Health inspection·August 4, 2022

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm 2. Observation on 08/03/22 at approximately 2:50 P.M., of Receptionist #438 standing behind the receptionist desk with her mask pull down exposing her nose and mouth. Observations of Resident #17 at this time, revealed the resident was sitting in her wheelchair on the other side of the receptionist desk. Residents Affected - Many Interview on 08/03/22 at 2:53 P.M., with Receptionist #438 verified the observation. 3. Observation on 08/04/22 at approximately 10:15 A.M., of the Director of Maintenance (DM) #470 sitting at the nurses' station with his face mask pulled down exposing his nose and mouth and observed two sets of glasses on top of his head. Another unidentified staff was observed standing next to DM #470 taking his blood pressure and Resident #17 was sitting in her wheelchair next to the nursing station. Interview at the time of the observation with DM #470 verified the observation and pulled up his mask. Based on observations, staff interviews, medical record reviews, and policy review, the facility failed to ensure supplies necessary for proper personal protective equipment (PPE) usage were readily accessible and signage for specified PPE needs were posted. This affected two (#213 and #217) of two residents reviewed for transmission-based precautions. The facility also failed to ensure staff properly wore PPE while in patient care areas throughout the facility. This directly affected one (#17) resident observed with the potential to affect all residents. The facility census was 65. Findings include 1. Interview on 08/01/22 at 10:49 A.M., with Licensed Practical Nurse (LPN) #434 indicated only Resident #213 was on transmission-based precautions (TBP). LPN #434 indicated there are usually bins for PPE or a door hanger and signs indicating type of precautions. LPN #434 verified when looking down hallway towards Resident #213's room and no PPE bin or signage was observed. Observation on 08/01/22 at 10:56 A.M., revealed LPN #434 placing bins for PPE and Transmission Based Precautions (TBP) signage for Resident #213 and Resident #217. Review of the medical record for Resident #213 revealed admission date of 07/22/22 and order for isolation for 14 days related to non-vaccinated. The order was set to expire on 08/05/22. Review of the medical record confirmed no evidence of COVID-19 vaccination. Review of the medical record for Resident #217 revealed admission date of 07/25/22 and order for (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 3 Event ID: 365550 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 365550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/04/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oak Hills Nursing Center 3650 Beavercrest Drive Lorain, OH 44053 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)