Inspection·March 5, 2024

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation and interview, the facility did not ensure food was stored, prepared and served under sanitary conditions in the first and second floor kitchenettes. This had the potential to affect all 39 residents on the first floor (Resident #4,#6,#7,#11,#14,#19,#20,#24,#29,#30,#33,#35,#37,#38,#41,#42,#48,#50,#51,#53,#55,#56,#57,#61,#64,#66,#71,#72,#7 and 32 residents on the second floor (#1,#2,#3,#12,#18,#21,#22,#28,#31,#34,#36,#39,#40,#44,#45,#49,#52,#54,#60,#62,#65,#69,#75,#77,#80,#82,#83,#84,#8 received foods from those kitchenettes, as the facility identified Resident #36 and #99, who lived on the second floor, as receiving nothing by mouth (NPO). The facility census was 104. Findings include: Observation on 03/03/24 at 4:30 P.M. of the second floor kitchenette area revealed two trays with dirty dishes and cups of coffee from the lunch meal sitting on the counter. Inside of a refrigerator there was a mint green colored liquid along with a syrup-like substance spilled on the bottom of the inside of refrigerator, and slices of unwrapped, undated cheese on the shelf along with an outdated gallon of milk dated 01/31/24 indicating the refrigerator was not being regularly cleaned and food was not being stored safely to prevent food borne illness. At the time of the observation, Licensed Practical Nurse #259 verified the findings. Observation on 03/03/24 at 4:45 P.M. of the first floor kitchenette revealed on the half wall separating the dining room from the kitchenette there were dried stains along the whole wall which looked like an unknown substance had been spilled on the wall and the wall was left uncleaned. The refrigerator had three trays of cheese sandwiches (approximately 15-20 sandwiches) in individual clear bags that were not labeled or dated. There was sliced cheese with multiple black dots of an unknown substance on the cheese, and it was loosely wrapped in plastic wrap that was not labeled or dated. State Tested Nursing Assistant (STNA) #644 verified the findings at the time of the observation and at 5:00 P.M. the Administrator also verified these findings. This deficiency represents non-compliance investigated under Complaint Number OH00150993. 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: 365071 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 365071 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beachwood Pointe Care Center 23900 Chagrin Blvd 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)