F 0732
Post nurse staffing information every day.
Level of Harm - Potential for
minimal harm
Based on observation and staff interview, the facility failed to have daily staffing information posted in a
prominent place on 09/05/24. This had the potential to affect all 150 residents in the facility.
Residents Affected - Many
Findings include:
On 09/05/24 at 10:45 A.M., observation of the facility revealed there was no daily staffing information
available for that day.
On 09/05/24 at 10:53 A.M., interview with the Administrator stated the daily staffing information should be
in a binder at the front desk. The Administrator verified the daily staffing information for 09/05/24 was not
available at the front desk and was currently being printed.
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other
safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the
date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER
REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Facility ID:
If continuation sheet
Page 1 of 3
Event ID:
365046
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
365046
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/11/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Daughters of Miriam Center for Nursing & Rehabilit
One David N Myers Parkway
Beachwood, OH 44122
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0761
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted
professional principles; and all drugs and biologicals must be stored in locked compartments, separately
locked, compartments for controlled drugs.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, staff interview, and review of facility policy, the facility failed to ensure medications were stored
in a secure location at all times. This had the potential to affect 40 residents (#1, #6, #7, #10, #12, #13, #15,
#16, #19, #22, #24, #27, #30, #36, #37, #46, #51, #60, #62, #65, #67, #69, #77, #79, #85, #88, #91, #99,
#103, #105, #106, #107, #110, #118, #119, #123, #130, #132, #147, and #148) residing on [NAME] three
unit. The facility census was 150.
Findings include:
On 09/09/24 at 10:05 A.M., an observation of the [NAME] three unit revealed a medication cart was
unattended and unlocked in the hallway between Resident #7's room and Resident #107's room. At the
time of observation, there was one resident ambulating in the hallway with a walker and one family member
present in the hallway.
On 09/09/24 at 10:10 A.M., upon returning to the medication cart, Licensed Practical Nurse (LPN) #700
confirmed the medication cart was left unattended and unlocked in the hallway. LPN #700 further stated the
medication cart should have been locked.
Review of the facility census revealed 40 residents (#1, #6, #7, #10, #12, #13, #15, #16, #19, #22, #24,
#27, #30, #36, #37, #46, #51, #60, #62, #65, #67, #69, #77, #79, #85, #88, #91, #99, #103, #105, #106,
#107, #110, #118, #119, #123, #130, #132, #147, and #148) resided on [NAME] three unit.
Review of the facility's policy titled Medication Administration/Treatment, dated 10/18, indicated the nurse
would cover all patient information to protect privacy and lock the medication cart before leaving the cart to
pass the medication.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365046
If continuation sheet
Page 2 of 3
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
365046
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/11/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Daughters of Miriam Center for Nursing & Rehabilit
One David N Myers Parkway
Beachwood, OH 44122
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0880
Provide and implement an infection prevention and control program.
Level of Harm - Minimal harm
or potential for actual harm
Based on record review, observations, and interview the facility failed to maintain standard infection control
protocol when administrating medications. This affected one (Resident #137) of one resident reviewed for
medication administration.
Residents Affected - Few
Findings include:
Review of medical record for Resident #137 revealed an admission date of 07/17/24. Diagnoses included
acute kidney failure, spastic quadriplegic cerebral palsy, and neuromuscular dysfunction of the bladder. The
resident had impaired cognition.
A random observation on 09/09/24 at 9:31 A.M. revealed Licensed Practical Nurse (LPN) # 515
administering medications for Resident #137. LPN #515 placed three of 13 medications from medication
cards into her bare hand.
Interview during observations LPN#515 stated medications should be placed into the medication cup, not a
bare hand.
Review of the facility policy titled Administering Oral Medications, dated 2010 revealed staff were directed
not to touch medications with their hands and to place all medications into a medication cup.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365046
If continuation sheet
Page 3 of 3
