Inspection·April 9, 2025

F 0773 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results. Based on medical record review, staff interview and review of facility policy, the facility failed to ensure timely provider notification of critical laboratory (lab) values. This affected three (#53, #68, and #86) of four residents reviewed for laboratory services. The facility census was 85. Findings include: 1. Review of the medical record for Resident #86 revealed an admission date of 09/25/24. Diagnoses included chronic obstructive pulmonary disease (COPD), cerebral infraction (stroke), malnutrition, anxiety and depression. Review of the Minimum Data Set (MDS) assessment, dated 03/17/25, revealed Resident #86 had intact cognition. The assessment indicated the resident was incontinent of bladder. Review of the care plan, dated 03/17/25, revealed Resident #86 was receiving antibiotic therapy. Interventions included administering antibiotic and observing for side effects and signs and symptoms of infection. Review of the lab service final report dated 03/21/25 at 5:49 P.M. revealed the urine culture resulted positive for Enterococcus faecalis, an organism that causes urinary tract infections (UTI). Review of the physician orders revealed on 03/25/25, an order for penicillin v potassium 500 milligram (mg), administered every eight hours to treat UTI (four days after lab results were receiving indicating the resident had a UTI). Review of the Medication Administration Record (MAR) for March 2025 confirmed penicillin v potassium 500 mg was administered from 03/25/25 through 04/02/25 at ordered. 2. Review of the medical record for Resident #53 revealed an admission date of 05/24/16. Diagnoses included Alzheimer, depression, anxiety, and gout. Review of the MDS assessment, dated 02/23/25, revealed Resident #86 had impaired cognition and was dependent on staff for toileting. The assessment indicated the resident was incontinent of bladder. Review of the care plan, dated 02/23/25, revealed Resident #86 had an infection related to a UTI. Interventions included administering an antibiotic and observing for side effects and signs and symptoms of infection. (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 04/09/2025 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)