Gables of Canton

Based on record review, staff interview and review of the facility policy, the facility failed to ensure residents had hot water at the proper temperature and failed to ensure the resident's hot water was monitored for proper temperature. This had the potential to affect all 73 residents residing in the facility.

Findings include:

Review of facility water temperature log revealed there was no hot water temperature monitoring recorded between 08/09/24 and 11/28/24.

Review of the facility water temperature log dated 11/29/24 revealed the following water temperatures were outside of the required range of 105 degrees Fahrenheit (F) and 120 degrees F: the 100 wing sink was 133 degrees F , the 100 wing restroom was 129 degrees, Resident #55's room water temperature was 127 degrees F, Resident #6's room water temperature was 100 degrees F, the 400 wing sink was 130 degrees F, Resident #22's room water temperature was 128 degrees F, Resident #23's room water temperature was 104 degrees F, Resident #17's room water temperature was 129 degrees F, Resident #45's room water temperature was 129 degrees F.

Interview on 12/06/24 at 1:59 P.M. the Administrator confirmed the facility did not complete the water temperature log for 09/09/24 to 11/28/24. The Administrator further confirmed water temperatures throughout the facility on 11/29/24 were outside of the acceptable range of 105 to 120 degrees F.

Interview on 12/06/24 at 2:01 P.M. with Maintenance #120 confirmed the facility did not complete the water temperature log for 09/09/24 to 11/28/24. Maintenance #120 further confirmed water temperatures throughout the facility on 11/29/24 were outside of the acceptable range of 105 to 120 degrees F.

Review of facility policy titled Temperature Control dated 2018 revealed to ensure the safety of all residents, visitors, and employees the hot water temperature (with exception to the main kitchen should be maintained within the established limits of 105 to 120 degrees F. The facility staff should conduct daily water temperature checks Monday through Friday in several areas of the building.

This violation represents noncompliance investigated under Complaint Number OH00160154.

Based on closed record review, pharmacy delivery slips, and interview, the facility failed to ensure Resident #47 received medication as ordered by a physician. This affected one (Resident #47) of three residents reviewed for medication administration. The facility census was 63.

Findings include:

Medical record review revealed Resident #65 was admitted to the facility on 08/02/22 with diagnoses including chronic obstructive pulmonary disease, dementia, depression, anxiety, and allergic rhinitis.

Review of Resident #65's current Order Summary Report, dated April 2024, revealed the physician order, dated 02/14/23, for the nurse was to administer Resident #65's medications. Further review revealed the physician order, dated 09/30/22, for Wixela Inhub AER 100/50 (60 inhalations), inhale one puff by mouth twice daily.

Review of the Health Status Note, dated 04/06/24 at 1:46 P.M., revealed the power-of-attorney (POA) was given six boxes of Wixela inhalers upon discharge from the facility.

Review of the pharmacy Packing Slip Proof of Delivery, dated October 2022 through March 2024, revealed Resident #65 received monthly, one Wixela Inhub AER 100/50 inhaler containing 60 inhalations.

Interview on 05/08/24 at 10:25 A.M. with Pharmacist #400 revealed the Wixela Inhub AER 100/50 inhaler contained exactly 60 inhalations in each inhaler.

Interview on 05/08/24 at 11:13 A.M. with Pharmacist #402 revealed the Wixela Inhub AER 100/50 inhaler contained exactly 60 inhalations in each inhaler and confirmed Resident #65 received automatic monthly refills of one Wixela inhaler. The pharmacist stated it would be impossible for there to be six inhalers with remaining doses if the inhaler was administered correctly and as ordered by the physician. Pharmacist #402 further confirmed that unused medications in the facility were not removed by pharmacy during audits as the resident paid for those medications and the medications were the property of the resident.

Interview on 05/08/24 at 10:51 A.M. with the Assistant Director of Nursing (ADON) confirmed Resident #65 had never self-administered her medications following admission to the facility and always required the nursing staff to administer her medications.

Interview on 05/08/24 at 11:40 A.M. with the Executive Director confirmed Resident #65 was discharged with six packaged Wixela Inhub AER 100/50 inhalers. The Executive Director further confirmed the resident received automatic monthly refills of her inhaler; and she was not certain why Resident #65 had six remaining inhalers if the medication had been administered as ordered by the physician.

This violation represents non-compliance investigated under Complaint number OH00152857.

Based on observation and interview, the facility failed to ensure the dryer was free from lint build up. This finding had the potential to affect all 62 residents residing in the facility. The census was 62.

Findings include:

Observation on 12/20/23 at 8:52 A.M. revealed the main laundry room had three dryers. All three dryers were observed to have lint buildup.

Interview on 12/20/23 at 8:54 A.M. with Maintenance Director #102 verified that all three dryers had lint buildup.

Review of the document titled The Gables of Canton - Laundry cleaning log-Monthly located in the laundry room revealed it was last signed off on 09/03/22.

Based on observation and interview, the facility failed to handle linens in a manner to maintain proper infection control procedures. This had the potential to affect all 22 residents on the 100 unit. The facility census was 62.

Findings Include:

Observation on 12/20/23 at 8:41 A.M. revealed clean linen uncovered and sitting on top of a linen cart outside of a residents' room, as well as sitting on the counter at the nurses' station.

Interview on 12/20/23 at 8:43 A.M. with Licensed Practical Nurse #179 confirmed the linen sitting uncovered and on top of linen cart and nurses' station countertop.

Based on observation and interview, the facility failed to ensure that food was was prepared in a sanitary manner. This had the potential to affect all 62 residents. Facility census was 62.

Findings include:

On 12/20/23 at 11:12 A.M. the surveyor requested a hairnet to enter the kitchen. Observation of Cook #107, Cook #112, and Server #160 revealed they were preparing food without wearing a hairnet. Cook #107 had short hair, Cook #112 had long hair loosely secured with a hair clip, and Server #160 had short hair and was wearing a cloth Christmas hair band with antlers. Cook #107 and Cook #112 were preparing food at the stove and steam table. Server #160 was observed putting soup in a bowl. At 11:18 A.M. the kitchen staff were still unable to find a hairnet for the surveyor so the surveyor obtained a hairnet from personal supply.

Observation on 12/20/23 at 11:30 A.M. revealed Cook #112 put slices of ham and a sandwich bun on the counter in the prep area. A knife, tongs, and large can of chow mein noodles were also lying on the the prep area. Cook #107 and Cook #112 were observed leaning over the prep area and their abdominal area was observed to be touching the prep area. Interview at 11:33 A.M. Cook #112 verified they had placed ham slices and bread on the prep area without a surface barrier and there were unclean items in contact with the prep area surface.

Based on observation and interview, the facility failed to maintain a clean and sanitary kitchen. This had the potential to affect all 62 residents. The facility census was 62.

Findings include:

Observation of the kitchen on 12/20/23 at 11:20 A.M. revealed the walk-in cooler had potatoes and onions laying loosely on the floor of the cooler and a white label/paper approximately five inches by seven inches was stuck to the floor.

Observation on 12/20/23 at 11:24 A.M. of food in the stand-up freezer revealed a loose french fry and onion ring lying in the freezer. There were open bags of peas, french fries, onion rings, and two bags of breaded meat in the stand-up freezer. An eggshell with part of an uncooked egg was observed behind the stove. There were dark, thick substances under the stove, griddle, and deep fryer. The floor throughout the kitchen was littered with various food items, fluids, and unknown debris.

Interview on 12/20/23 at 11:34 A.M. Culinary Director #120 verified the walk-in cooler had food items on the floor and the floor needed clean. Culinary Director #120 also verified there were loose food items in the stand-up freezer and there were multiple open bags of food. Culinary Director #120 verified the kitchen and kitchen floors needed cleaned and the items on the floor had been on the floor prior to 12/20/23.

Based on observation and staff interview, the facility failed to ensure hazardous chemicals were properly stored to prevent possible accidental exposures. This had the potential to affect all 13 residents located on the memory care unit. The facility census was 62.

Findings include:

Observation on 12/20/23 at 9:07 A.M. revealed a bottle of Bar Keepers Friend Soft cleaner sitting on a sink in activity room in the memory care unit. Observation also revealed a bottle of Tide laundry soap, and a bottle of fabric softener sitting on the dryer in the activity room in the memory care unit.

Interview on 12/20/23 at 9:10 A.M. with Licensed Practical Nurse #149 confirmed the Bar Keepers Friend Soft Cleaner was left unsecured sitting on top of the sink.

Interview on 12/20/23 at 9:14 A.M. with Care Partner #173 confirmed the Tide, and fabric softener was left unsecured sitting on top of the dryer.

Based on record review, interview, and review of a self reported incident (SRI), the facility failed to ensure residents were free from physical abuse. This affected one resident (Resident #55) out of the three residents reviewed for abuse.

Findings Include:

Resident #55 was admitted to the facility on 04/11/22 with diagnoses including chronic atrial fibrillation, dementia, anxiety disorder and a low mass body index.

Review of the facility submitted SRI, dated 10/31/22, revealed Resident #55 had severe cognitive impairment. Functionally she was totally dependent on one to two staff for all activities of daily living including eating, toileting, and personal hygiene. The SRI indicated on 10/29/22 around 8:30 P.M. in the evening, the nurse was coming down the hall to administer medications and she overheard the resident screaming. When the nurse entered the resident's room, she allegedly witnessed the aide (Care Associate #754) hitting the left side of the Resident #55's face.

Review of the written statement from the Licensed Practical Nurse (LPN #363) revealed she was standing at her medication cart and she heard yelling in Resident #55's room. As she entered the room she observed the resident lying on her back on the bed and above her next to the bed was CA #754. she was hanging onto the resident's arms. The resident was crying and yelling at CA #754. CA #754 was yelling back at the resident. The CA noticed that she (LPN #363) had walked into the room. She stated she noticed, at that time, CA #754 smack the resident. The CA was upset and had red marks on her arms from the the resident. The resident was crying and saying that the CA was beating her and hurting her neck. The LPN then stated that she did not know what happened before she walked into the room but the resident was afraid and very upset. The nurse then assessed the resident and got her up in her chair and brought her out into the hall to sit by the nurse

Review of the e-mailed statement from CA #754 dated 10/30/22 at 11:45 A.M. revealed on 10/30/22 between 8:00 P.M. and 8:30 P.M. saw Resident #55 wandering into other people's rooms. She stated she showed the resident where her room was and walked the resident into her room. This CA then sat the resident down on the edge of her bed and when she went to put the resident's legs up in the bed, the resident started attacking her. The resident was yelling and scratching so to calm her down or what the CA thought would calm her down at the time the CA took the residents hands and crossed them over her chest. The CA further stated that at this time she did raise her voice over the resident screaming saying stop and to calm down and for her to let go of the CA's arm. Once the CA realized that holding her arms was not working to calm her down she gave up. She told the resident ok and walked out of the room. By that time the nurse came in and was able to calm her down. She denied ever hitting the resident.

Further review of the self reported incident revealed a thorough skin assessment was completed and there were no signs of bruising or redness on the resident. The facility substantiated the allegation of abuse.

Interview with the Administrator on 11/08/22 at 11:00 A.M. revealed that she was aware of the incident with the resident. LPN #365 did inform the supervisor of the incident but she did not inform her until the end of the shift at 7:00 A.M. the following morning, 10/30/22. According to the Administrator, she began a thorough investigation. She stated that the CA continued to deny ever hitting the resident even though the LPN stated that was what she saw. The Administrator stated, the CA quit before the investigation progressed any further.

Licensed practical nurse #565 was interviewed via telephone on 11/08/22 at 12:10 P.M. When she was asked to tell about the events of the incident that occurred on 10/29/22, she stated she was standing at the medication cart on the 400 hall getting ready to pass bed time medications. She stated she then heard yelling and screaming coming from Resident #55's room. She stated when she went into the room the resident was lying on her back with the CA standing above her holding her arms. The resident was yelling and crying and the CA was also yelling. She stated that she then saw the CA let go of the resident and then hit the resident with the back side of her left hand she thinks across the resident's left face. The CA then walked out of the room. This LPN then stated the resident sat up and was hugging her crying. LPN #565 stated she got the resident up into her chair and kept her by her side all night to ensure that she felt safe. She stated the aide was suspended.

Further interview with the Administrator and the Director of Nursing on 11/08/22 at 1:30 P.M. revealed most residents on the 400 hall have dementia and were unable to accurately answer questions concerning abuse. Instead a skin sweep of the residents that would allow their skin to be assessed, this was done to ensure no one else was abused. The DON further stated that the next day Resident #55 was back to her self and she couldn't remember the incident.

This violation represents non-compliance investigated under Complaint Number OH00137165.