Health inspection·May 22, 2025

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on closed medical record review, review of the acute care hospital paperwork, facility policy review and interview, the facility failed to provide care per physician's orders and failed to timely identify and address a change in condition for Resident #71 resulting in hospitalization.Actual Harm occurred on 03/16/25 when Resident #71 began displaying changes in his baseline mentation, eating patterns, and activity level and staff failed to document, notify the physician and/or timely address the change in condition resulting in Resident #71 continuing to decline without physician notification through 03/22/25 when Resident #71 was transferred to an acute care hospital at the insistence of his family and was diagnosed with sepsis related to aspiration pneumonia and acute metabolic encephalopathy.Findings include: Review of the closed medical record for Resident #71 revealed an admission date of 02/12/25 and a discharge date of 03/22/25. Resident #71 had diagnoses including Alzheimer's disease, chronic obstructive pulmonary disease (COPD), and hypertension.Review of the care plan dated 02/12/25 revealed Resident #71 had a nutritional problem. Interventions included providing diet as ordered and monitoring intake and weight as ordered.Review of a physician's order dated 02/13/25 revealed an order to clean Resident #71's right elbow with normal saline, apply non adherent dressing, and a dry dressing daily. Review of the treatment administration record (TAR) dated February 2025 revealed that the wound care was not provided as ordered on 02/13/25, 02/14/25, 02/18/25, 02/19/25, 02/22/25, or 02/27/25.Review of a physician's order dated 02/13/25 revealed an order to weigh Resident #71 on admission and then every week for four weeks. The order was set to expire on 03/24/25. Resident #71 weighed 119 pounds on admission [DATE]) and at his last weight on 03/10/25 was 110 pounds which was a 7.5% weight loss in less than 30 days, indicating a severe weight loss for the resident. Resident #71 was identified as a weight loss on 03/11/25 and was ordered a dietary supplement twice daily. No further weights were documented. There was no documented evidence the physician was notified of the severe weight loss.Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #71 had severe cognitive impairment with a memory problem. The assessment revealed Resident #71 required staff supervision to moderate assistance for all activities of daily living.Review of the nursing documentation from 03/16/25 to 03/22/25, until the note on 03/22/25 at 12:53 A.M., revealed no documentation, physician notification and/or interventions regarding any changes in Resident #71's baseline mentation, eating patterns, or activity level. Review of skilled nursing documentation dated 03/22/25 at 12:53 A.M. revealed the resident's blood pressure was 114/50, heart rate 81, respirations 18, his pulse oximetry was 94% on room air, and his temperature was 97.9 degrees Fahrenheit.Review of the nursing progress note dated 03/22/25 at 5:41 P.M. revealed Resident #71 was not eating or drinking much since he was sick a week prior and his family was concerned. The doctor was notified, and an order was obtained to transfer the resident to the hospital. Review of the medical record revealed Resident #71 did not return from the hospital. Review of the medical record for Resident #71's stay Residents Affected - Few (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: 365555 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 365555 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE O'Brien Memorial Health Care C 563 Brookfield Ave SE Masury, OH 44438 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)