Inspection·July 2, 2024

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, record review, and review of the facility policy, the facility failed to maintain fall prevention interventions as ordered by the physician for Resident #112 to prevent further falls. This affected one resident (#112) of three residents reviewed for accidents. The facility census was 125. Findings include: Record review for Resident #112 revealed an admission date of 03/01/21. Diagnoses included encephalopathy, unspecified dementia with other behavioral disturbances, spinal stenosis, muscle weakness, difficulty in walking, unspecified psychosis, and Alzheimer's disease. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #112 was rarely or never understood. Resident #112 had no impairment to the upper or lower extremities and used no mobility devices. Resident #112 required setup or cleanup assistance with meals, substantial/max assistance for toileting, and partial/moderate assistance for transfers. Resident #112 had no falls since admission. Record review of the fall history for Resident #112 revealed Resident #112 had falls on 05/20/24, 05/30/24, and 06/13/24. Review of the fall risk evaluation dated 05/17/24 at 1:18 P.M. completed by Registered Nurse (RN) #254 revealed a score of 19 (high risk). Review of the progress notes dated 05/20/24 at 8:09 P.M. for Resident #112 completed by RN #266 revealed at 7:15 P.M. staff found Resident #112 on his right side on the floor of the right side of his bed and reported to this nurse. Cleansed four centimeters (cm) by four cm abrasion on the right elbow and applied a bordered gauze dressing. Resident was to walk with a walker, but the resident's walker was nowhere to be found. Every shift, staff was to ensure Resident #112 had his walker within reach. Review of the progress note dated 05/30/24 at 6:55 A.M. completed by Registered Nurse (RN) #271 revealed Resident #112 was found on the floor in his room by the state tested nursing assistant (STNA). This nurse was notified and went to assess the resident. Resident #112 was on the floor supine next to his bed. There was a very noticeable bump to the right side of his forehead. He was conscious and responded to us accordingly. Pain and discomfort were displayed by moaning and facial grimacing. A new intervention was to keep a light on in his room at night. (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: 365823 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 365823 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Center at the Ridge 3379 Main Street Mineral Ridge, OH 44440 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)