Inspection visit
Inspection
5 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 5 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0580
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room,
etc.) that affect the resident.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
medical record review and interview, the facility failed to ensure the power of attorney (POA) was notified of
a change in condition. This affected one resident (#32) of four residents reviewed for notification of change
in condition. The facility census was 51.
Findings include:
Review of the medical record for Resident #32 revealed an admission date of 01/31/25. Diagnoses included
but were not limited to metabolic encephalopathy, acute and chronic respiratory failure, obstructive sleep
apnea, congestive heart failure, and morbid obesity. Review of the banner bar of Resident #32's electronic
medical record revealed special instructions which stated: POA (power of attorney) would like to be notified
of any behaviors or concerns.
Review of Minimum Data Set (MDS) 3.0 quarterly assessment dated [DATE] for Resident #32 revealed a
Brief Interview of Mental Status (BIMS) score of 13 which indicated intact cognition. Review of activities of
daily living (ADLs) revealed Resident #32 was dependent upon staff for ADLs.
Review of the nursing progress note dated 04/17/25 timed 10:32 P.M. written by Registered Nurse (RN)
#223 revealed upon entering Resident #32's room, Resident #32 was noted to be bleeding puddles of
blood from bed onto floor. Emergency Medical Services (EMS) and Nurse Practitioner (NP) were called,
and Resident #32 was sent to the hospital. No evidence was recorded that the POA was notified.
Review of the nursing progress note dated 04/18/25 timed at 5:37 A.M. written by RN #223 for Resident
#32 returned from the hospital and noted the NP was aware. There was no evidence the POA was notified
of the resident's return.
Review of the nursing progress noted dated 05/20/25 timed at 5:24 P.M. written by Licensed Practical Nurse
(LPN) #215 revealed Resident #32 had worsening symptoms like shortness of breath (SOB), being
extremely tired and groggy as the shift progressed. The NP was notified of Resident #32's change in
condition and NP assessed Resident #32. LPN #215 was notified to have Resident #32 use his continuous
positive airway pressure (CPAP) machine (a device used to treat sleep apnea and other breathing
disorders. It delivers a constant stream of pressurized air through a mask to keep the airway open and
prevent pauses or shallow breaths) which Resident #32 refused. Resident #32 was noted to be sent out to
the hospital at approximately 4:00 P.M. for SOB and change in condition. There was no evidence the
resident's POA had been notified.
Review of the nursing progress note dated 05/23/25 written by LPN #204 revealed Resident #32
(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 10
Event ID:
365370
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
365370
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
06/11/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Momentous Health at Richfield
4360 Brecksville Rd
Richfield, OH 44286
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)
F 0580
Level of Harm - Minimal harm
or potential for actual harm
returned to the facility and the physician and NP were notified. No evidence was found of the POA being
notified of the resident's return.
Interview on 06/02/25 at 11:24 A.M. with Resident #32 revealed concerns related to his POA not being
notified of changes in his condition and when he has gone to the hospital in the past few months.
Residents Affected - Few
Interview on 06/03/25 at 11:15 A.M. with the Director of Nursing (DON) confirmed Resident #32's chart had
special instructions which listed the POA would like to be notified of concerns. The DON confirmed there
was no evidence of the POA being notified when Resident #32 went to the hospital on [DATE], returned on
04/18/25, went to the hospital on [DATE], or when he returned on 05/23/25.
Review of the policy Change in Condition Monitoring dated 05/01/22 revealed our facility shall promptly
notify the resident, his or her attending physician, and family/Power of Attorney (POA)/guardian of changes
in the resident's medical status.
This deficiency represents non-compliance investigated under Complaint Number OH00165009.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365370
If continuation sheet
Page 2 of 10
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
365370
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
06/11/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Momentous Health at Richfield
4360 Brecksville Rd
Richfield, OH 44286
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)
F 0584
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Many
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited
to receiving treatment and supports for daily living safely.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observations, staff and resident interviews, record review, and facility policy review, the facility failed to
ensure a safe, clean, homelike environment by ensuring general cleanliness was maintained, water
temperatures reached appropriate and homelike temperatures, and blinds, ceiling tiles, walls, and door
frames were without the need for repair. This affected all residents residing in the facility. The facility census
was 51.
Findings include:
During the onsite survey an interview on 06/04/25 at 11:07 A.M. with Chief Operating Officer (COO)
revealed she was aware of physical environmental concerns that resulted in citations during the previous
annual survey. She verified the physical environmental issues currently in the building, including water
temperatures not reaching the appropriate and homelike temperatures, and concerns regarding the general
repair and cleanliness of the room were ongoing. The COO confirmed the broken blinds, discolored and
bulging ceiling tiles, gouges, and missing paint on walls and door frames, furniture in disrepair, and general
housekeeping tasks were not completed by the facility's allegation of compliance date of 04/20/25 as
planned in the facility's plan of correction.
An interview on 06/09/25 at 1:06 P.M. with the Chief Executive Officer (CEO) confirmed the facility's
physical environmental needs were not met by the deadline of 04/20/25 as stated in the facility's previous
plan of correction.
A follow up interview with the Administrator on 06/11/25 at 11:03 A.M. revealed the new Director of
Maintenance who was due to begin employment on 06/09/25 fell through. The Administrator reported she is
still in need of a new Director of Maintenance and has refreshed the advertisement for the position. The
Administrator stated she had been working with the CEO to develop a revised corrective action plan. The
Administrator reported the CEO will be bringing in a contractor and the goal was to go room-to-room to
identify the environmental needs of each room.
Review of the policy Homelike Environment dated 05/01/22 revealed residents are to be provided with a
safe, clean, comfortable and homelike environment and encouraged to use their personal belongings to the
extent possible. The facility staff and management shall maximize, to the extent possible, the characteristics
of the facility that reflect a personalized, homelike setting. These characteristics include clean, sanitary
environment, adequate lighting, clean bed and bath linens that are in good condition, and pleasant and
neutral scents.
The following environmental concerns were identified at the time of the onsite investigation:
1. Interview on 06/02/25 at 1:47 P.M. with Resident #53 revealed her room was not being cleaned
consistently and had not been cleaned for the past five days. Observation at the time of the interview
revealed the floor appeared soiled with dried stains.
Interview on 06/02/25 at 1:56 P.M. with Resident #49 revealed had previously requested a new mattress
due to sinking in the middle several months ago but had not been addressed. Resident #49 also stated the
blinds had missing pieces and the bathroom ceiling tile was bulging.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365370
If continuation sheet
Page 3 of 10
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
365370
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
06/11/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Momentous Health at Richfield
4360 Brecksville Rd
Richfield, OH 44286
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)
F 0584
Level of Harm - Minimal harm
or potential for actual harm
Interview on 06/02/25 at 3:48 P.M. with Resident #34 stated sometimes there are no washcloths available
for bathing and towels are used.
Observation on 06/03/25 from 3:00 P.M. to 4:35 P.M. of a facility tour with the Administrator and
Maintenance Director #218 revealed the following concerns
Residents Affected - Many
- Resident #30's room was missing a light bulb above the sink in the resident's room. Saturated paper
towels with a strong urine odor were noted on the floor at the entrance to the resident's bathroom near the
bed. Resident #30's call light indicator cover was hanging and was not fully attached outside of the
resident's room.
- Resident #35's room was missing a bottom drawer in front of a three-drawer built-in cabinet. The floor of
Resident #35's room was heavily soiled.
- The flooring around the 100-hall nurse's station had a trail of various dried brown spots of an unknown
substance on the floor.
- Resident #49 and Resident #50's shared room had broken blinds covering the window. Ceiling tiles in the
bathroom were cracked and bulging. The privacy curtain dividing the room was visibly soiled.
- Resident #51's room had two stained ceiling tiles near the entrance door.
- The exit door at the end of the 100-hall outside Resident #53's room revealed various loose trash debris
including used gloves, napkins, condiment wrappers, lids, etc. outside of the exit door and visibly blowing
around the parking lot.
- Resident #53's room had multiple holes in the wall and ceiling tiles near the door. There were two stained
ceiling tiles, and dried stains on the floor. The toilet paper holder in Resident #53's bathroom was empty,
with two rolls of toilet paper on the back of the toilet and a partially used roll of toilet paper not easily
reached on the bathroom counter. An interview at the time of observation with Resident #53 stated it was
hard to reach the toilet paper, and she wished staff would replace the toilet paper on the older for her and
wished staff would clean her floors.
- A used glucometer test strip was on the floor outside the rooms of Residents #49, #50, #51, and #52.
- Resident #40's floor was visibly soiled. Resident #40's toilet was visibly soiled with dried brown stains
around the whole base of the commode. The bathroom had a strong pervasive odor, and the bathroom light
was missing a cover.
- The [NAME] shower room had cracked tiles to the floor and edges.
- Resident #41's room contained a sink, above which were dirty dishes with the present of gnats. Resident
#41's baseboards near the bathroom were loose.
- Resident #42's electrical outlet between the bathroom and the bed had visible white rough spackling and
dried white powder on the floor below. There were large stains on the ceiling tiles and the bathroom floor
and fixtures were visibly soiled.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365370
If continuation sheet
Page 4 of 10
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
365370
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
06/11/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Momentous Health at Richfield
4360 Brecksville Rd
Richfield, OH 44286
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)
F 0584
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Many
- Resident #43 and Resident #44's shared room had a visibly dirty floor with dried brown spots around and
behind the toilet. The bathroom had a strong pervasive odor. The bathroom doorframe was visible eroded
from a prior leak, and dried stains were visible on the window blinds.
- Resident #45's room contained two missing tiles near the sink base and the floor of the room was visibly
soiled.
- Resident #1 and Resident #2's shared room had two missing light bulbs in the room and no cover over the
bathroom light.
- Resident #3 and Resident #4's shared room floor was visibly soiled with various debris. The bathroom was
wet with what appeared to be a leak.
- Resident #5's bathroom had stains splattered on the blinds and walls surrounding the window.
- There was a partially missing floor tile on the [NAME] hall entrance to the dining room.
- There was missing wood trim pieces above the handrail outside room [ROOM NUMBER] which was
vacant at the time of the survey.
- Resident #6's room had a soiled privacy curtain. There were bulging ceiling tiles above the sink in
Resident #6's room. The bathroom floor had wet, soiled paper towels in a pile on the floor.
- Resident #7 had a stained ceiling tile above the bed and the room contained broken window blinds.
- Resident #8's room had a hole in the wall next to the bed. There was a stained ceiling tile near the air
conditioning unit.
- Resident #9's room had peeling paint on the bathroom door, stained and bulging ceiling tiles above the
bed, and a missing trim piece near the entrance door to the room.
- Resident #10's room had three missing light bulbs, seven stained ceiling tiles, and six missing drawers on
the bathroom cabinet. The clock in the room was non-functional. There were no paper towels in the room
and the entrance door was missing the mechanism/latch for the door handle.
- Resident #11's room had gouges on the wall and a visibly soiled floor.
- The dining room floor in the memory care unit was peeling up. The peeling floor had previously been
taped down but the tape had worn off and was not secured.
- Resident #14 and Resident #15's shared room contained visibly soiled floors to the room. The bathroom
contained a visibly soiled toilet seat.
- Resident #17's room had a dirty privacy curtain and a bathroom with surfaces which were visibly soiled.
- The East shower room had a stained ceiling tile near the vent near the entry door.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365370
If continuation sheet
Page 5 of 10
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
365370
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
06/11/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Momentous Health at Richfield
4360 Brecksville Rd
Richfield, OH 44286
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)
F 0584
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Many
- Resident #18's room contained various stains on the floor. Resident #18 was missing a drawer in the room
vanity.
- Resident #19's room had a stained privacy curtain that would not slide on the track. There was a brown
stained sheet on the bed. The wall underneath the window had missing paint. There was a broken drawer in
the dresser cabinet. The resident's bathroom was visibly soiled and had a strong pervasive odor.
- Resident #21's room had a visibly dirty fan with a soiled and sticky floor.
- Resident #22's room had a heavily soiled floor.
- Resident #25 and Resident #26's room contained no privacy curtain.
The Administrator confirmed the above findings at the time of observation during the facility environmental
tour.
2. Review of the facility water temperature logs dated 04/21/25, 04/28/25, 05/05/25, 05/12/25, 05/20/25 and
05/27/25 revealed on 04/28/25 the East one shower room was recorded as 103.2 degrees Fahrenheit (F),
on 05/12/25 the East two shower rooms were recorded as 103.4 degrees F and on 05/27/25 the East one
shower room was recorded as 103.1 degrees F.
Observation and interview on 06/02/25 at 12:00 P.M. with the Administrator conducting water temperatures
revealed the shared bathroom for Resident #34 and #35's faucet was 103.1 degrees F after running the hot
water for a few minutes and the hot water in the East shower room was 100.7 degrees F. The Administrator
confirmed the above findings at the time of observation and confirmed the water temperatures did not meet
the required minimum of 105 degrees F.
Review of the 05/01/22 facility policy called Water Temperature revealed maintenance staff shall conduct
periodic tap water temperature checks and record the water temperatures in a safety log. Water
temperatures would not be more than 120 degrees.
3. An observation on 06/04/25 at 9:15 A.M. with Maintenance Director #218 of the shower rooms revealed
the rooms contained no washcloths in the East shower room and approximately 10 washcloths in the
[NAME] shower room. Maintenance Director #218 confirmed the lack of washcloths in the shower room.
Observation on 06/04/25 at 9:15 A.M. with Maintenance Director #218 of the shower rooms revealed no
washcloths in the east shower room and approximately 10 washcloths in the west shower room.
Maintenance Director #218 confirmed the above observations.
Observation on 06/04/25 at 9:22 A.M. of the laundry area with Maintenance Director #218 and Laundry
Staff #229 revealed no washcloths in the clean laundry area. Laundry Staff #229 confirmed staff frequently
run out of washcloths and reported more were on order but had not arrived and he was waiting for the dirty
washcloths to come back to laundry to wash them for resident use.
This deficiency represents non-compliance investigated under Master Complaint Number OH00165391 and
Complaint Number OH00165087.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365370
If continuation sheet
Page 6 of 10
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
365370
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
06/11/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Momentous Health at Richfield
4360 Brecksville Rd
Richfield, OH 44286
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)
F 0678
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to
physician orders and the resident’s advance directives.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
review of personnel files, interviews, and review of the nursing job description, the facility failed to ensure
nurses providing direct care to residents maintained current cardiopulmonary resuscitation (CPR)
certification. This had the potential to affect all 37 residents whose advanced directives were listed as full
code (term used to signify all measures which should be taken to resuscitate, including CPR). The facility
census was 51.
Findings include:
Review of the personnel files for three licensed practical nurses (LPNs) and the Director of Nursing (DON)
revealed one LPN (LPN #215) had a hire date of [DATE] with proof of CPR certification from [DATE]
through [DATE] and from [DATE] through [DATE]. There was no evidence LPN #215 had active CPR
certification from [DATE] through [DATE].
Interview on [DATE] at 3:30 P.M. with Business Office Manager (BOM) #207 confirmed there was no
evidence of active CPR certification for LPN #215 in the personnel file. During the interview, it was revealed
that BOM #207 just started the Human Resources position the end of [DATE] and began performing
personnel file audits, at which time she notified any staff whose file was noted to have missing necessary
items, such as documentation of active CPR certification during their course of employment, and she had
received the CPR documentation with the issue date of [DATE].
During a follow-up interview on [DATE] at 5:00 P.M., BOM #207 provided proof of ongoing, valid CPR for
LPN #223 and LPN #228, whose files previously showed a gap in certification, but confirmed there was no
further documentation of CPR certification from the time of the lapsed certification (expired [DATE]) and the
new certification (issued [DATE]).
Interview on [DATE] at 10:54 A.M. with LPN #215 confirmed there was a gap in her CPR certification and
that LPN #215 was not certified in CPR from the end of [DATE] until [DATE].
Interview on [DATE] at 11:00 A.M. with the DON confirmed all facility nurses should maintain current CPR
certification. A follow-up interview on [DATE] at 12:28 P.M. with the DON confirmed LPN #215 was assigned
to work units per facility need and could work on any unit.
Review of the job description for Licensed Practical Nurse last updated [DATE] revealed the LPN must be
certified in CPR.
This deficiency represents non-compliance investigated under Complaint Number OH00165087.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365370
If continuation sheet
Page 7 of 10
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
365370
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
06/11/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Momentous Health at Richfield
4360 Brecksville Rd
Richfield, OH 44286
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)
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
medical record review and interview, the facility failed to ensure weights were obtained upon readmission
from the hospital and refusals were consistently documented. This affected one resident (Resident #32) of
four residents reviewed for weights. The facility census was 51.
Residents Affected - Few
Findings include:
Review of the medical record for Resident #32 revealed an admission date of 01/31/25. Diagnoses included
but were not limited to metabolic encephalopathy, acute and chronic respiratory failure, obstructive sleep
apnea, congestive heart failure, and morbid obesity.
Review of the Minimum Data Set (MDS) 3.0 quarterly assessment dated [DATE] revealed Resident #32 had
a Brief Interview of Mental Status (BIMS) score of 13 which indicated intact cognition. Review of activities of
daily living (ADLs) indicated Resident #32 was dependent upon staff for ADLs.
Review of the physician order dated 04/18/25 and discontinued on 05/22/25 for Resident #32 revealed an
order for monthly weights every day shift starting on the 18th every month for screening.
Review of the most recent weight recorded in the medical record for Resident #32 revealed it was on
04/18/25 with a weight of 536 pounds.
Review of Resident #32's census revealed Resident #32 went to the hospital on [DATE] and returned on
05/23/25.
Review of the 05/23/25 nursing admission assessment with care plan revealed under section four:
dietary/nutritional status section revealed the most recent weight was 536 pounds from 04/18/25. No
indication was recorded of any resident refusal.
Review of the nursing progress notes dated 05/23/25 for readmission revealed no documentation of weight
refusal for Resident #32.
Review of the physician orders following hospitalization on 05/20/25 and readmission on [DATE] revealed
no physician orders for weight monitoring frequency.
Interview on 06/03/25 at 11:15 A.M. with the DON confirmed there was no readmission weight was
obtained nor was a refusal documented for Resident #32 upon readmission from the hospital on [DATE] as
required.
Review of the policy Weight Management dated 05/01/22 revealed the nursing assistant will weigh
residents within 24 hours of admission to the facility, then weekly for four weeks and then monthly
thereafter. Resident's weight information is recorded and trended in the medical record by the unit manager
or charge nurse.
This deficiency represents non-compliance investigated under Complaint Number OH00165009.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365370
If continuation sheet
Page 8 of 10
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
365370
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
06/11/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Momentous Health at Richfield
4360 Brecksville Rd
Richfield, OH 44286
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)
F 0804
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Level of Harm - Minimal harm
or potential for actual harm
Based on observation, interview, and review of the facility menus, the facility failed to serve palatable meals
at appetizing temperatures for residents' meals. This had the potential to affect all 51 residents residing in
the facility. The facility indicated all residents received meals from the kitchen. The facility census was 51.
Residents Affected - Many
Findings include:
Review of the breakfast menu for 06/03/25 revealed the planned meal included a cheese omelet, two
breakfast sausage links, cold or hot cereal, assorted juices, and milk of choice.
Observation on 06/03/24 at 6:45 A.M. with Dietary Manager #208 revealed initial food temperatures on the
steam table as follows: egg cheese omelet 166 degrees Fahrenheit (F), sausage links 181 degrees F,
pureed sausage 179 degrees F, pureed eggs 169 degrees F, oatmeal 172 degrees F, mechanical sausage
173 degrees F, white milk 31 degrees F, chocolate milk 32 degrees F, and apple juice 30 degrees F.
Continuous observation of the breakfast tray line on 06/03/25 beginning at 7:09 A.M. with Dietary Manager
#208 revealed Dietary Manager #208 was preparing trays. Hand hygiene, proper sanitation and portions
were observed during tray line. At 7:46 A.M. Dietary Manager #208 confirmed she ran out of oatmeal and
needed to use cold cereal for the four remaining trays for Residents #18, #22, #23, and #25. Dietary
Manager #208 also confirmed they ran out of spoons and had to use plastic spoons for the last four trays
as well. Tray line finished at 7:52 A.M. A test tray was prepared and sent on the last food cart. The food cart
arrived on the east unit at 7:55 A.M. and the tray pass was initiated. The last resident food tray was passed
at 8:06 A.M.
Interview on 06/03/25 at 8:03 A.M. with Resident #33 revealed the food was cold and the kitchen does not
always have enough for meals.
Interview on 06/03/25 at 8:05 A.M. with Resident #48 revealed the kitchen always runs out of food and
meals are cold.
A test tray was completed with Dietary Manager #208 at 8:08 A.M. which revealed the following
temperatures: Cheese Omelet 118 degrees F, Sausage 109 degrees F, Sausage 109 degrees F, Pureed
Sausage 112.8 degrees F, pureed egg 106 degrees F and milk 65 degrees F. Taste test with Dietary
Manger #208 at the time revealed Dietary Manager #208 confirmed the food was not warm enough for
preference, and the pureed omelet was bland, tasteless, and did not have a desirable flavor.
Review of the Resident Council Meeting Minutes dated 05/27/25 revealed the residents reported food
concerns. Residents noted the meals were repetitive at times and residents requested more fresh fruit.
Review of the facility policy Food Temperatures at Point of Service dated 07/14/23 revealed best efforts will
be made to present hot food hot and cold foods cold at point of service by using thermal lids and bases,
heated or chilled plate and thermal pellets as necessary. Food service will monitor the palatability of food at
point of service by periodic test tray evaluation and review of resident council concerns.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365370
If continuation sheet
Page 9 of 10
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
365370
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
06/11/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Momentous Health at Richfield
4360 Brecksville Rd
Richfield, OH 44286
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)
F 0804
This deficiency represents non-compliance investigated under Complaint Numbers OH00165087 and
OH00164461.
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Many
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365370
If continuation sheet
Page 10 of 10
Reading this as a family member? Your long-term care ombudsman is a free advocate for residents and families.
Back to topCitations
5 citations recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F692 - Assisted nutrition and hydration
Provide enough food/fluids to maintain a resident's health.
F804 - Food and drink
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
F580 - Notification of Changes
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
F584 - Safe Environment
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
F678 - Personnel provide basic life support, including CPR, to a resident
Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives.
FAQ · About this visit
Common questions about this visit
What happened during the June 11, 2025 survey of MOMENTOUS HEALTH AT RICHFIELD?
This was a inspection survey of MOMENTOUS HEALTH AT RICHFIELD on June 11, 2025. The surveyor cited 5 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at MOMENTOUS HEALTH AT RICHFIELD on June 11, 2025?
Yes, 5 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Provide enough food/fluids to maintain a resident's health."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.
Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.
Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.