Health inspection·October 17, 2022

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review, and facility policy review the facility failed to provide showers as scheduled. This affected two (Resident's #5 and #6) of three residents reviewed for showers. The facility census was 40. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #5 revealed and admission date of 08/25/21. Diagnoses included Parkinson's disease, hydrocephalus, type two diabetes mellitus, and obstructive and reflux uropathy. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #5 had mild cognitive impairment. Resident #5 required extensive assistance of two staff for bed mobility, transfers, dressing, toileting, and personal hygiene; supervision with set-up help only for eating; and physical help of one staff for bathing. Resident #5 had an indwelling catheter for urine and was always continent of bowel. Review of the care plan dated 10/02/22 revealed Resident #5 had a self-care deficit related to diagnoses. Interventions included to assist with activities of daily living, dressing, grooming, toileting, feeding, and oral care. Review of the nursing assistant documentation revealed Resident #5 was scheduled for a shower every Monday and Thursday on the night shift. Review of the shower documentation from 09/13/22 to 10/12/22 revealed Resident #5 only received one shower on 10/11/22. Interview on 10/11/22 at 11:04 A.M. with Resident #5 revealed he had not had a shower in two weeks until this morning. Interview on 10/12/22 at 1:41 P.M. with the Director of Nursing (DON) verified there was no documented evidence of showers for Resident #5 from 09/13/22 through 10/12/22, except for 10/11/22. 2. Review of the medical record for Resident #6 revealed an admission date of 03/30/22. Diagnoses included vascular dementia without behavioral disturbances, hypertension, and atherosclerotic heart disease of native coronary artery without angina pectoris. Review of the quarterly MDS 3.0 assessment dated [DATE] revealed Resident #6 had moderate cognitive impairment. Resident #6 required extensive one-staff physical assistance for bed mobility, transfers, dressing, and personal hygiene; supervision with set-up help only for eating; and extensive two-staff physical assistance for toilet use. Resident #6 required physical help of one staff for (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: 365236 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 365236 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/17/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Homestead II 60 Wood St Painesville, OH 44077 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)