Inspection·November 27, 2023

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation and interview, the facility failed to document in the medical record an incident involving Resident #14 getting stuck in a stairwell. This affected one resident (#14) of three residents reviewed for accurate documentation. The facility census was 91. Findings include: Record review was conducted for Resident #14 who admitted to the facility on [DATE] with diagnoses including type two diabetes mellitus with diabetic neuropathy, cerebral infarction, morbid obesity, generalized anxiety disorder, abnormalities of gait and mobility, need for assistance for personal care, contractures of muscles lower left leg, contracture of muscle right lower leg, infarction of spinal cord, major depressive disorder recurrent severe without psychotic features, muscle weakness and borderline personality disorder. Review of the Minimum Data Set ( MDS) 3.0 assessment for Resident #14, dated 10/01/23, revealed Resident #14 had clear speech, was able to make self-understood, was able to understand others and had intact cognition with no signs of delirium, or disorganized thinking or hallucination, no rejection of care or wandering. Resident #14 had limited range of motion of upper extremity and lower extremities and a wheelchair was used for mobility. Resident #14 was low risk for elopement and depended on staff assistance for mobility off the unit. Review of Resident #14's plan of care dated 09/21/23 revealed she had a deficit in self-care activites related to generalized muscle weakness, type two diabetes, stroke and infarction of spinal cord requiring extensive assistance of one staff person for mobility. Further review of the medical record revealed no documentation in October 2023 through 11/20/23 of Resident #14 getting stuck in a stairwell and later found by staff. Observation of the stairwell on 11/20/23 revealed an unsecured door on the first floor opened into a stairwell with steps going up to the second floor. There were no steps going down to a lower level. Interview was conducted on 11/20/23 at 12:50 P.M. with Resident #14 who revealed she had requested to sit in the first floor activity room after buying herself something from the vending machine, and the aide who took her to the activity room was suppose to come get her within 20 minutes. Resident #14 stated she was confused how to get back to the elevator because it was the first time she was downstairs so another resident ended up pushing her into a stairwell on the first floor. Resident #14 (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 2 Event ID: 365185 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 365185 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Center Healthcare and Rehabilitation 5665 South Ave Youngstown, OH 44512 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)