Health inspection·June 14, 2023

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on resident interview, staff interview, review of admission agreement, and facility policy the facility failed to honor a resident's choice to smoke. This affected one (Resident #27) of five residents reviewed for choices regarding smoking. The facility census was 70. Findings include: Medical record review of Resident #27 revealed the resident was admitted to the facility on [DATE] and discharged on 04/18/20. Per the record, the resident was re-admitted on [DATE]. Diagnoses included dysphagia, anxiety disorder, memory deficit and cerebrovascular disease. Review of Resident #27's comprehensive Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had mildly impaired cognition and was not receiving supplemental oxygen. Review of Resident #27's care plan dated 11/18/22 revealed no focus for smoking cessation (quitting smoking) or safe smoking. Review of Resident #27's acknowledgement of documents and admission agreement, signed per the resident's Power of Attorney (POA), dated 11/18/22 revealed the POA and the resident were informed of the facility's smoking policy. Review of the facility admission agreement dated 05/2022 revealed under the section, 'Smoke-Free Environment,' stated the facility instructed all residents and visitors who smoked may do so under the following circumstances: under staff supervision or family/guardian supervision and only in designated areas. There was no mention of newly admitted residents being unable to smoke. Review of the facility policy titled, Smoking Policy, dated 10/2022 revealed for facilities who permit smoking, must provide a safe environment to those residents who wish to smoke. If the facility changes its policy to prohibit smoking, it should allow current residents who smoke to continue in designated areas. Further requests for an updated no smoking policy revealed the facility did not have a policy stating the facility was smoke-free. Interview on 06/11/23 at 10:02 A.M. with Resident #27 revealed the resident was alert and oriented and able to be interviewed. Resident #27 stated she had no concerns with her care except she was not allowed to smoke. Resident #27 stated she had seen other residents smoking outside but she was told (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: 365337 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 365337 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Manor at Greendale 2101 Greendale Boulevard Findlay, OH 45840 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)