Inspection·September 9, 2024

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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview, and facility policy review the facility failed to ensure Resident #200's scattered bruises were comprehensively assessed and monitored to include descriptions, measurements, and progression. This finding affected one resident (#200) of three residents reviewed for falls. The facility census was 116. Residents Affected - Few Findings include: Review of Resident #200's medical record revealed the resident was admitted on [DATE] and discharged against medical advice (AMA) on 08/10/24 with diagnoses including cerebral infarction, muscle weakness, and aphasia. Review of Resident #200's admission Evaluation dated 08/02/24 revealed the resident was alert to person, had aphasia, and was sometimes difficult to communicate his needs. The resident did not have skin impairments. Review of Resident #200's Wound Evaluation form dated 08/03/24 revealed the resident had redness and irritation on his buttocks. No other skin conditions were documented. Review of Resident #200's Fall Occurrence Evaluation form dated 08/04/24 revealed at 1:21 P.M. the resident was found by Licensed Practical Nurse (LPN) Minimum Data Set (MDS) Coordinator #808 lying on his right side with the right shoulder hyperextended. The resident was assessed, and all parties were notified. The resident was discharged to the hospital for an x-ray to rule out injury. Review of Resident #200's 5-Day Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #200 exhibited a memory problem and was frequently incontinent of urine and bowel. Review of Resident #200's Skin Inspection form dated 08/09/24 revealed no new skin areas were observed. Review of Resident #200's medication administration records (MAR) and treatment administration records (TAR) from 08/05/24 to 08/12/24 revealed orders dated 08/05/24 to monitor for bruising to the resident's bilateral arms and legs every shift and to monitor for bruising to the right eye every shift. The documentation confirmed the monitoring was completed as ordered; however, there was no description of the bruising. Review of Resident #200's progress note dated 08/10/24 at 5:42 P.M. authored by the Director of Nursing (DON) revealed Resident #200's wife was upset and wanted to take the resident home. She then (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: 365661 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 365661 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/09/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heights Rehabilitation and Healthcare Center, The 2801 E Royalton Rd Broadview Heights, OH 44147 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)