Inspection·August 2, 2022

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews the facility failed to provide reasonable accommodations during meals for Resident #128 with visual impairments and failed to provide appropriate length beds for Resident's #5 and #140. This affected three (Resident's #128, #5 and #140) of eight residents reviewed for reasonable accommodation of needs. The facility census was 169. Residents Affected - Few Findings include: 1. Review of the medical record revealed Resident #128 was admitted to the facility on [DATE] with diagnoses including legal blindness, as defined in United States of America and primary open-angle glaucoma, bilateral, indeterminate stage. Review of the comprehensive Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #128 had intact cognition and required supervision for eating. Review of the plan of care dated 06/10/20 revealed Resident #128 had impaired visual function related to blindness in right and left eye. Interventions included to adapt environment to the residents individual needs to ensure the resident could recognize objects/own environment. Interview on 07/25/22 at 10:15 A.M., Resident #128 stated he had difficulty consuming foods that were placed on a flat plate like spaghetti and rice. Resident #128 stated items like that slid off the plate. Observations and interview on 07/25/22 at 12:51 P.M., Nurse Aide Trainee (NAT) #735 was observed placing Resident #128's tray down on the table in front of the resident. NAT #735 did not indicate what/where the items were on the tray. Resident #128 scanned the tray with both hands feeling for food and drinks. Interview immediately after observation, NAT #735 provided little input related to policy and procedures related to adaptive ware and/or informing the resident of items on the tray. Interview on 07/27/22 at 10:00 A.M., Occupational Therapist (OT) #755 stated Resident #128 was referred to occupational therapy and an evaluation was completed on 07/25/22. OT #755 indicated the goal for Resident #128 would be to safely perform self-feeding tasks with independence with use of divided plate/scoop bowl/adaptive equipment as needed. Review of the staff training dated 07/25/22 revealed staff received training including how to set-up trays, explaining where food items were located on the tray and assisting with removing lids and/or cutting up food. (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 5 Event ID: 365388 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 365388 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Franklin Plaza Extended Care 3600 Franklin Boulevard Cleveland, OH 44113 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)