Inspection·February 22, 2024

F 0744 Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview, and facility self-reported incident (SRI) review, the facility failed to develop and implement effective, comprehensive, and individualized dementia/behavioral health care plans to address the total care needs of all residents and to prevent a resident-to-resident altercation resulting in resident injury. This affected two residents (#31 and #35) of three residents reviewed for abuse. The facility census was 34. Residents Affected - Few Actual harm occurred on 02/13/24 when Resident #35 sustained a head injury, which included bleeding from the head with two bumps (one to the forehead and one behind the ear) as a result of a resident-to-resident altercation that occurred after he wandered into Resident #31's room. Resident #35 was subsequently transferred to the emergency room where he required staples to the area. Findings Include: Record review revealed Resident #35 was admitted to the facility on [DATE] and discharged on 02/19/24. Medical diagnoses included unspecified dementia severe with agitation, restlessness and agitation, dysphagia, insomnia, and depression. Review of a nursing note dated 02/07/24 4:00 P.M. revealed resident was alert to self only. Review of a nursing note dated 02/08/24 at 7:23 A.M. revealed Resident #35 had been up walking the unit all night and required multiple redirection attempts. The note indicated Resident #35 attempted to go into other resident rooms without permission. Record review revealed no additional interventions were implemented at this time to address the resident's wandering behaviors. Review of Resident #35's care plan initiated 02/09/24 revealed no comprehensive or individualized interventions were in place to address Resident #35's wandering or behavioral health needs related to wandering, safety and/or dementia. Review of a nursing note dated 02/13/24 at 1:56 A.M. revealed Resident #35 continued to enter other resident rooms and was unable to be redirected. Record review revealed no additional interventions were implemented at this time to address the resident's wandering behaviors. Review of a nursing note dated 02/13/24 at 8:09 A.M. revealed Resident #35 was bleeding from the head with two bumps, one on the forehead and the other behind the head. Resident #35 was sent to the Emergency Department at 7:00 A.M. via Emergency Medical Services (EMS). (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: 365874 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 365874 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hudson Elms Nursing Center 563 W Streetsboro Road Hudson, OH 44236 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)