Ashtabula County Nursing Home

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, interview and policy review, the facility failed to ensure triggers were addressed for residents with post-traumatic stress disorder (PTSD). This affected four (#3, #11, #76 and #81) of four residents reviewed for trauma informed care. The facility identified four residents (#3, #11, #76 and #81) as having a diagnosis of PTSD. The facility census was 104. Findings include: 1.Review of the medical record for Resident #11 revealed an admission date of 11/13/25 with pertinent diagnoses included post-traumatic stress disorder (PTSD), vascular dementia, psychotic disturbance and anxiety. Review of the quarterly minimum data set (MDS) 3.0 assessment dated [DATE] revealed Resident #11 had moderate cognitive deficits, physical behavioral symptoms directed towards others occurring one to three days in the seven day look back period and verbal behavioral symptoms directed towards others occurring four to six days in the seven day look back period. The assessment indicated Resident #11 had a…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on record review, and interview the facility failed to ensure staff treated residents with respect and dignity. This affected one resident (Resident #57) out of four residents reviewed for dignity. The facility census was 104.Findings include:Review of the medical record for Resident #57 revealed an admission date of 06/08/24. Diagnoses included atrial-fibrillation, hearing loss, and acute and chronic respiratory failure with hypoxia. Review of the Annual Minimum Data Set (MDS) assessment, dated 04/28/26, revealed the resident had moderately impaired cognition. The resident required maximum assist for showers/bathing. Touching assist was needed for lower body dressing. The Resident needed set up or clean up assist for lying to sitting, chair to bed transfers, and toilet transfer. Review of the Health Status Note dated 05/28/26 at 4:00 P.M. revealed Resident #57 reported an incident to the Director of Nursing (DON) with the resident's granddaughter present in the room. During care, Certified Nursing Assistant (CNA) #249 was assisting Resident #57 to get dressed for the day and…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Oxygen tubing: Based on observation, interview, record review and review of facility policy, the facility failed to ensure a nebulizer mask was stored in a manner to prohibit contamination. This affected one (Resident #17) of one resident reviewed for respiratory care. The facility census was 104.Findings include: Review of the medical record for Resident #17 revealed an admission date of 10/21/22 with diagnoses including Chronic Obstructive Pulmonary Disease (COPD) and chronic respiratory failure with hypoxia. Review of the quarterly minimum data set (MDS) 3.0 assessment dated [DATE] revealed Resident #17 had severe cognitive impairment. The assessment also revealed the primary medical condition for Resident #17 was COPD. The assessment revealed Resident #17 had shortness of breath with exertion and lying flat and was on oxygen therapy.Review of the care plan dated 04/29/26 revealed Resident #17 had an altered respiratory status. Interventions included administer medication and puffers as ordered.Review of…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, record review and review of facility policy, the facility failed to ensure proper hand hygiene was performed during wound care. This affected one (Resident #8) of two residents reviewed for wound care. The facility census was 104.Findings include: Review of the medical record for Resident #8 revealed an initial date of admission of 04/09/19 and a readmission date of 05/03/23 with diagnoses including quadriplegia and chronic osteomyelitis unspecified (an infection affecting bone). Review of the quarterly minimum data set (MDS) 3.0 assessment dated [DATE] revealed Resident #8 was cognitively intact and had skin impairment of pressure areas. Review of the care plan dated 06/11/26 revealed Resident #8 was at risk for impaired skin integrity related to impaired mobility, catheter tubing, and quadriplegia. Interventions included check dressings to the coccyx and left ischial wounds, and wound care per order.Observation of wound care on 07/08/26 at 3:11 P.M. revealed three dressings for…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, interview and review of facility policy, the facility failed to ensure education was provided to residents on the influenza vaccine. This affected two (Resident #8 and #22) of five residents reviewed for immunizations. The facility census was 104.Findings include: 1.Review of the medical record for Resident #8 revealed an initial admission date of 04/09/19 and a readmission date of 05/03/23 with diagnoses including quadriplegia, chronic osteomyelitis, morbid obesity, bipolar disorder, and major depressive disorder. Review of the quarterly minimum data set (MDS) 3.0 assessment dated [DATE] revealed Resident #8 was cognitively intact and was administered the influenza vaccine. Review of the vaccine administration record within the medical record revealed Resident #8 received the influenza vaccine on 09/26/25 and no education was provided prior to the vaccine administration. 2.Review of the medical record for Resident #22 revealed an admission date of 12/21/24 with diagnoses including…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interview, the facility failed to ensure Resident #115's guardian was informed and gave consent for Resident #115 to be discharged from the facility. This affected one resident ( Resident # 115) of the three residents reviewed for discharge. The facility census was 114. Findings include: Review of the medical record revealed Resident #115 was admitted to the facility on [DATE] and discharged from the facility on 08/12/24. Guardian #392 was listed as the responsible party guardian and emergency contact #1. Resident #115's mother was the emergency contact #2. Medical diagnoses included pulmonary edema, Asperger's syndrome, diabetes, bipolar, hypertension, glaucoma, dependence on renal dialysis, depression, and anemia. Review of the Minimum Data Set ( MDS) 3.0 Discharge Return Not Anticipated assessment dated [DATE] revealed discharge was unplanned to home. Resident #115 had moderate impairment for decision making. Resident #115 displayed physical behaviors. Resident #115 needed set up…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation and interview the facility failed to ensure all meals were served at an appetizing temperature. This had the potential to affect 108 residents at the facility. The facility identified one resident (#30) as receiving no food from the kitchen. The facility census was 109. Findings include: On 08/30/23 at 11:34 A.M. observation of temperatures taken on the tray line revealed the roast turkey measured an internal temperature of 170 degrees Fahrenheit (F). The Brussel sprouts measured an internal temperature of 148 degrees F, and the scalloped corn measured an internal temperature of 160 degrees F. On 08/30/23 at 12:04 P.M. the food cart with the test tray left the kitchen. On 08/30/23 at 12:06 P.M. the cart was on the unit. On 08/30/23 at 12:07 P.M. two staff members started passing the food trays. On 08/30/23 at 12:26 P.M. all resident trays had been passed and the food on the test tray was evaluated. Review of the test tray with Assistant Dietary Manager (ADM) #759 revealed the tray consisted of roast turkey, Brussel sprouts, and scalloped corn. The turkey…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review and interview the facility failed to accurately code alarms on the Minimum Data Set (MDS) 3.0 assessment for Resident #29, Resident #63, Resident #96 and Resident #99. This affected four residents (#29, #63, #96 and #99) of four residents reviewed for alarms. Findings include: 1. Record review for Resident #99 revealed an admission to the facility on [DATE]. Resident #99's current diagnoses included unspecified dementia with behavioral disturbance, major depressive disorder, generalized osteoarthritis, and primary hypertension. A fall risk assessment dated [DATE] revealed that Resident #99 was a high risk of falls. Review of the physician's orders for Resident #99 revealed an order, dated 10/30/19 for motion [NAME] alarm for bathroom, an order dated 09/22/19 for self releasing alarm belt to wheelchair, a motion [NAME] to the residents bed, and an order for bed tender alarm dated 06/05/18. A care plan relative to fall risk revealed individualized interventions for falls…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, record review and interview the facility failed to maintain adequate infection control practices during the administration of medication for Resident #62 and during meal services to prevent the spread of infection. This affected one resident (#62) of six residents observed during medication administration and six residents (#10, #27, #63, #73, #85 and #87) of ten residents observed for meal service. Findings include: 1. During medication observation on 12/03/19 at 7:19 A.M. Licensed Practical Nurse LPN #610 entered Resident #62's room to obtain a glucometer reading. LPN #610 entered the resident's room, washed her hands, applied gloves and then completed the blood sugar testing. After completing the test, the LPN discarded the items in the appropriate container, removed her gloves and then returned to the medication cart without first performing any hand washing or hand hygiene. The LPN then cleaned the glucometer with a sanitizing wipe and obtained the resident's Lantus Solostar KwikPen from the medication drawer and prepared it for administration. LPN #610…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on record review and interview the facility failed to ensure Resident #49 was free from misappropriation of money. This affected one resident (#49) of three residents reviewed for misappropriation. Findings include: Review of the medical record for Resident #49 revealed an admission date of 03/01/17 with diagnoses that included Parkinson's disease, congestive heart failure, chronic kidney disease and major depression. Review of the form titled, Resident Personal Funds revealed Resident #49 signed on 03/22/17 that she authorized the facility to manage her personal money while she was a resident at the facility. Review of a facility self-reported incident (SRI), tracking number 180181 revealed an incident involving misappropriation for Resident #49 was discovered on 09/08/19. The SRI revealed on 09/02/19 State Tested Nursing Assistant (STNA) #600 asked Resident #49 if she would like to have her coin purse locked up rather than leave her money in her room. Resident #49 agreed and STNA #600 took Resident #49's coin purse that contained $38.00 to Licensed Practical Nurse (LPN)…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, record review and interview the facility failed to ensure Resident #62, who had a diagnosis of diabetes mellitus received insulin injections in accordance with the physician's order for administration and to meet the resident's needs. This affected one resident (#62) of six residents observed for medication administration. Findings include: Review of the medical record for Resident #62 revealed an admission date of 03/02/18 with diagnoses including diabetes mellitus type 2, dementia and chronic kidney disease. Record review revealed the resident had a physician's order, dated 09/18/19 for NovoFine Lantus Solostar KwikPen Insulin Needles, inject one applicator subcutaneously every morning and at bedtime. The order included to rotate sites, use arms not abdomen for injection. During medication administration observation on 12/03/19 at 7:42 A.M., Licensed Practical Nurse (LPN) #610 entered Resident #62's room with the prepared Lantus Solostar Kwikpen and exposed the resident's abdomen which revealed two small blue, red, and purple colored bruises to the right…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, record review and interview the facility failed to ensure medications were administered to Resident #59 via gastrostomy tube to decrease the risk of stomach upset/gastrointestinal disturbance. This affected one resident (#59) six residents observed for medication administration. Findings include: Review of the medical record for Resident #59 revealed an admission date of 06/23/04 with diagnoses including heart failure, gastro-esophageal reflux disease, gastrostomy status and chronic bronchitis. Review of the physician's orders, dated 06/27/19 revealed the resident had an order for Potassium chloride solution 20 milliequivalents (meq) per 15 milliliters (ml) 10 percent (%) solution, give 7.5 ml via gastrostomy tube once daily for heart failure. During medication administration observation on 12/03/19 at 9:38 A.M., Licensed Practical Nurse (LPN) #610 prepared the Potassium chloride solution 10% 7.5 ml into a medication administration cup. Observation of the Potassium Chloride medication label revealed a note that stated, must dilute before using. Interview at the…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.