Health inspection·February 6, 2024

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm Based on record review and interviews the facility failed to ensure physician orders were followed to hold Resident #100's tube feed in preparation for a dentist appointment. This affected one resident (Resident #100) of three reviewed for quality of care. Residents Affected - Few Findings include: Record review of Resident #100 revealed an initial admission date of 04/04/19 and readmission of 07/29/23. She was discharged on 02/02/24. Diagnoses included metabolic encephalopathy, anoxic brain damage, pneumonia and sepsis. Review of the progress noted dated 01/09/24 at 10:38 A.M. revealed the resident's tube feeding was to be stopped at midnight related to dental appointment on 01/15/24. Review of Resident #100's physician orders for 01/14/24 revealed the resident was to be NPO (nothing by mouth) after midnight and the tube-feed was to be held. Review of the Medication Administration Record for January 2024 revealed the order for NPO status on 01/14/24 was signed off by Licensed Practical Nurse (LPN) #223. Interview on 02/06/24 at 1:18 P.M. with LPN #223 revealed she was told Resident #100 had an appointment the next morning but was not told about the NPO status. LPN #223 stated she was told to sign off on orders early to make it easier for next person covering the shift. She did not recall who told her this. She stated she overlooked the order for NPO. Interview on 02/06/24 at 2:27 P.M. with LPN #222 revealed she did not receive report about the NPO status for Resident #100. She stated the orders were already signed off by LPN #223 and nothing was lit up in the Medication Administration Record (MAR). Interview on 02/06/24 at 2:44 P.M. with Assistant Director of Nursing (ADON) revealed the expectation was orders would be administered as ordered. Review of an internal investigation conducted by the Director of Nursing (DON) on 01/17/24 after son called complaining of a missed appointment revealed the investigation had statements from both LPN #222 and LPN #223 confirming information in above interviews. This deficiency represent non-compliance investigated under Complaint Number OH00150118 and Complaint Number OH00150264. 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: 365048 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 365048 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/06/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center of Westlake 26520 Center Ridge Rd Westlake, OH 44145 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)