Inspection·August 28, 2024

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on observation, medical record review, and interview, the facility failed to monitor a resident's oxygen saturations in accordance with physician orders. This affected one (Resident #44) of three residents reviewed for respiratory care. The census was 87. Residents Affected - Few Findings include: Review of Resident #44's medical record revealed diagnoses including chronic respiratory failure, congestive heart failure, obstructive sleep apnea, and atherosclerotic heart disease. A physician order dated 05/17/24 revealed Resident #44 had an order for continuous oxygen at two liters per minute via nasal cannula. Instructions revealed to check placement and record oxygen saturation every shift. The only oxygen saturation able to be located between 08/15/24 and 08/26/24 revealed one oxygen saturation level was recorded on 08/23/24 at 4:32 A.M. and recorded as 97%. Observations on 08/28/24 at 2:05 P.M. revealed Resident #44's oxygen saturation level was 98% with oxygen at two liters per minute via nasal cannula. During an interview on 08/27/24 at 2:24 P.M., Registered Nurse (RN) #110 verified she was unable to locate any additional evidence of oxygen saturations being monitored. RN #110 stated Resident #44 was stable on her ordered oxygen and staff would monitor if she had signs of distress. The area on the order which would have resulted in the need for monitoring oxygen saturation levels on the Medication Administration Record (MAR) had not been activated in the electronic medical record. This deficiency represents non-compliance investigated under Complaint Number OH00156489. 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: 365482 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 365482 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Navarre Ctr for Rehab & Nrsg Care 517 Park Street NW Navarre, OH 44662 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)