Inspection·September 5, 2025

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview, and self-reported incident (SRI) review, the facility failed to provide adequate supervision for a Resident #45 for an outside appointment. This affected one (Resident #45) of four residents reviewed for appointments. The facility census was 44. Findings include:Review of the closed medical record for Resident #45 revealed an admission date of 06/24/25. Diagnoses included gastrointestinal tumor, malignant neoplasm of the liver and bile duct, chronic obstructive pulmonary disease (COPD). There was no diagnosis of dementia. The resident was discharged home on [DATE]. Review of the plan of care dated 06/24/25 revealed Resident #45 required supervised leave of absence (LOA). Review of the 5-day Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #45 had intact cognition. Review of the baseline care plan report dated 07/01/25 and reviewed with Resident #45 and family revealed Resident #45's appointments on 07/03/25 and on 07/10/25 stated daughter to transport written beside the appointments. The appointment on 07/07/25 did not have anything written beside it. Review of the Director of Nursing (DON's) note dated 07/07/25 at 6:40 A.M. per charge nurse, Resident #45 left the facility via Lake [NAME] for his scheduled urology appointment. Review of facility SRI tracking number 262468 and investigation dated 07/07/25 revealed Resident #45 was admitted to the facility on [DATE] with multiple follow-up doctor appointments. The appointments were placed in Matrix, and transportation was set up with Lake [NAME] transportation services. A care plan meeting for short term residents (PATH meeting) was held with the resident and his daughter where she stated that she may be cancelling appointments. She was advised at that time to let the nursing staff know so the transportation could be cancelled and the order removed from our system. On 07/03/25 Resident#45 attended an appointment using Lake [NAME] services without incident. On 07/07/25 the resident had a scheduled urology appointment, Lake [NAME] transported him leaving the building around 6:40 A.M. Around 9:22 A.M. the facility received a call from the urology department that the resident had not been picked up. Resident #45's return trip was scheduled for 8:45 A.M. to 9:15 A.M. The building contacted Lake [NAME] for an estimated time of arrival (ETA) and it was reported Resident #45 was marked as will call. The facility informed Lake [NAME] that Resident #45 needed a return trip. Lake [NAME] stated that he would be picked up. Resident #45's daughter called the facility around 10:30 A.M. stating that the appointment had been cancelled and questioned why the resident had gone to the appointment. The resident's daughter was unable to state who she informed at the facility that she had cancelled the appointment. No nursing staff at the building were notified of the appointment being cancelled. The urology office was called by the facility to confirm that the appointment had been cancelled, and the scheduling department stated that it had been cancelled and rescheduled for 07/07/25. Resident #45's daughter drove to the appointment office and picked up Resident #45. She took the resident back to his assisted living apartment rather than returning to the facility. Interview on 09/05/25 at 8:54 A.M. the DON revealed the facility typically asks family to go on (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: 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 09/05/2025 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)