Health inspection·December 9, 2023

F 0837 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Establish a governing body that is legally responsible for establishing and implementing policies for managing and operating the facility and appoints a properly licensed administrator responsible for managing the facility. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** THE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NON-COMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Based on review of personnel files, review of Board of Executives of Long-Term Services and Support (BELTSS) documentation, and staff interview the facility failed to ensure the Administrator had a valid license. This had the potential to affect all 61 residents residing in the facility. Findings included: Review of the Administrator's personnel file revealed no evidence the Administrator had a valid license from 01/01/23 to 11/22/23. Review of facility documentation revealed on 11/22/23 at 12:26 P.M., BELTSS Employee #100 called and reported the Administrator had not had a valid Long Term Healthcare Administrator license since 01/01/23. On 12/09/23 at 11:40 A.M., surveyor interview with the Administrator confirmed BELTSS arrived to the facility on [DATE] and reported she did not have a valid Long-Term Nursing Home Administration license. Per the Administrator, mid- December 2022 she had submitted her continuing education (CE) and $300.00 payment and one of her CE's was rejected because she entered it incorrectly. The Administrator reported she had corrected the CE, however there was a late fee of $50.00 she was not aware of. When she looked in the BELTSS system it showed she had a zero balance. She was not aware of the $50 late fee and after so long the agency will keep adding late fees if not paid. The representative from BELTSS informed her she owed $100.00 and her license had not been valid since 01/01/23 and she needed to find coverage for the building. She immediately went online and paid the fines and BELTSS called her and told her that her license was then valid. Per the Administrator, all this happened on 11/22/23 within hours and they facility did not have to find an Administrator to cover the building. The Administrator reported she had no evidence to provide she had a zero balance or a valid license from 01/01/23 to 11/22/23. This deficiency represents non-compliance investigated under Complaint Number OH00148587. The deficient practice was corrected on 06/30/23 when the facility implemented the following corrective action: On 06/30/23 the Administrator paid her late fees and subsequently her license was active on this (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: 365545 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 365545 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Briarfield at Ashley Circle 5291 Ashley Circle Youngstown, OH 44515 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)