Health inspection·May 15, 2024

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, staff interview, and policy review, the facility failed to ensure dependent residents were assisted with repositioning to prevent skin impairment. This affected three (#46, #53, #72) of three residents reviewed for repositioning. The census was 74. Residents Affected - Few Findings included 1. Review of Resident #46's medical record revealed an admission date of 12/29/23. Diagnoses included acute and chronic respiratory failure with hypoxia, obstructive uropathy, diabetes, cerebrovascular attack, tracheostomy, gastrostomy, and ventilator dependent. Review of the care plan for Resident #46 dated 01/02/24 revealed the resident was at risk for skin impairment related to immobility. Interventions included to assist to turn and reposition at frequent intervals to provide pressure relief and to offload the hips and sacrum to promote skin integrity. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #46 was rarely or never understood. The resident's was assessed as dependent for toileting and for transfers. Observation of Resident #46 on 05/14/24 at 9:40 A.M., 11:45 A.M., 1:05 P.M., and 2:14 P.M. revealed the resident was laying on his back in bed with his position unchanged. 2. Review of Resident #53's medical record revealed an admission date of 06/29/21. Diagnoses included hypoxic ischemic encephalopathy, aphasic, respiratory failure, tracheostomy, gastrostomy, and ventilator dependent. Review of the quarterly MDS assessment dated [DATE] revealed Resident #53 was rarely or never understood. The resident was dependent for toileting and bed mobility. Review of the care plan dated 03/19/24 for Resident #53 revealed the resident was at risk to develop skin conditions related to fragile skin. Interventions were to encourage and assist to turn every two hours. Observation of Resident #53 on 05/14/24 at 9:38 A.M., 11:47 A.M., 1:04 P.M., and 2:14 P.M. revealed the resident was sitting upright in a geriatric chair with his head leaning over to the left side of the chair. The resident's position was unchanged throughout the observations. 3. Review of Resident #72's medical record revealed an admission date of 03/08/24. Diagnoses (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: 365690 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 365690 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarview Care Center 115 Oregonia Road Lebanon, OH 45036 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)