Parkview Northwest Healthcare Center

Inspectors wroteBased on record review, staff interview and review of the facility policy, the facility failed to ensure a preadmission screening and resident review (PASARR) Level II was completed after a significant change in resident status. This affected one (Resident #14) of two residents reviewed for PASARRs. The facility census was 46 residents.

Inspectors wroteBased on observations, medical record review, staff interview, review of the facility's investigation, review of the witness statements, review of the facilities self-reported incidents (SRIs), review of an emergency medical services (EMS) report, review of hospital records, review of emergency room (ER) notes, review of the local weather report, and review of a facility policy, the facility failed to provide adequate supervision and implement timely interventions for exit-seeking behaviors for Resident #39, who was cognitively impaired, had a history of recent exit-seeking behaviors, and who resided in a secured unit, to prevent his elopement from the facility without staff knowledge. [...]

Inspectors wroteBased on review of the nursing staffing schedules, staff interviews and review of the staff roster, the facility failed to have a Registered Nurse (RN) in the facility for at least eight hours a day, seven days a week and failed to have a full time Director of Nursing (DON) employed at the facility. This had the potential to affect all 27 residents residing at the facility. Facility census was 27.

Inspectors wroteBased on observation, staff interview, review of online resources per the Centers for Disease Control (CDC) and the Center for Medicare and Medicaid Studies (CMS), and review of facility policy, the facility failed to ensure staff wore eye protection in resident areas. This had the potential to affect all residents residing in the facility. The facility failed to ensure staff wore appropriate personal protective equipment (PPE) which affected one (Resident #172) of one facility-identified residents on transmission based precautions. The facility also failed to properly sanitize blood glucose meters which affected one (Resident #173) out of two facility-identified residents with physician orders for finger stick blood sugar testing. The census was 27.

Inspectors wroteBased on record review, observation, staff interview and review of facility policy, the facility failed to ensure controlled substance medications were properly counted. This had the potential to affect five (#10, #19, #122, #172, #273) of five residents with controlled substances being stored in Cart 2. The census was 27.

Inspectors wrote3. Review of the medical record for Resident #16 revealed an admission date of 03/23/21 with diagnosis including depressive disorder with psychotic symptoms, mood disorder, unspecified psychosis and bipolar disorder. Review of the quarterly MDS assessment dated [DATE] revealed the resident was cognitively intact and received antipsychotic and antidepressant medications. Review of the physician orders for 08/21 revealed Resident #16 was taking Risperidone one milligram (mg) by mouth daily for mood disorder, Venlafaxine Hydrochloride extended release 75 mg by mouth-take three tablets to equal 225 mg-daily for mood disorder and Lithium Carbonate extended release 300 mg by mouth every 12 hours for mood disorder. [...]

Inspectors wrote3. Review of Resident #72 medical record revealed an admission order of 07/29/21. Diagnoses included bipolar, and anxiety. Review of the most recent five-day MDS assessment revealed Resident #72 was cognitively impaired. Review of the physicians orders dated on 07/29/21 and 08/01/21 revealed an order for an antianxiety medication (Ativan) 0.5 mg (milligrams) to be given every six hours as needed. The medication did not have a stop date. Review of the 08/21 Medication Administration Record (MAR) revealed the resident received one dose on 08/22/21. Observations of Resident #72 on 08/23/21 and 08/24/21 at random times noted the resident was usually in the dining room with his head on the table asleep. Interview with Registered Nurse #99 on 08/24/21 at 4:30 P.M. verified there was no stop date for the medication, and it should not have went through without clarification for a stop date. 4. [...]

Inspectors wroteBased on observation, staff interview, review of facility policy, and review of manufacturer's recommendation, the facility failed to ensure tuberculosis (TB) testing solution was dated upon opening. This had the potential to affect all residents residing in the facility except for Resident #18 who was identified by the facility as being allergic to TB testing solution. The census was 27.

Inspectors wroteBased on record review and staff interview, the facility failed to ensure residents and/or resident representatives were provided education regarding the benefits and potential side effects of the influenza immunization and pneumococcal immunization. Additionally, the facility failed to ensure residents either received the influenza immunization and pneumococcal immunization or did not receive the influenza immunization and pneumococcal immunization due to medical contraindications or refusal. This affected five (#4, #5, #13, #14, and #17) out of five residents reviewed for immunizations. The facility census was 27.

Inspectors wroteBased on medical record review, observation, staff and resident interview, and review of facility policy the facility failed to ensure residents have call lights in reach. This affected two (#4 and #172) of 13 residents sampled for call lights. The census was 27.

Inspectors wroteBased on record review, staff interview, and review of facility policy, the facility failed to ensure the resident's medical record was updated regarding a residents code status. This affected one (#17) of 13 residents sampled. The census was 27.

Inspectors wroteBased on medical record review, observations, resident and staff interview, and review of the Resident Assessment Instrument (RAI) manual, the facility failed to ensure the Minimum Data Set (MDS) assessment was accurate regarding dental status. This affected two (#4 and #17) of 13 residents sampled. The census was 27.

Inspectors wroteBased on record review, staff interview, the facility failed to ensure the resident's medical record included a Level II Preadmission Screening and Resident Review (PASARR) prior to admission to the facility. This affected one (#17) of 13 residents sampled. The census was 27.

Inspectors wroteBased on record review, observation, resident and staff interview, and review of facility policy, the facility failed to ensure resident care plans reflected resident dental status and/or elopement risk and residing in a secured unit. This affected three (#4, #17 and #19) of 13 residents sampled. The census was 27.

Inspectors wroteBased on medical record review, staff interview and policy review, the facility failed to complete a recapitulation of a discharged resident's stay. This affected one (#23) out of three residents reviewed for closed records. The facility census was 27.

Inspectors wroteBased on medical record review, observations, resident and staff interview, and review of facility documents, the facility failed to offer activity programming per the activity calendar. This affected one (#17) of one residents reviewed for activities. The census was 27.

Inspectors wroteBased on medical record review, observation, staff interview, review of facility policy, and review of the Resident Assessment Instrument (RAI) manual, the facility failed to ensure bed rails were used appropriately. This affected one (#4) of two facility-identified residents with rails to their beds. The census was 27.

Inspectors wroteBased on medical record review, observations and staff interview, the facility failed to ensure residents have adaptive feeding equipment in place per the physician orders. This affected one (#4) of one residents with adaptive devices for eating. The census was 27.

Inspectors wroteBased on record review, observation, resident interview, and staff interview, the facility failed to accurately document the dental status for two residents (#19 and #242) of the five residents reviewed for dental concerns. The facility census was 27.

Inspectors wroteBased on observation, record review and staff interview, the facility failed to ensure a resident call light was functioning. This affected one (Resident #173) out of 16 residents reviewed for call lights. The facility census was 27.

Inspectors wroteBased on observation and resident and staff interview the facility failed to ensure residents were provided the information needed to contact the Ohio Department of Health (ODH), the state survey agency. This had the potential to affect all residents residing in the facility. The census was 27.

Inspectors wroteBased on review of Safe Serve and staff interview the facility failed to have any dietary staff certified in food service management and safety. This had the potential to affect all residents in the facility. The facility census was 40.

Inspectors wroteBased on observation, staff interview, review of the resident census and review of facility policy the facility failed to maintain residents rooms in a clean and sanitary manner. Holes were noted on the walls with exposing dry wall and wood, and window blinds were dirty. This affected three rooms (7, 12 and 13) of 15 rooms on the lower level. The facility identified six Resident's (#1, #4, #20, #21, #22 and #190) who resided in the affected rooms. The facility census was 40.

Inspectors wroteBased on observation, staff interview, review of census list and review of facility policy the facility failed to maintain the canopy over the courtyard on the lower level. This had the potential to affect 16 residents (#1, #3, #4, #5, #8, #11, #15, #17, #18, #20, #22, #27, #36, #37, # 38 and #190) who resided on the secured unit and used the courtyard. Total census of the facility was 40. Observation on 02/19/19 at 11:32 A.M. of the lower level courtyard attached to the secured unit, revealed the canopy was in disrepair. Further observation revealed several holes in the canopy and a large area where the canopy was completely separated from the frame and hanging down. Interview on 02/21/19 at 11:10 A.M. with the Director of Nursing (DON), verified the canopy over the courtyard had several holes in it and a large area where the canopy was separated from the frame and hanging down. [...]

Inspectors wroteBased on medical record review, staff and resident interview, and review of the facility policy, the facility failed to notify the physician of lab refusals for a resident. This affected one Resident (#29) of five reviewed for unnecessary medications during the investigation phase of the annual survey. The facility census was 40.

Inspectors wroteBased on review of medical record, observations, staff interview, review of facility incident log and review of facility policy the facility failed to implement their policies and procedures for residents with injuries of unknown origin. The facility failed to investigate and report to the state agency. This affected one Resident (#22) of one reviewed for accidents. Total census was 40.

Inspectors wroteBased on review of medical record, observations, staff interview, review of facility incident log and review of facility policy the facility failed to ensure an injury of unknown origin was reported to the state agency. This affected one Resident (#22) of one reviewed for accidents. Total census was 40.

Inspectors wroteBased on review of medical record, observations, staff interview, review of facility incident log and review of facility policy the facility failed to ensure an injury of unknown origin was investigated. This affected one Resident (#22) of one reviewed for accidents. Total census was 40.

Inspectors wroteBased on medical record review, staff interview, and facility policy review the facility failed to notify the Ombudsman of a residents' discharge. This affected one (#20) of two residents reviewed for hospitalization. The facility census was 40 residents.

Inspectors wroteBased on medical record review and staff interview, the facility failed to develop baseline care plan within the required 48 hour of admission. This affected one Resident (#29) of 13 reviewed during the investigation phase of the annual survey. The facility census was 40.

Inspectors wroteBased on medical record review, staff and resident interviews, and review of facility policy, the facility failed to provide care conference/care planning quarterly for residents. This affected one Resident (#39) of one reviewed for care conferences/care planning during the investigation phase of the annual survey. The facility census was 40.

Inspectors wroteBased on observation, staff interview, review of resident list and review of facility policy the facility failed to ensure the residents environment was free from accident hazards. This affected one room (12) of 15 rooms on the secured lower level. room [ROOM NUMBER] had exposed wires. The facility identified 14 Residents (#3, #5, #8, #11, #15, #17, #18, #20, #22, #27, #36, #37, #38 and #190) as being cognitively impaired and ambulatory who resided on the secured lower level. Total census of facility was 40.

Inspectors wroteBased on observation, staff interview, review of the narcotic logs, and review of facility policy, the facility failed to ensure a nurse documented in the narcotic log in a timely manner after administration of a narcotic. The facility also failed to ensure administration of a narcotic when it was signed out of the narcotic log. This affected two (#25 and #26) of 24 residents the facility identified as receiving medications from the medication cart on floor two. The facility census was 40.

Inspectors wroteBased on medical record review, observation, staff interview, and review of facility policy, the facility failed to remove/dispose of discontinued medication. This affected one of three medication carts observed during the annual survey. This directly affected one Resident (#16) who had expired medications in the medication cart. The facility census was 40.

Inspectors wroteBased on review of nursing staffing schedules and staff interview the facility failed to have Registered Nursing (RN) services eight consecutive hours a day seven days a week. This had the potential to affect all residents in the facility. The facility census was 40.