Every finding on record at Kendal at Oberlin

Based on observations, staff interviews, and review of facility policy, the facility failed to store food in a sanitary manor by using food after the use by date and not properly covering and dating open food items. This had the potential to affect all 24 resident who received meals from the kitchen. Findings include: Observation during a tour of the kitchen on 05/07/17 at 8:50 A.M. revealed a container of purple onions with a use by date of 05/03/17 and a container of sliced mushrooms dated 04/24/17. Observation of the refrigerator revealed a cooking sheet with meat on it. The pan of meat was not covered or dated with a open or use by date. Interview on 05/07/17 at 8:54 A.M. with Cook #200 revealed the cooking sheet had veal left over from diner the night before. Cook #200 verified the veal was not covered or dated. Interview on 05/07/17 at 8:56 A.M. with Dietary Aide #100 verified there was a outdated container of purple onions and container of mushrooms that was dated 04/24/17. Dietary Aide #100 revealed the date on the mushroom container was the date the facility received it. Dietary Aide #100 further verified the container of mushrooms did not have an open or use by date. Review of the facility policy Frozen/Cold/Perishable Food Items, dated 03/08/16, revealed cut vegetables and leftovers are to be discarded after three days from preparation.

Based on observation, interview and policy review, the facility failed to properly wrap, label and date food items. This affected 29 of 29 residents identified by the facility as receiving their meals from the main kitchen. The facility census was 30. Findings include: Observation in the facility freezer on 02/29/16 at 8:19 A.M. revealed one bag each of potato chips and hush puppies and 12 pie crusts removed from the original packaging without labels or dates. Observation on 02/29/16 at 8:19 A.M. also revealed two opened boxes of walnuts in the freezer not properly sealed. Additionally, observation on 02/29/16 at 8:21 A.M. revealed an opened and uncovered bag of thawed chicken in the walk in cooler. Interview on 02/29/16 at 8:19 A.M. with Chef #700 revealed the 12 pie crusts and the bags of hush puppies and potato chips were not labeled or dated. Further interview with Chef #700 on 02/29/16 at 8:19 A.M. revealed the two bags of walnuts were not properly sealed. Additional interview with Chef #700 on 02/29/16 at 8:21 A.M. revealed the thawed chicken in the walk in cooler was not properly covered. Review of the undated facility policy Food Handling and Sanitation revealed food items should be wrapped properly, dated when opened and when it is to be used by. Additionally, food items removed from original packaging should also be labeled and dated with the use by or expiration date.

Based on record review and staff interview, the facility failed to notify residents of their Medicare provider non-coverage for skilled services within the two day requirement. This affected two (Resident #6 and Resident #40) of three residents reviewed for liability notices for skilled service termination. The facility census was 30. Findings include: Record review for Resident #6's notice of Medicare provider non-coverage revealed a service end date on 11/04/2015 with the signature indicating receipt of the notice dated 11/03/15. Record review for Resident #40's notice of Medicare provider non-coverage revealed a service end date on 11/11/15 with the signature indicating receipt of the notice dated 11/11/15. Review of the Centers for Medicare and Medicaid services instructions for completion of the notice of Medicare non-coverage (NOMNC) reveals A Medicare health provider must give and advance completed copy of the NOMNC to enrollees ., no later than two days before the termination of services. Interview with Social Service Personnel (SSP) #111 on 03/03/16 at 11:00 A.M., verified the lack of proper notice of Medicare provider non-coverage for Resident #6 and Resident #40.

Based on record review, policy review and staff interview, the facility failed to notify family members or representatives of changes in resident status. This affected one (Resident #19) of three residents reviewed related to injuries from a fall. This also affected one (Resident #21) of three residents reviewed for weight loss. The census was 30. Findings include: 1. Record review for Resident #19 revealed an admission date of [DATE]. [DIAGNOSES REDACTED]. Resident #19's assessments included results noting a memory problem with moderate impaired, inattention, disorganized thinking and altered mental status. Continued record review for Resident #19 revealed a note on 02/11/16 by the clinical nurse practitioner (CNP) #222. The assessment of the skin revealed the skin to be intact with a bruise to the buttocks status [REDACTED]. Review of Resident #19's medical record and progress notes revealed no evidence of family notification of the bruise to the buttocks from a fall occurring on 02/07/16. Interview with CNP #222 on 03/03/16 at 12:30 P.M. verified the bruise was present to the buttocks during the assessment of Resident #19 on 02/11/16, but not recalling which side of the buttocks this was noted. Interview with minimum data set (MDS) nurse on 03/02/16 verified the lack of family notification for the bruising noted on 02/11/16. Facility policy review for Notification of family effective August 13, 2014 last reviewed August 13, 2014 revealed Kendal at Oberlin promptly notifies the resident, his or her Health Care provider, and representative of any changes in the resident ' s condition/status with the goal noted as to ensure families/representatives are aware of all changes with the resident. 2. Review of Resident #21's medical record revealed an admission date of [DATE], [DIAGNOSES REDACTED]. Brief interview for mental status (BIMS) score of 08 indicating the resident was cognitively impaired. Review on February 2016 dietary note revealed weight loss 10 (lbs.) pounds over the past two months currently at 183.2 lbs. with most being fluid loss. Interview on 03/03/16 at 3:07 P.M. with Registered Dietician License Dietitian (RDLD) #333 revealed we meet each month with a nutrition risk committee to discuss residents who have had changes and are not eating. Furthermore, identified that Resident #21's family had not been notified of Resident #21's weight loss. Review of facility policy dated 08/13/14 titled Notification of Family revealed to promptly notify the resident, his or her Health Care Provider, and representative of any changes in the resident's condition or status. To ensure families/representatives are aware of all changes with the resident. The nurse manager or license practical nurse (LPN) will notify family/representative with the following. There is a significant change in the resident's condition. Change in diet/supplements if recommended by Speech Therapy or physician.

Based on record review and staff interview, the facility failed to assess and monitor a skin abrasion and a bruise from a fall. This affected one (#19) of three residents reviewed for injuries from falls. The census at the time of the survey was 30. Findings include: Review of Resident #19's medical record revealed an admission date of [DATE]. [DIAGNOSES REDACTED]. Review of Resident #19's assessments indicated the resident had a memory problem with moderate impaired, inattention, disorganized thinking and altered mental status. Review of Resident #19's admission skin assessments dated 01/29/16 revealed an injury to the right flank area. This area was described as dark colored line to right flank status [REDACTED]. The skin assessment revealed no other areas of concern noted to the skin. The assessment had an X to the anatomical diagram on the left buttocks with notes indicating bruising resolved from fall. Review of the weekly skin assessment from 02/06/16 revealed a nurses note reporting the site to the left buttocks of bruising has resolved from previous fall. Review of a progress note dated 02/11/16, by the clinical nurse practitioner (CNP) revealed the assessment of the skin revealed the skin to be intact with a bruise to the buttocks status [REDACTED]. Review of the skin assessment report dated 02/14/16 for Resident #19 revealed an entry documenting bruising to flank and buttocks has resolved. No new skin issues noted or reported. Interview on 02/29/16 at 11:56 A.M., with Nurse #500 revealed Resident #19 sustained a fall with injury on 02/07/16. Nurse #500 stated the resident had an injury of an abrasion to the shoulder from the fall. Interview with Minimum Data Set (MDS) nurse on 03/02/16 at 1:30 P.M.,verified the lack of skin assessment documentation for the abrasion on the shoulder or bruising to the buttocks for Resident #19 from 02/06/16 through 02/14/16. Interview on 03/03/16 at 12:30 P.M., with the CNP, verified the bruise was present to the buttocks during the assessment on 02/11/16, but not recalling which side of the buttocks this was noted.

Based on surveyor observation, review of facility policy and staff interview, it was determined the facility failed to ensure hazardous cleaning products were being kept secured. This affected one (#3) of one resident identified as being confused and independently mobile. The facility census was 36. Findings include: Review of the medical record for Resident #35 revealed the resident was recently readmitted to the facility from the hospital. The facility had placed the resident on contact precautions related to the facility's infection control protocol. A chest of drawers was located directly outside of Resident #35's room. The top of the chest was observed to contain infection control supplies. One of the supplies was a large plastic canister of disposable germicidal impregnated cleaning cloths. The label indicated the product was an germicidal agent and contained a cautionary label which indicated the product was a hazard and to keep out of reach of children. It further instructed to contact the poison control center if the product came in contact with the eyes or skin. The label further directed these wipes were not a baby wipe for use on skin. Multiple observations during the survey on 04/01/11 and 04/02/11 revealed the germicidal cleaning wipes remained on the top of the chest and accessible to residents. Interview with the Director of Nursing on 04/02/11 at 2:00 P.M. verified the wipes were on top of the cart and verbalized the products should never be left there. Review of the facility policy and procedure entitled "Hazardous Materials and Handling/Storage," (with no effective date) directed staff that hazardous materials must be stored in clearly marked and strictly controlled safety and storage areas.

Based on review of facility documentation regarding discharge from skilled services and staff interview, it was determined the facility failed to provide an advanced beneficiary notice to two (#18 and #22) of three residents reviewed regarding discharge from skilled services. The facility identified a total of four residents who had been discharged from skilled services in the past six months. The facility census was 36. Findings include: Review of the skilled services discharge information for Resident #18 and #22 revealed Resident #18 was discharged from Medicare covered skilled services on 01/30/11 and Resident #22 was discharged from Medicare covered skilled services on 01/10/11. The residents were provided with a generic notice prior to being discharged from skilled services related to meeting therapy goals. Both residents were identified as having skilled service days remaining, however they were not provided with an advanced beneficiary notice. Interview with the Administrator on 04/02/11 at 3:15 P.M. verified both Resident #18 and #22 were discharged from skilled services, had skilled coverage days remaining, and both remained in the facility following discharge from Medicare covered skilled services. The Administrator identified the facility was unaware of the need to provide an advanced beneficiary notice to the residents.