Inspection·March 3, 2022

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 interview and record review, the facility failed to ensure weights were taken as ordered and meal intakes were recorded consistently for Residents #440 and Resident #445. This affected two residents (Resident #440 and Resident #445) of three residents reviewed for nutrition. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #445 revealed the resident was admitted on [DATE] with diagnoses including multiple fractures of ribs, right side, chronic obstructive pulmonary disorder (COPD), emphysema, heart failure, dementia, and pneumonia. Review of Resident #445's physician orders dated 02/03/22 and 02/24/22 revealed orders for weekly weights. Review of the care plan dated 02/04/22, revealed a care area for risk of altered nutrition/hydration with interventions dated 02/07/22 to monitor weight per protocol and monitor oral (P.O.) intake. Review of progress notes revealed Resident #445 was hospitalized from [DATE] until 02/24/22. Review of the Minimum Data Summary (MDS) 3.0 assessment dated [DATE], revealed Resident #445 was severely cognitively impaired and required maximum for oral hygiene, and upper body dressing. The resident was totally dependent for toileting, showers, lower body dressing, and bed mobility. Review of weights for Resident #445 revealed an admission weight on 02/03/22 of 88 pounds (lbs.) and a weight on 02/18/22 of 84 lbs. and a Body Mass Index (BMI) of 16.2, indicating the resident was underweight. There were no weights taken when the resident was readmitted to the facility on [DATE]. Review of the 02/28/22 Nutritional Assessment (NA) for Resident #445 revealed intakes were poor. Orders for a pureed diet and liquid supplements were continued pending a re-entry weight. Review of the P.O. intake log for Resident #445 from 02/25/22 to 02/28/22 revealed nothing was recorded for dinner during these dates. Interview on 03/01/22 at 4:55 P.M. with Registered Nurse (RN) #504 revealed the aides recorded meal intake on the log after each meal. The RN verified there was no dinner intake recorded for Resident #445 from 02/25/22 through 02/28/22. Interview on 03/02/22 11:53 A.M. with Registered Dietician (RDLD) #519 verified a re-entry weight (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: 365264 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 365264 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/03/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE O'Neill Healthcare Bay Village 605 Bradley Rd Bay Village, OH 44140 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)