Inspection·June 27, 2023

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, and policy review, the facility failed to notify the resident representative of changes in the resident's condition. This affected one (#89) of three residents reviewed for notification of changes in condition. The facility census was 86. Findings include Review of the medical record for Resident #89 revealed an admission date of 04/29/23 and a discharge date of 05/15/23. Diagnoses included cerebral infarction, end stage renal disease, diabetes mellitus type two, atrial fibrillation, hypertension, and a pulmonary embolism. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #89 had severe cognitive impairment. Review of two medication administration notes dated 05/05/23 at 8:03 P.M. and 8:04 P.M. noted the resident was in the emergency department. There was no documentation when Resident #89 was sent to the emergency department. Also, there was no documentation the resident's family was notified Resident #89 was sent to the emergency department. Review of a nursing note dated 05/07/23 at 4:04 A.M. revealed Resident #89's corpak (an enteral feeding tube device) could not be flushed and was clogged. Resident #89 was ordered to be sent to the emergency room via non-emergency transport. There was no documentation the family was notified Resident #89 was sent to the emergency room until the resident's daughter came to the facility to visit the resident on 05/07/23 at 12:21 P.M. Review of a nursing note dated 05/15/23 at 3:47 P.M. revealed a new order was received to increase the resident's insulin Lantus to 30 units subcutaneously in the morning. There was no documentation the family was notified. Review of a nursing note dated 05/15/23 at 6:39 P.M. revealed the resident's blood sugar was 586. Resident #89 was ordered a one-time dose of 10 units of the insulin Humulin R. There was no documentation the resident's family was notified. Interview on 06/27/23 at 1:30 P.M. with the Director of Nursing (DON) verified the family was not notified the Resident #89 was sent to emergency room on [DATE] and 05/07/23. The DON also verified the family was not notified of the new order for the insulin Lantus or when the resident's blood sugar level was elevated at 586. (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: 365623 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 365623 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lake Pointe Health Care 3364 Kolbe Rd 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)