Health inspection·May 11, 2023

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm Based on record review and interviews the facility failed to provide adequate and appropriate quality of care and services when transferring Resident #22 into bed after a fall incident. This affected one resident (Resident #22) of four residents reviewed for assistance with transfers. The facility census was 116. Residents Affected - Few Findings include: Review of the medical record for Resident #22 revealed an admission date of 09/10/20. Diagnoses included Alzheimer's disease, dementia with behavior disorder, left shoulder pain, hyperlipidemia, aphasia, anxiety, major depressive disorder (MDD), and cognitive communication deficit. Review of the comprehensive Minimum Data Set (MDS) 3.0 assessment, dated 04/05/23, revealed the resident had severely impaired cognition. Resident #22 required extensive assist by one staff member for for bed mobility, wheelchair mobility, dressing, and eating and was totally dependent on two staff members for transfers, toileting, and personal hygiene. Review of the plan of care dated 09/10/20 revealed the resident was at risk for falls due to dementia, Alzheimer's disease, anxiety, MDD, and decreased mobility. Interventions included bed in lowest position, clutter free pathways, call light within reach, defined perimeter mattress (DPM) to bed at all times, body pillow to bed at all times, large touch pad with in reach, and a bed alarm to alert staff for safety. Review of physician orders for May 2023 identified orders for Resident #22's bed to be in the lowest position, clutter free pathways, call light with in reach, defined perimeter mattress (DPM) to bed at all times, body pillow to bed at all times, large touch pad with in reach, and a bed alarm to alert staff for safety. Review of the nurses notes dated 03/27/23 at 8:00 P.M. Licensed Piratical Nurse (LPN) #814 documented Resident #22 was found on the floor next to right side of bed. She documented injuries to residents mouth, bruising to right side of face and bruising with swelling to right hand including her second digit. The physician was contacted and gave orders to send resident to the local emergency room (ER) for evaluation and treatment. Resident #22's family was updated about the fall and new orders to send the resident to the ER. Nurse to nurse was called to the local ER. Review of nurses noted dated 03/27/23 at 11:32 P.M. Resident #22 returned from the ER with no new orders, all scans completed at the hospital including x-rays, and Computed Tomography scans revealed no fractures. Resident #22 had bruising to right side of face and to her right hand including her second digit. (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: 365574 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 365574 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Crandall Nursing Home 800 S 15th St Sebring, OH 44672 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)