Medina Memorial Hospital SNF

Inspectors wroteBased on observation, interview, and record review conducted during the Standard survey completed on [DATE], the facility did not ensure the system developed for advance directives was implemented in a manner that was consistent with residents' wishes for three (Resident #6, #21, and #24) of 16 residents reviewed for advance directives. Specifically, the facility did not ensure that all advance directive identifiers were consistent with the resident's advance directives. Facility staff were utilizing a process that was not consistent with the facilities current documented processes.

Inspectors wroteBased on observation, interview and record review conducted during a Standard survey completed on 5/24/24, the facility did not ensure residents were free from physical restraints imposed for purposes of discipline or convenience that were not required to treat the resident's medical symptoms, used for the least amount of time and document ongoing re-evaluation of the need for restraints for three (Resident #9,23, and 24) of three residents reviewed for physical restraints. Specifically, Residents #9, #23 and #24 had no assessments for the initiation or ongoing re-evaluation of the continued use of position change alarms. Additionally, there were no provider orders or notes to address the medical reason that warranted the use of the device.

Inspectors wroteBased on interview and record review conducted during a Standard survey conducted 7/28/22 through 8/2/22, the facility did not use the services of a Registered Nurse (RN) for at least eight consecutive hours a day, seven days a week. Specifically, one of one resident care unit (skilled nursing facility (SNF) independent of the hospital) reviewed for staffing revealed an RN was not scheduled for eight consecutive hours per day on the weekends and holidays for the past four months. The finding is: Review of a facility Policy and Procedure (P&P) titled RN Staffing for [NAME] Memorial Hospital SNF dated 9/1/2020 documented an RN will be scheduled to be on the SNF unit for eight consecutive hours/day, seven days a week. [...]

Inspectors wroteBased on observation, interview, and record review conducted during a Standard survey started 7/28/22 and completed 8/2/22 the facility must attempt to use appropriate alternatives prior to installing a side or bed rail. If a bed or side rail is used, the facility must ensure correct installation, use, and maintenance of bed rails. Assess the resident for risk of entrapment from bed rails prior to installation. Review the risks and benefits of bed rails with the resident or resident representative and obtain informed consent prior to installation. Specifically, one (Resident #3) of one resident observed for side rail use the facility did not ensure the resident was assessed for the risk of entrapment prior to installation, and ensure risks versus benefits of the bed rails were reviewed with the resident or if applicable the resident's representative on an ongoing basis. The finding is: [...]

Inspectors wroteBased on interview and record review during the Standard survey from conducted from 7/28/22 through 8/2/22, the facility did not provide the appropriate liability and appeal notices to Medicare beneficiaries at the termination of Medicare coverage for three (Residents #11, 17, and 20) of three residents reviewed. Specifically, the facility did not provide responsible party (RP) with a Skilled Nursing Facility Advance Beneficiary Notice (SNF ABN) and a Notice of Medicare Non-Coverage (NOMNC) (#11), the facility did not provide the resident or RP with a SNF ABN and there was no documented evidence the NOMNC was mailed to RP after telephone contact (#17) and there was no documented evidence the NOMNC was mailed to the RP after telephone contact (#20).

Inspectors wroteBased on interiew and record review conducted during an Standard survey completed on 1/6/20, the facility did not ensure that all alleged violations including abuse, neglect, exploitation or mistreatment including injuries of unknown origin source, are reported immediately, but not later than two hours later after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury to the Administrator and other officials (including to the State Survey Agency and the Adult Protective Services where state law provides for jurisdiction in long-term care facilities) in accordance with State Law through established procedures. Specifically, one (Residents #26) of one resident reviewed for reporting of alleged violations of abuse were involved in a resident to resident altercation. [...]

Inspectors wroteBased on observation, record review, and interview completed during the Standard survey completed 1/6/20, the facility did not ensure that a resident with limited range of motion receives appropriate treatment and equipment to prevent further decrease in range of motion. Specifically, one (Resident #5) of one resident reviewed for range of motion (ROM) services was not provided with a palm guard (assistive device that positions the fingers away from the palm) to their right hand as recommended by Occupational Therapy (OT). The finding is: 1. Resident #5 was admitted to the facility on [DATE] with diagnoses including dementia, depression and contractures (loss of joint mobility). The Minimum Data Set (MDS- a resident assessment tool) dated 11/6/19 documented the resident was severely cognitively impaired, and was rarely/never understood, sometimes understands. [...]

Inspectors wroteBased on interview and record review conducted during the Standard survey completed on 1/6/20, the facility did not use the services of a Registered Nurse (RN) for at least eight consecutive hours a day, seven days a week. Specifically, one of one resident care unit (skilled nursing facility independent of the hospital) reviewed for staffing revealed an RN was not scheduled for eight consecutive hours per day on the weekends and holidays for the past four months. Specifically, one of one resident care unit (skilled nursing facility (SNF) independent of the hospital) reviewed for staffing revealed an RN was not scheduled for eight consecutive hours per day on the weekends and holidays for the past three months. The finding is: [...]