Health inspection·June 29, 2023

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 medical record review, staff and resident interview, review of the activity calendar, and policy review, the facility failed to ensure evening activities were provided. This affected three resident (#03, #16, and #47) out of 10 residents and three families interviewed for activities. The facility census was 73. Residents Affected - Few Findings Include: Review of the medical record for Resident #16 revealed an admission date of 08/18/22. Diagnoses included schizoaffective disorder, bipolar, anxiety, epilepsy, and alcohol induced dementia. Review of the quarterly Minimum Set (MDS) 3.0 dated 06/13/23, revealed she had intact cognition and was independent with transfers, ambulation, and hygiene. Review of the plan of care dated 06/12/23 revealed the resident is a sociable person and likes to participate in various activities. Intervention included to participate in group activities at least twice a week. Keeping busy with self-directed activities throughout the week. Interview on 06/26/23 at 11:59 A.M., during the initial screening process Resident #16 revealed there was nothing to do in the evening. Resident #16 stated she bought a [NAME] hoop for entertainment. Interview on 06/27/23 at 2:16 P.M., with Registered Nurse #390 stated activities are scheduled in the morning, after breakfast and in the afternoon between 2:00 P.M. and 3:00 P.M. There were no scheduled activities after dinner. Interviews on 06/28/23 with State Tested Nursing Assistant (STNA) #344 at 10:22 A.M. and STNA #322 at 3:10 P.M. each revealed no activities were provided during evening hours. Interviews on 06/28/23 at 3:55 P.M., during the resident council meeting Resident #47 said the place was an absolute ghost town after 4:00 P.M. and barely anything goes on besides reading the chronicle/newspaper thing on the weekends. Resident #03 said a friend of mine here has a saying when nothing is going on. Time to go back to our prison cells. Interview on 06/29/23 at 8:04 A.M., with Activity Personnel (AP) #348 stated all facility activities are provided from 8:00 A.M. to 4:00 P.M. seven days a week. AP #348 stated they have been without an Activity Director since April 2023. Interview on 06/29/23 at 8:59 A.M., with Human Resources (HR) Director #402 stated the former (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: 365155 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 365155 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avon Place Healthcare Center 32900 Detroit Rd Avon, OH 44011 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)