Health inspection·November 27, 2023

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm Based on observation, staff interview, and policy review, the facility failed to ensure residents had access to call lights. This affected three (Residents #24, #104, and #20) of five residents reviewed for call lights. The facility census was 108. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #24 revealed an admission date of 05/26/21. Medical diagnoses included dementia with behavioral disturbance, restlessness and agitation, emphysema, and anxiety. Review of the Minimum Data Set (MDS) 3.0 quarterly assessment, dated 10/10/23, revealed Resident #24 to have moderately impaired cognition. Resident #24 was not coded to have any behaviors. Resident #24 was coded to have clear speech, was able to make self understood and understand others. Observation on 11/27/23 at 8:32 A.M. revealed Resident #24 repeatedly called out for help. Resident #24 was in the bed and had her bed control remote in her hand pushing various buttons. Her call light was draped over a fixture on the wall approximately three feet away from Resident #24. An interview on 11/27/23 at 8:41 A.M. with State Tested Nursing Assistant (STNA) #290 verified the call light was out of reach and should not be hanging on the wall. 2. Review of the medical record for Resident #104 revealed an admission date of 04/13/23. Medical diagnoses included dementia, glaucoma, anxiety, and altered mental status. Review of the MDS 3.0 quarterly assessment, dated 10/17/23, revealed Resident #104 was cognitively impaired. Resident #104 was coded to have clear speech, was usually able to make self understood and usually able to understand others. Observation on 11/27/23 at 8:36 A.M. revealed Resident #104 in the bed. Her call light call light was observed on the floor, tucked under the right side of the bed. An interview on 11/27/23 at 8:42 A.M. with STNA #290 verified the call light was out of reach for Resident #104. 3. Review of the medical record for Resident #20 revealed an admission date of 08/15/22. Medical diagnoses included dementia without behavioral disturbance, cerebral infarction (stroke) with hemiplegia (paralysis) affecting the right dominant side, and anxiety. (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 2 Event ID: 365924 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 365924 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Amherst Manor Nursing Home 175 N Lake Street Amherst, OH 44001 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)