Inspection·October 24, 2024

F 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review, and facility policy review, the facility failed to ensure monitoring prior to and following dialysis treatments for Resident #33. This affected one resident of one (Resident #33) reviewed for dialysis. The facility census was 82. Residents Affected - Few Findings include: Review of the medical record for Resident #33 revealed an admission date of 06/06/23. Diagnoses included but were not limited to encephalopathy, stage five hypertensive chronic kidney disease, dependent on renal dialysis, Alzheimer's dementia, type II diabetes mellitus, legal blindness and unspecified protein-calorie malnutrition. Review of the Minimum Data Set (MDS) 3.0 quarterly assessment dated [DATE] for Resident #33 revealed she was on dialysis treatments. Review of the care plan for Resident #33, last reviewed on 09/05/24, revealed she was receiving dialysis and interventions included communication with dialysis center regarding medication, vital signs, weights, any restrictions, diet order, nutritional and fluid needs, lab results, and who to notify with concerns. Evaluation following dialysis treatment and report abnormal findings to the medical provider, nephrologist/dialysis center, resident and resident representative. Review of physician's order dated 09/07/24 for Resident #33 revealed an order to check dialysis site for signs and symptoms of infection and an order dated 09/10/24 for dialysis treatments on Tuesdays, Thursdays, and Saturdays. Review of the Medication Administration Record (MAR) and Treatment Administration Record (TAR) for October 2024 for Resident #33 revealed no monitoring of dialysis site. Review of the vitals documentation for Resident #33 revealed last documented occurrence of blood pressure monitoring was on 09/06/24. Review of the nursing progress note dated 10/22/24 timed at 4:26 P.M. for Resident #33 revealed she returned from dialysis with her site bleeding through the gauze and clothing. Nurse spoke with dialysis center, reinforced the dressing obtained vitals and continued to monitor. Review of nursing progress notes from 07/01/24 through 10/22/24 did not reveal any additional documentation on resident status prior to or post dialysis treatments. (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: 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 10/24/2024 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)