Inspection·January 24, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observations and interviews the facility failed to provide a dignified existence for all residents. This affected one (Resident #36) of 10 residents observed for activities and staff interaction. The census was 66. Findings Include: Review of medical record revealed Resident #36 was admitted on [DATE]. Diagnoses included unspecified dementia, history of falls, and anxiety disorder. Resident #36 was receiving hospice services. Review of the plan of care dated 08/17/21 revealed Resident #36 was at risk for falls due to balance problems, history of falls and weakness. Review of the plan of care dated 12/09/22 revealed Resident #36 had a self-care deficit and required assistance by staff for activities of daily living (ADL). Review of the 01/16/23 quarterly Minimum Data Set (MDS) 3.0 assessment for Resident #36 revealed she had severe cognitive impairment. Observation on 01/18/23 from 10:03 A.M. to 12:00 P.M. revealed Resident #36 dressed in street clothes seated in a Broda (geriatric) chair in front of the nurse's desk. Staff walking by Resident #36 did not engage with her in any manner; the staff did not extend a greeting or make any acknowledgement of her presence at any time during the observation. Observations on 01/18/23 from 1:55 P.M. to 3:52 P.M. revealed Resident #36 dressed in street clothes seated in a Broda chair in front of the nurse's desk. Staff were observed walking past Resident #36 with no interaction. Observation on 01/18/23 at 3:53 P.M. revealed staff taking Resident #36 to her room to complete incontinence care. Observation on 01/18/23 at 4:11 P.M. revealed Resident #36 was back out in front of the nurse's desk. Observation and interviews on 01/18/23 at 4:12 P.M. with State Tested Nurse Assistant (STNA) #40, Licensed Practical Nurse (LPN) #41 and Registered Nurse (RN) #89 revealed they were seated behind the nurse's desk. All staff were asked if Resident #36 attended any activities during the day. RN #89 was the only staff to reply stating Resident #36 attended activities in the evenings when family visited. Staff were unable to provide an explanation as to why Resident #36 was seated by herself throughout the day with no interaction by staff as they walked past and with no opportunities to interact with other residents. (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: 365711 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 365711 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Chardon Center 620 Water Street Chardon, OH 44024 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)