Health inspection·January 11, 2024

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, and review of facility policy, the facility failed to follow their policy titled Weight Management Program and Weight Loss by ensuring the physician was notified of significant weight loss. This affected three (#10, #56 and #78) out of three residents reviewed for weight loss. The facility census was 79. Findings Include: 1. Review of the medical record for Resident #56 revealed an admission date of 07/08/23 with a diagnosis of multi-system degeneration of autonomic nervous system. Review of the physician orders for 01/23 revealed a diet order of regular mechanical soft, chopped meat diet with thin liquids and house supplement two times per day. Review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #56 required set-up for meals and was identified for weight loss and required a mechanically altered diet. Review of the care plan revised 10/23 for Resident #56 revealed she was care planned for nutritional problems. Review of the dietician note dated 12/06/23 revealed weight loss of 7.6 % in three month, a slow and steady decline, intakes vary widely from over the past 30 days and has decreased to 25%-50%. Resident #56 receiving hospice services, and the Director of Nursing (DON) was notified. There was no documentation regarding physician notification regarding Resident #56's weight loss. 2. Review of the medical record for Resident #10 revealed an admission date of 06/30/23 with a diagnosis of Alzheimer's disease. Review of the physician orders for 01/23 revealed a diet order of regular pureed diet with nectar thickened liquids and house supplement three times per day. Review of the quarterly MDS dated [DATE] revealed the Resident #10 required maximum assist with eating and was identified for weight loss and required a mechanically altered diet. Review of the care plan revised 01/24 for Resident #10 revealed she was care planned for nutritional problems. (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 2 Event ID: 365447 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 365447 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookview Healthcare Center 214 Harding Street Defiance, OH 43512 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)