Inspection visit

Health inspectionAugust 17, 2023

ARBORS AT STOWCMS #3657208 citations on this visit

8 citations recorded

Inspector’s narrative

What the inspector wrote

This survey cited 8 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.

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 observation, record review, and interview the facility failed to ensure Resident #110's urinary catheter bag had been covered. This affected one resident (#110) of one resident observed for urinary catheters. In addition, the facility failed to ensure staff knocked on a common bathroom door prior to entering. This affected Resident #88. The facility census was 124. Findings include: 1. Review of Resident #110's medical records revealed an admission date of 05/01/23. Diagnoses included dementia, altered mental status, need for personal care assistance, and muscle weakness. Review of the care plan dated 05/01/23 revealed Resident #110 had a urinary catheter for elimination. Interventions included position catheter bag and tubing below the level of the bladder and away from entrance room door. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #110 had impaired cognition. The resident had a urinary catheter and was incontinent of bowel. Observation on 08/14/23 at 10:05 A.M. revealed Resident #110 was resting in bed. The resident's urinary catheter bag was on the floor visible from the door and was without a privacy bag placed on the outside catheter bag. Interview with State Tested Nursing Assistant (STNA) #101 confirmed Resident #110's urinary catheter bag was supposed to be covered and should not have been on the floor. Observation on 08/14/23 at 2:55 P.M. revealed Resident #110 was resting in bed. The urinary catheter was not visible. Interview at time of observation with Licensed Practical Nurse (LPN) #49 confirmed Resident #110's catheter was not visible and she attempted to locate it. LPN #49 had located the urinary catheter on the opposite side of Resident #110's bed on the floor, wrapped in a sheet. LPN #49 stated the urinary catheter should not have been placed on the floor and should have had a privacy bag placed on the outside. Observation on 08/16/23 at 1:58 P.M. revealed Resident #110 was sleeping in bed. Resident #110's urinary catheter was observed to have been hanging on the resident's footboard and was wrapped in a sheet. Interview with STNA #101 at time of observation revealed he had been unable to locate a privacy bag and stated the facility had ordered some. 2. Observation on 08/15/23 at 7:54 A.M. revealed LPN #90 had escorted Resident #88 into a common area bathroom. At 7:57 A.M. observation revealed Housekeeping Manager (HM) #135 had entered the common (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 13 Event ID: 365720 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 365720 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arbors at Stow 2910 L'Ermitage Pl Stow, OH 44224 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)

F 0550 Level of Harm - Minimal harm or potential for actual harm area bathroom without knocking while Resident #88 was using the bathroom. HM #135 had not spoken and had left the common area bathroom and exited the unit. Interview with LPN #90 after he had exited the bathroom with Resident #88 confirmed HM #135 had entered the bathroom without knocking or speaking. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365720 If continuation sheet Page 2 of 13 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 365720 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arbors at Stow 2910 L'Ermitage Pl Stow, OH 44224 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)

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, the facility failed to ensure resident wishes regarding end-of-life measures were clearly identified in the medical record. This affected three residents (#19, #37 and #116) of three residents reviewed for Advanced Directives. The facility census was 124. Findings include: 1. Record review revealed Resident #19 was admitted to the facility on [DATE] with diagnoses including Alzheimer's disease with late onset, severe dementia with psychotic disturbance and delusional disorders. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #19 was severely cognitively impaired and required extensive assistive of one staff using physical assistance for activities of daily living (ADL). Review of the physician's orders for Resident #19 revealed an order dated 06/05/23 and 07/05/23 for a Do Not Resuscitate Comfort Care Arrest (DNR CCA) meaning only comfort measures would be initiated in the event of an arrest. Review of the progress notes revealed no information concerning advanced directives. Review of the hard medical chart for Resident #19 revealed no information concerning advanced directives. Review of the care plan dated 06/27/23 revealed Resident #19 revealed a full code advanced directive meaning provide all measure in the event of a medical emergency. Interview with Licensed Practical Nurse (LPN) #127 on 08/14/23 at 4:22 P.M. confirmed there was no advanced directives in the hard medical chart but a code book was finally found that had the code status of everyone. 2. Record review revealed Resident #37 was admitted to the facility on [DATE] with diagnoses including moderate dementia with behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety. Review of the most recent MDS 3.0 quarterly assessment dated [DATE]revealed Resident #37 was severely cognitively impaired and required extensive assistance of one staff for all ADL. Review of the progress notes revealed no information concerning advanced directives. Review of the physician's orders for Resident #37 revealed an order dated 06/06/23 for a full resuscitation advanced directive. Review of the hard medical chart for Resident #37 revealed a DNR CCA dated 06/28/23. Review of the care plan dated 06/22/23 revealed Resident #37 had a Full Code advanced directive. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365720 If continuation sheet Page 3 of 13 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 365720 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arbors at Stow 2910 L'Ermitage Pl Stow, OH 44224 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)

F 0578 Review of the code book revealed Resident #37 was a Full Code, no date. Level of Harm - Minimal harm or potential for actual harm Interview with LPN #127 confirmed the discrepancy between the documents on 08/14/23 at 4:12 P.M. Residents Affected - Few 3. Record review revealed Resident #116 was admitted to the facility on [DATE] with diagnoses including dementia, hallucinations, and unspecified psychosis. Review of the most recent quarterly MDS 3.0 assessment dated [DATE] revealed Resident #116 was moderately impaired cognition. She required limited assistance of one staff for ADL. Review of a Social Service note dated 07/25/23 at 3:02 P.M. revealed Resident #116's code status was changed to Do Not Resuscitate Comfort Care (DNR CC). Review of a nurses note dated 07/25/23 at 6:55 P.M. revealed Resident #116's code status was change to DNRCC today. Optum talked to the Power of Attorney (POA) who let her know his wishes for his mother and she signed this order. The chart was updated, and the Nurse Practitioner (NP) was made aware of the families wishes. Review of physician's orders for Resident #116 revealed an order dated 07/25/23 for DNRCC. Review of the hard medical chart for Resident #116 revealed a DNR CCA. Review of the code book revealed Resident #116 was a DNR CC. Interview with LPN #127 confirmed the discrepancy between the documents on 08/14/23 at 4:14 P.M. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365720 If continuation sheet Page 4 of 13 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 365720 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arbors at Stow 2910 L'Ermitage Pl Stow, OH 44224 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)

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility failed to ensure the resident's environment was kept clean, neat, well lit, and homelike. This affected Resident #83 and had the potential to affect all the 59 residents (#1, #3, #6, #10, #12, #15, #16, #18, #19, #24, #25, #26, #27, #29, #31, #35, #37, #39, #41, #42, #43, #44, #45, #47, #49, #51, #53, #55, #57, #61, #63, #67, #71, #72, #74, #77, #81, #82, #83, #85, #87, #89, #91, #93, #94, #95, #98, #100, #101, #102, #106, #107, #112, #114, #116, #273, #274, #322 and #323) on the 300, 500, and 600 pods. The census was 124. Findings include: 1. During observation on the 600-pod on 08/15/23 at 3:00 P.M. revealed all four ceiling fans had excessive amounts of dust and debris buildup on the blades and hanging over the edge. Observation on 08/15/23 at 3:24 P.M. of the 500-pod revealed four fans with excessive amounts of dust and debris buildup on the blades and hanging over the edge. Observation of the air intake vent on the 500 and 600 pods also had an excessive amount of dust and debris buildup noted on the vent cover. Observation on 08/15/23 at 3:00 P.M. on the 600-pod revealed three of the eight pot lights had working light bulbs in them. Observation on 08/15/23 at 3:24 P.M. of the 500-pod revealed one of the 10 pot lights had a working light bulb, the rest were burned out. This observation was verified by Licensed Practical Nurse (LPN) #127 on 08/15/23 at 3:30 P.M. Observation of the carpeting from the front entrance and through the main halls leading to each pod on 08/16/23 at 9:23 A.M. with Housekeeping Manager (HM) #135 was very dark path down the wide center that included dried water stains. All the above was verified on 08/16/23 at 9:23 A.M. with Housekeeping Manager (HM) #135 who confirmed the light bulbs out, the dirty fan blades and black carpets. The above observations were verified on 08/16/23 at 12:15 P.M. with Maintenance Director #72. 2. Review of the medical record for Resident #83 revealed an admission date of 07/12/21 with diagnoses including Alzheimer's disease with late onset, dementia with other behavioral disturbance, depression, and disturbances of salivary secretion. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #83 had severe cognitive impairment, required extensive assistance of one staff member for bed mobility, dressing, eating, toilet use, and personal hygiene and required total dependance of two staff members for transfers. Observation on 08/14/23 at 11:51 A.M. and 08/15/23 at 2:45 P.M. of Resident #83's room revealed the left side of bed was up against a wall that was covered with what appeared to be dried food and liquids. Observation of Resident #83 on 08/15/23 at 2:45 P.M. revealed resident was lying facing the dirty wall, and Resident #83 was observed touching the dirty wall. Environmental tour completed on 08/16/23 at 10:40 A.M. to 11:00 A.M. with HM #135. Observation and interview with HM #135 during environmental tour confirmed Resident #83's wall was covered in what (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365720 If continuation sheet Page 5 of 13 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 365720 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arbors at Stow 2910 L'Ermitage Pl Stow, OH 44224 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)

F 0584 appeared to be dried food and liquids. Level of Harm - Minimal harm or potential for actual harm Interview with HM #135 on 08/16/23 at 10:45 A.M. revealed housekeepers were not able to clean Resident #83's wall because the resident had not been getting out of his bed. HM #135 further stated resident rooms were cleaned daily and deep cleaned monthly. Residents Affected - Some Observation on 08/17/23 at 11:25 A.M. revealed Resident #83's wall next to the bed was clean. Review of daily patient room cleaning, revised on 09/05/17, revealed housekeepers were to spot clean with a cloth and disinfectant for all vertical surfaces. Review of the 08/23 deep cleaning calendar revealed Resident #83's room was scheduled to be deep cleaned on 08/11/23. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365720 If continuation sheet Page 6 of 13 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 365720 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arbors at Stow 2910 L'Ermitage Pl Stow, OH 44224 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)

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review, and facility policy review the facility failed to report an incident of elopement to the state agency as required. This affected one resident (#272) of one resident reviewed for elopement and Self-Reported Incidents (SRI). The facility census was 124. Findings include: Review of Resident #272's medical record revealed an admission date of 09/08/22 with diagnoses including dementia and need for personal care assistance. Review of the care plan dated 05/30/23 revealed Resident #272 was at risk for elopement related to dementia and impaired safety awareness. Interventions included observe for wandering, cue, reorient, and supervise as needed. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #272 had impaired cognition. The resident had wandering behaviors and supervision with ambulation. Review of progress note dated 06/17/23 revealed Resident #272 exited a secured unit after a nurse had opened the door to the unit. Resident #272 was observed outside of the facility by a State Tested Nursing Assistant (STNA). The progress note stated the STNA and nurse had went outside and observed Resident #272 lying in the grass. Resident #272 was brought back inside the facility and was assessed for injuries with none noted. Resident #272 was asked how he had gotten in the grass, and resident stated he had fallen. The progress note stated Resident #272 was off the secured unit for ten minutes. Interview on 08/14/23 at 9:35 A.M. with STNAs #69 and #101 revealed Resident #272 got off the secured unit after a nurse had not made sure the door to the memory care was closed when she exited. STNAs #69 and #101 stated Resident #272 was located outside of the unit by an STNA. STNAs #69 and #101 were unable to state how long Resident #272 was off the unit and stated the resident had exit seeking behaviors and had attempted to open his window on numerous occasions, and his window screen was still out from a recent attempt to get it open. Observation of Resident #272's room at time of the interview with STNA #101 revealed Resident #272 was sleeping in bed and his window screen was not securely in the window, it was knocked out at the bottom. Interview on 08/17/23 at 8:36 A.M. with the Director of Nursing (DON) revealed Resident #272 had exited the secured unit after a nurse exited the unit. The DON stated the door to the memory care unit had malfunctioned and had not locked after the nurse left the unit. The DON stated an STNA had been providing care to another resident when he observed Resident #272 outside of the facility. The DON stated the STNA and a nurse went outside and observed Resident #272 lying in the grass. The DON stated no SRI was filed with the state agency due to Resident #272 was only off the unit for approximately ten minutes and did not have injuries. Review of the facility policy titled Abuse, Neglect and Exploitation, revised 10/24/22, revealed the facility was to report all alleged violations to the state agency within specified timeframes. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365720 If continuation sheet Page 7 of 13 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 365720 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arbors at Stow 2910 L'Ermitage Pl Stow, OH 44224 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)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to prevent an elopement of Resident #272. This affected one resident (#272) of one resident reviewed for elopement. The facility census was 124. Findings include: Review of Resident #272's medical records revealed an admission date of 09/08/22. Diagnoses included dementia and need for personal care assistance. Review of the care plan dated 05/30/23 revealed Resident #272 was at risk for elopement related to dementia and impaired safety awareness. Interventions included observe for wandering, cue, reorient, and supervise as needed. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #272 had impaired cognition. Resident #272 had wandering behaviors and required supervision with ambulation. Review of the progress note dated 06/17/23 revealed Resident #272 exited a secured unit after a nurse opened the door to the unit. Resident #272 was observed outside of the facility by a State Tested Nursing Assistant (STNA). The progress note stated the STNA and a nurse went outside and observed Resident #272 lying in the grass. Resident #272 was brought back inside the facility and was assessed for injuries with none noted. Resident #272 was asked how he had gotten in the grass, and the resident stated he had fallen. The progress note stated Resident #272 was off the secured unit for ten minutes. Review of the progress note dated 07/02/23 revealed Resident #272 had exit seeking behaviors and was observed pushing on exit doors. Review of the progress note dated 07/11/23 revealed Resident #272 was observed in another resident's room pushing the window into the stopper with force in an attempt to get the window open. Resident #272 was redirected into his own room and attempted to do the same thing. Review of the progress note dated 07/14/23 revealed Resident #272 was wandering around the unit saying I gotta get out of here. Review of the progress note dated 07/16/23 revealed Resident #272 was opening windows in rooms and pushing on exit doors. Review of the progress notes dated 07/19/23 and 07/20/23 revealed Resident #272 was pushing on exit doors. Interview on 08/14/23 at 9:35 A.M. with STNAs #69 and #101 revealed Resident #272 had gotten off the secured unit after a nurse had not made sure the door to the memory care was closed when she exited. STNAs #69 and #101 stated Resident #272 was located outside of the unit by an STNA. STNAs #69 and #101 were unable to state how long Resident #272 was off the unit and stated the resident had exit seeking behaviors and had attempted to open his window on numerous occasions, and his window screen was still out from a recent attempt to get it open. Observation of Resident #272's room at time of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365720 If continuation sheet Page 8 of 13 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 365720 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arbors at Stow 2910 L'Ermitage Pl Stow, OH 44224 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)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few interview with STNA #101 revealed the resident was sleeping in bed and his window screen was not secured in the window, it was knocked out at the bottom. Interview on 08/17/23 at 8:36 A.M. with Director of Nursing (DON) revealed on 06/17/23 Resident #272 exited the secured unit after a nurse had exited the unit. The DON stated the door to the memory care unit had malfunctioned and had not locked after the nurse left the unit. The DON stated an STNA was providing care to another resident when he observed Resident #272 outside of the facility. The DON stated the STNA and a nurse had went outside and observed Resident #272 lying in the grass. The DON stated it had been determined the door to the secured unit had stayed unlocked for approximately seven seconds after the nurse exited the unit and Resident #272 was able to open the door. The DON denied being aware Resident #272 had other incidents or exit seeking behaviors. The DON was made aware of the progress notes that indicated Resident #272 had exit seeking behaviors and had attempted to open his window and knocked the screen out. At the time of the interview with the DON, Resident #272's window was visible from the conference room, and the DON confirmed Resident #272's screen was knocked out on the bottom. Observation from the conference room on 08/17/23 at 4:15 P.M. revealed Resident #272 was attempting to open the window in his room. Resident #272 was observed pushing open his window and was moving the dresser that was in front of the window to open the window. Resident #272 was observed with a hanger in his room and was using the hanger in an attempt to open the window. Resident #272 was observed to have completely removed the window screen and continued to attempt to open the window. At the time of the observation the DON and Administrator were asked to come to the conference room. The DON and Administrator arrived in the conference room at 4:25 P.M. and observed Resident #272 attempting to open his window and confirmed the screen was popped out of the window and was lying on the grass. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365720 If continuation sheet Page 9 of 13 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 365720 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arbors at Stow 2910 L'Ermitage Pl Stow, OH 44224 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)

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, observation, and record review the facility failed to ensure proper positioning of Resident #110's urinary catheter bag. This affected one resident (#110) of one resident observed for urinary catheters. The facility census was 124. Findings include: Review of Resident #110's medical record revealed an admission date of 05/01/23. Diagnoses included dementia, altered mental status, need for personal care assistance, and muscle weakness. Review of the care plan dated 05/01/23 revealed Resident #110 had a urinary catheter for elimination. Interventions included position catheter bag and tubing below the level of the bladder and away from entrance room door. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #110 had impaired cognition, had a urinary catheter, and was incontinent of bowel. Observation on 08/14/23 at 10:05 A.M. revealed Resident #110 was resting in bed. The resident's urinary catheter bag was on the floor visible from the door. Interview with State Tested Nursing Assistant (STNA) #101 confirmed Resident #110's urinary catheter bag should not have been on the floor. Observation on 08/14/23 at 2:55 P.M. revealed Resident #110 was resting in bed, and the urinary catheter was not visible. Interview at time of observation with Licensed Practical Nurse (LPN) #49 confirmed Resident #110's catheter was not visible, and she attempted to locate it. LPN #49 located the urinary catheter on the opposite side of Resident #110's bed on the floor, wrapped in a sheet. LPN #49 stated the urinary catheter should not have been placed on the floor. Observation on 08/16/23 at 1:58 P.M. revealed Resident #110 was sleeping in bed. Resident #110's urinary catheter was observed hanging on the resident's footboard above the level of the resident's bladder. Interview with STNA #101 at the time of the observation revealed the resident's urinary catheter should have been positioned below the resident's bladder. Interview on 08/17/23 at 12:05 P.M. with the Director of Nursing (DON) revealed the facility did not have a policy related to catheter care and stated the staff had performed annual competencies regarding care. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365720 If continuation sheet Page 10 of 13 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 365720 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arbors at Stow 2910 L'Ermitage Pl Stow, OH 44224 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)

F 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, observation, and record review the facility failed to provide adequate pain management to Resident #110. This affected one resident (#110) of one resident reviewed for pain management. The facility census was 124. Residents Affected - Few Findings include: Review of Resident #110's medical records revealed an admission date of 05/01/23. Diagnoses included dementia, muscle weakness, difficulty walking, and need for personal care assistance. Review of the care plan dated 05/01/23 (revised 07/11/23) revealed Resident #110 was at risk for pain related to a right femur fracture. Interventions included administer pain medications as ordered and give half an hour prior to treatment or care. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #110 had impaired cognition. Resident #110 required extensive assistance with bed mobility, transfers, toileting, and personal hygiene. Review of the physician orders dated 07/17/23 to 08/09/23 revealed Resident #110 was ordered Tramadol (pain medication) 50 milligrams (mg) every morning and at bedtime for a right femur fracture. Observation on 08/14/23 at 12:09 P.M. revealed Resident #110 was in his wheelchair in the common dining area with family. Resident #110 was not interviewable; however, observation revealed the resident had signs of facial grimacing and was not placing weight down on his left hip. Interview with Resident #110's family at time of observation revealed the resident had recently broken his hip (unable to recall which hip) and stated the resident was receiving pain medication. Resident #110's family stated they were unaware if he had received any pain medication recently and stated the resident appeared to be in more pain than usual. Interview on 08/14/23 at 12:18 P.M. with Licensed Practical Nurse (LPN) #49 revealed she had not administered any pain medication to Resident #110, and she stated she was unaware if the resident had any pain medication ordered. LPN #49 checked Resident #110's physician orders and confirmed the resident had no pain medication ordered; however, she was unable to state the reason for no pain medication. LPN #110 stated she would contact the physician to inform of the resident's pain and lack of pain medication. Review of Resident #110's physician orders dated 08/14/23 revealed an order for Tramadol 50 mg twice daily. Review of Resident #110's Medication Administration Record (MAR) revealed LPN #49 administered Tramadol on 08/14/23 at 1:25 P.M. for a pain level of 8/10. Review of the progress note dated 08/14/23 authored by LPN #49 revealed Resident #110's previously ordered Tramadol had not been renewed upon readmission to facility from the hospital. The progress note stated the physician had been contacted and had placed orders to resume Tramadol 50 mg twice daily. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365720 If continuation sheet Page 11 of 13 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 365720 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arbors at Stow 2910 L'Ermitage Pl Stow, OH 44224 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)

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview the facility failed to ensure adequate amounts of staff to provide timely and adequate resident care. This affected two residents (#14 and #46) of eight residents reviewed for staffing and had the potential to affect all 124 residents residing in the facility. Findings include: 1. Review of Resident #46's medical records revealed an admission date of 03/24/22. Diagnoses included dementia, muscle weakness, and difficulty walking. Review of the care plan dated 03/24/23 revealed Resident #46 required extensive assistance of one staff for toileting and personal hygiene. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #46 had impaired cognition. Resident #46 required extensive assistance with toileting and personal hygiene and was incontinent of bowel and bladder. Interview on 08/14/23 at 9:35 A.M. with State Tested Nursing Assistant (STNAs) #69 and #101 revealed concerns related to staffing. STNAs #69 and #101 stated there were times there was only one aide on the unit for approximately 23 residents. STNAs #69 and #101 stated there had not been enough staff to provide timely incontinence care or showers and both had observed residents who had been heavily soiled when they had arrived to start their shift at 6:00 A.M. Observation on 08/15/23 at 7:10 A.M. revealed Resident #46 was sitting in a wheelchair in a common dining area. Resident #46's incontinence brief appeared to be soiled, and Resident #46 was not interviewable. Interview with STNA #69 at time of the observation revealed she was the only STNA present on the unit and the assigned nurse had two units she was working on. STNA #69 confirmed Resident #69's brief appeared to be soiled and she proceeded to take the resident into the bathroom. Observation of incontinence care with STNA #69 revealed Resident #46's incontinence brief was soiled with urine and feces. STNA #69 stated she had not provided incontinence care for Resident #69 and the previous shift had stated incontinence rounds had been completed; however, she was unable to state at what time the rounds were completed. 2. Review of Resident #14's medical records revealed an admission date of 04/26/23. Diagnoses included schizophrenia, delusion, muscle weakness, and need for personal care assistance. Review of the MDS assessment dated [DATE] revealed Resident #14 had intact cognition. Resident #14 required extensive assist with bed mobility, transfers, toileting, personal hygiene, and ambulation. Review of the care plan dated 07/31/23 revealed Resident #14 required assistance with activities of daily living related to delusional disorder. Resident #14 required assistance of one staff with personal hygiene. Resident #14 was at risk for falls related to being unsteady at times. Observation on 08/17/23 at 11:14 A.M. revealed the Director of Nursing (DON) was applying pressure to Resident #14's nose. The DON stated Resident #14 had fallen out of her wheelchair and hit her (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365720 If continuation sheet Page 12 of 13 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 365720 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arbors at Stow 2910 L'Ermitage Pl Stow, OH 44224 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)

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete face on the ground. Interview with Licensed Practical Nurse (LPN) #111 revealed she was not present on the unit when Resident #14 had fallen. Interview with STNA #82 revealed she was in the shower room with another resident, and she had not observed Resident #14's fall. STNA #82 further stated the nurse was off the unit and the other assigned STNA was on a break, and no staff had been present in the common area when Resident #14 had fallen. Observation of Resident #14 at time of interviews revealed the resident had a laceration to the bridge of her nose and both eyes appeared to have bruising, as well as a reddened area to the resident's forehead. Event ID: Facility ID: 365720 If continuation sheet Page 13 of 13

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Citations

8 citations recorded^*CMS

What do CMS severity letters mean?

Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.

General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.

Each letter combines severity with scope: how many residents the deficiency affected.

0550GeneralS&S Dpotential for harm
F550 - Resident Rights
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
0689GeneralS&S Dpotential for harm
F689 - Accidents
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
0578GeneralS&S Dpotential for harm
F578 - The right to request, refuse, and/or discontinue treatment, to participate in or
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
0584GeneralS&S Epotential for harm
F584 - Safe Environment
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
0609GeneralS&S Dpotential for harm
F609 - The facility must develop and implement written policies and procedures that:
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
0690GeneralS&S Dpotential for harm
F690 - Incontinence
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
0697GeneralS&S Dpotential for harm
F697 - Pain Management
Provide safe, appropriate pain management for a resident who requires such services.
0725GeneralS&S Dpotential for harm
F725 - Nursing Services
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.

FAQ · About this visit

Common questions about this visit

What happened during the August 17, 2023 survey of ARBORS AT STOW?

This was a inspection survey of ARBORS AT STOW on August 17, 2023. The surveyor cited 8 deficiencies, recorded on the federal Form 2567 statement of deficiencies.

Were any deficiencies cited at ARBORS AT STOW on August 17, 2023?

Yes, 8 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her right..."

What type of survey was this?

This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.

SourceView on CMS Care Compare

Next steps

Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.

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Data from CMS Care Compare public records. Dataset last refreshed June 15, 2026. If you believe any information is inaccurate, report it here.

Health inspection·August 17, 2023