Inspection·April 5, 2023

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. Based on interview and record review, the facility failed to ensure restorative programs were provided as ordered. This affected one Resident (#122) of three reviewed for restorative programs. The facility census was 156. Findings include: Review of the medical record for Resident #122 revealed an admission date of 09/28/22. Diagnoses included left sided hemiplegia, dysphagia, and speech and language deficits following non-traumatic subarachnoid hemorrhage. Review of the Medicare Quarterly Minimum Data Set assessment, dated 03/20/23, revealed Resident #122 had intact cognition. Resident #122 required extensive two staff assistance with bed mobility, dressing, personal hygiene, and toileting, locomotion on unit only occurred once or twice, and total two staff assistance with transfers. The assessment indicated Resident #122 was not on therapy services during the assessment period. Resident #122 was on restorative nursing programs for range of motion and transfers. Review of the plan of care dated 09/20/22 revealed Resident #122 was at risk for impaired function of range of motion and impaired physical mobility in transfers. Resident #122 required restorative programs. Interventions included cue and prompt resident to perform exercises, encourage to wear non-skid footwear, use gait belt for safety, praise resident efforts and success through entire restorative program, monitor for fatigue, reassess restorative program quarterly, and refer to therapy as needed. Review of physician's order dated 09/28/22 revealed Resident #122 was to have mobility per the plan of care. Review of plan of care response history for restorative active range of motion program revealed Resident #122 was to receive restorative exercises three to seven times per week for 15 minutes. Review of the look back period of 30 days revealed Resident #122 received restorative sessions on 03/09/23, 03/15/23, 03/27/23, and 03/28/23. Review of the plan of care response history for restorative sit to stand transfer program revealed Resident #122 was to receive restorative assistance three to seven times per week for 15 minutes. Review of the look back period of 30 days revealed Resident #122 received restorative sessions on 03/07/23 and 03/15/23. (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 04/05/2023 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)