Inspection·November 4, 2024

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Based on medical record review, staff interview, and review of the facility policy, the facility failed to timely notify resident representatives of significant changes in health status. This affected one (Resident #79) of three residents reviewed for falls. The facility census was 77 residents. Findings include: Review of the medical record for Resident #79 revealed an admission date of 08/29/24 with diagnoses of vascular dementia with other behavioral disturbances, diabetes, expressive language disorder, adjustment disorder, rheumatoid arthritis and fracture of the first lumbar vertebrae with a discharge date of 10/22/24. Review of the Minimum Data Set (MDS) assessment for Resident #79 dated 09/05/24 revealed the resident was severely cognitively impaired required staff assistance with activities of daily living (ADLs.). Review of the nurse progress note for Resident #79 dated 09/08/24 timed at 10:45 P.M. revealed the resident had a fall without injury and the resident's representative was notified. Review of the nurse progress note for Resident #79 dated 09/09/24 timed 1:35 P.M. revealed the resident had an unwitnessed fall in the hallway without injuries and the resident's representative was notified. Review of the communication with physician note for Resident #79 dated 09/09/24 timed 5:14 P.M. revealed the resident's representative was visiting and noticed the resident had complaints of pain to the left hand and the fifth digit appeared swollen and bruised. The nurse assessed the resident and notified the nurse practitioner who ordered an x-ray to the left hand. Review of the left-hand x-ray results for Resident #79 dated 09/09/24 timed 10:08 P.M. revealed the resident had an acute displaced fracture of the 5th digit (pinky finger) middle phalanx. Review of the nursing notes for Resident #79 dated 09/09/24 to 09/15/24 revealed the notes did not include notification to Resident #79's representative of the fracture. Interview on 11/04/24 at 12:30 P.M. with Resident #79's representative confirmed Resident #79's left finger did not look right on 09/09/24 so an x-ray was ordered. Resident #79's representative confirmed she was not notified until 09/16/24 that the resident had a fractured finger. (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 4 Event ID: 365836 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 365836 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Village at St Edward Nrsg Care 3131 Smith Rd Fairlawn, 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)