Health inspection·July 12, 2019

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure call lights were within reach at all times for Residents #32, #5, and #25. This affected three of three residents reviewed for environmental concerns. The facility census was 46. Residents Affected - Few Findings include: 1. Resident #32 was admitted to the facility on [DATE] with diagnoses of cerebellar stroke syndrome, atherosclerotic heart disease, hypertension, difficulty walking, muscle weakness and cognitive communication deficit. Her comprehensive assessment dated [DATE] revealed she was severely cognitively impaired for decision making and had functional limitations of both hands. Observation on 07/09/19 at 10:42 A.M. of Resident #32 revealed her push button type call light was not within her reach. This was verified by State Tested Nursing Assistant (STNA #132) at the time of the observation. On 07/09/19 at 10:46 A.M. interview with Resident #32's daughter revealed she was concerned that her mother could not reach the call light. The daughter said she was unsure if her mother could push the button due to contracted fingers on both hands and thought a flat, touch-pad type of call light would be easier. This was verified by STNA #132 who revealed she was unsure why Resident #32 was not provided with a touch-pad type of call light. 2. Resident #5 was admitted to the facility on [DATE] with diagnoses of dementia, heart failure, morbid obesity, hypertension, osteoarthritis, anxiety, shortness of breath, muscle weakness and psychosis. Her comprehensive assessment dated [DATE] revealed she had functional limitations of both hands. Observation on 07/09/19 at 10:51 A.M. of Resident #5 revealed her call light was not within her reach. This was verified at 10:52 A.M. by STNA #162. On 07/09/19 at 10:52 A.M. interview with STNA #162 revealed Resident #5 was not able to use the push button type call light, but might be able to use a touch-pad call light. STNA #162 verified all residents' call lights must be kept within reach at all times. 3. Resident #25 was admitted to the facility on [DATE] with diagnoses of Alzheimer's disease, and a history of falling. His comprehensive assessment dated [DATE] revealed he required extensive assistance for bed mobility and had limited range of motion. (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: 365774 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 365774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/12/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Medina Bsd Opco LLC 550 Miner Dr Medina, OH 44256 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)