Health inspection·November 7, 2023

F 0567 Honor the resident's right to manage his or her financial affairs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, resident and staff interviews, and review of facility policy, the facility failed to ensure residents had access to personal funds on the weekends. This affected one resident (#38) out of the five residents reviewed for personal funds during the annual survey. The facility census was 47. Residents Affected - Few Findings include: Record review for Resident #38 revealed the resident was admitted to the facility on [DATE] and had diagnoses including Parkinson's disease, moderate persistent asthma, and acute respiratory failure. Review of the quarterly Minimum Data Set (MDS) assessment, dated 09/22/23, revealed the resident had intact cognition evidenced by a Brief Interview for Mental Status (BIMS) assessment score of 15. The resident was assessed to require supervision for bed mobility, transfers, toileting, and eating. Interview with Resident #38 on 11/05/23 at 9:41 A.M. confirmed the resident did not have access to personal funds on the weekends. Interview with Registered Nurse (RN) #145 on 11/05/23 at 3:20 P.M. confirmed resident funds were not typically available on the weekends unless staff knew in advance so they could leave the money in an envelope for the resident. Interview with Business Office Manager #147 on 11/05/23 at 3:25 P.M. confirmed a lock box containing money was put in the activities office for residents to access their money on the weekends. Interview with Activity Director #130 on 11/05/23 at 3:28 P.M.confirmed the employee had no knowledge of a lock box with money being left in activities office for residents to have access to their funds on the weekends. Telephone interview with Activity Assistant #105 on 11/05/23 at 3:34 P.M. confirmed the employee had no knowledge of a lock box with money being left in the activities office for residents to have access to their funds on the weekends. Review of the facility policy titled Resident Personal Funds revised on 09/2017 revealed residents must have ready and reasonable access to any funds the facility holds. Residents would have access to petty cash on an ongoing basis and would be able to arrange for access to larger fund amounts. Requests for less than 100 dollars would be honored within the same day. Although the facility did not need to maintain a minimum amount on its premises, it was expected to maintain amounts of petty cash on hand that might be required by the residents. 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 2 Event ID: 365906 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 365906 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Monarch Meadows Nursing and Rehabilitation 299 Commerce Dr Seaman, OH 45679 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)