Inspection·April 26, 2024

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, review of QSO-24-08-NH and review of facility policy, the facility failed to ensure enhanced barrier precaution (EBP) guidelines were followed for all residents that required EBP. This affected five of ten residents (Resident #1, #23, #50, #51, #57) reviewed for EBP. The facility census was 59. Residents Affected - Some Findings Include: 1. Review of the medical record for Resident #23 revealed and admission date of 12/07/23. Diagnoses included respiratory disorders, tracheostomy, morbid obesity and acute respiratory failure with hypoxia. Review of the Minimum Date Set (MDS) assessment dated [DATE] revealed Resident #23 had intact cognition. Resident #23 was on oxygen, required suctioning, had a tracheostomy and required a mechanical ventilator for respiratory support. Review of the physician orders for April 2024 revealed Resident #23 was on Levofloxacin (antibiotic) 500 milligram (mg) tablet for ten days for pneumonia. There were also orders for tracheostomy care, use of ventilator and suctioning when needed. Observation of Resident #23's room door on 04/26/24 at 5:20 A.M. revealed a yellow bag hanging from the door with personal protective equipment (PPE) in it with no signage on what type of precautions the resident was on. Interview on 04/26/24 at 5:28 A.M. with Registered Nurse (RN) #300 revealed she did not know if Resident #23 was on enhanced barrier precautions. RN #300 stated she did not wear a gown when connecting or reconnecting Resident #23 from the ventilator or when providing ventilator/tracheostomy care. RN #300 verified there was no enhance barrier precaution sign on Resident #23's door or wall outside of residents' room. Interview on 04/26/24 at 6:43 A.M. with Resident #23 revealed not all staff wore PPE when caring for him. 2. Review of the medical record for Resident #50 revealed an admission date of 07/17/23. Diagnoses included unspecified tracheostomy complication and respiratory failure. Review of the MDS assessment dated [DATE] revealed Resident #50 was cognitively impaired, on oxygen, had a tracheostomy, and received tracheostomy care, suctioning and tube feeding. (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: 365707 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 365707 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Phoenix of Fairlawn 120 Brookmont Rd Akron, OH 44333 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)