Norwalk Memorial Home

Inspectors wroteBased on personnel file review, online State of Ohio State Tested Nursing Aide Registry review, staff interview and review of facility policy, the facility failed to ensure a current/active license for one, Certified Nursing Assistant #117, of five employees reviewed for current/active licensure. This had the potential to affect all residents. The facility census was 54. Review of Certified Nursing Assistant (CNA) #117's personnel file revealed a hire date of [DATE]. Review of the Ohio Department of Health State Tested Nursing Aide registry review dated [DATE] at 2:58 P.M. revealed CNA #117's registry had expired on [DATE] and she was not eligible to work. [...]

Inspectors wroteBased on medical record review, staff interview, review of the Food and Drug Administration (FDA) Black Box Warning information, and policy review, the facility failed to ensure psychotropic medications were administered to address appropriate conditions that reflect resident current health conditions and failed to ensure the residents were adequately monitored while receiving psychotropic medications. This affected four (#17, #46, #47, and #51) of five residents reviewed for unnecessary medications. The facility census was 66.

Inspectors wroteBased on medical record review, review of room and board rates, and staff interview, the facility failed to ensure Skilled Nursing Facility Advanced Beneficiary Notices (SNF ABNs) contained all required and accurate information. This affected two (#51 and #112) of three residents reviewed for beneficiary notices. The facility census was 66. Findings Include: 1. Review of the medical record revealed Resident #51 was admitted to the facility on [DATE] with diagnoses including dementia, disorientation, and skin cancer. Review of the SNF ABN provided to Resident #51 on 12/26/23, prior to the discontinuation of skilled services on 12/29/23, revealed the notice contained no information regarding what skilled services were being discontinued and noted the estimated cost per day of the service as $235.00 per day. [...]

Inspectors wroteBased on medical record review, review of resident census information, email correspondence with the local Ombudsman, and staff interview, the facility failed to ensure the state Ombudsman's office was notified of resident discharge or transfer from the facility as required. This affected two (#30 and #60) of two residents reviewed for hospitalization. The facility census was 66.

Inspectors wroteBased on observation, staff interview, medical record review, and review of hospital provider documentation, the facility failed to timely implement behavioral health services upon return from an emergency department (ED) visit for suicidal ideations. This affected one (#46) of three residents reviewed for behaviors. The facility census was 66.

Inspectors wroteBased on observation, staff interview, medical record review, review of manufacturer guidelines, and policy review, the facility failed to ensure residents were free from significant medication administration errors. This affected one (#04) of four residents observed for medication administration. The facility census was 66.

Inspectors wroteBased on review of personnel files, staff interview, and review of the facility abuse policy, the facility failed to develop and implement policies and procedures to include screening of all employees against the State of Ohio Nurse Aide Registry to identify if an employee had a finding concerning abuse. This had the potential to affected all 66 residents residing in the facility. The census was 66. Findings Include: Review of the personnel files for the Director of Nursing (DON), Licensed Practical Nurse (LPN) #249, LPN #273, and Dietary Aide (DA) #280 revealed no evidence they were screened prior to employment using the State of Ohio Nurse Aide Registry. The identification of findings would be necessary to determine if any employee had actions identified that would validate allegations of abuse, neglect, exploitation, mistreatment of residents, or misappropriation of their property. [...]

Inspectors wroteBased on observation, staff interview, and policy review, the facility failed to ensure posted nursing staff information was posted daily as required. This had the potential to affect all 66 residents. The facility census was 66.

Inspectors wroteBased on observation and staff interview, the facility failed to serve residents seated together for meals at the same time. This affected nine (#20, #40, #44, #5, #19, #23, #15, #26, and #13) of twelve residents observed in the dining room during lunch service. The facility census was 61.

Inspectors wroteBased on observation, staff interview, and review of a facility policy, the facility failed to complete shiftily reconciliation counts for controlled medications stored in medication carts and refrigerators on the Transitional Care Unit (TCU). This deficient practice affected nine (#1, #2, #32, #53, #54, #55, #56, #57, and #153) residents with controlled substances kept in the medication cart or refrigerator in the TCU. The census was 61.

Inspectors wroteBased on observation, staff interview, and review of a facility policy, the facility failed to ensure medications were stored securely in the medication cart during medication administration. This had the potential to affect 23 Residents (#3, #4, #6, #11, #15, #16, #17, #18, #20, #21, #23, #26, #27, #31, #32, #33, #34, #35, #40, #41, #44, #49 and #303) residing on the B Hall and left side of C Hall for whom the medications were administered by the facility. The facility census was 61.

Inspectors wroteBased on observation, staff interview, review of the Centers for Disease Control and Prevention (CDC) guidelines, and review of facility policy, the facility failed to ensure staff were wearing the appropriate personal protective equipment (PPE) when entering the room of a resident on quarantine for unknown COVID-19 status, changed PPE when exiting the quarantine room, and unvaccinated staff were wering a N95 when entering resident rooms. This had the potential to affect 13 residents (#2, #25, #45, #48, #53, #54, #55, #56, #58, #59, #153, #154, and #304) The facility census was 61.

Inspectors wroteBased on medical record review, staff interview, and review of a facility policy, the facility failed to ensure advance directives were consistent throughout the medical record for one (#9) of 24 residents reviewed for advance directives. The census was 61.

Inspectors wroteBased on medical record review, review of the Beneficiary Protection Notification Review, and staff interview, the facility failed to provide the Advance Beneficiary Notice of Non-Coverage when Medicare Part A services ended to one (#41) of three residents reviewed for Beneficiary Protection Notification. The facility census was 61.

Inspectors wroteBased on medical record review, observation, staff interview, and review of facility policy, the facility failed to assess the use of a pressure mat alarm used as a fall precaution to prevent a resident from changing positions without staff assistance. This affected one (#31) of one resident reviewed for pressure mat alarms. The facility identified 17 residents who utilized pressure mat alarms for fall precautions. The facility census was 61.

Inspectors wroteBased on medical record review, staff interview, and review of facility policy, the facility failed to provide written notice of transfer for hospitalizations. This affected two (#47 and #33) of two residents reviewed for transfer notification. The facility census was 61.

Inspectors wroteBased on medical record review, staff interview, and review of facility policy, the facility failed to provide bed hold notification to residents transferred to the hospital. This affected two (#47 and #33) of two residents reviewed for bed hold notification. The facility census was 61.

Inspectors wroteBased on review of medical record, family interview, and staff interview, the facility failed to ensure a resident and resident family were provided a written summary of the baseline care plan. This affected one (#154) of one resident reviewed for baseline care plans. The facility census was 61.

Inspectors wroteBased on medical record review, staff interview, and review of a facility policy, the facility failed to ensure resident's advanced directive wishes were consistent throughout the medical record. This affected two (#47 and #46) of 24 residents reviewed for advanced directives. The facility census was 69.

Inspectors wroteBased on record review, review of Self-Reported Incident (SRI) investigation, staff interview, and review of facility policy, the facility failed to follow their policy to timely report an injury of unknown origin to the Administrator and the State Agency for one (#3) of one resident reviewed for an injury of unknown origin. This had the potential to affect all 69 residents of the facility.

Inspectors wroteBased on record review, review of Self-Reported Incident (SRI) investigation, staff interview, and review of facility policy, the facility failed to timely report an injury of unknown origin to the Administrator and the State Agency for one (#3) of one resident reviewed for an injury of unknown origin. This had the potential to affect all 69 residents of the facility.

Inspectors wroteBased on medical record review, review of facility policy, and staff interview, the facility failed to provide written notification of a transfer to the hospital for one (#67) of two residents reviewed for hospitalization. The facility census was 69.

Inspectors wroteBased on medical record review and staff interview, the facility failed to have a policy regarding resident bed holds upon transfer from the facility and failed to provide notification of the facility bed hold policy upon discharge to an acute care hospital for two (#67 and #65) of two residents reviewed reviewed for hospitalization. The facility identified 12 residents identified by the facility who discharged to the hospital. The facility census was 69.