Inspection·November 9, 2021

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 observation, record review and interview the facility failed to ensure call lights were within reach and accessible for Residents #4, #17, #34, #36, and #40. This affected five (#4, #17, #34, #36, and #40) of 51 residents reviewed for call light placement. Residents Affected - Few Findings include: 1. Resident #4 was admitted to the facility on [DATE] with diagnoses including diabetes mellitus, anxiety disorder, and major depressive disorder. Review of the most recent Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #4 had severe cognitive impairment and required extensive assistance with activities of daily living (ADLs). Observation and interview on 11/07/21 at 12:30 P.M. revealed Resident #4 did not have a call light cord attached to the wall. Interview with Certified Nursing Assistant (CNA) #108 at the time of observation verified the call light was out of reach and that Resident #4 would be able to use the call light if it was within reach. 2. Resident #17 was admitted to the facility on [DATE] with diagnoses including atrial fibrillation, chronic respiratory failure with hypoxia, and vitreous degeneration of left eye. Review of the most recent MDS 3.0 assessment dated [DATE] revealed Resident #17 was cognitively intact and required extensive assistance with ADLs. Observation on 11/07/21 at 09:33 A.M. revealed Resident #17's call light was dangling off the side rail, out of the resident's reach. Interview with Restorative Nurse #125 at time of the observation verified the resident's call light was out of reach. 3. Resident #34 was admitted to the facility on [DATE] with diagnoses including unspecified dementia chronic obstruct pulmonary disease, major depressive disorder, macular degeneration, weight loss, abdominal aortic aneurysm, acute respiratory failure, repeated falls, and psychotic disorder with delusions. Review of the most recent MDS 3.0 assessment dated [DATE] revealed Resident #34's moderately impaired cognition and extensive assistance was required for ADLs. Observation on 11/07/21 at 09:30 A.M. revealed Resident #59's call light was on the floor. (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 7 Event ID: 365452 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 365452 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/09/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearlview Rehab & Wellness Ctr 4426 Homestead Dr Brunswick, OH 44212 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)