Health inspection·September 11, 2023

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to implement a comprehensive and effective infection control program to properly and timely diagnosis, implement necessary infection control precautions, conduct adequate and timely education for staff on infection control relative to preventing the spread of potentially contagious/communicable rashes (scabies) and failed to notify the local health department of potentially contagious skin rashes. This affected three residents (#1, #41, and #81) of three residents reviewed for skin rashes and infection control and had the potential to affect all residents residing at the facility. The facility census was 108. Residents Affected - Few Findings include: On 09/06/23 at 11:53 A.M. and 12:10 P.M. interviews with Licensed Practical Nurse (LPN) #302 and LPN #303 revealed there had been three residents, Resident #1, #41 and #81 with rashes and itching. The Certified Nurse Practitioner (CNP) had followed up and done treatments. There were no other residents and no employees that they were aware of, who had current concerns with rashes and/or itching. Interview on 09/06/23 at 4:34 P.M. with the Administrator and Director of Nursing (DON) revealed there had been a scabies outbreak on the third floor a few years back. Every year at about the same time they had some residents with rashes and itching. Corporate invested in a new heating, ventilation, and air conditioning (HVAC) system and that seemed to help. At the time of the outbreak and again for the next couple years the facility looked at soap, laundry detergent, washing machines, mold, mildew, and many other things. Each year there were still a few residents with rashes and itching. The DON stated scabies was highly contagious and felt if the rashes were due to scabies, a lot more residents would have been affected. The DON verified three residents, #1, #41 and #81 had been treated with Permethrin (a topical treatment for scabies). None of the residents were diagnostically tested for scabies, so the DON stated the facility couldn't say definitively the residents had scabies, so they didn't proceed as if it was scabies. On 09/07/23 at 3:14 P.M. telephone interview with CNP #316 revealed she ordered Permethrin (a treatment for scabies) because it was known that people in close quarters could get scabies as well as dermatitis. The CNP revealed for Resident #1 the rash could have been dermatitis or could have been scabies There was no confirmation, so the resident was treated with topicals/ointments. CNP #316 told the nurse about laundry precautions and felt isolation was physically impossible (due to the resident wandering). CNP #316 had nursing dress the resident in long sleeve shirts. An email from the DON on 09/09/23 at 3:23 P.M. revealed the local health department was not contacted related to the three residents with rashes as the facility did not have a confirmed case of scabies. The CNP's did an investigation of what could have caused the rash and itching. They assessed 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 4 Event ID: 365432 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 365432 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Diplomat Healthcare 9001 W 130th St North Royalton, OH 44133 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)