Inspection·March 15, 2025

F 0692 Provide enough food/fluids to maintain a resident's health. 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 interview, and facility policy review, the facility failed to monitor and address significant weight loss. This affected one (Resident #121) of three residents reviewed for nutrition. The facility census was 113. Residents Affected - Few Findings Include: Medical record review revealed Resident #121 was admitted to the facility on [DATE]. Diagnoses included anemia, other nondisplaced fracture of upper end of left humerus and left femur, pain, arteriovenous fistula, pneumonitis, thrombocytopenia, pulmonary embolism, dysplasia, type II diabetes, infection and inflammatory reaction due to other cardiac and vascular devices, depression, hemiplegia and hemiparesis, moderate protein calorie malnutrition, cognitive communication deficit, difficulty walking, other abnormalities of gait and mobility, osteoarthritis, morbid obesity, hypotension, chronic kidney disease (stage V), atrial fibrillation, hypertension, hyperlipidemia, asthma, hypothyroidism, and end stage renal disease. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #121 was cognitively intact. Review of Resident #121 weights revealed on 01/04/25 she weighed 261.8 pounds, on 02/07/25 she weighed 236.9 pounds. This represented a 9.5% weight loss in one month. There were no other weights taken to verify the significant weight loss prior to her discharge date of 02/22/25. Review of Resident #121 progress and nutritional notes dated 02/07/25 to 02/22/25 revealed no documentation to support the significant weight loss was addressed. Review of Resident #121 nutritional assessment dated [DATE] revealed a documented current weight of 261 pounds. There was nothing within the nutritional assessment to confirm or address the significant weight loss. Review of Resident #121's MDS assessment, section K, dated 02/09/25, revealed a current weight of 261 pounds. The MDS nutritional assessment was dated after the significant weight loss was documented, so it should have been identified and addressed within that assessment, but was not. Interview with the Director of Nursing (DON) on 03/15/25 at 2:45 P.M. confirmed they did not identify or address Resident #121 significant weight loss. The DON indicated they should have informed the dietitian and the physician of the significant weight loss. The DON also indicated they should have taken another weight to determine if the weight loss was accurate. Review of facility Weight Assessment and Intervention policy, dated December 2008, revealed weights (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: 365215 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 365215 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Suburban Healthcare and Rehabilitation 20265 Emery Rd North Randall, OH 44128 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)