered. This affected two (#14, and #39) of two residents reviewed for dialysis. The facility identified four residents who received dialysis treatments. The facility census was 53.

Inspectors wroteBased on medical record review, observation, staff interview, and policy review, the facility failed to prevent a medication error rate of less than five percent (%). This affected two residents (#7 and #39)of four observed for medication administration. There were 27 opportunities observed with four errors resulting in a 14.81% medication error rate. The facility census was 53.

Inspectors wroteBased on observation, staff interview and facility policy review, the facility failed to ensure residents were free of any significant medication error. This affected one resident (#39) of one resident observed to receive insulin from an insulin pen. The facility identified five residents that receive insulin by an insulin pen. The facility census was 53.

Inspectors wroteBased on medical record review, observation, and staff interview, the facility failed to identify conjunctivitis (pink eye)in one resident (#49) of three residents reviewed for infections. The facility census was 53.