Inspection·July 11, 2019

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 observation, record review, resident interview, staff interview, and family interview, the facility failed to preserve the dignity of one resident by having her use a bedside commode instead of providing her assistance to use the toilet in the bathroom which would provide privacy. This affected one (Resident #7) of one resident reviewed for resident rights. The census was 45. Findings include: Review of the medical record revealed Resident #7 was admitted on [DATE]. Diagnoses included dementia with behavioral disturbances, unspecified lack of coordination, mono-arthritis, left knee, pain in right wrist, muscle weakness and difficulty in walking. Review of the plan of care for Resident #7 revealed the resident was at risk for falling related to a history of falls and decline in her Activity of Daily Living (ADL)'s. Her goal was to remain free from falls with major injury. Her interventions included the resident required two staff assistance with transfers and to encourage the commode during bedtime care. Review of the Individual Plan Report for Resident #7 for ADL's from Matrix Care which was what the aides used to assist residents, revealed she used a walker and required one to two assistance with ADL's. Fall interventions included to use the commode for toileting for safety. Review of progress notes for Resident #7 dated 03/31/18 at 11:52 A.M. which was an interdisciplinary team note revealed the resident tends to show signs of weakness with ambulating to the restroom. When resident was returning to the bed, the resident lost balance and was lowered to the floor. Intervention was to have the resident use the commode due to increased weakness and balance concerns. Interview with spouse of Resident #7 of 07/08/19 at 9:26 A.M., revealed she was not able to use the toilet in her room because there was a male resident in the adjoining room who uses it so she had to use a bed side commode. Observation of toileting on 07/09/19 at 11:59 P.M., with Certified Resident Care Associate (CRCA) (#400, #401) in the room of Resident #7 for toileting before lunch was completed. They used a two-assistance transfer with a gait belt to the commode. Resident #7 was in her wheelchair in her room, the bedside commode was by the curtain which was pulled. Resident pulled up using the walker and moved her feet slightly to aide with the transfer. Interview with CRCA #400 on 07/10/19 at 11:17 A.M. revealed Resident #7 had not walked to the (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: 365387 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 365387 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/11/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Briar Hill Health Campus 600 Sterling Dr North Baltimore, OH 45872 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)