Inspection·August 9, 2023

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to ensure an allegation of misappropriation was reported to the state agency as required. This affected one resident (Resident #85) of three reviewed for misappropriation. The facility census was 84. Findings include: Review of Resident #85's medical record revealed an admission date of 05/25/20 with diagnoses including dementia, hypertension, anxiety, and dysphagia (difficulty swallowing). Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #85 had memory impairment and required extensive assistance with bed mobility, transfers, and hygiene. Resident #85 was discharged from the facility on 06/08/23. Review of the facility's July 2023 concern log revealed on 07/24/23 Resident #85's niece filed a concern for missing guitar and television. The notes related to the concerns indicated unable to locate the television and a family member took the guitar. Review of the concern form dated 07/24/23 revealed Resident #85 passed away on 06/08/23. The guitar was not with Resident #85's personal belongings. Under follow-up actions the response indicated the activity staff reported a family member took the guitar. Interview on 08/08/23 at 10:12 A.M. with Licensed Social Worker (LSW) #200 revealed she was not aware of the missing guitar and television until the concern was reported. Through her investigation it was determined a family member took the guitar. LSW #200 stated there was a television in storage but the niece indicated it was not Resident #85's. LSW #200 said the niece was not concerned about the television. LSW #200 did not report the allegation of misappropriation to the State agency. Review of the facility's undated policy titled Ohio Abuse, Neglect and Misappropriation revealed for alleged violations of misappropriation of resident property the facility must report the allegation no later than 24 hours. This deficiency represents non-compliance investigated under Complaint Number OH00145012. 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: 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 08/09/2023 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)