Inspection·December 12, 2019

F 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to provide Resident #42 with activities that met his preferences and psychosocial needs. This affected one resident (Resident #42) out of 27 residents interviewed regarding activities. Residents Affected - Few Findings include: Medical record review revealed Resident #42 was admitted to the facility on [DATE] with diagnoses including major depressive disorder and dementia without behavioral disturbances. Review of the annual Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #42 was cognitively intact and independent in daily decision making, and it was very important to Resident #42 to do activities with groups of people, to participate in favorite activities, and to go outside to get fresh air when the weather permitted. Review of the activity assessment dated [DATE] indicated Resident #42's current activity pursuits/interests included shopping and outdoors. It was additionally noted he enjoyed visiting his wife, Bingo, football pool and shopping at the local department store. Review of the activity plan of care revised on 10/14/19 indicated he would benefit from a variety of programs to help maintain his current functional abilities. The interventions included documenting attendance/refusals, encouraging him to attend, praising attendance and providing him a monthly calendar. Although the plan was revised, it lacked inclusion of Resident #42's preferences or interventions to meet his activity needs. Interview of Resident #42 on 12/09/19 at 1:35 P.M. revealed Resident #42 was very disappointed and disheartened that the facility had decided not to continue dine in (lunch brought to the facility from area restaurants monthly) each month from November until March. The facility had also chosen to discontinue outings to an area department store from November until March. Resident #42 was told the food gets too cold when it was brought in for lunch, and there was not enough staff for the outings. Interview of Assistant Activities Director (AAD) #502 on 12/11/19 at 8:14 A.M. revealed the dine in was only from March through October because a staff member fell in the snow and was injured. AAD #502 confirmed that the residents would like to have dine in all year, and Resident #42 had also requested that it continue all year. Interview of Activities Director #501 on 12/11/19 at 8:34 A.M. revealed field trips were from March through October for safety reasons, and dine in was March through October. AD #501 stated that the (continued on next page) 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: 365072 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 365072 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anna Maria of Aurora 889 North Aurora Road Aurora, OH 44202 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)