Inspection·January 16, 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 and interview the facility failed to ensure Resident #247 was treated with dignity and respect. The affected one resident (Resident #247) of two residents reviewed for dignified treatment in the facility. Findings include: Record review revealed Resident #247 was admitted to the facility on [DATE] with diagnoses including heart and lung disease, multiple fractures of the ribs which resulted from a fall prior to admission to the facility, spinal stenosis (narrowing of the spinal canal causing numbness, weakness or pain in the arms and/or legs) spondylosis (spinal arthritis) and macular degeneration (blurred or no vision). The resident was admitted for rehabilitation following a fall at home. Review of Resident #247's Minimum Data Set (MDS) 3.0 assessment dated [DATE] indicated he needed extensive assistance of one staff member with bed mobility (how one moves to and from a lying position, turns side to side, and positions body while in bed). Interview with Resident #247 on 01/13/19 at 10:36 P.M. revealed he was frustrated with the staff answering his call light and not providing requested assistance at the time they answered. He reported when staff finally provided the needed assistance, they rushed out of his room before he could ask for anything else. He then had to push the call light again to ask for additional assistance and the process repeated in the same manner. During observation of medication pass with Registered Nurse (RN) #400 on 01/15/19 at 8:40 A.M., RN #400 entered Resident #52's room to administer medications through the resident's gastrostomy (feeding) tube. The tube wasn't functional and RN #400 was attempting measures to unclog it. Resident #247, the roommate, was in the bed near the door and called out in a loud voice saying he couldn't find his call light. RN #400 continued to attempt to unclog Resident #52's gastrostomy tube. After a brief pause she walked over to Resident #247 and told the resident it's right here, you have it. Resident #247 responded that he did not have it and when the covers were pulled back he in fact had the TV remote but the call light was in the sheets. RN #400 gave the call light to Resident #247 and without comment or apology for being mistaken walked back to Resident #52's bedside. As RN #400 again sat near Resident #52 waiting for another nurse to bring supplies to unclog the tube at 8:47 A.M., Resident #247 stated loudly, I wondered if I could be pulled up. RN #400 did not respond to the resident. After several minutes, RN #400 asked the surveyor questions about the survey process. Resident #247 continued to watch the surveyor and RN #400 conversing. After about 5 (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 4 Event ID: 365406 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 365406 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant View Health Care Center 401 Snyder Ave Barberton, OH 44203 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)