Inspection·June 30, 2022

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **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 allow a resident who smoked, the opportunity to smoke. This affected one resident (Resident #86) of one resident reviewed for resident rights. Findings Include: Resident #86 was admitted to the facility on [DATE] with diagnoses including cerebral infarctions, dissection of vertebral artery, hemiplegia and hemiparesis, visual field defects, muscle weakness, tobacco use, hyperlipidemia, and acute ischemic heart disease. Resident #86 was discharged from the facility on 05/04/22. Review of Resident #86 medical records revealed a progress note dated 05/04/22 indicated the resident was to discharge from the facility because he was unable to smoke while in isolation. Review of Resident #86's medical record revealed no evidence the resident was assessed for smoking safely at the facility. The medical record revealed because he was not permitted to smoke while being in isolation, Resident #86 discharged from the facility against medical advice (AMA). Interview with Director of Nursing (DON) on 06/30/22 at 9:20 A.M. confirmed Resident #86 was in isolation at the time of his admission to the facility (dated 05/03/22). DON revealed the facility policy/stance was the facility did not allow any resident in isolation to smoke for infection control reasons. DON revealed although the resident did not sign the facility smoking policy it was reviewed with him. She stated they offered nicotine patches, gum, and other items to curb the addiction while he was in isolation, but he did not want that. She confirmed the documentation supported Resident #86 discharged from the facility AMA because he was not permitted to smoke while on isolation. She also confirmed they did not do a smoking assessment at the time of admission because he was not going to be smoking during isolation. Review of facility Smoking policy, dated 08/07/20, revealed the goal of the policy was for residents to be able to smoke per policy after passing a safe smoking assessment. The purpose was to ensure the residents who smoke, had a comfortable and safe environment which to smoke. Nursing staff or designee would complete an assessment upon admission for residents who requested to smoke. Only residents who are determined by the assessment to be a safe smoker would be permitted to smoke. Residents who have been assessed and found not to be safe to smoke independently will only be allowed to smoke in designated smoking areas, where they are supervised by a family member/personal visitor. The policy did not reflect a resident who smokes inability to smoke if under infection control isolation (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 8 Event ID: 365250 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 365250 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Buckeye Care and Rehabilitation 1900 East Main Street Lancaster, OH 43130 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)